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Cyranka K, Klupa T, Pilecki M, Sarna-Palacz D, Juryk A, Storman D, Dudek D, Malecki MT, Matejko B. Diabetes distress and diabetes burnout explored in various areas of life in patients with type 1 diabetes: effect of short-term psychological intervention. Endocrine 2024:10.1007/s12020-024-03760-0. [PMID: 38448676 DOI: 10.1007/s12020-024-03760-0] [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: 11/20/2023] [Accepted: 02/24/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Diabetes distress (DD) and diabetes burnout (DB) are recognized psychological phenomena in patients with T1DM (type 1 diabetes mellitus). Still, there is an urgent need to create professional psychological intervention procedures to provide patients with adequate care. AIM The aim of the study was to assess the level of DD and DB in T1DM patients at baseline and after 5 of sessions psychological intervention in the group of participants who applied for help. METHODS 34 T1DM patients who requested psychological support (22 females, 12 males) and 30 patients in a control group (14 females, 16 males) participated in the study. At baseline clinical test results between groups were compared. Next, in the studied group measurements were repeated after a set of five psychological face-to-face individual interventions which lasted 30-60 min each. They were support sessions with elements of cognitive-behavioral interventions done by clinical psychologists. Session 1: introduction, interview and collection of test results; session 2-4: work on the indicated by the patient and test results most problematic aspect of diabetes, session 5: a summary and plan for further treatment if needed. The control group results were obtained only at baseline. Research tools: DDS; PAID, Diabetes Burnout test by Polonsky. RESULTS At the baseline, significant differences were observed between the studied group and control group: in DB/DD levels: DB (3.9 ± 1.7 vs 2.4 ± 1.6; p < 0.001); DDS (3.2 ± 1.0 vs 2.7 ± 1.0; p = 0.064); PAID (62.3 ± 14.1vs 34.4 ± 21.0; p < 0.001). There were also group differences in HbA1c levels (8.7 ± 2.4 vs 7.3 ± 1.5; p = 0.028). After psychological interventions, there was a significant improvement in DB (3.9 ± 1.7vs 2.9 ± 1.2; p < 0.001; DDS (3.2 ± 1 vs 3.0 ± 0.7; p = 0.03); PAID (62.3 ± 14.1 vs 51.8 ± 12.5; p < 0.001). CONCLUSIONS DD and DB constitute a significant problem in the group of T1DM patients, but providing appropriate specialist care may help them accept diabetes and improve life satisfaction, as well as regain control over their diabetes management.
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Affiliation(s)
- Katarzyna Cyranka
- Department of Psychiatry, Jagiellonian University Medical College, Kraków, Poland.
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.
- University Hospital in Krakow, Kraków, Poland.
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Kraków, Poland
| | - Maciej Pilecki
- Department of Psychiatry, Jagiellonian University Medical College, Kraków, Poland
- University Hospital in Krakow, Kraków, Poland
| | | | - Andrzej Juryk
- Department of Psychiatry, Jagiellonian University Medical College, Kraków, Poland
- University Hospital in Krakow, Kraków, Poland
| | - Dawid Storman
- University Hospital in Krakow, Kraków, Poland
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Polska
| | - Dominika Dudek
- Department of Psychiatry, Jagiellonian University Medical College, Kraków, Poland
- University Hospital in Krakow, Kraków, Poland
| | - Maciej T Malecki
- University Hospital in Krakow, Kraków, Poland
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- University Hospital in Krakow, Kraków, Poland
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Lewinski AA, Shapiro A, Crowley MJ, Whitfield C, Jones JR, Jeffreys AS, Coffman CJ, Howard T, McConnell E, Tanabe P, Barcinas S, Bosworth HB. Diabetes distress in Veterans with type 2 diabetes mellitus: Qualitative descriptive study. J Health Psychol 2024:13591053241233387. [PMID: 38384142 DOI: 10.1177/13591053241233387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
Diabetes distress (DD) is a negative psychosocial response to living with type 2 diabetes mellitus (T2DM). We sought insight into Veterans' experiences with DD in the context of T2DM self-management. The four domains in the Diabetes Distress Scale (i.e. regimen, emotional, interpersonal, healthcare provider) informed the interview guide and analysis (structural coding using thematic analysis). The mean age of the cohort (n = 36) was 59.1 years (SD 10.4); 8.3% of patients were female and 63.9% were Black or Mixed Race; mean A1C was 8.8% (SD 2.0); and mean DDS score was 2.4 (SD 1.1), indicating moderate distress. Veterans described DD and challenges to T2DM self-management across the four domains in the Diabetes Distress Scale. We found that (1) Veterans' challenges with their T2DM self-management routines influenced DD and (2) Veterans experienced DD across a wide range of domains, indicating that clinical interventions should take a "whole-person" approach.Trial Registration: NCT04587336.
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Affiliation(s)
- Allison A Lewinski
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
- Duke University School of Nursing, Durham, NC, USA
| | - Abigail Shapiro
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
| | - Matthew J Crowley
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Chelsea Whitfield
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
| | - Joanne Roman Jones
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
- Department of Nursing, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Amy S Jeffreys
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
| | - Cynthia J Coffman
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Teresa Howard
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
| | - Eleanor McConnell
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
- Geriatric Research, Education and Clinical Center (GRECC), Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Paula Tanabe
- Duke University School of Nursing, Durham, NC, USA
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Susan Barcinas
- College of Education, North Carolina State University, Raleigh, NC, USA
| | - Hayden B Bosworth
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
- Duke University School of Nursing, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC USA
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Liakos A, Karagiannis T, Avgerinos I, Tsapas A, Bekiari E. Burden and Coping Strategies of Hypoglycemia in People with Diabetes. Curr Diabetes Rev 2024; 20:e201023222415. [PMID: 37867276 DOI: 10.2174/0115733998271244231010100747] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 10/24/2023]
Abstract
Hypoglycemia is a limiting adverse effect of glucose-lowering medications and particularly insulin replacement therapy. This review provides insights into the burden of hypoglycemia in the management of diabetes and outlines strategies available to reduce the risk of hypoglycemia and improve patients' well-being. People with type 1 diabetes are primarily affected by hypoglycemic episodes which are associated with direct physical harms like injuries and cardiac events as well as indirect psychosocial consequences including constant anxiety, absenteeism, increased healthcare costs and overall poorer quality of life. These complications are more prominent amongst individuals with hypoglycemia unawareness or overnight hypoglycemia and could even extend to caregivers such as parents of children with diabetes. Patients experiencing frequent or severe hypoglycemic events might also develop a pathological fear of hypoglycemia and adopt aberrant behaviors intending to maintain higher blood glucose levels. Modern pharmaceutical options with a safer profile in terms of hypoglycemia are available including novel basal insulins with lower rates of nocturnal hypoglycemia along with ultra-rapid-acting insulin analogs with a shorter duration of action that might avert late post-meal hypoglycemia. Continuous glucose monitoring and sensor-augmented insulin pump therapy with low glucose suspend technology can also prevent hypoglycemia, although concerns about cost and patient satisfaction remain. Advancements in insulin therapy and technological modalities should be coupled with ongoing education and support for patients to become co-managers of their disease and reduce the risk of hypoglycemia.
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Affiliation(s)
- Aris Liakos
- Clinical Research and Evidence Based Medicine Unit, Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece
- Diabetes Center, Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Thomas Karagiannis
- Clinical Research and Evidence Based Medicine Unit, Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece
- Diabetes Center, Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Ioannis Avgerinos
- Clinical Research and Evidence Based Medicine Unit, Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece
- Diabetes Center, Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Apostolos Tsapas
- Clinical Research and Evidence Based Medicine Unit, Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece
- Diabetes Center, Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece
- Harris Manchester College, University of Oxford, Oxford, United Kingdom
| | - Eleni Bekiari
- Clinical Research and Evidence Based Medicine Unit, Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece
- Diabetes Center, Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece
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Masmoudi R, Hadj Kacem F, Bouattour M, Guermazi F, Sellami R, Feki I, Mnif M, Masmoudi J, Baati I, Abid M. Diabetes Distress and Illness Perceptions in Tunisian Type 2 Diabetes Patients. Diabetes Metab Syndr Obes 2023; 16:3547-3556. [PMID: 37954887 PMCID: PMC10637203 DOI: 10.2147/dmso.s430001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/27/2023] [Indexed: 11/14/2023] Open
Abstract
Purpose Diabetes distress (DD) refers to the negative emotions and burden of living with diabetes. Illness perceptions are among the factors that can influence self-management and psychological distress in diabetics. This study aimed to determine the prevalence and the associated factors of DD in Tunisian patients with type 2 diabetes mellitus. We also studied the relationship between DD and illness perceptions in diabetics. Patients and Methods This was a cross-sectional study conducted among individuals with type 2 diabetes, followed up at the outpatient endocrinology unit at the Hedi Chaker University Hospital, Tunisia. DD was assessed using the Diabetes Distress Scale (DDS-17). The Brief Illness Perception Questionnaire (Brief-IPQ) was used to assess diabetes illness perceptions. Multivariate logistic regression was used to determine independent factors associated with the presence of DD. Results A total of 103 patients were recruited. The mean age was 59.31 (±10.83) years; 54.4% were female. In total, 70.9% had DD. Using regression analysis, we demonstrated that the illness perceptions of personal control, HbA1C, absence of comorbidities, lower age at diabetes diagnosis, and socioeconomic status were significantly associated with DD. Conclusion This study sheds light on the high prevalence of DD among patients with type 2 diabetes in Tunisia. Illness perception-focused psychological intervention would be efficacious in reducing diabetes distress in patients with type 2 diabetes mellitus.
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Affiliation(s)
- Rim Masmoudi
- Psychiatry “A” Department, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Faten Hadj Kacem
- Department of Endocrinology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Maroua Bouattour
- Department of Family Medicine, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Fatma Guermazi
- Psychiatry “A” Department, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Rim Sellami
- Psychiatry “A” Department, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Ines Feki
- Psychiatry “A” Department, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Mouna Mnif
- Department of Endocrinology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Jawaher Masmoudi
- Psychiatry “A” Department, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Imen Baati
- Psychiatry “A” Department, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Mohamed Abid
- Department of Endocrinology, Hedi Chaker University Hospital, Sfax, Tunisia
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Hayashino Y, Okamura S, Tsujii S, Ishii H. Diabetes Distress Is Associated With Future Risk of Progression of Diabetic Nephropathy in Adults With Type 2 Diabetes: A Prospective Cohort Study (Diabetes Distress and Care Registry at Tenri [DDCRT23]). Can J Diabetes 2023; 47:519-524. [PMID: 37164214 DOI: 10.1016/j.jcjd.2023.04.018] [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: 08/01/2022] [Revised: 04/20/2023] [Accepted: 04/29/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Our aim in this study was to investigate the prospective association between diabetes distress assessed with Problem Areas in Diabetes (PAID) survey scores at baseline and the subsequent risk of development or progression of diabetic nephropathy in people with type 2 diabetes. METHODS Longitudinal data were acquired from 2,845 individuals with type 2 diabetes registered in a Japanese diabetes registry. A Cox proportional hazards model was used to adjust for possible confounders to examine the prospective association between baseline diabetes distress (PAID score ≥40) and the development or progression of albuminuria. RESULTS Mean patient age, body mass index, and glycated hemoglobin level were 64.8 years, 24.5 kg/m2, and 57.4 mmol/mol (7.5%), respectively. We did not observe a significant association between diabetes distress and the subsequent risk of diabetic nephropathy development from normoalbuminuria to microalbuminuria/macroalbuminuria (multivariable-adjusted hazard ratio [HR]=0.95 over 4.2 years, 95% confidence interval [CI] 0.77 to 1.17, p=0.640); however, we identified a significant association for progression from microalbuminuria to macroalbuminuria (multivariable-adjusted HR=1.34 over 7.0 years, 95% CI 1.01 to 1.80, p=0.045). Stratification by sex revealed a significant association between diabetes distress and the subsequent risk of progressing diabetic nephropathy (HR=1.45, 95% CI 1.06 to 1.98, p=0.019) in males, but not females (HR=1.42, 95% CI 0.95 to 2.14, p=0.087). CONCLUSIONS Diabetes distress at baseline, assessed using the PAID survey, was associated with a subsequent risk of progressing diabetic nephropathy independent of possible confounders in males, but not females, with type 2 diabetes.
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Affiliation(s)
- Yasuaki Hayashino
- Department of Endocrinology, Tenri Hospital, Tenri City, Nara, Japan.
| | - Shintato Okamura
- Department of Endocrinology, Tenri Hospital, Tenri City, Nara, Japan
| | - Satoru Tsujii
- Department of Endocrinology, Tenri Hospital, Tenri City, Nara, Japan
| | - Hitoshi Ishii
- Department of Doctor-Patient Relationships, Nara Medical University, Kashihara, Nara, Japan
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Mach C, Bulanadi J, Gucciardi E, Segal P, De Melo M. Exploring the Needs of Adults Living With Type 1 or Type 2 Diabetes Distress Using the Problem Areas in Diabetes 5 Tool. Can J Diabetes 2023; 47:51-57.e1. [PMID: 36154985 DOI: 10.1016/j.jcjd.2022.07.008] [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: 03/01/2022] [Revised: 07/12/2022] [Accepted: 07/28/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVES This study investigated the feasibility and acceptability of implementing a screening tool as a part of routine care and the subsequent screening experiences of patients and clinicians. Additionally, potential sources of diabetes distress (DD) were identified in this clinical population. METHODS Our investigation was a cross-sectional, mixed-methods, convenience sample of 203 patients living with type 1 or type 2 diabetes from 2 Canadian tertiary hospital-based clinics. The Problem Areas in Diabetes 5 (PAID5) scale was used to assess DD. Structured telephone interviews of patients with high DD scores and care provider focus group transcriptions were analyzed using a deductive thematic content analysis. RESULTS The prevalence of DD was 45%. Lack of medication coverage (p=0.02) and presence of neuropathy (p=0.04) were approximately 5- and 2-fold more likely to be predictors of high DD, respectively. Patient interviews identified DD screening as an opportunity to share and feel supported but demonstrated their fear of discussing mental health concerns. Patients found discussion about mental health helpful and often did not require a referral to a mental health specialist. Staff focus groups discussed screening as a feasible tool, but also acknowledged barriers and knowledge gaps that preclude DD screening integration in routine clinical practice. Specialized training for clinicians may help increase confidence and improve uptake of DD screening into routine clinical practice. CONCLUSIONS The prevalence of DD in outpatient care settings is high. Findings suggest that integrating the PAID5 screening tool into regular clinical practice is feasible by patients and care providers.
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Affiliation(s)
- Calvin Mach
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jeroselle Bulanadi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Enza Gucciardi
- School of Nutrition, Ryerson University, Toronto, Ontario, Canada
| | - Phillip Segal
- Faculty of Medicine, Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada; Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Margaret De Melo
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
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Abd El Kader AI, Ibrahim ME, Mohamed HS, Osman BM. Diabetes Distress and Self-Care Activities Among Patients With Diabetes Type II: A Correlation Study. SAGE Open Nurs 2023; 9:23779608231189944. [PMID: 37584032 PMCID: PMC10424545 DOI: 10.1177/23779608231189944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/05/2023] [Accepted: 07/09/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction Diabetes mellitus (DM) is a main, highly prevalent, and challenging public health issue. Suboptimal self-care for type II diabetes can lead to poor glycemic control, complications, and even death. Objective This study investigated the incidence of distress and its link with self-care habits of patients with diabetes type II. Methods A correlational, cross-sectional design with a convenient sample of 200 patients was used to conduct this study. Three questionnaires were administered: (A) the demographic and medical data questionnaire; (B) diabetes self-care activities in brief; and (C) the diabetes distress scale in Arabic language. Results The patients' mean age was 51.78 ± 11.34; 80% of patients practiced lower levels of diabetes self-care, and 37% of them had a high level of diabetes distress. Self-care is associated with diabetes distress (R = -0.152, p-value = .032). Conclusion Self-care activities can help in the early detection and management of diabetes distress. Sustained self-care education is promising to minimize diabetes distress. The potential advantages of association between diabetes distress and self-care can offer self-care programs that enhance diabetes distress management.
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Affiliation(s)
| | | | - Helalia Shalabi Mohamed
- Community Health Nursing, Faculty of Nursing, Cairo University, Cairo, Egypt
- Community Health Nursing, College of Nursing, PAAET, Safat, Kuwait
| | - Basma Mohamed Osman
- Community Health Nursing, Faculty of Nursing, Cairo University, Cairo, Egypt
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Looking at Diabetes-Related Distress through a New Lens: The Socio-Ecological Health Model. ENDOCRINES 2022. [DOI: 10.3390/endocrines3040064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Diabetes-related distress (DRD) is defined as an emotional state experienced by people with diabetes (PWD) who are worried about their disease management, the emotional burden from the condition, and/or potential difficulties accessing care or support. The psychosocial aspect of diabetes management is a factor that directly influences patients’ well-being as well as the chronic management of the condition yet is not a primary clinical problem being addressed within the healthcare setting. This review advocates for a re-evaluation and subsequent adjustment of the current DRD screening methodology by implementing the five primary components (Intrapersonal, Interpersonal, Organizational, Community, and Public Policy) of the Socio-Ecological Model of Health (SEMH), bridging the gaps from a public-health perspective. We searched two electronic databases for studies published in the United States from 1995 to 2020 reporting the effects of social determinants of health (SDOH) on DRD. Articles that contained at least one of the five elements of the SEMH and focused on adults aged 18 years or older were included. SDOH, which include circumstances where individuals grow, work, and age, are highly influenced by external factors, such as the distribution of wealth, power, and resources. Current DRD screening tools lack the capacity to account for all major components of SDOH in a comprehensive manner. By applying the SEMH as a theory-based framework, a novel DRD screening tool addressing sex, ethnicity, and socioeconomic background should be implemented to better improve diabetes management outcomes. By exploring the relationships between each level of the SEMH and DRD, healthcare professionals will be better equipped to recognize potential stress-inducing factors for individuals managing diabetes. Further efforts should be invested with the goal of developing a novel screening tool founded on the all-encompassing SEMH in order to perpetuate a more comprehensive diabetes treatment plan to address barriers within the SDOH framework.
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Liu Y, Jiang J, You W, Gong D, Ma X, Wu M, Li F. Exploring facilitators and barriers to self-management engagement of Chinese people with type 2 diabetes mellitus and poor blood glucose control: a descriptive qualitative study. BMC Endocr Disord 2022; 22:294. [PMID: 36435767 PMCID: PMC9701421 DOI: 10.1186/s12902-022-01214-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/11/2022] [Indexed: 11/28/2022] Open
Abstract
AIMS To explore facilitators and barriers to self-management engagement of Chinese people with poorly controlled type 2 diabetes. METHODS Purposive sampling method was used for recruitment. Semi-structured interview and thematic analysis was used for data collection and analysis. RESULTS Twenty-six semi-structured interviews were conducted. Poor blood glucose control introduced awareness of susceptibility to complications, while mental disorders could be concomitant. General knowledge about healthy lifestyle and unhealthy habits impeded lifestyle management. Temporary remission of hyperglycemia and no perceived symptoms interfered engagement of medication therapy and regular blood glucose monitoring. Family and work environments could impact self-management engagement. Accessibility to reliable diabetes-related information influenced self-management engagement. CONCLUSIONS Awareness of susceptibility to complications motivated self-management engagement, while the awareness could cause mental disorders that need to be addressed. Customized lifestyle plans and behavior change technologies were crucial for lifestyle management. The progression of diabetes, importance of continuity of medication therapy, and the value of blood glucose monitoring should be clarified in diabetes education. Building diabetes-friendly social environments and providing reliable diabetes-related information were essential.
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Affiliation(s)
- Yuan Liu
- National Metabolic Management Center, Institute for Chronic Disease Management, Jining No. 1 People's Hospital, Jining, China.
| | - Jiajia Jiang
- National Metabolic Management Center, Institute for Chronic Disease Management, Jining No. 1 People's Hospital, Jining, China
| | - Wenjun You
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Dandan Gong
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Xiaoqing Ma
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Min Wu
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Feng Li
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
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Kurza D, Kobos E. Diabetes distress in adult patients with type 1 and type 2 diabetes. MEDICAL SCIENCE PULSE 2022. [DOI: 10.5604/01.3001.0016.1166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Diabetes is a chronic and demanding condition, exposing patients to complex physical and mental challenges, and making them particularly vulnerable to distress. Diabetes distress related to disease in diabetic patients is a term encompassing challenges associated with the psychosocial adaptation required of these individuals. Aim of the study: To assess distress in patients with diabetes mellitus. Material and methods: This study was conducted among 107 patients with type 1 and 2 diabetes mellitus reporting for follow-up at a diabetes clinic. The Diabetes Distress Scale (DDS) was used for data collection. Results: Moderate and severe diabetes distress was found in 36.4% and 15% of respondents in the study group, respectively. The total mean score for the DDS was 2.19. The largest percentages of respondents with high levels of distress were observed in patients with a financial situation rated lower than good (30.6%), those having less than secondary education (28.0%), and those under 30 years of age (27.8%). Patients with type 1 diabetes (26.9%), a disease duration > 30 years (30.8%), those using insulin pump therapy (30%) or CGM (Continuous Glucose Monitoring) and FGM (Flash Glucose Monitoring) systems (50%), and those showing ≥ 3 chronic diabetic complications (37.5%) experienced severe distress. Conclusions: Overall, diabetic patients showed a moderate level of distress. The greatest inconveniences caused by the disorder were associated with regimen-related distress and emotional burden. Rural patients with a lower level of education and a lower financial status showed higher levels of distress. Patients experiencing chronic complications from diabetes and those with higher levels of glycated hemoglobin also presented with more severe distress.
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Affiliation(s)
- Dominika Kurza
- Department of Development of Nursing, Social and Medical Sciences, Faculty of Health Sciences, Medical University of Warsaw, Poland
| | - Ewa Kobos
- Department of Development of Nursing, Social and Medical Sciences, Faculty of Health Sciences, Medical University of Warsaw, Poland
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Abstract
First envisioned by early diabetes clinicians, a person-centred approach to care was an aspirational goal that aimed to match insulin therapy to each individual's unique requirements. In the 100 years since the discovery of insulin, this goal has evolved to include personalised approaches to type 1 diabetes diagnosis, treatment, prevention and prediction. These advances have been facilitated by the recognition of type 1 diabetes as an autoimmune disease and by advances in our understanding of diabetes pathophysiology, genetics and natural history, which have occurred in parallel with advancements in insulin delivery, glucose monitoring and tools for self-management. In this review, we discuss how these personalised approaches have improved diabetes care and how improved understanding of pathogenesis and human biology might inform precision medicine in the future.
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Affiliation(s)
- Alice L J Carr
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK.
| | - Carmella Evans-Molina
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, USA
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
- Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Richard A Oram
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK.
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Gupta SK, Rastogi A, Kaur M, Lakshmi PVM. Diabetes-related distress and its impact on self-care of diabetes among people with type 2 diabetes mellitus living in a resource-limited setting: A community-based cross-sectional study. Diabetes Res Clin Pract 2022; 191:110070. [PMID: 36067916 DOI: 10.1016/j.diabres.2022.110070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 11/18/2022]
Abstract
AIM To assess the a) prevalence, b) factors associated, and c) effect on self-care practices (SCP) of diabetes related distress (DRD) among patients with Type 2 Diabetes Mellitus (T2DM) in rural Punjab, India. METHODS Amongst the cohort of 700 patients, the Diabetes Distress Scale-17 (DDS-17) was used to assess DRD and the Summary of Diabetes Self Care Activities scale (SDSCA) for diabetes SCP. Multivariable logistic regression identified the factors associated with DRD. RESULTS DRD was universal [severe or moderate in 391 (56%) and 309 (44%) patients, respectively]. Hypertension increased the odds of severe DRD [aOR 3.47; 95% CI:2.48-4.87, p-<0.01] whereas living in a joint family reduced the odds of severe DRD [aOR 0.68; 95% CI: 0.47-0.97, p- 0.03]. Patients with severe DRD were less likely to perform DM SCPs [aOR 0.53; 95% CI:0.32-0.85, p-0.01]. CONCLUSIONS The burden of DRD was alarmingly high. There is an urgent need to screen, prevent and treat DRD to improve selfcare in T2DM.
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Affiliation(s)
- Saurabh Kumar Gupta
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ashu Rastogi
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Manmeet Kaur
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
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13
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Ajele WK, Babalola OB, Idehen EE, Oladejo TA. Relationship between depression and psychological well-being among persons with diabetes during COVID-19 pandemic: diabetes distress as a mediator. J Diabetes Metab Disord 2022; 21:631-635. [PMID: 35402318 PMCID: PMC8983087 DOI: 10.1007/s40200-022-01025-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/03/2022] [Indexed: 12/16/2022]
Abstract
Purposes The study examined the relationship between depression, diabetes distress and psychological well-being and also assessed the mediating role of diabetes distress on depression relationship with psychological well-being among persons with diabetes during the covid-19 pandemic. Methods The study conducted a cross-sectional survey design. A total of 223 (age 35 to 73 years, mean = 53.26 years and SD = 11.05 years) people living with diabetes who are registered patients and were attending the clinic in Department of medicine, Ondo State Specialist Hospital, Okitipupa were selected for the study using the convenient sampling technique. The data were analysed using Pearson Multiple correlation and mediation model 4 of PROCESS macro. The analyses were carried out with ROCESS macro for IBM/SPSS Version 25.0. Results Showed psychological well-being has negative significant relationship between diabetes distress (r = -0.42, p < .05) and depression (r = 0.52, p < .05) among persons with diabetes during covid-19 pandemic. The result showed significant and negative direct relationship between depression and diabetes distress (β = -0.47, p < 0.05), 95% Cl: = -0.60 (-0.34). The results also showed significant direct relationship depression and psychological well-being (β = 0.36, p < 0.05), 95% Cl: = 0.26 (0.47) and further that diabetes distress significantly mediate indirect relationship between depression and psychological well-being among persons with diabetes during covid-19 pandemic (β = -0.19, p < .05), 95% Cl: = 0.29 (-0.09). Conclusion Depression and diabetes distress associated with the psychological well-being of persons with diabetes during covid-19 pandemic and diabetes distress may play vital role on the association between depression and with the psychological well-being of persons with diabetes during covid-19 pandemic.
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Affiliation(s)
| | | | - Egbe Emmanuel Idehen
- Department of Psychology, Obafemi Awolowo University, Osun State, Ile-Ife, Nigeria
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14
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The role of cultural beliefs and distress in adherence to recommended physical activity among patients with type 2 diabetes mellitus. J Behav Med 2022; 45:472-480. [DOI: 10.1007/s10865-022-00301-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/17/2022] [Indexed: 10/18/2022]
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15
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Bhaskara G, Budhiarta AAG, Gotera W, Saraswati MR, Dwipayana IMP, Semadi IMS, Nugraha IBA, Wardani IAK, Suastika K. Factors Associated with Diabetes-Related Distress in Type 2 Diabetes Mellitus Patients. Diabetes Metab Syndr Obes 2022; 15:2077-2085. [PMID: 35873530 PMCID: PMC9296679 DOI: 10.2147/dmso.s363431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/16/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Diabetes-related distress is a unique emotional problem that is directly related to the burden and anxieties felt by type 2 diabetes mellitus (T2DM) patients. Diabetes-related distress may lead to pessimism and lower self-efficacy which resulted in a deficiency of self-treatment compliance and can cause further bad glycemic control. Knowing the associated factors of diabetic-related distress and solving them may help T2DM patients improve their glycemic control. METHODS This study is an analytical study with cross-sectional design conducted at Sanglah General Hospital from January to April 2021. The data were taken using the consecutive sampling method; 124 samples were collected according to inclusion and exclusion criteria. The participants filled Diabetes Distress Scale questionnaire (DDS17 Bahasa Indonesia). The data analysis was done using univariate (descriptive), bivariate (chi-square) and multivariate (logistic regression) analysis. RESULTS Seventy-five subjects out of 124 (60.5%) had diabetes-related distress. The associated factors of diabetes-related distress one among others are the insulin usage as diabetic therapy (OR= 8.30, 95% CI 2.24-30.72; p = 0.002), had a hypoglycaemia in last 3 months (OR=44.59, 95% CI 4.36-455.51; p = 0.001), had diabetes-related retinopathy (OR=10.28, CI 95% 1.54-68.70; p=0.016), and lack of family support (OR=44.791, 95% CI 10.02-200.22; p < 0.001). CONCLUSION Our present study revealed that diabetes distress prevalence is predominantly and associated among in type 2 diabetes mellitus. We suggest diabetes-related distress screening and regular health promotion which focus on relationship between diabetes and psychological may be a great potential action to improve public health and patient outcomes.
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Affiliation(s)
- Gilang Bhaskara
- Internal Medicine Education Program, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Anak Agung Gde Budhiarta
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - Wira Gotera
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - Made Ratna Saraswati
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - I Made Pande Dwipayana
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - I Made Siswadi Semadi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - Ida Bagus Aditya Nugraha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
| | | | - Ketut Suastika
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
- Correspondence: Ketut Suastika, Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia, Tel +62 81 138 0916, Email
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16
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Im J, Escudero C, Zhang K, Choi D, Sivakumar A, Booth GL, Sale J, Pritlove C, Advani A, Yu CH. Perceptions and correlates of distress due to the COVID-19 pandemic and stress management strategies among people with diabetes: a mixed methods study. Can J Diabetes 2021; 46:253-261. [PMID: 35568426 PMCID: PMC8531237 DOI: 10.1016/j.jcjd.2021.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/14/2021] [Accepted: 10/17/2021] [Indexed: 11/18/2022]
Abstract
Background Greater risk of adverse health outcomes and public health measures have increased distress among people with diabetes during the coronavirus-2019 (COVID-19) pandemic. The objectives of this study were to explore how the experiences of people with diabetes during the COVID-19 pandemic differ according to sociodemographic characteristics and identify diabetes-related psychosocial correlates of COVID distress. Methods Patients with type 1 or 2 diabetes were recruited from clinics and community health centres in Toronto, Ontario, as well as patient networks. Participants were interviewed to explore the experiences of people with diabetes with varied sociodemographic and clinical identities, with respect to wellness (physical, emotional, social, financial, occupational), level of stress and management strategies. Multiple linear regression was used to assess the relationships between diabetes distress, diabetes self-efficacy and resilient coping with COVID distress. Results Interviews revealed that specific aspects of psychosocial wellness affected by the pandemic, and stress and illness management strategies utilized by people with diabetes differed based on socioeconomic status, gender, type of diabetes and race. Resilient coping (β=−0.0517; 95% confidence interval [CI], −0.0918 to −0.0116; p=0.012), diabetes distress (β=0.0260; 95% CI, 0.0149 to 0.0371; p<0.0001) and diabetes self-efficacy (β=−0.0184; 95% CI, −0.0316 to −0.0052; p=0.007) were significantly associated with COVID distress. Conclusions Certain subgroups of people with diabetes have experienced a disproportionate amount of COVID distress. Assessing correlates of COVID distress among people with diabetes will help inform interventions such as diabetes self-management education to address the psychosocial distress caused by the pandemic.
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17
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Deshmukh H, Wilmot EG, Gregory R, Barnes D, Narendran P, Saunders S, Furlong N, Kamaruddin S, Banatwalla R, Herring R, Kilvert A, Patmore J, Walton C, Ryder REJ, Sathyapalan T. Predictors of diabetes-related distress before and after FreeStyle Libre-1 use: Lessons from the Association of British Clinical Diabetologists nationwide study. Diabetes Obes Metab 2021; 23:2261-2268. [PMID: 34142425 DOI: 10.1111/dom.14467] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/02/2021] [Accepted: 06/14/2021] [Indexed: 02/05/2023]
Abstract
AIM To identify the baseline demographic and clinical characteristics associated with diabetes-related distress (DRD) and factors associated with improvement in DRD after initiating use of the FreeStyle Libre (FSL) in people living with type 1 diabetes (T1D). METHODS The study was performed using baseline and follow-up data from the Association of British Clinical Diabetologists nationwide audit of people with diabetes who initiated use of the FSL in the United Kingdom. DRD was assessed using the two-item diabetes-related distress scale (DDS; defined as the average of the two-item score ≥3). People living with T1D were categorized into two groups: those with high DRD, defined as an average DDS score ≥3 and those with lower DRD, defined as a DDS score <3. We used a gradient-boosting machine-learning (GBM) model to identify the relative influence (RI) of baseline variables on average DDS score. RESULTS The study population consisted of 9159 patients, 96.6% of whom had T1D. The median (interquartile range [IQR]) age was 45.1 (32-56) years, 50.1% were women, the median (IQR) baseline body mass index was 26.1 (23.2-29.6) kg/m2 and the median (IQR) duration of diabetes was 20 (11-32) years. The two components of the DDS were significantly correlated (r2 = 0.73; P < 0.0001). Higher DRD was prevalent in 53% (4879/9159) of people living with T1D at baseline. In the GBM model, the top baseline variables associated with average DDS score were baseline glycated haemoglobin (HbA1c; RI = 51.1), baseline Gold score (RI = 23.3), gender (RI = 7.05) and fear of hypoglycaemia (RI = 4.96). Follow-up data were available for 3312 participants. The top factors associated with improvement in DDS score following use of the FSL were change in Gold score (RI = 28.2) and change in baseline HbA1c (RI = 19.3). CONCLUSIONS In this large UK cohort of people living with T1D, diabetes distress was prevalent and associated with higher HbA1c, impaired awareness of hypoglycaemia and female gender. Improvement in glycaemic control and hypoglycaemia unawareness with the use of the FSL was associated with improvement in DRD in people living with T1D.
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Affiliation(s)
- Harshal Deshmukh
- Hull University Teaching Hospitals NHS Trust and the University of Hull, Hull, UK
| | - Emma G Wilmot
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | | | | | - Parth Narendran
- Queen Elizabeth Hospital Birmingham and University of Birmingham, Birmingham, UK
| | - Simon Saunders
- Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, UK
| | - Niall Furlong
- St Helens and Knowsley Teaching Hospitals NHS Trust, St Helens, UK
| | | | | | | | - Anne Kilvert
- Northampton General Hospital NHS Trust, Northampton, UK
| | - Jane Patmore
- Hull University Teaching Hospitals NHS Trust and the University of Hull, Hull, UK
| | - Chris Walton
- Hull University Teaching Hospitals NHS Trust and the University of Hull, Hull, UK
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18
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Alyahya MS, Al-Sheyab NA, Alqudah JA, Younis OB, Khader YS. Effect of Multimedia Messaging Service on Exercise Self-efficacy in Diabetic Patients. Am J Health Behav 2021; 45:902-915. [PMID: 34702437 DOI: 10.5993/ajhb.45.5.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: To increase patients' self-efficacy for initiation of physical activity, there is a need to include physical activity into patient education in clinic settings. In this study, we aimed to assess the effectiveness of multimedia messaging service (MMS) education on exercise self-efficacy in patients with type 2 diabetes mellitus (T2DM). Methods: We used a quasi-experimental, pretest-posttest design to study 98 patients with T2DM. The intervention group received MMS education targeting exercise self-efficacy for 2 months, and the control group received routine care only. Patients in both groups completed the Exercise Self-efficacy scale at 3 stages (at baseline, at 4 weeks, and at 8 weeks post-intervention). Results: We found a slight increase between baseline, first follow-up, and second follow-up in interpersonal and competing demands factors in the intervention group (p = .002, p = .001, respectively), but no improvement in the control group in any of the 3 factors over time (p > .05). Also, Cohen's d values indicated a medium effect size in all exercise self-efficacy subscales (interpersonal [0.734], competing demands [0.665], and internal feelings [0.696]). Conclusions: Health education using theoretically-based MMS targeting exercise self-efficacy was effective and affordable in promoting and changing patients' beliefs and physical activity behaviors.
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Affiliation(s)
- Mohammad S. Alyahya
- Mohammad S. Alyahya, Associate Professor, Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan;,
| | - Nihaya A. Al-Sheyab
- Nihaya A. Al-Sheyab, Professor of Child and Adolescent Health, Allied Medical Sciences Department/Faculty of Applied Medical Sciences, Adjunct Professor, Faculty of Nursing, Jordan University of Science and Technology, Irbid,
Jordan
| | - Jumana A. Alqudah
- Jumana A. Alqudah, Department of Public Health, Community Medicine and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Othman Beni Younis
- Othman Beni Younis, MD, Clinical Assistant Professor of Family Medicine, Department of Public Health, Community Medicine and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yousef S. Khader
- Yousef S. Khader, Professor of Epidemiology, Medical Education and Biostatistics, Department of Public Health, Community Medicine and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid,
Jordan
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19
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Lewinski AA, Shapiro A, Bosworth HB, Crowley MJ, McCant F, Howard T, Jeffreys AS, McConnell E, Tanabe P, Barcinas S, Coffman CJ, King HA. Veterans' Interpretation of Diabetes Distress in Diabetes Self-Management: Findings From Cognitive Interviews. Sci Diabetes Self Manag Care 2021; 47:391-403. [PMID: 34559032 DOI: 10.1177/26350106211043487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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 project was to identify additional facets of diabetes distress (DD) in veterans that may be present due to the veteran's military-related experience. METHODS The study team completed cognitive interviews with veterans with type 2 diabetes mellitus (T2DM) to examine how they answered the Diabetes Distress Scale (DD Scale), a tool that assesses DD. The DD Scale was used because of its strong associations with self-management challenges, physician-related distress, and clinical outcomes. RESULTS The veterans sample (n= 15) was 73% male, mean age of 61 (SD = 8.6), 53% Black, 53% with glycosylated hemoglobin level <9%, and 67% with prescribed insulin. The DD Scale is readily understood by veterans and interpreted. Thematic analysis indicated additional domains affecting DD and T2DM self-management, including access to care, comorbidities, disruptions in routine, fluctuations in emotions and behaviors, interactions with providers, lifelong nature of diabetes, mental health concerns, military as culture, personal characteristics, physical limitations, physical pain, sources of information and support, spirituality, and stigma. CONCLUSIONS This study describes how a veteran's military experience may contribute to DD in the context of T2DM self-management. Findings indicate clinicians and researchers should account for additional domains when developing self-management interventions and discussing self-management behaviors with individuals with T2DM.
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Affiliation(s)
- Allison A Lewinski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina.,School of Nursing, Duke University, Durham, North Carolina
| | - Abigail Shapiro
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Hayden B Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina.,School of Nursing, Duke University, Durham, North Carolina.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.,Department of Medicine, Division of General Internal Medicine, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Matthew J Crowley
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina.,Division of Endocrinology, Diabetes and Metabolism, Duke University School of Medicine, Durham, North Carolina
| | - Felicia McCant
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Teresa Howard
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Amy S Jeffreys
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Eleanor McConnell
- School of Nursing, Duke University, Durham, North Carolina.,Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Paula Tanabe
- School of Nursing, Duke University, Durham, North Carolina.,Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Cynthia J Coffman
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina.,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Heather A King
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina.,Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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20
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Sisman P, Polat I, Aydemir E, Karsi R, Gul OO, Cander S, Ersoy C, Erturk E. How the COVID-19 outbreak affected patients with diabetes mellitus? Int J Diabetes Dev Ctries 2021; 42:53-61. [PMID: 34539126 PMCID: PMC8432957 DOI: 10.1007/s13410-021-00992-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 07/28/2021] [Indexed: 01/02/2023] Open
Abstract
Background Global COVID-19 outbreak has been such a stressful experience for most of the people. Using a web-based cross-sectional study, we aimed to evaluate the acute stress response, depression, and anxiety in patients with diabetes mellitus (DM) during the COVID-19 pandemic, and to examine the effect of these psychiatric problems on diet habits and glycemic controls of patients. Methods This web-based survey of COVID-19 was sent to the patients through the Whatsapp platform. All participants reported their demographic data, diabetes-related information, changes in self-monitoring blood glucose measurements, physical parameters, and eating habits after COVID-19, then completed Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale, Revised (IES-R) questionnaires which assessed acute stress sypmtoms, anxiety, and depression. Results Three hundred and four patients with DM [(141 type 1 DM (T1D) and 163 type 2 (T2D)] were included in the study. In our study, female gender, higher BMI and weight, decreased in financial income after outbreak, presence of diabetic complications and comorbid diseases (i.e., retinopathy, neuropathy, diabetic foot, hypertension, dyslipidemia), worsened glycemic levels, increased carbohydrate consumption, and snacking were associated with higher anxiety and depression scores. Depression was higher in patients with T2D and duration of illness was correlated with acute stress level. Conclusions It is important to be aware of the possibility of acute stress, depression, and anxiety after pandemic in patients with DM whose glycemic control is impaired. Psychological problems should not be ignored beyond physical inactivity and worsening eating habits.
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Affiliation(s)
- Pinar Sisman
- Medicana Hospital, Endocrinology and Metabolism Clinic, Bursa, Turkey
| | - Irmak Polat
- Istanbul Faculty of Medicine Department of Psychiatry, Istanbul University, Istanbul, Turkey
| | - Ensar Aydemir
- Medical School Department of Endocrinology and Metabolism, Uludag University, Bursa, Turkey
| | - Remzi Karsi
- School of Health Science, KTO Karatay University, Konya, Turkey
| | - Ozen Oz Gul
- Medical School Department of Endocrinology and Metabolism, Uludag University, Bursa, Turkey
| | - Soner Cander
- Medical School Department of Endocrinology and Metabolism, Uludag University, Bursa, Turkey
| | - Canan Ersoy
- Medical School Department of Endocrinology and Metabolism, Uludag University, Bursa, Turkey
| | - Erdinc Erturk
- Medical School Department of Endocrinology and Metabolism, Uludag University, Bursa, Turkey
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21
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Patra S, Patro BK, Padhy SK, Mantri J. Prevalence of diabetes distress and its relationship with self-management in patients with type 2 diabetes mellitus. Ind Psychiatry J 2021; 30:234-239. [PMID: 35017806 PMCID: PMC8709516 DOI: 10.4103/ipj.ipj_60_19] [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: 07/12/2019] [Revised: 04/11/2021] [Accepted: 07/27/2021] [Indexed: 11/19/2022] Open
Abstract
CONTEXT Diabetes distress (DD) in India has been studied mainly in the context of depression. Little is known about DD, its determinants, distribution, and its impact. AIMS This study aims to estimate the prevalence of DD and identify its socio-demographic and clinical determinants in type 2 diabetes mellitus patients. To assess the relationship of DD with self-management in nondepressed type 2 diabetes mellitus. SETTINGS AND DESIGN A cross-sectional descriptive study in noncommunicable disease clinic of a tertiary care medical center. SUBJECTS AND METHODS DD Scale was used to assess DD in 200 patients with type 2 diabetes mellitus. Diabetes Self-Management Questionnaire was used to evaluate self-management behavior. Patient Health Questionnaire 9 was used to exclude depression. STATISTICAL ANALYSIS USED Sample size calculation was done as per prevailing prevalence estimates. SPSS 20.0 was used for statistical analysis. ANOVA and Independent t-tests were done to compare between groups means. Hierarchical multiple regression analysis was done, keeping self-management as a dependent variable and socio-demographic, clinical variables, and DD as independent variables. RESULTS The prevalence of DD was 42% in our sample. The duration of diabetes showed that a significant association with DD. DD was significantly and negatively associated with all four domains of self-management, while statistical significance was reached in three domains: dietary control (β = -0.378, P < 0.01); glucose management (β = -0.181, P < 0.01); and healthcare use (β = -0.244, P < 0.01). CONCLUSIONS DD is widespread in our patients and harms self-management. There is a need to address DD to improve disease-specific outcomes.
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Affiliation(s)
- Suravi Patra
- Department of Psychiatry, AIIMS, Bhubaneswar, Odisha, India
- Address for correspondence: Dr. Suravi Patra, Department of Psychiatry, AIIMS, Bhubaneswar, Odisha, India. E-mail:
| | - Binod Kumar Patro
- Department of Community and Family Medicine, AIIMS, Bhubaneswar, Odisha, India
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22
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Ischaq Nabil Asshiddiqi M, Yodchai K, Taniwattananon P. Predictors of diabetes distress among older persons with type 2 diabetes mellitus in Indonesia. J Res Nurs 2021; 26:307-317. [DOI: 10.1177/1744987120943936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Older persons living with diabetes have an obligation to change their daily lifestyle, which may contribute to diabetes distress. Furthermore, predictive factors of diabetes distress in older persons might be different from other age groups due to age-related factors. Aims The purpose of the study was to examine the predictive factors of diabetes distress in older persons diagnosed with type 2 diabetes mellitus (T2DM) in Indonesia. Methods A cross-sectional design was used in this study. Participants were recruited from an outpatient department of a tertiary hospital in Klaten City, Central Java, Indonesia. Data were analysed using multiple linear regression with a stepwise method. Results A total 198 older persons were included in the study. The study demonstrated self-efficacy (β = −0.298, P < 0.01), spirituality (β = −0.139, P < 0.05), blood glucose (β = 0.134, P < 0.05), and non-supportive family behaviour (β = 0.135, P < 0.05) as the variables that could statistically predict diabetes distress in older persons with T2DM. Conclusions Self-efficacy is the strongest predictor of diabetes distress. Moreover, the findings can be used as evidence to guide identification and future management of diabetes distress among older persons with T2DM.
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Affiliation(s)
- M Ischaq Nabil Asshiddiqi
- Student, Master of Nursing Science, Department of Adult and Gerontological Nursing, Prince of Songkla University, Thailand
- Lecturer, Faculty member, Department of Gerontological Nursing, Alma Ata University, Indonesia
| | - Kantaporn Yodchai
- Assistant Professor, Department of Adult and Gerontological Nursing, Prince of Songkla University, Thailand
| | - Ploenpit Taniwattananon
- Associate Professor, Department of Adult and Gerontological Nursing, Prince of Songkla University, Thailand
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Wolde AK. Diabetic Distress Among Diabetic Patients in the Amhara Regional State, Ethiopia. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2021; 43:171-181. [PMID: 33823688 DOI: 10.1177/0272684x211004931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Diabetes distress is a psychological reaction to the threat of diabetes, when an individuals diagnosed with diabetes consider the coping resources they possess as insufficient to manage the illness threat, thus triggering emotional distress specific to diabetes. Research conducted in Ethiopia regarding diabetes-related distress is scant. The main purpose of this study was to assess the status of diabetic distress among diabetic patients in the hospitals of the Amhara Region. A hospital-based cross-sectional survey research approach was employed. A total of 14 hospitals was included in the study using stratified simple random sample methods. The participans of the study were 532 diabetic patients who were selected using systematic simple random sampling methods. The pertinent data were collected using diabetic distress scale-17 (DDS-17). The instrument of the study was rated, piloted, and finally validated. Both descriptive and inferential techniques were used to analyze the data. The cutoff for low, moderate, and high distress level was <2, 2-2.9, and >3, respectively. The study revealed that the participant in the study area experienced a moderate level of distress. The status of diabetic distress for the diabetic sub-scale was also determined for emotional burden, physician-related distress, regimen-related distress, and interpersonal distress, it was also found to be (2.79 ± 0.85), (3.14 ± 0.87), (3.19 ± 0.81), and (3.04 ± 0.93) respectively. The most important domain in measuring diabetic distress was regimen-related distress. Statistically, a significant difference was detected in the level of diabetic distress among diabetic patients concerning marital status, educational status, the experience of living with diabetes, and having habits of planned physical exercise. Statistically, a significant difference was not observed for age, sex, and occupational status. Diabetic distress was a solemn psychological problem among diabetic patients in the hospitals of the Amhara Region. A strong policy document is required to bind the physical treatment with psychological elements to reduce distress.
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Affiliation(s)
- Abraham Kebede Wolde
- Department of Psychology, College of Education and Behavioral Sciences, Bahir Dar University, Amhara, Ethiopia
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Kolb L. An Effective Model of Diabetes Care and Education: The ADCES7 Self-Care Behaviors™. Sci Diabetes Self Manag Care 2021; 47:30-53. [PMID: 34078208 DOI: 10.1177/0145721720978154] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE The ADCES7 Self-Care Behaviors™ (ADCES7) is a robust framework for self-management of diabetes and other related conditions, such as prediabetes and cardiometabolic diseases. It is the position of the Association of Diabetes Care and Education Specialists (ADCES) that at the cornerstone of diabetes self-management education and support, the ADCES7 is the framework for achieving behavior change that leads to effective self-management through improved behavior and clinical outcome measures. The ADCES7 model guides the health care team in effective person-centered collaboration and goal setting to achieve health-related outcomes and improved quality of life. Continued research and evidence are critical to expand this model and broaden its application to other chronic conditions. Given the advances in the science of diabetes management as well as diabetes self-management education and support, ADCES has evaluated the ADCES7 within the framework of these advances, including the digital and dynamic health care landscape. CONCLUSION This revised position statement blends the updates in research and ADCES's vision and expansion beyond diabetes to refresh the ADCES7 framework. This revision reflects the perspectives of all members of the health care team as they problem solve with individuals who are at risk for or who have diabetes and related conditions to achieve healthier outcomes.
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Affiliation(s)
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- From the Association of Diabetes Care and Education Specialists, Chicago, Illinois
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Huynh G, Tran TT, Do THT, Truong TTD, Ong PT, Nguyen TNH, Pham LA. Diabetes-Related Distress Among People with Type 2 Diabetes in Ho Chi Minh City, Vietnam: Prevalence and Associated Factors. Diabetes Metab Syndr Obes 2021; 14:683-690. [PMID: 33623403 PMCID: PMC7894807 DOI: 10.2147/dmso.s297315] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/29/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Diabetes-related distress (DRD) refers to the condition of negative emotion as a result of living with diabetes and the burden of self-care. This study aims to evaluate the prevalence and associated factors of DRD among people with type 2 diabetes. METHODS A cross-sectional study was carried out on people with Type 2 Diabetes at three hospitals in Ho Chi Minh City, between April and November 2020. The study used the Vietnamese version of the Diabetes Distress Scale (DDS) which includes 17 items. The mean total distress score was calculated on the average of the 17 items. A mean score of equal to 2.0 or higher was classified as moderate to severe distress. Descriptive statistics were performed by frequency and percentage, and the multivariate Logistic Regression Analysis was used to assess information where p-value <0.05 was considered statistically significant. RESULTS A total of 517 participants, who were mainly over 60 years old (56.8%) with females being 65.0%, participated in the study. Results showed that 23.6% and 5.8% of them, respectively, were found as being moderately or highly distressed. Some factors that correlated with the total distress results included age, timescale of diabetes, and glycemic control level (HbA1c). The rate of total distress in those who were over 60 years old and had a HbA1c <7 were less prevalent than those who were under 60, and had a HbA1c ≥7 (OR 0.5 95% CI 0.3-0.7; OR 0.5 95% CI: 0.3-0.9, respectively, all p<0.05), whilst the timescale of diabetes between 5 and 10 years was significantly more prevalent than those who had a timescale less 5 years (OR 1.8 95% CI 1.1-2.9, p<0.05). CONCLUSION A high rate of distress exists in people with diabetes. Therefore, combining the evaluation of distress as part of the regular diagnostic procedures of diabetes care, and recommending physicians apply a comprehensive approach to diabetes management, is necessary.
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Affiliation(s)
- Giao Huynh
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Thien Thuan Tran
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Thi Hoai Thuong Do
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Thi Thuy Dung Truong
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Phuc Thinh Ong
- Center for Population Health Sciences, Hanoi University of Public Health, Hanoi, Vietnam
| | - Thi Ngoc Han Nguyen
- Infection Control Department, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Le An Pham
- Family Medicine Training Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Correspondence: Le An Pham; Giao Huynh University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang Street, District 5, Ho Chi Minh City, VietnamTel +84908153743; +84908608338 Email ;
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Kintzoglanakis K, Vonta P, Copanitsanou P. Diabetes-Related Distress and Associated Characteristics in Patients With Type 2 Diabetes in an Urban Primary Care Setting in Greece. CHRONIC STRESS 2020; 4:2470547020961538. [PMID: 33029569 PMCID: PMC7522819 DOI: 10.1177/2470547020961538] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/06/2020] [Indexed: 11/27/2022]
Abstract
Background Diabetes-related distress (DRD) is a common psychological issue of people living with diabetes. International guidelines advise to take DRD into consideration in diabetes care but evidence for Greece is scarce. In the present study we aimed to estimate the frequency of DRD as assessed by Diabetes Distress Scale (DDS) and to examine its connections with clinical and sociodemographic characteristics among patients with type 2 diabetes mellitus (T2D) in urban primary care (PC) in Greece. Methods This descriptive survey included adults with a diagnosis of T2D of at least six months under medication treatment attending a novel, public urban PC unit. Patients with other forms of diabetes, dementia, and psychosis were excluded. Patients were screened for DRD with DDS instrument and correlations were made between DRD and clinical and sociodemographic characteristics. Results In 135 eligible participants the frequency of moderate to high levels of DRD (DDS ≥ 2) was 24.4% and of high levels of DRD (DDS ≥ 3) was 7.4%. Emotional burden (EB) subscale was significantly correlated with younger age, insulin use, duration of insulin use, and the number of insulin injections per day. Longer diabetes duration showed significant correlation with DDS total, EB, and regimen distress. Participants with lower income, sedentary lifestyle, micro-vascular complications, more episodes of hypoglycaemia, and higher levels of glycated haemoglobin (HbA1c) experienced significantly higher distress. Conclusion DRD screening is important in urban PC and in more susceptible patients as those on more insulin injections per day, with longer diabetes duration, higher levels of HbA1c, lower income, sedentary lifestyle, and more episodes of hypoglycaemia.
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Affiliation(s)
| | | | - Panagiota Copanitsanou
- General Hospital of Piraeus "Tzaneio", Piraeus, Greece.,Department of Nursing Science, National and Kapodistrian University of Athens, Athens, Greece
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Onyenekwe B, Young E, Nwatu C, Okafor C, Ugwueze C. Diabetes Distress and Associated Factors in Patients with Diabetes Mellitus in South East Nigeria. DUBAI DIABETES AND ENDOCRINOLOGY JOURNAL 2020. [DOI: 10.1159/000508706] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
<b><i>Background:</i></b> Diabetes distress (DD) is a common worldwide problem in diabetic patients irrespective of age and type of treatment. In the DAWN 2 study (Diabetes Attitudes, Wishes, and Needs), DD was reported by 44.6% of participants. <b><i>Objectives:</i></b> The purpose of this study was to assess the prevalence and level of DD and its associated factors among adult diabetic patients in South East Nigeria. <b><i>Methods:</i></b> The present study was cross-sectional and descriptive. Patients attending the adult diabetes clinic were enrolled. The questionnaire was administered by the investigators. All patients were eligible. Their demographic and clinical data were obtained. They were screened for DD using the DD Scale (DDS)-2 and DDS-17. Data were tabulated and analyzed using SPSS version 21. <b><i>Results:</i></b> There were 110 subjects (38 males and 72 females), aged 36–85 years (60.5 ± 10.0). Only 9 (8.2%) had diabetes mellitus (DM) type 1, while the rest had type 2 DM. Twenty-five subjects (22.7%) were on insulin injection. Hypertension was coexistent in 72%, and they were prescribed 3–10 medications (5.9 ± 1.5) at the time of assessment. The male and female subjects were comparable. Moderate to severe DD was present in 51.9% (DDS-17). The average scores were for DDS-2, 3.1; DDS-17, 2.3; emotional burden, 2.9; physician-related distress, 1.4; regimen-related distress, 2.5, and interpersonal distress, 2.2. Distress was significantly associated with a younger age, T1DM, longer duration of diabetes, use of insulin injection, and HbA<sub>1C</sub> level. <b><i>Conclusion:</i></b> DD is a common consequence of living with diabetes and impairs diabetes self-care behavior and glycemic control. Active screening for DD should be an integral part of diabetes care. Diabetes self-management education and support should be implemented at diagnosis and as needed thereafter, especially when DD is diagnosed.
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Nachimuthu S, Vijayalakshmi R, Sudha M, Viswanathan V. Coping with diabetes during the COVID - 19 lockdown in India: Results of an online pilot survey. Diabetes Metab Syndr 2020; 14:579-582. [PMID: 32416527 PMCID: PMC7211739 DOI: 10.1016/j.dsx.2020.04.053] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 12/24/2022]
Abstract
AIM The management of diabetes has become a challenge due to the COVID 19 lockdown. An online-based pilot survey was conducted to study how people with diabetes were coping with their Diabetes during the COVID - 19 lockdown. METHOD The questions were designed in an online survey, Survey Monkey, to conduct this cross-sectional study. The link was generated and sent to 100 registered patients of the MV Hospital for Diabetes Royapuram who had not contacted the hospital after the lockdown announcement. The survey was done between April 1 and April 15, 2020.Oral consent was obtained through telephone before the link was sent by Whatsapp to them.The questionnaire consisted of questions on home blood glucose monitoring, regularity in doing their physical activity and dietary compliance and anxiety about the viral infection. RESULTS 92% of the participants had Type 2 diabetes. Only 28% of the participants were checking their blood glucose levels regularly. 80% of the participants mentioned that they were following regular exercise and diet control during the lockdown period. 40% of the participants were anxious about the Covid infection. CONCLUSION SMBG needs to be practiced on regular basis, especially among the patients with diabetes on insulin therapy. Most of the people surveyed were coping well with their Diabetes. Patients have reported that they were able to maintain proper dietary compliance and be more physically active at home during this lockdown. These findings need to be ascertained in larger sample of patients.
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Affiliation(s)
| | - R Vijayalakshmi
- MV Hospital for Diabetes, Diabetes Research Centre, Chennai, India
| | - M Sudha
- MV Hospital for Diabetes, Diabetes Research Centre, Chennai, India
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Perceptions of healthcare professionals and people with type 2 diabetes on emotional support: a qualitative study. BJGP Open 2020; 4:bjgpopen20X101018. [PMID: 32184215 PMCID: PMC7330186 DOI: 10.3399/bjgpopen20x101018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 10/22/2019] [Indexed: 11/29/2022] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) is a demanding condition that impacts the person living with the condition physically and psychologically. Promoting emotional support is a key strategy to improve diabetes care. Aim To explore the views and experiences of people with T2DM and healthcare professionals (HCPs) on emotional support in diabetes care, and identify barriers and facilitators to the provision of emotional support in clinical practice. Design & setting A qualitative study in England with data collected from four focus groups. Method Focus group discussions were conducted with people with T2DM (n = 10) and HCPs (n = 10). The analysis was informed by the framework method and principles of the constant comparative approach. Results Emotional support was lacking in diabetes primary care, and there was a need to normalise the emotional impact of T2DM. Barriers to emotional support included: lack of HCP confidence to discuss emotional issues; lack of counselling training; and time constraints in consultations. Inappropriate use of the word ‘depression’ creates a sense of taboo for those experiencing emotions other than depression. Conclusion Consensus between the two target groups indicated a strong need to integrate emotional support in diabetes care, and the need to support and train HCPs in addressing psychosocial aspects of T2DM. Shared language is recommended across diabetes services to appropriately refer to wellbeing. Addressing barriers and considering ways to incorporate emotional management in diabetes consultations is recommended, includings introducing HCP training to increase confidence and enhance counselling skills.
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Liu SY, Huang J, Dong QL, Li B, Zhao X, Xu R, Yin HF. Diabetes distress, happiness, and its associated factors among type 2 diabetes mellitus patients with different therapies. Medicine (Baltimore) 2020; 99:e18831. [PMID: 32176027 PMCID: PMC7440060 DOI: 10.1097/md.0000000000018831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This study aimed to investigate diabetes distress, happiness, and its associated factors of patients with type 2 diabetes mellitus (T2DM) treated by different therapies, and to analyze the related impact factors. A total of 1512 patients with T2DM were randomly selected from 18 tertiary hospitals in Hunan province from January 2016 to April 2016 who has been treated with oral antidiabetics monotherapy, insulin monotherapy, and combination therapy. Use the general information questionnaire, WHO-5 (the World Health Organization 5 well-being index) and PAID (the problem areas in diabetes scale) to collect the data. There are 846 (55.95%) patients that have serious emotional disorders, and the diabetes related distress in insulin treatment group was higher than that in combination treatment group (P < .05). Happiness of T2DM patients in combination therapy was higher than oral antidiabetic drug monotherapy and insulin monotherapy (P < .05). There was a negative correlation between diabetic suffering and happiness in patients with different treatments (R ranged from -0.335 to -0.436, P < .001). Age and happiness experience could explain 14.8% of the variance. Acute and chronic complications, controlled blood glucose level, lifestyle, therapies, and school education can explain 18.3% variance. Under different therapies, the suffering and happiness of T2DM patients differed from each other. The suffering and happiness of T2DM were related to different therapies, age, complications, glycaemic control, lifestyle, school education, and so on.
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Affiliation(s)
- Shun-Ying Liu
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University
| | - Jin Huang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University
| | - Qiao-Liang Dong
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University
| | - Bei Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University
| | - Xue Zhao
- the affiliated hospital of Guizhou medical university
| | - Rong Xu
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University
| | - Hong-Fang Yin
- Department of Endocrinology, Hunan Provincial People's Hospital, Changsha, Hunan, P.R. China
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Lum ZK, Khoo ZR, Toh WYS, Kamaldeen SAK, Shakoor A, Tsou KYK, Chew DEK, Dalan R, Kwek SC, Othman N, Lian JX, Bte Sunari RN, Lee JYC. Efficacy and Safety of Use of the Fasting Algorithm for Singaporeans With Type 2 Diabetes (FAST) During Ramadan: A Prospective, Multicenter, Randomized Controlled Trial. Ann Fam Med 2020; 18:139-147. [PMID: 32152018 PMCID: PMC7062498 DOI: 10.1370/afm.2500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 10/15/2019] [Accepted: 10/21/2019] [Indexed: 02/06/2023] Open
Abstract
PURPOSE We aimed to evaluate the efficacy and safety of use of the Fasting Algorithm for Singaporeans with Type 2 Diabetes (FAST) during Ramadan. METHODS We performed a prospective, multicenter, randomized controlled trial. The inclusion criteria were age ≥21 years, baseline glycated hemoglobin (HbA1c) level ≤9.5%, and intention to fast for ≥10 days during Ramadan. Exclusion criteria included baseline estimated glomerular filtration rate <30 mL/min, diabetes-related hospitalization, and short-term corticosteroid therapy. Participants were randomized to intervention (use of FAST) or control (usual care without FAST) groups. Efficacy outcomes were HbA1c level and fasting blood glucose and postprandial glucose changes, and the safety outcome was incidence of major or minor hypoglycemia during the Ramadan period. Glycemic variability and diabetes distress were also investigated. Linear mixed models were constructed to assess changes. RESULTS A total of 97 participants were randomized (intervention: n = 46, control: n = 51). The HbA1c improvement during Ramadan was 4 times greater in the intervention group (-0.4%) than in the control group (-0.1%) (P = .049). The mean fasting blood glucose level decreased in the intervention group (-3.6 mg/dL) and increased in the control group (+20.9 mg/dL) (P = .034). The mean postprandial glucose level showed greater improvement in the intervention group (-16.4 mg/dL) compared to the control group (-2.3 mg/dL). There were more minor hypoglycemic events based on self-monitered blood glucose readings in the control group (intervention: 4, control: 6; P = .744). Glycemic variability was not significantly different between the 2 groups (P = .284). No between-group differences in diabetes distress were observed (P = .479). CONCLUSIONS Our findings emphasize the importance of efficacious, safe, and culturally tailored epistemic tools for diabetes management.
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Affiliation(s)
- Zheng Kang Lum
- Department of Pharmacy, Faculty of Science, National University of Singapore
| | - Zi Rui Khoo
- Department of Pharmacy, Faculty of Science, National University of Singapore
| | | | | | - Abdul Shakoor
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Keith Yu Kei Tsou
- Department of Family Medicine, National University Polyclinics, Singapore
| | | | - Rinkoo Dalan
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Sing Cheer Kwek
- Department of Family Medicine, National University Polyclinics, Singapore
| | - Noorani Othman
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Joyce Xia Lian
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | | | - Joyce Yu-Chia Lee
- Department of Pharmacy, Faculty of Science, National University of Singapore .,Department of Pharmacy, Tan Tock Seng Hospital, Singapore
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Sayyed Kassem L, Aron DC. The assessment and management of quality of life of older adults with diabetes mellitus. Expert Rev Endocrinol Metab 2020; 15:71-81. [PMID: 32176560 DOI: 10.1080/17446651.2020.1737520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 02/28/2020] [Indexed: 12/11/2022]
Abstract
Introduction: As the population ages, the number of older adults with diabetes mellitus will continue to rise. The burden of diabetes on older adults is significant due to the disease itself, its complications, and its treatments. This is compounded by geriatric syndromes such as frailty and cognitive dysfunction. Consequently, health and diabetes-related quality of life (QoL) are diminished.Areas covered: This article reviews the value of assessing QoL in providing patient-centered care and the associations between QoL measures and health outcomes. The determinants of QoL particular to diabetes and the older population are reviewed, including psychosocial, physical, and cognitive burdens of diabetes and aging and the impact of hypoglycemia on QoL. Strategies are described to alleviate these burdens and improve QoL, and barriers to multidisciplinary patient-centered care are discussed. QoL measurement instruments are reviewed.Expert opinion: The goals of treating diabetes and its complications should be considered carefully along with each patient's capacity to withstand the burdens of treatment. This capacity is reduced by socioeconomic, psychological, cognitive, and physical factors reduces this capacity. Incorporating measurement of HRQoL into clinical practices is possible, but deficiencies in the systems of health-care delivery need to be addressed to facilitate their use.
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Affiliation(s)
- Laure Sayyed Kassem
- Endocrinology Section, Northeast Ohio Veterans Healthcare System, Cleveland, OH, USA
- Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - David C Aron
- Endocrinology Section, Northeast Ohio Veterans Healthcare System, Cleveland, OH, USA
- Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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An Effective Model of Diabetes Care and Education: Revising the AADE7 Self-Care Behaviors ®. DIABETES EDUCATOR 2020; 46:139-160. [PMID: 31928334 DOI: 10.1177/0145721719894903] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE The AADE7 Self-Care Behaviors® (AADE7) is a robust framework for self-management of diabetes and other related conditions, such as prediabetes and cardiometabolic diseases. It is the position of the American Association of Diabetes Educators (AADE) that, at the cornerstone of diabetes self-management education and support, the AADE7 is the framework for achieving behavior change that leads to effective self-management through improved behavior and clinical outcome measures. The AADE7 model guides the health care team in effective person-centered collaboration and goal setting to achieve health-related outcomes and improved quality of life. Continued research and evidence are critical to expand this model and broaden its application to other chronic conditions. Given the advances in the science of diabetes management, as well as in diabetes self-management education and support, AADE has evaluated the AADE7 within the framework of these advances, including the digital and dynamic health care landscape. CONCLUSION This revised position statement blends the updates in research and AADE's vision and expansion beyond diabetes to refresh the AADE7 framework. This revision reflects the perspectives of all members of the health care team as they problem solve with individuals who are at risk for or who have diabetes and related conditions to achieve healthier outcomes.
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Affiliation(s)
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- American Association of Diabetes Educators, Chicago, Illinois
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Luciani M, Fabrizi D, Rebora P, Rossi E, Di Mauro S, Kohl Malone S, Ausili D. Self-care in People with Type 2 Diabetes Mellitus Research Protocol of a Multicenter Mixed Methods Study (SCUDO). PROFESSIONI INFERMIERISTICHE 2019; 72:203-12. [PMID: 31884779 DOI: 10.7429/pi.2019.723203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
About 11% of the adult global populations is estimated to be living with type 2 diabetes mellitus (T2DM) by 2040. T2DM requires people to make decisions regarding complex therapeutic regimes, to maintain their well-being and quality of life, to manage symptoms and to reduce disease complications. All these behaviours, requiring knowledge, motivation, experience, and skills, have been referred to the concept of self-care. The intricacy and multidimensionality of T2DM self-care requires a complex approach to its overall comprehension. This Embedded Mixed Method study aims to investigate the experience of self-care in Type 2 Diabetes Mellitus adult patients. It comprises a prospective observational design, and an interpretive description. Quantitative data will be collected with validated questionnaires from 300 patients at baseline and once a year for two years on: diabetes self-care, quality of life, diabetes related distress, and sleep quality. Socio-demographic and clinical data will be collected from medical records. Qualitative data will be collected using semi-structured interviews on circa 10-20 patients, at baseline and once a year for two years, analysed according to interpretive description. Quantitative and qualitative data will be analysed separately and then merged and interpreted. This study will expand our understanding of self-care in people with T2DM. The expected outcome will be a better understanding of the effect of self-care on glycaemic control and therefore clinical outcomes and costs.
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Affiliation(s)
- Michela Luciani
- RN, MSc, PhD. Università di Milano – Bicocca, Dipartimento di Medicina e
Chirurgia. Monza, Italy
| | - Diletta Fabrizi
- RN, MSc, PhDs. Università di Milano – Bicocca, Dipartimento di Medicina e Chirurgia. Monza, Italy. Corrispondence e-mail:
| | - Paola Rebora
- PhD. Università di Milano Bicocca, Centro di Biostatistica ed Epidemiologia Clinica, Dipartimento di Medicina e Chirurgia. Monza, Italy
| | - Emanuela Rossi
- PhD. Università di Milano Bicocca, Centro di Biostatistica ed Epidemiologia Clinica, Dipartimento di Medicina e Chirurgia. Monza, Italy
| | - Stefania Di Mauro
- RN, MSc. Università di Milano – Bicocca, Dipartimento di Medicina e Chirurgia. Monza, Italy
| | - Susan Kohl Malone
- PhD. New York University, Rory Meyers College of Nursing. New York, USA
| | - Davide Ausili
- RN, MSc, PhD. Università di Milano – Bicocca, Dipartimento di Medicina e Chirurgia. Monza, Italy
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Abstract
BACKGROUND An older, more diverse population and longer life spans are major contributors to the anticipated tripling of Type 2 diabetes prevalence by 2050. Diabetes-related distress affects up to 40% of people diagnosed with Type 2 diabetes and may be a greater risk for older adults due to greater prevalence of comorbidities. OBJECTIVE The objective of this phenomenological study was to describe how diabetes-related distress in older adults (≥65 years) with Type 2 diabetes might be uniquely experienced. METHODS Participants were recruited using convenience sampling and snowball sampling. Interpretive phenomenology guided the research design and analysis. With interpretive interviews, we investigated the everyday health, symptoms, and life experiences of living with Type 2 diabetes and elevated diabetes distress. RESULTS Among the older adults in this study, the most prevalent symptoms were fatigue, hypoglycemia, diarrhea, pain, loss of balance, and falling. These diabetes-related symptoms led to substantial loss of independence, decreased quality of life, and constrained social lives due to restricted activities. DISCUSSION Diabetes-related distress presents with some unique symptoms and responses in older adults. Improving knowledge regarding the symptom experience of older adults with diabetes-related distress may allow healthcare providers to tailor treatment and thus improve outcomes for older adults struggling with diabetes.
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Bruno BA, Choi D, Thorpe KE, Yu CH. Relationship Among Diabetes Distress, Decisional Conflict, Quality of Life, and Patient Perception of Chronic Illness Care in a Cohort of Patients With Type 2 Diabetes and Other Comorbidities. Diabetes Care 2019; 42:1170-1177. [PMID: 31048410 DOI: 10.2337/dc18-1256] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 03/31/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The primary outcome is to evaluate the relationship between diabetes distress and decisional conflict regarding diabetes care in patients with diabetes and two or more comorbidities. Secondary outcomes include the relationships between diabetes distress and quality of life and patient perception of chronic illness care and decisional conflict. RESEARCH DESIGN AND METHODS This was a cross-sectional study of 192 patients, ≥18 years of age, with type 2 diabetes and two or more comorbidities, recruited from primary care practices in the Greater Toronto Area. Baseline questionnaires were completed using validated scales: Diabetes Distress Scale (DDS), Decisional Conflict Scale (DCS), Short-Form Survey 12 (SF-12), and Patient Assessment of Chronic Illness Care (PACIC). Multiple linear regression models evaluated associations between summary scores and subscores, adjusting for age, education, income, employment, duration of diabetes, and social support. RESULTS Most participants were >65 years old (65%). DCS was significantly and positively associated with DDS (β = 0.0139; CI 0.00374-0.0246; P = 0.00780). DDS-emotional burden subscore was significantly and negatively associated with SF-12-mental subscore (β =-3.34; CI -4.91 to -1.77; P < 0.0001). Lastly, DCS was significantly and negatively associated with PACIC (β = -6.70; CI -9.10 to -4.32; P < 0.0001). CONCLUSIONS We identified a new positive relationship between diabetes distress and decisional conflict. Moreover, we identified negative associations between emotional burden and mental quality of life and patient perception of chronic illness care and decisional conflict. Understanding these associations will provide valuable insights in the development of targeted interventions to improve quality of life in patients with diabetes.
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Affiliation(s)
- Brigida A Bruno
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dorothy Choi
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Catherine H Yu
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada .,Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
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K. Wolde A, G. Wondim M. Diabetic Distress Among Diabetic Patients in the Referral Hospital of Amhara Regional State, Ethiopia. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2019; 40:105-114. [DOI: 10.1177/0272684x19857580] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The main purpose of this study was to assess the status of diabetic distress among diabetic patients of referral hospitals in Amhara Regional State. Hospital-based cross-sectional survey was conducted on 346 participants. The participants of the study were selected using both probability and nonprobability sampling techniques. The instrument of the study was adapted and contextualized to the Ethiopian context to avoid cultural conflicts, and then it was rated and piloted. Both descriptive and inferential techniques were used to analyze the data. The cut-off for low, moderate, and high distress level was <2, 2–2.9, and ≥3, respectively. From a total of 346 sample patients, 54 (15.6%) had experienced no or little distress (1.54 ± .28), 162 (46.8%) had moderate distress (2.78 ± .82), and 130 (37.6%) had experienced high distress (3.94 ± .62). Statistically significant difference was observed in the level of diabetic distress with respect to age, F(2, 343) = 4.336, p < .05; marital status, F(2, 343) = 4.590, p < .05; educational status, F(5, 340) = 2.831, p < .05; and having habits of planned physical exercise, F(3, 245) = 2.911, p < .05. Statistically significant difference was not observed for sex, smoking habits, an experience of living with diabetics, and occupational status. The result of regression analysis shows that the independent variable altogether accounted for only 4.2% of the variance of diabetic distress. Diabetic distress was a serious psychological problem among diabetic patients in the referral hospitals of Amhara Region.
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Affiliation(s)
- Abraham K. Wolde
- Department of Psychology, College of Education and Behavioral Science, Bahir Dar University, Ethiopia
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Sørgård B, Iversen MM, Mårtensson J. Continuous glucose monitoring in adults with type 1 diabetes: A balance between benefits and barriers: A critical incident study. J Clin Nurs 2019; 28:3318-3329. [PMID: 31090960 DOI: 10.1111/jocn.14911] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 03/12/2019] [Accepted: 04/14/2019] [Indexed: 01/22/2023]
Abstract
AIMS AND OBJECTIVES To describe positively and negatively perceived situations experienced by adults with type 1 diabetes using continuous glucose monitoring and the actions they take to deal with these situations. BACKGROUND Real-time continuous glucose monitoring has been shown to improve glycaemic control and reduce hypoglycaemia. Although many patients with type 1 diabetes report great benefits when using continuous glucose monitoring, a substantial number discontinue using the device. Little is known about the different situations and experiences with the daily use of continuous glucose monitoring that contribute to such differences. DESIGN A descriptive design based on the critical incident technique was used. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ) (see File S1). METHODS Individual interviews were conducted with a purposive sample of 23 adults with type 1 diabetes, including current and former users of continuous glucose monitoring from four different outpatient clinics. RESULTS The participants described that they felt that the use of continuous glucose monitoring was a balance between benefits and barriers, and how, through their actions, they tried to adapt their use of continuous glucose monitoring to fit their lifestyles. Various life events affected and altered the balance between benefits and barriers and thus affected their use of continuous glucose monitoring. CONCLUSIONS Continuous glucose monitoring is perceived as an effective and important tool in the self-management of diabetes type 1. It enables a better everyday life and increased satisfaction with treatment. At the same time, the use of continuous glucose monitoring can be both demanding and challenging. RELEVANCE TO CLINICAL PRACTICE Understanding the complex interplay between perceived benefits, treatment burden and adherence to continuous glucose monitoring use is important for nurses engaged in diabetes care. Education and support regarding the use of continuous glucose monitoring must be based on the understanding and perspectives of the patient to alleviate stress and barriers and enhance self-efficacy. As the use of continuous glucose monitoring can change over time, this must be a continuous process beyond initial training.
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Affiliation(s)
- Beate Sørgård
- Department of Health and Caring Sciences, Faculty of Health and Social Science, Western University of Applied Sciences, Bergen, Norway.,Department of Medicine, Vestre Viken, Baerum Hospital, Oslo, Norway
| | - Marjolein M Iversen
- Department of Health and Caring Sciences, Faculty of Health and Social Science, Western University of Applied Sciences, Bergen, Norway
| | - Jan Mårtensson
- Department of Health and Caring Sciences, Faculty of Health and Social Science, Western University of Applied Sciences, Bergen, Norway.,Department of Nursing, School of Health and Welfare, Western Norway University of Applied Sciences, Bergen, Norway
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Kalra S, Das AK, Baruah MP, Unnikrishnan AG, Dasgupta A, Shah P, Sahay R, Shukla R, Das S, Tiwaskar M, Vijayakumar G, Chawla M, Eliana F, Suastika K, Orabi A, Rahim AAA, Uloko A, Lamptey R, Ngugi N, Bahendeka S, Abdela AA, Mohammed F, Pathan MF, Rahman MH, Afsana F, Selim S, Moosa M, Murad M, Shreshtha PK, Shreshtha D, Giri M, Hussain W, Al-Ani A, Ramaiya K, Singh S, Raza SA, Aye TT, Garusinghe C, Muthukuda D, Weerakkody M, Kahandawa S, Bavuma C, Ruder S, Vanny K, Khanolkar M, Czupryniak L. Euthymia in Diabetes: Clinical Evidence and Practice-Based Opinion from an International Expert Group. Diabetes Ther 2019; 10:791-804. [PMID: 31012081 PMCID: PMC6531538 DOI: 10.1007/s13300-019-0614-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Indexed: 01/12/2023] Open
Abstract
AIM To develop an evidence-based expert group opinion on various types of euthymia associated with diabetes mellitus (DM) and its management. BACKGROUND Diabetes mellitus is a metabolic syndrome characterized by diverse biomedical and psychosocial features. Emotional health disturbances may lead to psychological and psychiatric dysfunction and may negatively influence glycemic control. Patients with DM may experience diabetes distress (DD) associated with burden of self-care, interpersonal issues, and emotional worries regarding the ability to cope with the illness. Euthymia or a state of positive mental health and psychological well-being should be considered a key outcome of diabetes care. Therefore, to achieve optimal outcomes, the consideration and measurement of psychological and psychiatric aspects along with glycemic levels are very important. A group of multidisciplinary clinical experts came together in an international meeting held in India to develop a workable concept for euthymia in diabetes care. A multidisciplinary approach was suggested to enhance the clinical outcomes and facilitate patient-centered care. During the meeting emphasis was given to the concept of a euthymia model in diabetes care. This model focuses on enhancement of self-care skills in diabetic patients and preventative health awareness among diabetes care providers. Euthymia also encompasses patient-provider communication to aid enhancement of coping skills. RESULTS After due discussions and extensive deliberations, the expert group provided several recommendations on implementing the concept of euthymia in DM care. CONCLUSIONS Introduction of the concept of euthymia in routine clinical practice is important to improve the quality of life and coping skills in patients with DM. A timely clinical assessment of psychological and psychiatric aspects along with patient-reported outcomes of diabetes contributes to overall health and well-being of affected individuals. FUNDING Sanofi India.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India.
| | - A K Das
- Department of Endocrinology and Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - M P Baruah
- Department of Endocrinology, Excel Hospital, Guwahati, Assam, India
| | - A G Unnikrishnan
- Department of Endocrinology and Diabetes, Chellaram Diabetes Institute, Pune, Maharashtra, India
| | - Arundhati Dasgupta
- Department of Endocrinology, Rudraksh Superspecialty Care, Siliguri, India
| | - Parag Shah
- Department of Endocrinology and Diabetes, Gujarat Endocrine Centre, Ahmedabad, India
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India
| | - Rishi Shukla
- Department of Endocrinology, Regency Hospital Ltd., Kanpur, India
| | - Sambit Das
- Department of Endocrinology, Apollo Hospitals, Bhubaneswar, India
| | - Mangesh Tiwaskar
- Department of Diabetology, Shilpa Medical Research Centre, Mumbai, India
| | - G Vijayakumar
- Department of Diabetology, Apollo Hospitals, Chennai, India
| | - Manoj Chawla
- Department of Diabetology, Lina Diabetes Care and Mumbai Diabetes Research Centre, Mumbai, India
| | - Fatimah Eliana
- Department of Internal Medicine, Faculty of Medicine, YARSI University, Jakarta, Indonesia
| | - Ketut Suastika
- Indonesian Association of Endocrinology, Jakarta, Indonesia
| | - Abbas Orabi
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Andrew Uloko
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Roberta Lamptey
- Department of Family Medicine, Korle Bu Teaching Hospital, University of Ghana, School of Public Health Ghana, Accra, Ghana
| | - Nancy Ngugi
- Department of Internal Medicine and Diabetes, Kenyatta National Hospital, Nairobi, Kenya
| | - Silver Bahendeka
- Department of Internal Medicine, Diabetes and Endocrinology, St. Francis Hospital, Nsambya, Kampala, Uganda
| | | | - Fariduddin Mohammed
- Department of Endocrinology of Bangabandhu Sheikh, Mujib Medical University, Dhaka, Bangladesh
| | - Mohammed Faruque Pathan
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | | | - Faria Afsana
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | - Shajada Selim
- Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Muaz Moosa
- Department of internal Medicine, Indira Gandhi Memorial Hospital, Malé, Maldives
| | - Moosa Murad
- Department of internal Medicine, Indira Gandhi Memorial Hospital, Malé, Maldives
| | | | - Dina Shreshtha
- Department of Endocrinologist, Norvic International Hospital Kathmandu, Kathmandu, Nepal
| | - Mimi Giri
- Department of Endocrinology, Nepal Mediciti Hospital, Kathmandu, Nepal
| | - Wiam Hussain
- Department of Endocrinology & Diabetes, Dr Wiam Clinic, Royal Hospital, Awali Hospital, Awali, Bahrain
| | - Ahmed Al-Ani
- Department of Internal Medicine, Hamad Hospital, Doha, Qatar
| | - Kaushik Ramaiya
- Department of Diabetology, Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania
| | - Surender Singh
- Department of Internal Medicine, Aster Al Raffah Hospital, Muscat, Oman
| | - Syed Abbas Raza
- Department of Endocrinology, Shaukat Khanum Hospital and Research Center, Lahore, Pakistan
| | - Than Than Aye
- Myanmar Society of Endocrinology and Metabolism, Yangon, Myanmar
| | - Chaminda Garusinghe
- Department of Endocrinology, Colombo South Teaching Hospital, Colombo, Sri Lanka
| | - Dimuthu Muthukuda
- Department of Endocrinology, Sri Jayawardenapura General Hospital, Sri Jayawardenapure Kotte, Sri Lanka
| | - Muditha Weerakkody
- Department of Endocrinology, Teaching Hospital Karapitiya, Galle, Sri Lanka
| | | | - Charlotte Bavuma
- College of Medicine and Health Science, University of Rwanda, Kigali, Rwanda
| | - Sundeep Ruder
- Department of Endocrinology and metabolism, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Koy Vanny
- Department of Diabetes and endocrinology, Dr KoyVanny Diabetes & Endocrine Clinic, Phnom Penh, Cambodia
| | - Manish Khanolkar
- Department of Endocrinology and Diabetes, Waikato Hospital, Hamilton, New Zealand
| | - Leszek Czupryniak
- Department of Diabetology & Internal Medicine, Medical university of Warsaw, Warsaw, Poland
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Siaw MYL, Lee JYC. Multidisciplinary collaborative care in the management of patients with uncontrolled diabetes: A systematic review and meta-analysis. Int J Clin Pract 2019; 73:e13288. [PMID: 30369012 DOI: 10.1111/ijcp.13288] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/22/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Diabetes is a chronic and complex disease that requires a multidisciplinary collaborative care approach. OBJECTIVE The primary objective was to evaluate the clinical outcomes of patients with uncontrolled diabetes within a multidisciplinary collaborative care model. The secondary objective was to evaluate the humanistic and economic outcomes of this model of care. METHODS A search using PubMed, SCOPUS, and CINAHL from 2007 to 2017 was conducted. Articles selected included randomised controlled studies on multidisciplinary collaborative care (defined as care provision by ≥ two different care providers) vs usual care (defined as standard care provided solely by physicians) for patients with uncontrolled diabetes. In addition, the eligible article had to report at least two of the three outcomes such as clinical (glycated haemoglobin [HbA1c], systolic blood pressure [SBP], low-density lipoprotein [LDL], and triglyceride [TG]), humanistic (patient-reported measures), and economic (healthcare costs and utilisations) outcomes. Parameters examined included study characteristics, care interventions, patient characteristics, and study outcomes. Primary outcomes using mean differences (MDs) with 95% confidence intervals (CIs) were analysed either by fixed- or random-effects models. RESULTS A total of 16 studies were included in the review. Multidisciplinary collaborative care significantly improved HbA1c (MD = -0.55%, 95% CI = -0.65% to -0.45%, P < 0.001, I2 = 35%) and SBP (MD = -4.89 mm Hg, 95% CI = -6.64 to -3.13 mm Hg, P < 0.001, I2 = 46%) over 3-12 months. The humanistic outcomes in the multidisciplinary collaborative care model were either improved or maintained over time. In comparison to usual care, the healthcare costs and utilisations in the multidisciplinary collaborative care model were comparable without incurring excessive costs. CONCLUSIONS Multidisciplinary collaborative care appeared to positively impact on the clinical, humanistic, and economic outcomes of patients with uncontrolled diabetes.
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Affiliation(s)
- Melanie Yee Lee Siaw
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore City, Singapore
| | - Joyce Yu-Chia Lee
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore City, Singapore
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Machen ML, Borden HC, Hohmeier KC. The Impact of a Community Pharmacy Diabetes Self-Management Education Program on Diabetes Distress. J Pharm Technol 2019; 35:3-10. [PMID: 34861019 DOI: 10.1177/8755122518805429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Negative psychosocial implications stemming from the presence of diabetes, known as diabetes distress, place people with diabetes at twice the likelihood of having clinical depression than those who do not have the disease. While many community pharmacies have incorporated diabetes self-management education (DSME) programs into their practices, there are no known studies that evaluate the impact that this model may have on diabetes distress. Objective: The purpose of this study is to evaluate the impact that a community pharmacy DSME program has on diabetes distress. Methods: Retrospective chart review for pre- and post-DSME Problem Areas in Diabetes scale scores, pertinent health history (type and duration of diabetes, A1C, and medications), and demographic information (age, gender) of patients who completed Blount Discount Pharmacy's DSME program. Data were analyzed using descriptive and inferential statistics. Results: Of the 17 charts that were reviewed, there was an overall decrease in Problem Areas in Diabetes scale scores from baseline (P = .029). Greater reduction was observed in patients with a long-standing history of diabetes compared with those who were diagnosed with diabetes within the previous 12 months of DSME. Conclusions: The findings suggest that a community pharmacy DSME program may reduce diabetes distress and warrant future study.
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Affiliation(s)
- Morgan L Machen
- University of Tennessee Health Science Center, Nashville, TN, USA.,Blount Discount Pharmacy, Maryville, TN, USA
| | - Hamilton C Borden
- University of Tennessee Health Science Center, Nashville, TN, USA.,Blount Discount Pharmacy, Maryville, TN, USA
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Muchiri JW, Gericke GJ, Rheeder P. Stakeholders’ perceptions of dietary and related self-management challenges and education programme preferences for type 2 diabetes adults. JOURNAL OF ENDOCRINOLOGY METABOLISM AND DIABETES OF SOUTH AFRICA 2018. [DOI: 10.1080/16089677.2018.1541211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- JW Muchiri
- Department of Human Nutrition, University of Pretoria, Pretoria, South Africa
| | - GJ Gericke
- Department of Human Nutrition, University of Pretoria, Pretoria, South Africa
| | - P Rheeder
- Department of Internal Medicine, University of Pretoria, Pretoria, South Africa
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Schmidt CB, van Loon BJP, Vergouwen ACM, Snoek FJ, Honig A. Systematic review and meta-analysis of psychological interventions in people with diabetes and elevated diabetes-distress. Diabet Med 2018; 35:1157-1172. [PMID: 29896760 DOI: 10.1111/dme.13709] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2018] [Indexed: 12/13/2022]
Abstract
AIMS The clinical relevance of diabetes-distress is increasingly recognized, but little is known about the efficacy of interventions specifically targeted to treat elevated diabetes-distress. Therefore, this systematic review sought to determine the efficacy of psychological interventions aimed at treating elevated diabetes-distress in people with Type 1 or Type 2 diabetes. METHODS We systematically searched literature from five databases. Randomized controlled trials (RCTs) with an English abstract, describing the results of a psychological intervention in adults with diabetes were included. Articles were eligible for inclusion if the primary outcome was diabetes-distress measured by the Problem Areas in Diabetes Scale (PAID-5/PAID-20) or the Diabetes Distress Scale (DDS-17). Only mean group diabetes-distress values above cut-off at baseline or the results of a subgroup above cut-off (PAID-5 ≥ 8, PAID-20 ≥ 40 or DDS-17 ≥ 3) were included. RESULTS The search yielded 8907 articles. After removing 2800 duplicates, 6107 articles remained. Titles and abstracts were screened, leaving 394 potential articles of interest, nine of which were RCTs. In a random-effects meta-analysis, the pooled effect size for diabetes-distress was 0.48 (Cohen's d), Z = 3.91, P < 0.0001. Statistical heterogeneity was I² = 46.67% (confidence intervals 45.06% to 48.28%). Diabetes-tailored psychological interventions reduced HbA1c (Cohen's d = 0.57), whereas mindfulness-based interventions did not (Cohen's d = 0.11). CONCLUSIONS This systematic review shows that specifically diabetes-tailored psychological interventions are effective in reducing elevated diabetes-distress and HbA1c . More rigorous studies are warranted to establish the full potential of these interventions. PROSPERO database registration ID: CRD42017075290.
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Affiliation(s)
- C B Schmidt
- Departments of Psychiatry, Amsterdam, The Netherlands
- Departments of Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | | | - F J Snoek
- Departments of Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Medical Psychology, Academic Medical Centre (AMC), Amsterdam, The Netherlands
- Departments of Medical Psychology, Amsterdam, The Netherlands
| | - A Honig
- Departments of Psychiatry, Amsterdam, The Netherlands
- Departments of Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Departments of Psychiatry, VU Medical Centre, Amsterdam, The Netherlands
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Due-Christensen M, Zoffmann V, Willaing I, Hopkins D, Forbes A. The Process of Adaptation Following a New Diagnosis of Type 1 Diabetes in Adulthood: A Meta-Synthesis. QUALITATIVE HEALTH RESEARCH 2018; 28:245-258. [PMID: 29235942 DOI: 10.1177/1049732317745100] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
While Type 1 diabetes (T1D) is generally associated with childhood, half of all cases occur in adulthood. The adaptive strategies individuals employ during the initial adaptive phase may have an important impact on their risk of future diabetes complications and their psychosocial well-being. We conducted a systematic review of six databases and included nine qualitative studies in a meta-synthesis, the aims of which were to develop a better understanding of how adults newly diagnosed with T1D experience the diagnosis and the phenomena associated with the early process of adaptation to life with diabetes. The meta-synthesis identified five constructs that shaped and influenced the early adaptive process: disruption, constructing a personal view of diabetes, reconstructing a view of self, learning to live with diabetes, and behavioral adaptations. The adaptive processes of adults to a diabetes diagnosis are highly referenced to prior life experiences, social habitus, and psychological orientation.
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Affiliation(s)
| | - Vibeke Zoffmann
- 2 Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - David Hopkins
- 4 King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom
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Aljuaid MO, Almutairi AM, Assiri MA, Almalki DM, Alswat K. Diabetes-Related Distress Assessment among Type 2 Diabetes Patients. J Diabetes Res 2018; 2018:7328128. [PMID: 29770340 PMCID: PMC5892264 DOI: 10.1155/2018/7328128] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 01/20/2018] [Accepted: 02/04/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Diabetes is one of the most common chronic diseases; it is a debilitating and hard to live with. Diabetes-related distress (DRD) refers to the emotional and behavioral changes caused by diabetes. Our study aims to assess the prevalence of DRD among type 2 diabetes (T2D) patients using Diabetes Distress Scale-17 items (DDS-17) and its relation to complications and treatment modalities. METHODS A cross-sectional study of adult T2D patients with follow-up visits at the Diabetes and Endocrinology Center in Taif, Saudi Arabia, between January and July 2017. We excluded patients with other forms of diabetes, untreated hypothyroidism, and psychiatric illness. The total score of DDS-17 was calculated by summing the 17 items' results and then dividing the total by 17. If the total score was >2, then it was considered as clinically significant results (moderate distress), but if it is ≥3, then it is classified as a high distress. RESULTS A total of 509 T2D patients with a mean age of 58 ± 14 years were included. The majority of participants were male, married, not college educated, and reported a sedentary lifestyle. We found 25% of the screened T2D patients have moderate to high DRD. Regarding the DRD components, emotional distress was the most prevalent followed by physician-related distress. HabA1c was significantly higher in those with high combined distress and high emotional distress compared to those with mild/moderate distress (p = 0.015 and 0.030, resp.). CONCLUSION Our study shows that DRD is a medically relevant issue that clinicians need to address. Despite observing a low prevalence of DRD compared to other studies, we found significant correlations between DRD scores and HabA1c, triglyceride levels, BMI, T2D duration, and interval between visits.
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Affiliation(s)
| | | | | | | | - Khaled Alswat
- Taif University School of Medicine, Taif, Saudi Arabia
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46
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Chew BH, Vos RC, Metzendorf M, Scholten RJPM, Rutten GEHM. Psychological interventions for diabetes-related distress in adults with type 2 diabetes mellitus. Cochrane Database Syst Rev 2017; 9:CD011469. [PMID: 28954185 PMCID: PMC6483710 DOI: 10.1002/14651858.cd011469.pub2] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Many adults with type 2 diabetes mellitus (T2DM) experience a psychosocial burden and mental health problems associated with the disease. Diabetes-related distress (DRD) has distinct effects on self-care behaviours and disease control. Improving DRD in adults with T2DM could enhance psychological well-being, health-related quality of life, self-care abilities and disease control, also reducing depressive symptoms. OBJECTIVES To assess the effects of psychological interventions for diabetes-related distress in adults with T2DM. SEARCH METHODS We searched the Cochrane Library, MEDLINE, Embase, PsycINFO, CINAHL, BASE, WHO ICTRP Search Portal and ClinicalTrials.gov. The date of the last search was December 2014 for BASE and 21 September 2016 for all other databases. SELECTION CRITERIA We included randomised controlled trials (RCTs) on the effects of psychological interventions for DRD in adults (18 years and older) with T2DM. We included trials if they compared different psychological interventions or compared a psychological intervention with usual care. Primary outcomes were DRD, health-related quality of life (HRQoL) and adverse events. Secondary outcomes were self-efficacy, glycosylated haemoglobin A1c (HbA1c), blood pressure, diabetes-related complications, all-cause mortality and socioeconomic effects. DATA COLLECTION AND ANALYSIS Two review authors independently identified publications for inclusion and extracted data. We classified interventions according to their focus on emotion, cognition or emotion-cognition. We performed random-effects meta-analyses to compute overall estimates. MAIN RESULTS We identified 30 RCTs with 9177 participants. Sixteen trials were parallel two-arm RCTs, and seven were three-arm parallel trials. There were also seven cluster-randomised trials: two had four arms, and the remaining five had two arms. The median duration of the intervention was six months (range 1 week to 24 months), and the median follow-up period was 12 months (range 0 to 12 months). The trials included a wide spectrum of interventions and were both individual- and group-based.A meta-analysis of all psychological interventions combined versus usual care showed no firm effect on DRD (standardised mean difference (SMD) -0.07; 95% CI -0.16 to 0.03; P = 0.17; 3315 participants; 12 trials; low-quality evidence), HRQoL (SMD 0.01; 95% CI -0.09 to 0.11; P = 0.87; 1932 participants; 5 trials; low-quality evidence), all-cause mortality (11 per 1000 versus 11 per 1000; risk ratio (RR) 1.01; 95% CI 0.17 to 6.03; P = 0.99; 1376 participants; 3 trials; low-quality evidence) or adverse events (17 per 1000 versus 41 per 1000; RR 2.40; 95% CI 0.78 to 7.39; P = 0.13; 438 participants; 3 trials; low-quality evidence). We saw small beneficial effects on self-efficacy and HbA1c at medium-term follow-up (6 to 12 months): on self-efficacy the SMD was 0.15 (95% CI 0.00 to 0.30; P = 0.05; 2675 participants; 6 trials; low-quality evidence) in favour of psychological interventions; on HbA1c there was a mean difference (MD) of -0.14% (95% CI -0.27 to 0.00; P = 0.05; 3165 participants; 11 trials; low-quality evidence) in favour of psychological interventions. Our included trials did not report diabetes-related complications or socioeconomic effects.Many trials were small and were at high risk of bias for incomplete outcome data as well as possible performance and detection biases in the subjective questionnaire-based outcomes assessment, and some appeared to be at risk of selective reporting. There are four trials awaiting further classification. These are parallel RCTs with cognition-focused and emotion-cognition focused interventions. There are another 18 ongoing trials, likely focusing on emotion-cognition or cognition, assessing interventions such as diabetes self-management support, telephone-based cognitive behavioural therapy, stress management and a web application for problem solving in diabetes management. Most of these trials have a community setting and are based in the USA. AUTHORS' CONCLUSIONS Low-quality evidence showed that none of the psychological interventions would improve DRD more than usual care. Low-quality evidence is available for improved self-efficacy and HbA1c after psychological interventions. This means that we are uncertain about the effects of psychological interventions on these outcomes. However, psychological interventions probably have no substantial adverse events compared to usual care. More high-quality research with emotion-focused programmes, in non-US and non-European settings and in low- and middle-income countries, is needed.
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Affiliation(s)
- Boon How Chew
- University Medical Center UtrechtJulius Center for Health Sciences and Primary CareUniversiteitsweg 100UtrechtNetherlands3508 GA
- Faculty of Medicine and Health Sciences, Universiti Putra MalaysiaDepartment of Family MedicineSerdangSelangorMalaysia43400 UPM
| | - Rimke C Vos
- University Medical Center UtrechtJulius Center for Health Sciences and Primary CareUniversiteitsweg 100UtrechtNetherlands3508 GA
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupMoorenstr. 5DüsseldorfGermany40225
| | - Rob JPM Scholten
- Julius Center for Health Sciences and Primary Care / University Medical Center UtrechtCochrane NetherlandsRoom Str. 6.126P.O. Box 85500UtrechtNetherlands3508 GA
| | - Guy EHM Rutten
- University Medical Center UtrechtJulius Center for Health Sciences and Primary CareUniversiteitsweg 100UtrechtNetherlands3508 GA
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Martinez K, Lockhart S, Davies M, Lindsay JR, Dempster M. Diabetes distress, illness perceptions and glycaemic control in adults with type 2 diabetes. PSYCHOL HEALTH MED 2017; 23:171-177. [PMID: 28610449 DOI: 10.1080/13548506.2017.1339892] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The emotional distress associated with adjusting to and living with diabetes has been termed diabetes distress. Diabetes distress is associated with glycaemic control but interventions to reduce diabetes distress have failed to consistently improve diabetes control. Various illness perceptions have previously been linked with both diabetes distress and glycaemic control but interrelationships between these features have not been previously investigated. We hypothesised that illness perceptions mediate the relationship between diabetes distress and glycaemia. Participants with type 2 diabetes attending diabetes outpatient clinics (n = 84) provided demographic and clinical information and completed the Diabetes Distress Scale-17 and the Brief Illness Perceptions Questionnaire. Using regression analysis we demonstrated that the illness perceptions of personal control, regimen-related distress, socioeconomic status and insulin use were significant contributors in the final model predicting HbA1c. Higher levels of personal control were associated with better glycaemic control. Conversely, regimen-related distress was associated with hyperglycaemia. Mediation analyses showed that the relationship between regimen-related distress and HbA1c was mediated by personal control. Our work suggests that psychological interventions designed to reduce diabetes distress may be more efficacious in improving glycaemic control if they address an individual's perception of personal control.
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Affiliation(s)
- Kelly Martinez
- a School of Psychology , Queen's University Belfast , Belfast , Northern Ireland
| | - Sam Lockhart
- b School of Medicine, Dentistry & Biological Sciences , Queen's University Belfast , Belfast , Northern Ireland
| | - Mark Davies
- c Psychology Department , Belfast City Hospital , Belfast , Northern Ireland
| | | | - Martin Dempster
- a School of Psychology , Queen's University Belfast , Belfast , Northern Ireland
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McEwen MM, Pasvogel A, Murdaugh C, Hepworth J. Effects of a Family-based Diabetes Intervention on Behavioral and Biological Outcomes for Mexican American Adults. THE DIABETES EDUCATOR 2017; 43:272-285. [PMID: 28447545 PMCID: PMC6380685 DOI: 10.1177/0145721717706031] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose The purpose of the study was to investigate the effects of a family-based self-management support intervention for adults with type 2 diabetes (T2DM). Methods Using a 2-group, experimental repeated measures design, 157 dyads (participant with T2DM and family member) were randomly assigned to an intervention (education, social support, home visits, and telephone calls) or a wait list control group. Data were collected at baseline, postintervention (3 months), and 6 months postintervention. A series of 2 × 3 repeated measures ANOVAs were used to test the hypotheses with interaction contrasts to assess immediate and sustained intervention effects. Results Significant changes over time were reported in diet self-management, exercise self-management, total self-management, diabetes self-efficacy for general health and total diabetes self-efficacy, physician distress, regimen distress, interpersonal distress, and total distress. There were likewise sustained effects for diet self-management, total self-management, diabetes self-efficacy for general health, total self-efficacy, physician distress, regimen distress, and interpersonal distress. Conclusions Results support and extend prior research documenting the value of culturally relevant family-based interventions to improve diabetes self-management and substantiate the need for intensive, longer, tailored interventions to achieve glycemic control.
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Affiliation(s)
- Marylyn Morris McEwen
- University of Arizona College of Nursing, Community and Health Systems Science Division, Tucson, Arizona (Dr McEwen, Dr Pasvogel, Dr Murdaugh, Dr Hepworth)
| | - Alice Pasvogel
- University of Arizona College of Nursing, Community and Health Systems Science Division, Tucson, Arizona (Dr McEwen, Dr Pasvogel, Dr Murdaugh, Dr Hepworth)
| | - Carolyn Murdaugh
- University of Arizona College of Nursing, Community and Health Systems Science Division, Tucson, Arizona (Dr McEwen, Dr Pasvogel, Dr Murdaugh, Dr Hepworth)
| | - Joseph Hepworth
- University of Arizona College of Nursing, Community and Health Systems Science Division, Tucson, Arizona (Dr McEwen, Dr Pasvogel, Dr Murdaugh, Dr Hepworth)
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Due-Christensen M, Hommel E, Ridderstråle M. Potential positive impact of group-based diabetes dialogue meetings on diabetes distress and glucose control in people with type 1 diabetes. PATIENT EDUCATION AND COUNSELING 2016; 99:1978-1983. [PMID: 27444233 DOI: 10.1016/j.pec.2016.07.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/15/2016] [Accepted: 07/13/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To evaluate the effect of group-based diabetes dialogue meetings (DDMs) on diabetes distress, perceived competence and glycaemic control. METHODS Patients with type 1 diabetes (T1D) were invited to DDMs with peers and healthcare professionals. The impact of participation was evaluated by change in diabetes distress measured by Problem Areas in Diabetes (PAID), diabetes competence measured by Perceived Competence in Diabetes (PCD), change in HbA1c before and one year after the DDMs. RESULTS 120 patients with T1D participated in at least one DDM: 75% female, mean age 50 years (range 21-76), mean diabetes duration 23 years (range 0-64); 39% of all participants had a baseline PAID score≥33, indicating high levels of distress. After one year, both PAID (from 30.4±16.6 to 27.4±17.1; n=81, p=0.03), and mean HbA1c (61.6±10.2 to 58.8±9.9; n=120, p<0.0001) had improved significantly. PCD showed no change. Meanwhile, the benefit from participating was rated high with a median of four out of five and the major gain being the possibility to share experiences with peers. CONCLUSION Group-based DDMs were highly appreciated by participants and associated with significant improvements in diabetes distress and HbA1c. PRACTICE IMPLICATIONS DDMs target a large group of patients using few staff resources.
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Affiliation(s)
- M Due-Christensen
- Steno Diabetes Center, Gentofte, Denmark; Faculty of Nursing and Midwifery King's College London, London, UK.
| | - E Hommel
- Steno Diabetes Center, Gentofte, Denmark
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Doubova SV, Martinez-Vega IP, Aguirre-Hernandez R, Pérez-Cuevas R. Association of hypertension-related distress with lack of self-care among hypertensive patients. PSYCHOL HEALTH MED 2016; 22:51-64. [PMID: 27677320 DOI: 10.1080/13548506.2016.1239830] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Research on factors associated with poor adherence to self-care focuses primarily on psychiatric emotional disorders such as depression and anxiety, whereas non-psychiatric chronic-disease-related emotional distress has received little attention in hypertensive patients. The objective of this study was to evaluate the association of hypertension-related distress with the lack of self-care including low adherence to pharmacological treatment, lack of regular physical activity, low intake of fruits and vegetables and frequent intake of high-salt foods. A cross-sectional survey was conducted in 2014 in two family medical units affiliated with the Mexican Institute of Social Security. The study included 487 hypertensive patients >19 years of age. The conceptual framework for the study was based on the Health Promotion Model. The analysis included multiple Poisson regression models. We found that 21.1% of participants had hypertension-related distress. Low adherence to pharmacological treatment was identified in 45.8% of patients, whereas 46.8% lacked regular physical activity, 30.8% reported a low consumption of fruits and vegetables, and 54.6% frequently consumed foods high in salt content. Hypertension-related distress was associated with lack of regular physical activity and low intake of fruits and vegetables. These findings highlight the importance of addressing distress in order to improve self-care of hypertensive patients.
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Affiliation(s)
- Svetlana V Doubova
- a Epidemiology and Health Services Research Unit, CMN Siglo XXI , Mexican Institute of Social Security , Mexico City , Mexico
| | - Ingrid Patricia Martinez-Vega
- a Epidemiology and Health Services Research Unit, CMN Siglo XXI , Mexican Institute of Social Security , Mexico City , Mexico
| | - Rebeca Aguirre-Hernandez
- b Departamento de Farmacología de la Facultad de Medicina , Universidad Nacional Autónoma de México, Ciudad Universitaria , Mexico City , Mexico
| | - Ricardo Pérez-Cuevas
- c Division of Social Protection and Health , Inter-American Development Bank , Mexico City , Mexico
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