Health-Related Social Control and Perceived Stress Among High-Risk Latina Mothers with Type 2 Diabetes and Their At-Risk Adult Daughters

BACKGROUND

Diabetes-related multi-morbidity and cultural factors place Latinas with diabetes at increased risk for stress, which can threaten illness management. Families provide an ideal focus for interventions that seek to strengthen interpersonal resources for illness management and, in the process, to reduce stress. The current study sought to examine whether participating in a dyadic intervention was associated with reduced perceived stress and, furthermore, whether this association was mediated by persuasion and pressure, two forms of health-related social control.

METHOD

Latina mothers with diabetes and their at-risk adult daughters participated in either (1) a dyadic intervention that encouraged constructive collaboration to improve health behaviors and reduce stress, or (2) a usual-care minimal control condition. Actor-partner interdependence model analysis was used to estimate the effect of the intervention on dyads' perceived stress, and mother-daughter ratings of health-related social control as potential mediators.

RESULTS

Results revealed that participating in the intervention was associated with significantly reduced perceived stress for daughters, but not for mothers (β =  - 3.00, p = 0.02; β =  - 0.57, p = 0.67, respectively). Analyses also indicated that the association between the intervention and perceived stress was mediated by persuasion, such that mothers' who experienced more health-related persuasion exhibited significantly less post-intervention perceived stress (indirect effect =  - 1.52, 95% CI = [- 3.12, - 0.39]). Pressure exerted by others, however, did not evidence a mediating mechanism for either mothers or daughters.

CONCLUSION

These findings buttress existing research suggesting that persuasion, or others' attempts to increase participants' healthy behaviors in an uncritical way, may be a driving force in reducing perceived stress levels.

Diabetes Distress and Illness Perceptions in Tunisian Type 2 Diabetes Patients

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.

Advancing the Study of Resilience to Daily Stressors

Historically, studies of childhood and adult resilience have typically focused on adaptation to chronic life adversities, such as poverty and maltreatment, or isolated and potentially traumatic events, such as bereavement and serious illness. Here, we present a complementary view and suggest that stressors experienced in daily life may also forecast individual health and well-being. We argue that daily process approaches that incorporate intensive sampling of individuals in natural settings can provide powerful insights into unfolding adaptational processes. In making this argument, we review studies that link intraindividual dynamics with diverse health-related phenomena. Findings from this research provide support for a multiple-levels-analysis perspective that embraces greater unity in pivotal resilience constructs invoked across childhood and adult literatures. Drawing on insights and principles derived from life-span theory, we conclude by outlining promising directions for future work and considering their broader implications for the field of resilience.

Diabetic Distress Among Diabetic Patients in the Amhara Regional State, Ethiopia

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.

Insulin-Based Infusion System: Advancing the Development

BACKGROUND

Deviations in glucose control in critical care have been shown to increase mortality and morbidity. However, optimal glucose control through present technologies has shown to be a challenge. The insulin balanced infusion system (IBIS) is a new and emerging technology.

METHODS

The closed loop system was tested in a stress trial to evaluate glucose stability in response to various conditions in nonrandomized people with type 1 diabetes mellitus (n=12). The prototype used in this trial was based on intermittent capillary measurements.

RESULTS

Induced stresses in the study using unpredicted stimuli of intravenous or oral glucose and intravenous insulin boluses, was contained with glucose remaining in target 43.8% of the time. Mean increase in glucose concentration after glucose load was 17.4 mg/dl; after insulin bolus, no hypoglycemia (blood glucose less than 70 mg/dl) occurred.

CONCLUSION

The use of IBIS proved safe and feasible under a wide range of conditions. The sensing and stress response of the IBIS demonstrated noticeable features.

Wondim M. Diabetic Distress Among Diabetic Patients in the Referral Hospital of Amhara Regional State, Ethiopia

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.

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

Objective:

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

Methods:

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

Results:

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

Conclusion:

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

Objetivo:

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

Métodos:

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

Resultados:

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

Conclusão:

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

Incorporation of a Stress Reducing Mobile App in the Care of Patients With Type 2 Diabetes: A Prospective Study

Background

Severe and sustained emotional stress creates a physiological burden through increased sympathetic activity and higher energy demand. This may lead to increased oxidative stress and development of the metabolic syndrome. Emotional stress has been shown to contribute to the onset, progression, and control of type 2 diabetes (T2D). Stress management and biofeedback assisted relaxation have been shown to improve glycemic control. Use of a mobile app for stress management may enhance the scalability of such an approach.

Objective

The aim of this study was to assess the effect of using a mobile app of biofeedback-assisted relaxation on weight, blood pressure (BP), and glycemic measures of patients with T2D.

Methods

Adult patients with T2D and inadequate glycemic control (hemoglobin A1c [HbA1c]>7.5%) were recruited from the outpatient diabetes clinic. Baseline weight, BP, HbA1c, fasting plasma glucose (FPG), triglycerides (TG), and 7-point self-monitoring of blood glucose were measured. Patients were provided with a stress reducing biofeedback mobile app and instructed to use it 3 times a day. The mobile app—Serenita—is an interactive relaxation app based on acquiring a photoplethysmography signal from the mobile phone’s camera lens, where the user places his finger. The app collects information regarding the user’s blood flow, heart rate, and heart rate variability and provides real-time feedback and individualized breathing instructions in order to modulate the stress level. All clinical and biochemical measures were repeated at 8 and 16 weeks of the study. The primary outcome was changes in measures at 8 weeks.

Results

Seven patients completed 8 weeks of the study and 4 completed 16 weeks. At week 8, weight dropped by an average of 4.0 Kg (SD 4.3), systolic BP by 8.6 mmHg (SD 18.6), HbA1c by 1.3% (SD 1.6), FPG by 4.3 mmol/l (4.2), and serum TG were unchanged.

Conclusions

Stress reduction using a mobile app based on biofeedback may improve glycemic control, weight, and BP.

Depression and anxiety after 2 years of follow-up in patients diagnosed with diabetes or rheumatoid arthritis

We studied emotional health in patients with diabetes mellitus (n = 89) or rheumatoid arthritis (n = 100) aged 18–65 years, at the time of diagnosis and after 24 months. Predictors for depression or anxiety according to the Hospital Anxiety and Depression scale after 2 years were assessed by logistic regression, with psychosocial factors and coping as dependent factors. There were many similarities between patients with diabetes mellitus or rheumatoid arthritis. Having children at home, low score on the Sense of Coherence scale, and high score on the coping strategy “protest” were important risk factors for depression and anxiety after 2 years.