Factors associated with psychological and behavioral functioning in people with type 2 diabetes living in France

Health profile and medication adherence of diabetic patients in the Portuguese population

AIMS

To understand the psychological and behavioural impact of type 2 diabetes in the Portuguese Primary Care setting.

METHODS

Observational, cross-sectional study of a convenience sample of portuguese people diagnosed with type 2 diabetes mellitus. The Diabetes Health Profile (DHP-18) and the Four Item Morisky Medication Adherence Scale (MMAS-4) were applied, as well as socio-demographic and disease-related questions.

RESULTS

In a n=110 patient sample, lower education level showed a negative impact on the Psychological Distress dimension (p=0,013). In the Barriers to activity dimension, significant differences were found between different age groups (p=0,033) - a better health profile was observed in the 40-59 years group and also between gender (p=0,039) - greater impact in female subjects. Disinhibited Eating dimension wasn't associated with any of the studied variables. However, all the groups showed worse results in this domain. No associations were found between DHP and medication adherence. Worse medication adherence is more common when there is a prevailing notion of lack of control of diabetes.

DISCUSSION AND CONCLUSION

Using DHP, a larger negative impact related to type 2 diabetes mellitus is found in those with lower educational level, female and younger (20-39 years) or older (60-79 years) subjects. Broader information strategies aimed at improving the quality of life of diabetic patients is necessary, particularly those related to nutrition.

To what extent is the elevated risk of psychological distress in people with diabetes accounted for by physical disability? Findings from a large population-based study

OBJECTIVES

People with diabetes experience an elevated risk of psychological distress compared with people without diabetes. It is unclear how much of this elevated risk is attributable to the greater levels of physical disability in people with diabetes, and how this risk varies according to sociodemographic and health-behavioural characteristics. This study quantified levels of psychological distress in people with and without diabetes, considering these factors.

DESIGN

Cross-sectional analysis of questionnaire data.

SETTING

Men and women aged ≥45 years, in the 45 and Up Study, from New South Wales, Australia.

PARTICIPANTS

236 441 people who completed the baseline postal questionnaire (distributed from 1 January 2006-31 December 2008), with valid data for diabetes status and psychological distress.

PRIMARY OUTCOME MEASURES

High psychological distress (Kessler-10 >22). Modified Poisson regression with robust error variance was used to estimate prevalence ratios (PRs), comparing prevalence of high psychological distress among those with and without diabetes and across physical functional limitation (PFL) levels, adjusting for potential confounders.

RESULTS

Overall, 8.4% (19 803/236 441) of participants reported diabetes. 11.8% (2339) of individuals with diabetes and 7.2% (15 664) without diabetes had high psychological distress: age-adjusted and sex-adjusted PR=1.89 (95% CI 1.81 to 1.97), becoming 1.58 (1.52 to 1.65) and 1.22 (1.17 to 1.27) following additional adjustment for sociodemographic factors, health behaviours and additionally for PFL, respectively. Compared with individuals with neither diabetes nor PFL, the adjusted PRs for high psychological distress were: 1.37 (1.17 to 1.60) with diabetes but no PFL, 7.33 (7.00 to 7.67) without diabetes but with severe PFL and 8.89 (8.36 to 9.46) with both diabetes and severe PFL.

CONCLUSIONS

People with diabetes have a 60% greater risk of high psychological distress than people without diabetes; a substantial proportion of this elevation is attributable to higher levels of disability with diabetes, especially factoring in measurement error. Psychological distress is strongly related to physical impairment.

Health locus of control and self-care behaviors in diabetic foot patients

BACKGROUND

Diabetic foot affects more than 25% of diabetic patients and finally up to 20% of cases result in amputation. The most important factor resulting in severe complications or even death is lack of self-care. Health locus of control has been introduced as one of health factors and predicting factors of self-care. This research was performed for analyzing the correlation between self-care behaviors and health locus of control in diabetic foot patients.

METHODS

In this descriptive study, 120 patients with diabetic foot were chosen using convenience sampling from endocrine clinic and wards of endocrine and vascular surgery of Teleqani Hospital of Shahid Beheshti Medical University. The data were gathered by demographic, self-care behavior, and health locus of control questionnaires. The t-test, analysis of variance (ANOVA) and spearman coefficient were used to analyze the data.

RESULTS

RESULTS of this research showed that there is a direct and significant relation between selfcare behaviors and internal health locus of control (p<0.001), and also in contrast with chance health locus of control (p<0.001).

CONCLUSION

We have to consider these factors' role in nursing interventions and patient-care education programs and plans. Probably, interventions and programs that will lead to the strengthening of internal health locus of control improve and strengthen patients' self-care behaviors and their involvement in treatment.

Associations between Familial Factor, Trait Conscientiousness, Gender and the Occurrence of Type 2 Diabetes in Adulthood: Evidence from a British Cohort

Objective

To investigate social, familial, and psychological factors in influencing the occurrence of type 2 diabetes in adulthood.

Method

Some 17,415 babies born in Great Britain in 1958 and followed up at 7, 11, 33, and 50 years of age. The prevalence of type 2 diabetes at age 50 years was the outcome measure.

Results

Some 5,032 participants with data on parental social class, childhood cognitive ability tests scores at age 11 years, educational qualifications at age 33 years, personality traits, occupational levels, and type 2 diabetes (all measured at age 50 years) were included in the study. Available information also included whether cohort members’ parents or siblings had diabetes. Using logistic regression analyses, results showed that sex (OR=0.63: 0.42-0.92, p<.05), family history (OR=3.40: 1.76-6.55, p<.01), and trait conscientiousness (OR=0.76: 0.64-0.90, p<.001) were all significantly and independently associated with the occurrence of type 2 diabetes in adulthood. It appears that the occurrence of type 2 diabetes is greater among men than women (4.3% vs 2.5%).

Conclusion

Familial (genetic and non-genetic) and psychological factors are significantly associated with the prevalence of type 2 diabetes in adulthood.

Les déterminants de la qualité de vie subjective des patients diabétiques : un regard biopsychosocial

La qualité de vie des patients diabétiques est déterminée par un grand nombre de facteurs de type biologique, social et psychologique, qui interagissent ensemble. Le modèle biopsychosocial (BPS), élaboré par Engel dans les années 1980, est basé sur cette notion holistique et interactive. Plus récemment, cette conception a été opérationnalisée sous la forme d’un questionnaire hétéro-évaluatif qui comporte 20 items (outil INTERMED). Même si la notion de conception holistique du bien-être de l’individu diabétique est reconnue dans la pratique clinique, notamment hospitalière, peu de travaux s’intéressant, de manière expérimentale, au bénéfice de ce concept sont disponibles dans la littérature. L’étude présentée a inclus 28 patients diabétiques, hospitalisés en service d’endocrinologie. Chaque participant a donné son consentement écrit, s’est entretenu avec une investigatrice, et a rempli une échelle mesurant la qualité de vie (SF-36). 43 % d’entre eux présentent un haut niveau de complexité BPS, ce qui indique un besoin de prise en charge multidisciplinaire. À travers des analyses de corrélation, il a été démontré que chaque composante de la complexité est associée de manière négative, et statistiquement significative, à la qualité de vie perçue. De plus, la complexité globale permet de mieux expliquer la qualité de vie que la simple prise en compte de n’importe quel facteur local. En pratique, ces résultats soulignent la nécessité de prendre en charge les éléments psychosociaux auprès des patients afin d’assurer au mieux le vécu subjectif de leur état de santé. Des services, tels que la psychiatrie de liaison, deviennent ainsi essentiels dans l’offre de soin holistique et multidisciplinaire.