Depression, Coping Strategies, Glycemic Control and Patient Compliance in Type 2 Diabetic Patients in an endocrine Outpatient Clinic

The utility of Problem Areas in Diabetes (PAID) scale amongst patients with Type 2 diabetes (T2DM): An experience from a teaching hospital in Southern India

Objectives:

The purpose of this study was to establish the prevalence of diabetes-specific psychological distress (DSPD) among patients with type 2 diabetes mellitus (T2DM) using the “Problem areas in diabetes” (PAID) scale at a teaching hospital in southern India. Other objectives included observing the relationship between socio-demographic factors and DSPD and, finally exploring the level of acceptance of the PAID scale by Asian–Indian patients.

Methods:

The patients with T2DM aged >18 years attending the diabetes outpatient clinic were recruited. They completed two sets of questionnaires; PAID and a satisfactory questionnaire, which included socio-demographic characteristics and questions relating to the acceptance of PAID. Statistical analysis was performed using Stata 13.1 and Excel.

Results:

A total of 253 questionnaires were completed, including 157 (62.1%) male and 96 (37.9%) female patients. The prevalence of DSPD was 32.8% (83/253). Younger age (OR 3.65, 95% CI 1.36–9.80) and presence of retinopathy (OR 2.60, 95% CI 1.12–6.04) were significantly associated with DSPD. However, it was observed that one-third of the patients had an elevated level of distress regardless of socio-demographic or clinical factors. PAID was well accepted by the participants and 84.6% (214/253) were pleased to complete it again.

Conclusion:

About one-third of the patients with T2DM had DSPD. Psychological distress was higher in the younger age group and those with retinopathy. PAID is an easy, well-accepted questionnaire and would serve as a useful tool to screen for DSPD.

Prevalence of Depressive Symptoms in Patients with Type 1 and 2 Diabetes Mellitus

PURPOSE

Patients with diabetes are at increased risk of developing depression. The aim of the study was to determine the occurrence of depressive symptoms in patients with type 1 (T1DM) and type 2 diabetes (T2DM), including the association with different independent sociodemographic and clinical variables.

PATIENTS AND METHODS

The studies were carried out on 618 people, including 115 patients with T1DM and 215 patients with T2DM and 288 people without diabetes constituting two control groups. Subjects were characterized in terms of sociodemographic, clinical and biochemical aspects, and the occurrence of depressive symptoms using Beck Depression Inventory (BDI) was determined. In the logistic regression analysis, the correlations between BDI score and with independent variables such as sex, age, body mass index, duration of diabetes, HbA1c level, diabetic complications and mean arterial pressure were examined.

RESULTS

The mean BDI score was significantly higher in women and men with T1DM and T2DM compared to controls. In diabetic patients, depressive symptoms occurred more often in women than in men. Among patients with T1DM, the incidence of depressive symptoms was 17.5% of the women and 8.6% of the men and in patients with T2DM, the incidence of depressive symptoms was revealed in 28.9% of the women and in 19.8% of the men. In patients with T1DM and T2DM, the occurrence of depressive symptoms increases with age, HbA1c level and complications, and the risk of depressive symptoms turned out to be almost three times higher in women than in men with T2DM.

CONCLUSION

The prevalence of depressive symptoms in diabetic patients is higher than in non-diabetics. Depressive symptoms account for 13% of the patients with T1DM and 24.7% of the patients with T2DM. The risk of depressive symptoms in T1DM and T2DM increases with age, HbA1c level and the presence of complications, and it is gender-related in T2DM only.

Experiences and challenges of adults living with type 2 diabetes mellitus presenting at the University Teaching Hospital in Lusaka, Zambia

OBJECTIVE

The study explored the experiences and challenges of adults living with type 2 diabetes mellitus (T2DM) presenting at the University Teaching Hospital (UTH) in Lusaka.

RESEARCH DESIGN

A qualitative descriptive study was conducted. The research relied on purposive sampling to select 28 participants for in-depth interviews. Participants were interviewed during clinical visits at UTH.

RESULTS

Views from participants showed that some adults living with T2DM experienced physical and mental illnesses. Participants' views reflected that their livelihood with T2DM was influenced by family support, poor or non-adherence to treatment guidelines and access to information, education and communication materials. The most important challenges reported were psychosocial and financial.

CONCLUSION

The study concluded that some adults living with T2DM experience a lot of physical sicknesses and their challenges, especially of the psychosocial nature may require professional attention. However, particular attention should be paid to the patient's self-care and psychosocial therapy. Self-care protocols should be tailored to complement the different types of patients with diabetes and improve their quality of life. Cite Now.

Evaluation of factors related to glycaemic control among South Korean patients with type 2 diabetes

Aims

To examine specific self‐care behaviours, depression, and diabetes‐related stress among South Korean patients with type 2 diabetes and to evaluate whether these factors are related to glycaemic control.

Methods

This cross‐sectional study included 171 patients with type 2 diabetes who visited an endocrinology clinic. A structured questionnaire and electronic medical records were used to collect data regarding self‐care behaviours, depression, diabetes‐related distress, and glycaemic control between May 2015 and July 2015.

Results

Compared with the group with good glycaemic control, the group with poor glycaemic control had significantly lower values for medication adherence and significantly greater values for regimen‐related distress. Depression was not significantly associated with glycaemic control. In logistic regression analysis, only medication adherence was independently associated with glycaemic control.

Conclusions

Medication adherence should be continuously emphasized and monitored in clinical practice to effectively manage glycaemic control among patients with type 2 diabetes. Furthermore, consideration of diabetes‐related distress may help improve glycaemic control among patients with type 2 diabetes.

What is already known about this topic?

To control glycaemic levels, patients with type 2 diabetes should practice self‐care (medication, diet, exercise, and blood glucose monitoring). However, patients with type 2 diabetes complain that self‐care is complicated and difficult to follow in daily life.

Many people with type 2 diabetes experience high levels of depression and distress stemming from concerns associated with diabetes and its management.

Diabetes‐related distress, depression, and self‐care behaviours have been thought to be related to glycaemic levels. However, data from cross‐sectional studies on this relationship are not consistent. There are few studies on these variables in patients with type 2 diabetes in South Korea.

What this paper adds?

Diabetes‐related distress was only associated with glycaemic control, whereas depression and self‐care behaviours were not significantly associated with glycaemic control among South Korean patients with type 2 diabetes.

We subcategorized diabetes‐related distress into emotional burden, physician‐related distress, regimen‐related distress, and diabetes‐related interpersonal distress, but only regimen‐related distress was significantly associated with glycaemic control. We subcategorized self‐care behaviours into medication, diet, exercise, and blood glucose monitoring, but only medication was significantly associated with glycaemic control.

Our findings suggest that among patients with type 2 diabetes, glycaemic control was only associated with medication adherence among the self‐care behaviours that we evaluated.

The implications of this paper:

In the clinical setting, health‐care providers, including nurses, should assess and address regimen‐related distress as this is a known barrier to accomplishment of optimal glycaemic control.

Health‐care providers, including nurses, should explain the need for medication adherence to patients so that they can manage type 2 diabetes, and they should continuously reassess adherence to medications.

Future research in diabetes should include assessment of specific domains of diabetes‐related distress and specific domains of self‐care, along with measures of blood glucose control.

Coping strategies have a strong impact on quality of life, depression, and embitterment in patients with Cushing's disease

PURPOSE

Quality of life (QoL) and psychosocial well-being are substantially impaired in patients with Cushing's disease (CD), not only at the acute illness stage but also after therapy; however, the reason for these impairments remains unclear.

METHODS

In this cross-sectional, patient-reported outcome study, we conducted a postal survey on psychosocial impairment and coping strategies in patients after surgical treatment of CD in three large tertiary referral centers. In total, 176 patients with CD completed a compilation of self-assessment inventories pertaining to depression (Hospital Anxiety and Depression Scale, HADS), QoL (Short Form SF-36, Tuebingen CD; Tuebingen CD-25), coping style (Freiburg questionnaire on coping with illness, FKV-LIS), and embitterment (Bern Embitterment Inventory), on average 6.8 ± 6.66 years after surgery. Regression analyses were performed to identify predictors of psychosocial impairment.

RESULTS

At the time of the study, 21.8 % of patients suffered from anxiety, 18.7 % experienced an above-average feeling of embitterment, and 13.1 % suffered from depression. Maladaptive coping styles (FKV-LIS subscales depressive coping and minimizing importance) emerged as robust and strong predictors of psychosocial impairment in all inventories; while age, sex, and hydrocortisone intake failed to explain the variance in these measures.

CONCLUSION

Similar to several studies in non-pituitary patient cohorts (e.g., patients with multiple sclerosis or lower back pain), our results indicate that psychosocial impairment in CD is significantly influenced by how the patient deals with the illness. Therefore, psychological training of positive coping styles could be a helpful complementary therapy in the overall treatment strategy of CD.

Impact of Demographic, Socioeconomic, and Psychological Factors on Glycemic Self-Management in Adults with Type 2 Diabetes Mellitus

Diabetes mellitus (DM) is reported as one of the most complex chronic diseases worldwide. In the United States, Type 2 DM (T2DM) is the seventh leading cause of morbidity and mortality. Individuals with diabetes require lifelong personal care to reduce the possibility of developing long-term complications. A good knowledge of diabetes risk factors, including obesity, dyslipidemia, hypertension, family history of DM, and sedentary lifestyle, play an essential role in prevention and treatment. Also, sociodemographic, economic, psychological, and environmental factors are directly and indirectly associated with diabetes control and health outcomes. Our review intends to analyze the interaction between demographics, knowledge, environment, and other diabetes-related factors based on an extended literature search, and to provide insight for improving glycemic control and reducing the incidence of chronic complications.