A psychometric evaluation of the Diabetes Symptom Checklist-Revised (DSC-R) cognitive distress, fatigue, hyperglycemia, and hypoglycemia subscales in patients with type 1 and type 2 diabetes

Association of SGLT-2 Inhibitors With Treatment Satisfaction and Diabetes-Specific and General Health Status in Adults With Cardiovascular Disease and Type 2 Diabetes

Background It is unknown if initiation of a sodium-glucose cotransporter-2 inhibitor (SGLT-2i) is associated with changes in patient-reported health status outside of clinical trials. Methods and Results Using a prospective observational study design, adults with type 2 diabetes and cardiovascular disease were recruited from 14 US hospitals between November 2019 and December 2021 if they were new users of noninsulin antidiabetic medications. The primary outcome was change in 6-month diabetes treatment satisfaction. Secondary outcomes included diabetes-related symptom distress, diabetes-specific quality of life, and general health status for all patients and based on cardiovascular disease type. Inverse probability of treatment weight using propensity score was performed to compare outcome changes based on medication use. Of 887 patients (SGLT-2i: n=242) included in the inverse probability of treatment weight analyses, there was no difference in changes in treatment satisfaction in SGLT-2i users compared with other diabetes medication users (0.99 [95% CI, -0.14 to 2.13] versus 1.54 [1.08 to 2.00], P=0.38). Initiating an SGLT-2i versus other diabetes medications was associated with a greater reduction in ophthalmological symptoms (-3.09 [95% CI, -4.99 to -1.18] versus -0.38 [-1.54 to 0.77], P=0.018) but less improvement in hyperglycemia (1.08 [-2.63 to 4.79] versus -3.60 [-5.34 to -1.86], P=0.026). In subgroup analyses by cardiovascular disease type, SGLT-2i use was associated with a greater reduction in total diabetes symptom burden and neurological sensory symptoms in patients with heart failure. Conclusions Among patients with type 2 diabetes and cardiovascular disease, initiating an SGLT-2i was not associated with changes in diabetes treatment satisfaction, total diabetes symptoms, diabetes-specific quality of life, or general health status.

Patient-reported outcome measures for assessing health-related quality of life in people with type 2 diabetes: A systematic review

Patient-Reported Outcome Measures (PROMs) are important tools to assess outcomes relevant to patients, with Health-Related Quality Of Life (HRQOL) as an important construct to be measured. Many different HRQOL PROMs are used in the type 2 diabetes field, however a complete overview of these PROMs is currently lacking. We therefore aimed to systematically describe and classify the content of all PROMs that have specifically been developed or validated to measure (aspects of) HRQOL in people with type 2 diabetes. A literature search was performed in PubMed and EMBASE until 31 December 2021. Studies on the development or validation of a PROM measuring HRQOL, or aspects of HRQOL, in people with type 2 diabetes were included. Title and abstract and full-text screening were conducted by two independent researchers and data extraction was performed independently by one of the researchers. Data were extracted on language in which the PROM was developed, target population, construct(s) being measured, names of (sub)scales and number of items per (sub)scale. In addition, all PROMs and subscales were classified according to specific aspects of HRQOL based on the Wilson & Cleary model (symptom status, functional status, general health perceptions) to aid researchers in PROM selection. In total 220 studies were identified that developed or validated PROMs that measure (aspects of) HRQOL in people with type 2 diabetes. Of the 116 unique HRQOL PROMs, 91 (of the subscales) measured symptom status, 60 measured functional status and 26 measured general health perceptions. In addition, 16 of the PROMs (subscales) measured global quality of life. 61 of the 116 PROMs (subscales) also include characteristics of the individual (e.g. aspects of personality, coping) or environment (e.g. social or financial support) and patient-reported experience measures (PREMs, e.g. measure of a patient's perception of their personal experience of the healthcare they have received, e.g. treatment satisfaction), which are not part of the HRQOL construct. Only 9 of the 116 PROMs measure all aspects of HRQOL based on the Wilson & Cleary model. Finally, 8 of the 116 PROMs stating to measure HRQOL, measured no HRQOL construct. In conclusion, a large number of PROMs are available for people with type 2 diabetes, which intend to measure (aspects of) HRQOL. These PROMs measure a large variety of (sub)constructs, which are not all HRQOL constructs, with a small amount of PROMs not measuring HRQOL at all. There is a need for consensus on which aspects of HRQOL should be measured in people with type 2 diabetes and which PROMs to use in research and daily practice. PROSPERO: CRD42017071012. COMET database: http://www.comet-initiative.org/studies/details/956 .

Are disease-related symptoms important to predicting developing diabetes from prediabetes?

BACKGROUND

There are not many studies conducted to detect and recognize the symptoms during the prediabetes period. In our study, we aimed to determine the symptoms that can be seen in prediabetes and diabetes and their prevalence and to determine the similarities and differences between the two groups.

METHODS

Individuals who were diagnosed with prediabetes or diabetes, over the age of 18, literate, and accepted to collaborate were included in our study. The "Diabetes Symptoms Checklist Scale" was used by interviewing 321 participants, 161 prediabetic and 160 diabetic, face-to-face.

RESULTS

It has been found that the most common symptom in both the prediabetes and the diabetes group is "fatigue" (88.2% prediabetes, 89.4% diabetes). The symptoms seen in the dimensions of neurology and hyperglycemia are more common in individuals with diabetes than in individuals with prediabetes [neurology score: 1.85 ± 0.84 vs. 1.66 ± 0.64 (p = 0.02), respectively; hyperglycemia score: 2.39 ± 0.94 vs. 2.08 ± 0.83 (p = 0.002), respectively]. It was observed that the symptom burden increased in all subdimensions with the long duration of illness, being a female, not working, having a family history, and not doing exercise, and high fasting blood glucose and high HbA1c values. The level of education, family history, accompanying hyperlipidemia, neurology, and hyperglycemia symptoms are associated with diabetes; and it has been determined that cardiology symptoms are associated with prediabetes.

DISCUSSION

Especially; during the follow-up of patients with prediabetes who have a low education level and diabetic family history and concomitant hyperlipidemia, there may be an increase in neurological and hyperglycemic symptoms at the point of development of type 2 diabetes. In this respect, we recommend that these factors, which we found to be predictive of diabetes compared to prediabetes, should be questioned more carefully during patient visits.

Measurement Properties of Patient-Reported Outcome Measures for Diabetes: Systematic Review

BACKGROUND

The management of diabetes is complex. There is growing recognition of the use of patient-reported outcome measures (PROMs) as a standardized method of obtaining an outlook on patients' functional status and well-being. However, no systematic reviews have summarized the studies that investigate the measurement properties of diabetes PROMs.

OBJECTIVE

Our aims were to conduct a systematic review of studies investigating the measurement properties of diabetes PROMs by evaluating the methodological quality and overall level of evidence of these PROMs and to categorize them based on the outcome measures assessed.

METHODS

This study was guided by the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Relevant articles were retrieved from the Embase, PubMed, and PsychINFO databases. The PROMs were evaluated with the COSMIN (COnsensus-based Standards for the selection of health Measurement Instruments) guidelines.

RESULTS

A total of 363 articles evaluating the measurement properties of PROMs for diabetes in the adult population were identified, of which 238 unique PROMs from 248 studies reported in 209 articles were validated in the type 2 diabetes population. PROMs with at least a moderate level of evidence for ≥5 of 9 measurement properties include the Chinese version of the Personal Diabetes Questionnaire (C-PDQ), Diabetes Self-Management Instrument Short Form (DSMI-20), and Insulin Treatment Appraisal Scale in Hong Kong primary care patients (C-ITAS-HK), of which the C-PDQ has a "sufficient (+)" rating for >4 measurement properties. A total of 43 PROMs meet the COSMIN guidelines for recommendation for use.

CONCLUSIONS

This study identified and synthesized evidence for the measurement properties of 238 unique PROMs for patients with type 2 diabetes and categorized the PROMs according to their outcome measures. These findings may assist clinicians and researchers in selecting appropriate high-quality PROMs for clinical practice and research.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42020180978; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020180978.

Fatigue Among Adults With Type 1 Diabetes Mellitus and Implications for Self-Management: An Integrative Review

Purpose The aim of this review was to integrate empirical and theoretical literature on fatigue among adults with type 1 diabetes mellitus (T1DM). A methodological review using an integrative approach was used. Databases MEDLINE via Pubmed, CINAHL, PsycINFO, and Science Direct were searched for peer-reviewed articles published in English from 2007-2017, using the following search terms and Boolean operators: "Type 1 Diabetes" and "Fatigue." Of 199 articles initially retrieved, 14 were chosen for inclusion. These articles included 13 quantitative (7 cross-sectional, 2 cohort, 2 secondary data analyses, 2 experimental) and 1 qualitative phenomenology. Fatigue was identified as one of the most troublesome symptoms reported in persons with T1DM. Four main themes emerged: fatigue in T1DM is multidimensional and related to psychological, physiological, situational, and sociodemographic factors. Conclusions Fatigue is considered a classic symptom of hyperglycemia; however, there were minimal data to support the theory that fatigue is related to hyperglycemia or hypoglycemia. Studies on fatigue among persons with T1DM are limited to small samples and cross-sectional designs with few randomized controlled trials addressing fatigue and diabetes-related symptoms. Evidence is conflicting regarding the onset of fatigue among persons with T1DM and the relationship between fatigue and diabetes duration. The prevalence of fatigue is likely influenced by disease physiology, psychological stress, and lifestyle factors, but more research is needed to confirm these relationships as causal inference is unclear.

Motivational profiles, accelerometer-derived physical activity, and acute diabetes-related symptoms in adults with type 2 diabetes

Background

Using self-determination theory, the objective of this study was to examine, over a one-month period, how physical activity (PA) motivation would influence accelerometer-derived PA behavior, and ultimately, acute diabetes-related symptoms burden among adults with type 2 diabetes (T2D adults). Using both a person and variable-centered approach, this objective was attained by means of: 1) investigating the indirect effect of PA participation on the relationship between PA motivation and acute diabetes-related symptom burden and 2) examining whether participants who met PA recommendations (i.e., 150 min of moderate-to-vigorous PA per week) would experience less acute diabetes-related symptom burden over a one-month period.

Methods

A two-wave prospective longitudinal design was used. At time 1, participants completed a questionnaire assessing their PA motivation and were asked to wear an ActiGraph GT3x accelerometer for four consecutive weeks. At time 2, they completed a short questionnaire assessing their acute diabetes-related symptoms (i.e., symptoms related to fatigue, cognitive distress, hyperglycemia, and hypoglycemia). The final sample includes 165 adults (89 or 53.61% women) aged from 26 to 75 years (M = 62.05, SD = 8.75) with T2D, which provided at least 21 valid days of accelerometer-derived data.

Results

First, results of a path analysis demonstrated that over a one-month period, the average number of minutes spent practicing moderate to vigorous PA per week mediated the relationship between intrinsic and external PA motivation and the level of burden associated with the following diabetes-related symptoms: fatigue, cognitive distress, and hyperglycemia. In addition, results of covariance analyses showed that participants meeting PA recommendations also reported significantly less burden associated with these three symptoms over a month period. Then, the existence of four motivational profiles (Self-Determined, High Introjected, Low Motivation, and Non-Self-Determined) was confirmed using a k-means analysis. Results of covariance and chi-square analyses further showed, respectively, that compared to other motivational profiles, the Self-Determined profile was associated with a higher score on weekly PA participation and meeting PA recommendations.

Conclusions

The results highlight the importance of promoting autonomous motives for PA participation among T2D adults. They also suggest that T2D adults meeting PA recommendations experience less acute diabetes-related symptoms burden, which further support the importance of their PA motivation.

Early declines in physical function among aging adults with type 2 diabetes

AIMS

Type 2 diabetes (T2DM) is associated with reduced physical function and early disability. We hypothesized that changes in physical function occur early and differ by age. Our aims were to determine and compare differences in and predictors of physical function in older and younger adults with T2DM.

METHODS

Eighty adults completed six-minute walk distance (6MWD) tests, wore wrist actigraphy for 5days and completed diabetes health and symptom surveys. Comparative and bivariate analyses were completed to assess differences between age groups determined by serial Box's M-plot analyses.

RESULTS

6MWD was low (476.9±106.2m), and negatively associated with female gender, age, neuropathic pain, diabetes duration, BMI, poor sleep quality, and fatigue and positively with habitual activity and education (p<0.05). Covariance matrices changed at age 59. In subjects age <58, 6MWD was predicted by gender, sleep quality, and neuropathic pain (R²=0.593, p<0.001). In those age ≥59, 6MWD was predicted by diabetes duration, education, and habitual activity (R²=0.554, p<0.001). There were no shared predictors of 6MWD between groups.

CONCLUSIONS

T2DM is associated with early declines in physical function; the predictors of which change in midlife. Therapies to maintain or improve physical function should be tailored by age, pain symptoms, and habitual activity levels.

Psychometric evaluation of the Korean version of the Diabetes Symptom Checklist-Revised (DSC-R) for patients with type 2 diabetes

Background

This study was to elucidate the psychometric properties of the Korean version of the Diabetes Symptom Checklist-Revised (K-DSC-R), which is a patient-reported outcome measure of diabetes symptom burden.

Methods

A sample of 432 Korean patients with diabetes was recruited from university hospitals. The data were analyzed using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), multitrait/multi-item correlation, Pearson’s correlation, t-test, ANOVA, and Cronbach’s alpha for construct, item-convergent/discriminant, concurrent, and known-groups validity, and internal consistency reliability.

Results

EFA extracted a total of 29 items clustered into 7 subscales from the K-DSC-R. The construct of the seven-subscales was supported by CFA. The scaling success rates of item-convergent validity were 100% for all subscales, and those of item-discriminant validity ranged from 83.3% to 100%. Patients in more-depressed groups and in the HbA1c-uncontrolled group had higher K-DSC-R scores, satisfying the known-groups validity. The subscales of the K-DSC-R were moderately correlated with health-related quality of life, indicative of the established concurrent validity. The Cronbach’s alpha of the K-DSC-R was 0.92.

Conclusions

The psychometric properties of the K-DSC-R have been established. It is thus appropriate for use with respect to reliability and validity in practice and clinical trials for Korean patients with type 2 diabetes.