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Carlton J, Powell PA, Broadley M, de Galan BE, Heller S, Comins J, Rosilio M, Pouwer F, Gall MA, Child CJ, McCrimmon RJ, Rowen D. Development of a new health-related quality of life measure for people with diabetes who experience hypoglycaemia: the Hypo-RESOLVE QoL. Diabetologia 2024:10.1007/s00125-024-06182-9. [PMID: 38777868 DOI: 10.1007/s00125-024-06182-9] [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: 12/05/2023] [Accepted: 04/15/2024] [Indexed: 05/25/2024]
Abstract
AIMS/HYPOTHESIS Valid and reliable patient-reported outcome measures are vital for assessing disease impact, responsiveness to healthcare and the cost-effectiveness of interventions. A recent review has questioned the ability of existing measures to assess hypoglycaemia-related impacts on health-related quality of life for people with diabetes. This mixed-methods project was designed to produce a novel health-related quality of life patient-reported outcome measure in hypoglycaemia: the Hypo-RESOLVE QoL. METHODS Three studies were conducted with people with diabetes who experience hypoglycaemia. In Stage 1, a comprehensive health-related quality of life framework for hypoglycaemia was elicited from semi-structured interviews (N=31). In Stage 2, the content validity and acceptability of draft measure content were tested via three waves of cognitive debriefing interviews (N=70 people with diabetes; N=14 clinicians). In Stage 3, revised measure content was administered alongside existing generic and diabetes-related measures in a large cross-sectional observational survey to assess psychometric performance (N=1246). The final measure was developed using multiple evidence sources, incorporating stakeholder engagement. RESULTS A novel conceptual model of hypoglycaemia-related health-related quality of life was generated, featuring 19 themes, organised by physical, social and psychological aspects. From a draft version of 76 items, a final 14-item measure was produced with satisfactory structural (χ2=472.27, df=74, p<0.001; comparative fit index =0.943; root mean square error of approximation =0.069) and convergent validity with related constructs (r=0.46-0.59), internal consistency (α=0.91) and test-retest reliability (intraclass correlation coefficient =0.87). CONCLUSIONS/INTERPRETATION The Hypo-RESOLVE QoL is a rigorously developed patient-reported outcome measure assessing the health-related quality of life impacts of hypoglycaemia. The Hypo-RESOLVE QoL has demonstrable validity and reliability and has value for use in clinical decision-making and as a clinical trial endpoint. DATA AVAILABILITY All data generated or analysed during this study are included in the published article and its online supplementary files ( https://doi.org/10.15131/shef. DATA 23295284.v2 ).
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Affiliation(s)
- Jill Carlton
- Sheffield Centre of Health and Related Research (SCHARR), University of Sheffield, Sheffield, UK.
| | - Philip A Powell
- Sheffield Centre of Health and Related Research (SCHARR), University of Sheffield, Sheffield, UK
| | - Melanie Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Bastiaan E de Galan
- Department of Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Disease, Maastricht University, Maastricht, the Netherlands
| | - Simon Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Jonathan Comins
- Medical Science Innovation, Centre of Expertise, Patient Focused Drug Development, Novo Nordisk A/S, Søborg, Denmark
| | - Myriam Rosilio
- Diabetes & Obesity Medical Unit, Eli Lilly & Company, Neuilly sur seine, France
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense, Denmark
| | - Mari-Anne Gall
- Medical & Science, Diabetes, Clinical Drug Development, Novo Nordisk A/S, Søborg, Denmark
| | | | - Rory J McCrimmon
- Systems Medicine, School of Medicine, University of Dundee, Dundee, Scotland
| | - Donna Rowen
- Sheffield Centre of Health and Related Research (SCHARR), University of Sheffield, Sheffield, UK
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Dakroub D, Sakr F, Dabbous M, Dia N, Hammoud J, Rida A, Ibrahim A, Fahs H, Obeid S, Hallit S, Malaeb D. The socio-demographic and lifestyle characteristics associated with quality of life among diabetic patients in Lebanon: a cross-sectional study. Pharm Pract (Granada) 2023; 21:2775. [PMID: 37090463 PMCID: PMC10117344 DOI: 10.18549/pharmpract.2023.1.2775] [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: 09/26/2022] [Accepted: 11/03/2022] [Indexed: 04/25/2023] Open
Abstract
Objective Diabetes mellitus (DM) is a chronic non-communicable endocrine disease that has a considerable impact on both the health and quality of life (QoL) of patients. This study aimed to investigate the sociodemographic factors associated with the quality of life among the Lebanese population with DM. Methods A cross-sectional study that enrolled 125 diabetic patients aged ≥18, was conducted between January and June of 2021. The validated Arabic version of the Audit of Diabetes-Dependent Quality of Life (ADDQoL) questionnaire is utilized by all patients to measure the quality of life (QoL). A logistic regression was then performed. Results The life domains "freedom to eat" and "freedom to drink", were the most negatively impacted by diabetes. According to the multivariate analysis monthly income OR 3.4, 95 % CIs 1.25 -9.6, P = 0.017, educational level (OR) 0.2, 95 % CIs 0.07 -0.89, HbA1c (OR) 7, 95 % CIs 1.5 -32.35, and FBG [odds ratio (OR) 1.01, 95 % (CIs) 1.004 -1.021, P = 0.005] were independently associated with impaired QOL. Conclusion The study showed that diabetes generally had a negative impact on QoL. The findings also suggest that certain sociodemographic factors, such as monthly income and educational level along with clinical parameters like HbA1c, might be associated with a lower quality of life among Lebanese diabetic patients.
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Affiliation(s)
- Diana Dakroub
- PharmD. Lebanese International University, School of Pharmacy, Lebanon.
| | - Fouad Sakr
- PharmD, MPH. Lebanese International University, School of Pharmacy, Lebanon. Université Paris-Est Créteil, École Doctorale Sciences de la Vie et de la Santé, Université Paris-Est Créteil, Institut Mondor de Recherche Biomédicale, France.
| | - Mariam Dabbous
- PharmD. Lebanese International University, School of Pharmacy, Lebanon.
| | - Nada Dia
- PharmD, MSc, MPH. Lebanese International University, School of Pharmacy, Lebanon.
| | - Jana Hammoud
- PharmD. Lebanese International University, School of Pharmacy, Lebanon.
| | - Aya Rida
- PharmD. Lebanese International University, School of Pharmacy, Lebanon.
| | - Aya Ibrahim
- PharmD. Lebanese International University, School of Pharmacy, Lebanon.
| | - Hala Fahs
- PharmD. Lebanese International University, School of Pharmacy, Lebanon.
| | - Sahar Obeid
- BSc, MSc, PhD. School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon.
| | - Souheil Hallit
- PharmD, MSc, MPH, PhD. School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon. Research Department, Psychiatric Hospital of the Cross, P.O. Box 60096, Jal Eddib, Lebanon. Applied Science Research Center, Applied Science Private University, Amman, Jordan.
| | - Diana Malaeb
- PharmD, BCPS, MPH, PhD. Lebanese International University, School of Pharmacy, Lebanon. College of Pharmacy, Gulf Medical University, United Arab Emirates.
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Broadley M, Chatwin H, Søholm U, Amiel SA, Carlton J, De Galan BE, Hendrieckx C, McCrimmon RJ, Skovlund SE, Pouwer F, Speight J. The 12-Item Hypoglycemia Impact Profile (HIP12): psychometric validation of a brief measure of the impact of hypoglycemia on quality of life among adults with type 1 or type 2 diabetes. BMJ Open Diabetes Res Care 2022; 10:10/4/e002890. [PMID: 35977753 PMCID: PMC9389129 DOI: 10.1136/bmjdrc-2022-002890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The aim of this study was to determine the psychometric properties of the 12-Item Hypoglycemia Impact Profile (HIP12), a brief measure of the impact of hypoglycemia on quality of life (QoL) among adults with type 1 (T1D) or type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS Adults with T1D (n=1071) or T2D (n=194) participating in the multicountry, online study, 'Your SAY: Hypoglycemia', completed the HIP12. Psychometric analyses were undertaken to determine acceptability, structural validity, internal consistency, convergent/divergent validity, and known-groups validity. RESULTS Most (98%) participants completed all items on the HIP12. The expected one-factor solution was supported for T1D, T2D, native English speaker, and non-native English speaker groups. Internal consistency was high across all groups (ω=0.91-0.93). Convergent and divergent validity were satisfactory. Known-groups validity was demonstrated for both diabetes types, by frequency of severe hypoglycemia (0 vs ≥1 episode in the past 12 months) and self-treated episodes (<2 vs 2-4 vs ≥5 per week). The measure also discriminated by awareness of hypoglycemia in those with T1D. CONCLUSIONS The HIP12 is an acceptable, internally consistent, and valid tool for assessing the impact of hypoglycemia on QoL among adults with T1D. The findings in the relatively small sample with T2D are encouraging and warrant replication in a larger sample.
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Affiliation(s)
- Melanie Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Hannah Chatwin
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Uffe Søholm
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | | | - Jill Carlton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Bastiaan E De Galan
- Department of Internal Medicine, Diabetes Section, Radboudumc, Nijmegen, The Netherlands
- Department of Internal Medicine/Endocrinology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Christel Hendrieckx
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Rory J McCrimmon
- Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Søren E Skovlund
- Patient-Centered Research Science, Evidera, London, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense, Denmark
| | - Jane Speight
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
- School of Psychology, Deakin University, Geelong, Victoria, Australia
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Planalp EM, Kliems H, Chewning BA, Palta M, LeCaire TJ, Young LA, Cox ED. Development and validation of the self-management Barriers and Supports Evaluation for working-aged adults with type 1 diabetes mellitus. BMJ Open Diabetes Res Care 2022; 10:10/1/e002583. [PMID: 34980593 PMCID: PMC8724717 DOI: 10.1136/bmjdrc-2021-002583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/11/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION To optimize type 1 diabetes mellitus self-management, experts recommend a person-centered approach, in which care is tailored to meet people's needs and preferences. Existing tools for tailoring type 1 diabetes mellitus education and support are limited by narrow focus, lack of strong association with meaningful outcomes like A1c, or having been developed before widespread use of modern diabetes technology. To facilitate comprehensive, effective tailoring for today's working-aged adults with type 1 diabetes mellitus, we developed and validated the Barriers and Supports Evaluation (BASES). RESEARCH DESIGN AND METHODS Participants 25-64 years of age with type 1 diabetes mellitus were recruited from clinics and a population-based registry. Content analysis of semistructured interviews (n=33) yielded a pool of 136 items, further refined to 70 candidate items on a 5-point Likert scale through cognitive interviewing and piloting. To develop and validate the tool, factor analyses were applied to responses to candidate items (n=392). Additional survey data included demographics and the Diabetes-Specific Quality of Life (QOL) Scale-Revised. To evaluate concurrent validity, hemoglobin A1c (HbA1c) values and QOL scores were regressed on domain scores. RESULTS Factor analyses yielded 5 domains encompassing 30 items: Learning Opportunities, Costs and Insurance, Family and Friends, Coping and Behavioral Skills, and Diabetes Provider Interactions. Models exhibited good to adequate fit (Comparative Fit Index >0.88 and Root Mean Squared Error of Approximation <0.06). All domains demonstrated significant associations with HbA1c and QOL in the expected direction, except Family and Friends. Coping and Behavioral Skills had the strongest associations with both HbA1c and QOL. CONCLUSIONS The BASES is a valid, comprehensive, person-centered tool that can tailor diabetes support and education to individuals' needs in a modern practice environment, improving effectiveness and uptake of services. Clinicians could use the tool to uncover patient-specific barriers that limit success in achieving HbA1c goals and optimal QOL.
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Affiliation(s)
| | - Harald Kliems
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Betty A Chewning
- Department of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Mari Palta
- Population Health Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Tamara J LeCaire
- Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Laura A Young
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Elizabeth D Cox
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
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Holmes-Truscott E, Cooke DD, Hendrieckx C, Coates EJ, Heller SR, Speight J. A comparison of the acceptability and psychometric properties of scales assessing the impact of type 1 diabetes on quality of life-Results of 'YourSAY: Quality of Life'. Diabet Med 2021; 38:e14524. [PMID: 33445223 DOI: 10.1111/dme.14524] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/07/2021] [Accepted: 01/10/2021] [Indexed: 01/19/2023]
Abstract
AIMS To compare the acceptability, reliability and validity of five contemporary diabetes-specific quality of life (QoL) scales among adults with type 1 diabetes in the United Kingdom and Australia. METHODS Adults with type 1 diabetes (UK = 1139, Australia = 439) completed a cross-sectional, online survey including ADDQoL-19, DCP, DIDP, DSQOLS and Diabetes QoL-Q, presented in randomised order. After completing each scale, participants rated it for clarity, relevance, ease of completion, length and comprehensiveness. We examined scale acceptability (scale completion and user ratings), response patterns, structure (exploratory and confirmatory factor analyses) and validity (convergent, concurrent, divergent and known groups). To assess cross-country reproducibility, analyses conducted on the UK dataset were replicated in the Australian dataset. RESULTS Findings were largely consistent between countries. All scales were acceptable to participants: ≥90% completing all items, and ≥80% positive user ratings, except for DSQOLS' length. Scale structure was not supported for the DCP. Overall, in terms of acceptability and psychometric evaluation, the DIDP was the strongest performing scale while the ADDQoL-19 and Diabetes QoL-Q scales also performed well. CONCLUSIONS These findings suggest that the recently developed brief (7 items), neutrally worded DIDP scale is acceptable to adults with type 1 diabetes and has the strongest psychometric performance. However, questionnaire selection should always be considered in the context of the research aims, study design and population, as well as the wider published evidence regarding both the development and responsiveness of the scales.
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Affiliation(s)
- Elizabeth Holmes-Truscott
- School of Psychology, Deakin University, Geelong, Vic., Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Vic., Australia
| | - Debbie D Cooke
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, Vic., Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Vic., Australia
| | - Elizabeth J Coates
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Simon R Heller
- Department of Oncology and Human Metabolism, University of Sheffield, Sheffield, UK
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, Vic., Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Vic., Australia
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Wu C, Ge YL, Zhang XY, Liu MC, Heng CN, Zhang LY, Du YL, He SZ, Shang L, Lang HJ. The influence of hypoglycemia on the specific quality of life in type 2 diabetes mellitus: a comparative cross-sectional study of diabetics with and without hypoglycemia in Xi'an, China. Health Qual Life Outcomes 2021; 19:151. [PMID: 34011369 PMCID: PMC8136059 DOI: 10.1186/s12955-021-01790-0] [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: 02/02/2021] [Accepted: 05/13/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose This study aims to explore the incidence of hypoglycemia in patients with type 2 diabetes mellitus (T2DM) and the influence of hypoglycemia on the specific quality of life in T2DM patients. Methods It was a comparative cross-sectional study consisting of 519 T2DM patients in Xi'an, China and patients were investigated by self-reported hypoglycemia and specific quality of life questionnaires from September 2019 to January 2020. Descriptive analysis, t-test, Chi-square test, hierarchical regression analysis and stepwise multiple regression analysis were applied to assess the influence of hypoglycemia on the specific quality of life. Results The incidence of hypoglycemia in T2DM patients was 32.18%. The mean score of specific quality of life in diabetes without hypoglycemia was 57.33 ± 15.36 and was 61.56 ± 17.50 in those with hypoglycemia, which indicated that hypoglycemia had a serious impact on the quality of life of diabetics (t = − 5.172, p = 0.000). In the Univariate analysis of specific quality of life, age, education background, marital status, living status, duration of diabetes, monthly income per capita were independent and significant factors associated with specific quality of life of two groups of T2DM patients (p < 0.05). In the hierarchical regression analysis, the duration of the diabetes more than 11 years and the frequency of hypoglycemia more than 6 times in half a year entered the equation of specific quality of life of 519 diabetics respectively (p < 0.001). In multiple linear regression analysis, age, marital status and income all entered the regression equation of quality of life of the two groups (p < 0.05). Conclusion Hypoglycemia will have a serious impact on the quality of life of T2DM patients. In order to improve the living quality in diabetics, effective measurements should be taken to strengthen the management of blood glucose and to avoid hypoglycemia.
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Affiliation(s)
- Chao Wu
- Fourth Military Medical University, Xi'an, Shanxi, China
| | - Yi-Ling Ge
- Fourth Military Medical University, Xi'an, Shanxi, China
| | | | - Ming-Chao Liu
- Fourth Military Medical University, Xi'an, Shanxi, China
| | - Chun-Ni Heng
- Tang Du Hospital of Fourth Military Medical University, Xi'an, Shanxi, China
| | - Lin-Yuan Zhang
- Fourth Military Medical University, Xi'an, Shanxi, China
| | - Yan-Ling Du
- Fourth Military Medical University, Xi'an, Shanxi, China
| | - Shi-Zhe He
- Fourth Military Medical University, Xi'an, Shanxi, China
| | - Lei Shang
- Fourth Military Medical University, Xi'an, Shanxi, China.
| | - Hong-Juan Lang
- Fourth Military Medical University, Xi'an, Shanxi, China.
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Deng H, Shu Y, Lv P, Zhao L, Cheng K, Zhang T, Song Y, Yang H, Tang H, Pei J, Shen X. Acupuncture for diabetic peripheral neuropathy: study protocol for a randomized, placebo-controlled trial. Trials 2020; 21:879. [PMID: 33106185 PMCID: PMC7586683 DOI: 10.1186/s13063-020-04811-3] [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: 04/13/2020] [Accepted: 10/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) is the most common chronic complication of diabetes mellitus that has a considerable impact on quality of life, but there are few effective therapeutic strategies. The aim of this trial is to determine the efficacy and safety of manual acupuncture (MA) versus sham acupuncture (SA) for DPN. METHODS/DESIGN This is a study protocol for a randomized, placebo-controlled clinical trial. A total of 118 patients with DPN will be recruited and randomly assigned in a 1:1 ratio to either the MA group or SA group. All patients will receive 24 sessions over 12 weeks. Participants will complete the trial by visiting the research center at month 6 for a follow-up assessment. The primary outcome is peroneal motor nerve conduction velocity (peroneal MNCV) at week 12 compared with baseline. Secondary outcomes include peroneal motor nerve action potential amplitude (peroneal MNAP) and latent period (peroneal MNLP), sural sensory nerve conduction velocity (sural SNCV), action potential amplitude (sural SNAP) and latent period (sural SNLP), fasting plasma glucose (FPG), 2-h postprandial blood glucose (2hPG), glycated hemoglobin (HbAlc) at week 12 compared with baseline, Michigan Neuropathy Screening Instrument (MNSI) score and Diabetes Specific Quality of Life scale (DSQL) at week 12 and month 6 compared with baseline. Safety will be assessed during the whole trial. Masking effectiveness will be assessed by patients. DISCUSSION This trial may provide high-quality evidence for evaluating the efficacy and safety of MA treatment for DPN compared with SA treatment. Results of this study will be published in peer-reviewed journals. TRIAL REGISTRATION Chinese Clinical Trials Registry ChiCTR1800020444. First registered on 29 December 2018, retrospectively registered, http://www.chictr.org.cn/showproj.aspx?Proj=31063 .
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Affiliation(s)
- Haiping Deng
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Pudong District, Shanghai, China.,Shanghai Research Center of Acupuncture and Meridian, Pudong District, Shanghai, China
| | - Yu Shu
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Pudong District, Shanghai, China
| | - Peiran Lv
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Pudong District, Shanghai, China
| | - Ling Zhao
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Pudong District, Shanghai, China
| | - Ke Cheng
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Pudong District, Shanghai, China.,Shanghai Research Center of Acupuncture and Meridian, Pudong District, Shanghai, China
| | - Tingting Zhang
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Pudong District, Shanghai, China
| | - Yi Song
- Long-Hua Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Xuhui District, Shanghai, China
| | - Hua Yang
- Long-Hua Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Xuhui District, Shanghai, China
| | - Hong Tang
- Long-Hua Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Xuhui District, Shanghai, China
| | - Jian Pei
- Long-Hua Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Xuhui District, Shanghai, China.
| | - Xueyong Shen
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Pudong District, Shanghai, China.
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Lebel S, Mutsaers B, Tomei C, Leclair CS, Jones G, Petricone-Westwood D, Rutkowski N, Ta V, Trudel G, Laflamme SZ, Lavigne AA, Dinkel A. Health anxiety and illness-related fears across diverse chronic illnesses: A systematic review on conceptualization, measurement, prevalence, course, and correlates. PLoS One 2020; 15:e0234124. [PMID: 32716932 PMCID: PMC7384626 DOI: 10.1371/journal.pone.0234124] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with chronic diseases commonly report fears of illness or symptoms recurring or worsening. These fears have been addressed from an illness-specific perspective (e.g., fear of cancer recurrence), a generic illness perspective (e.g., fear of progression), and a psychiatric perspective (DSM-5 illness anxiety disorder and somatic symptom disorder). The broader concept of health anxiety (HA) can also be applied to patients with a chronic disease. This review was conducted to investigate the conceptual, theoretical, measurement-overlap, and differences between these distinct perspectives. We also aimed to summarize prevalence, course, and correlates of these fears in different chronic illnesses. METHODS We used PsycINFO, PubMED, CINAHL, Web of Science, SCOPUS, and PSYNDEX to conduct a systematic review of studies pertaining to these fears in chronic illness published from January 1996 to October 2017. A total of 401 articles were retained. RESULTS There were commonalities across different conceptualizations and diseases: a high prevalence of clinical levels of fears (>20%), a stable course over time, and a deleterious impact on quality of life. Reviewed studies used definitions, models, and measures that were illness-specific, with only a minority employing a psychiatric perspective, limiting cross-disease generalizability. There appears to be some applicability of DSM-5 disorders to the experience of fear of illness/symptoms in patients with a chronic illness. While conceptualizing HA on a continuum ranging from mild and transient to severe may be appropriate, there is a lack of agreement about when the level of fear becomes 'excessive.' The definitions, models, and measures of HA across chronic illnesses involve affective, cognitive, behavioral, and perceptual features. CONCLUSIONS The concept of HA may offer a unifying conceptual perspective on the fears of illness/symptoms worsening or returning commonly experienced by those with chronic disease.
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Affiliation(s)
- Sophie Lebel
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Christina Tomei
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Georden Jones
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Nicole Rutkowski
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Viviane Ta
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Geneviève Trudel
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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9
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Speight J, Holmes-Truscott E, Hendrieckx C, Skovlund S, Cooke D. Assessing the impact of diabetes on quality of life: what have the past 25 years taught us? Diabet Med 2020; 37:483-492. [PMID: 31797443 DOI: 10.1111/dme.14196] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2019] [Indexed: 01/06/2023]
Abstract
Over the past 25 years, there has been significant acknowledgement of the importance of assessing the impact of diabetes on quality of life. Yet, despite the development of several diabetes-specific quality of life measures, the challenges we faced in 1995 remain. There is little consensus on the definition of quality of life because of the complexity and subjectivity of the concept. General quality of life comprises several domains of life, and these are highly individualized. Assessing the impact of diabetes on these life domains adds to the complexity. While comprehensive diabetes-specific quality-of-life measures typically increase respondent burden, brief questionnaires may not capture all relevant/important domains. Today, the lack of resolution of these challenges may explain why the impact of diabetes on quality of life is not systematically assessed in research or clinical care. Few researchers report detailed rationales for assessment, there is often a mismatch between the concept of interest and the measure selected, and data are misinterpreted as assessing the impact of diabetes on quality of life when, in reality, related but distinct constructs have been assessed, such as diabetes distress, treatment satisfaction or health status. While significant efforts are being made to increase routine monitoring of psychological well-being and understand the lived experience, no guidelines currently recommend routine clinical assessment of diabetes-specific quality of life, and there is no consensus on which questionnaire(s) to use. The gaps identified in this review need urgent attention, starting with recognition that assessment of diabetes-specific quality of life is as important as biomedical markers, if we are to improve the lives of people with diabetes.
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Affiliation(s)
- J Speight
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - E Holmes-Truscott
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - C Hendrieckx
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
| | - S Skovlund
- Steno Diabetes Centre Northern Denmark, Aalborg University Hospital, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - D Cooke
- School of Health Sciences, University of Surrey, Guildford, UK
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10
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Krzemińska S, Bąk E, Šáteková L, Polanská A, Hašová K, Laurinc M. Comparison of Diabetes-Dependent Quality of Life (ADDQoL) in Patients with T2DM in Poland, The Czech Republic, and Slovakia. Diabetes Metab Syndr Obes 2020; 13:3773-3786. [PMID: 33116726 PMCID: PMC7585271 DOI: 10.2147/dmso.s273339] [Citation(s) in RCA: 2] [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: 07/25/2020] [Accepted: 09/11/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The purpose of the paper was to perform a comparative analysis of the impact of T2DM on QoL, including specific ADDQoL domains and associations between QoL, selected socio-demographic factors (including gender, age, education, residence, marital status, professional activity) or clinical parameters (HbA1c levels, fasting blood glucose, BMI, duration of DM, complications, treatment used), in adult diabetic patients from Poland, the Czech Republic and Slovakia. The study group included 608 patients diagnosed with T2DM. There were 214 patients from Poland, 196 from the Czech Republic and 198 from Slovakia. RESULTS Overall, respondents from all three countries rated their QoL as good or very good. The mean scores for the item "If I did not have diabetes, my quality of life would be" were slightly higher for Poles than for Slovaks and Czechs. In the ADDQoL results, the weighted impact scores were negative for all domains. The lowest scores in all three countries were found for "freedom to eat" for all patients; the highest for "living conditions". For Polish patients, the linear regression model demonstrated the following significant AWI predictors: pre-university education and past smoking. For Czech patients, the linear regression model demonstrated that none of the characteristics analyzed were significant independent predictors of AWI. In the For Slovak patients, the linear regression model demonstrated the following significant AWI predictors: higher education and concurrent heart failure. CONCLUSION In summary, our findings demonstrate that T2DM has a negative impact on all aspects of patients' QoL, which is the strongest in terms of the freedom to eat and dietary habits, regardless of the country. Education, past smoking, and concurrent heart failure were the only independent predictors of QoL in our study. This suggests a need for further research that would include more variables and a larger number of patients.
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Affiliation(s)
- Sylwia Krzemińska
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
- Correspondence: Sylwia Krzemińska Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Bartla 5, Wroclaw51-618, Poland Email
| | - Ewelina Bąk
- Faculty of Health Sciences, University of Bielsko-Biala, Bielsko-Biala, Poland
| | - Lenka Šáteková
- Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
| | | | | | - Milan Laurinc
- National Institute of Cardiovascular Children’s Cardiology Center, Bratislava, Slovakia
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11
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Amiel SA, Choudhary P, Jacob P, Smith EL, De Zoysa N, Gonder-Frederick L, Kendall M, Heller S, Brooks A, Toschi E, Kariyawasam D, Potts L, Healy A, Rogers H, Sevdalis N, Stadler M, Qayyum M, Bakolis I, Goldsmith K. Hypoglycaemia Awareness Restoration Programme for People with Type 1 Diabetes and Problematic Hypoglycaemia Persisting Despite Optimised Self-care (HARPdoc): protocol for a group randomised controlled trial of a novel intervention addressing cognitions. BMJ Open 2019; 9:e030356. [PMID: 31209097 PMCID: PMC6588968 DOI: 10.1136/bmjopen-2019-030356] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Severe hypoglycaemia (SH), when blood glucose falls too low to support brain function, is the most feared acute complication of insulin therapy for type 1 diabetes mellitus (T1DM). 10% of people with T1DM contribute nearly 70% of all episodes, with impaired awareness of hypoglycaemia (IAH) a major risk factor. People with IAH may be refractory to conventional approaches to reduce SH, with evidence for cognitive barriers to hypoglycaemia avoidance. This paper describes the protocol for the Hypoglycaemia Awareness Restoration Programme for People with Type 1 Diabetes and Problematic Hypoglycaemia Persisting Despite Optimised Self-care (HARPdoc) study, a trial to assess the impact on hypoglycaemia experience of a novel intervention that addresses cognitive barriers to hypoglycaemia avoidance, compared with an existing control intervention, recommended by the National Institute of Health and Care Excellence. METHODS AND ANALYSIS A randomised parallel two-arm trial of two group therapies: HARPdoc versus Blood Glucose Awareness Training, among 96 adults with T1DM and problematic hypoglycaemia, despite attendance at education with or without technology use, in four centres providing specialist T1DM services. The primary outcome will be the SH rate at 12 and/or 24 months after randomisation to either course. Secondary outcomes include rates of SH requiring parenteral therapy, involving unconsciousness or needing emergency services; hypoglycaemia awareness status, overall diabetes control and quality of life measures. An implementation study to evaluate how the interventions are delivered and how implementation impacts on clinical effectiveness is planned as a parallel study, with its own protocol. ETHICS AND DISSEMINATION The protocol was approved by the London Dulwich Research Ethics Committee, the Health Research Authority, National Health Service R&D and the Institutional Review Board of the Joslin Diabetes Center in the USA. Study findings will be disseminated to study participants and through peer-reviewed publications and conference presentations, including user groups. TRIAL REGISTRATION NUMBER NCY02940873; Pre-results.
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Affiliation(s)
- Stephanie A Amiel
- Diabetes Department, Denmark Hill Campus, King's College London Faculty of Life Sciences and Medicine, London, UK
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - Pratik Choudhary
- Diabetes Department, Denmark Hill Campus, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Peter Jacob
- Diabetes Department, Denmark Hill Campus, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Emma Lauretta Smith
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - Nicole De Zoysa
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - Linda Gonder-Frederick
- Department of Psychiatry and Behavioral Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Mike Kendall
- Diabetes Department, Denmark Hill Campus, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Simon Heller
- School of Medicine and Biomedical Sciences, University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
| | - Augustin Brooks
- Bournemouth Diabetes and Endocrine Centre, Royal Bournemouth Hospital, Bournemouth, UK
| | - Elena Toschi
- Joslin Diabetes Center, Harvard University, Cambridge, Massachusetts, USA
| | - Dulmini Kariyawasam
- Department of Diabetes, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
| | - Laura Potts
- Department of Biostatistics, Department of Health Services and Population Research, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Andy Healy
- Department of Biostatistics, Department of Health Services and Population Research, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Helen Rogers
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - Nick Sevdalis
- Centre for Implementation Science, Health Sciences and Population Research Department, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Marietta Stadler
- Diabetes Department, Denmark Hill Campus, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Mustabshira Qayyum
- Diabetes Department, Denmark Hill Campus, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Ioannis Bakolis
- Department of Biostatistics, Department of Health Services and Population Research, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Kimberley Goldsmith
- Department of Biostatistics, Department of Health Services and Population Research, Institute of Psychiatry Psychology and Neuroscience, London, UK
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Yamabe M, Kuroda M, Hirosawa Y, Kamino H, Ohno H, Yoneda M. Comparison of insulin glargine 300 U/mL and insulin degludec using flash glucose monitoring: A randomized cross-over study. J Diabetes Investig 2019; 10:352-357. [PMID: 29989335 PMCID: PMC6400163 DOI: 10.1111/jdi.12894] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/21/2018] [Accepted: 07/02/2018] [Indexed: 12/12/2022] Open
Abstract
AIMS/INTRODUCTION We compared the efficacy and safety of insulin glargine 300 U/mL (Gla300) and insulin degludec U100 (Deg) using a flash glucose monitoring system. MATERIALS AND METHODS A total of 24 Japanese patients with type 2 diabetes were randomized to receive once-daily Gla300 (n = 12) or Deg (n = 12) in the morning. The primary end-points were the mean percentage of time in the target glucose range (70-179 mg/dL) and hypoglycemia (<70 mg/dL), as measured using flash glucose monitoring during the last 7 days of each 14-day period. RESULTS The percentages of time with glucose levels <70 mg/dL were not significantly different between the two insulin treatments. No significant differences were observed in the percentages of time with glucose levels of 70-179 mg/dL or ≥180 mg/dL. The percentage of time with nocturnal hypoglycemia with Gla300 was significantly lower than that with Deg treatment (P = 0.021). This difference might be attributable to the difference in the duration of action between the two formulations, and the incidence of nocturnal hypoglycemia with Deg treatment was associated with the concomitant use of metformin (P = 0.035). CONCLUSIONS The two formulations were comparable in efficacy, whereas the incidence of nocturnal hypoglycemia was significantly lower with Gla300. Thus, the present study suggests that, although Gla300 and Deg are comparable long-acting insulin analogs, Gla300 is safer with respect to the incidence of hypoglycemia.
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Affiliation(s)
- Mizuho Yamabe
- Department of Internal MedicineMurakami Memorial HospitalOnomichiHiroshimaJapan
| | - Mami Kuroda
- Department of Internal MedicineMurakami Memorial HospitalOnomichiHiroshimaJapan
| | - Yasuyo Hirosawa
- Department of Internal MedicineMurakami Memorial HospitalOnomichiHiroshimaJapan
| | - Hiromi Kamino
- Department of Internal MedicineMurakami Memorial HospitalOnomichiHiroshimaJapan
| | - Haruya Ohno
- Department of Endocrinology and Diabetic MedicineHiroshima University HospitalHiroshima CityHiroshimaJapan
| | - Masayasu Yoneda
- Department of Endocrinology and Diabetic MedicineHiroshima University HospitalHiroshima CityHiroshimaJapan
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13
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Kawaguchi Y, Sawa J, Sakuma N, Kumeda Y. Efficacy and safety of insulin glargine 300 U/mL vs insulin degludec in patients with type 2 diabetes: A randomized, open-label, cross-over study using continuous glucose monitoring profiles. J Diabetes Investig 2019; 10:343-351. [PMID: 29947060 PMCID: PMC6400202 DOI: 10.1111/jdi.12884] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 06/06/2018] [Accepted: 06/19/2018] [Indexed: 12/12/2022] Open
Abstract
AIMS/INTRODUCTION Compared with glargine 100 U/mL (Gla100), glargine 300 U/mL (Gla300) and degludec (Deg) - the ultralong-acting insulins - reportedly have more stable effects and reduce the risk of hypoglycemia. Currently, they are considered to be the most useful basal insulins. The present study aimed to compare the efficacy and safety of Gla300 and Deg on glycemic control using continuous glucose monitoring. MATERIALS AND METHODS In this single-center, open-label, parallel-group, two-period, cross-over study, 30 patients with type 2 diabetes were randomized to once-daily Gla300 followed by Deg with the same units (n = 15) or vice versa (n = 15). The primary end-points of this study were the mean percentage of time within the target glucose range of 70-180 mg/dL as efficacy and hypoglycemia of <70 mg/dL as safety indicators, as measured using continuous glucose monitoring during each treatment period. RESULTS The mean percentage of time within the target glucose range was not different between Gla300 and Deg (77.8 ± 19.2 vs 76.9 ± 18.3%, P = 0.848). However, the mean percentage of time of hypoglycemia with Gla300 was significantly lower than that of Deg (1.3 ± 2.7 vs 5.5 ± 6.4%, P = 0.002). In the secondary safety end-points, the mean percentage of time of severe hypoglycemia (<54 mg/dL) or nocturnal hypoglycemia with Gla300 was also significantly lower than that of Deg. CONCLUSIONS The present study showed the comparable efficacy of Gla300 and Deg on glycemic control; however, the risk of hypoglycemia was markedly lower for Gla300 than for Deg.
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Affiliation(s)
- Yuji Kawaguchi
- Department of Internal MedicineMinami Osaka HospitalOsakaJapan
| | - Jun Sawa
- Department of Internal MedicineMinami Osaka HospitalOsakaJapan
| | - Noriko Sakuma
- Department of Internal MedicineMinami Osaka HospitalOsakaJapan
| | - Yasuro Kumeda
- Department of Internal MedicineMinami Osaka HospitalOsakaJapan
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Sturt J, Dliwayo TR, Forjaz V, Hamilton K, Bryce C, Fraser J, Griffiths F. Eliciting the Impact of Digital Consulting for Young People Living With Long-Term Conditions (LYNC Study): Cognitive Interviews to Assess the Face and Content Validity of Two Patient-Reported Outcome Measures. J Med Internet Res 2018; 20:e268. [PMID: 30309832 PMCID: PMC6231804 DOI: 10.2196/jmir.9786] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/30/2018] [Accepted: 06/18/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Digital consulting, using email, text, and Skype, is increasingly offered to young people accessing specialist care for long-term conditions. No patient-reported outcome measures (PROMs) have been evaluated for assessing outcomes of digital consulting. Systematic and scoping reviews, alongside patient involvement, revealed 2 candidate PROMs for this purpose: the patient activation measure (PAM) and the physician's humanistic behaviors questionnaire (PHBQ). PAM measures knowledge, beliefs, and skills that enable people to manage their long-term conditions. PHBQ assesses the presence of behaviors that are important to patients in their physician-patient interactions. OBJECTIVE This study aimed to assess the face and content validity of PAM and PHBQ to explore whether they elicit important outcomes of digital consulting and whether the PROMs can isolate the digital consultation component of care. METHODS Participants were drawn from 5 clinics providing specialist National Health Service care to 16- to 24-year-olds with long-term health conditions participating in the wider LYNC (Long-Term Conditions, Young People, Networked Communications) study. Overall, 14 people undertook a cognitive interview in this substudy. Of these, 7 participants were young people with either inflammatory bowel disease, cystic fibrosis, or cancer. The remaining 7 participants were clinicians who were convenience sampled. These included a clinical psychologist, 2 nurses, 3 consultant physicians, and a community youth worker practicing in cancer, diabetes, cystic fibrosis, and liver disease. Cognitive interviews were transcribed and analyzed, and a spreadsheet recorded the participants' PROM item appraisals. Illustrative quotes were extracted verbatim from the interviews for all participants. RESULTS Young people found 11 of the PAM 13 items and 7 of the additional 8 PAM 22 items to be relevant to digital consulting. They were only able to provide spontaneous examples of digital consulting for 50% (11/22) of the items. Of the 7 clinicians, 4 appraised all PAM 13 items and 20 of the PAM 22 items to be relevant to evaluating digital consulting and articulated operationalization of the items with reference to their own digital consulting practice with greater ease than the young people. Appraising the PHBQ, in 14 of the 25 items, two-thirds of the young people's appraisals offered digital consulting examples with ease, suggesting that young people can detect and discern humanistic clinician behaviors via digital as well as face-to-face communication channels. Moreover, 17 of the 25 items were appraised as relevant by the young people. This finding was mirrored in the clinician appraisals. Both young people and the clinicians found the research task complex. Young participants required considerably more researcher prompting to elicit examples related to digital consulting rather than their face-to-face care. CONCLUSIONS PAM and PHBQ have satisfactory face and content validity for evaluating digital consulting to warrant proceeding to psychometric evaluation. Completion instructions require revision to differentiate between digital and face-to-face consultations.
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Affiliation(s)
- Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | | | - Vera Forjaz
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Kathryn Hamilton
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Carol Bryce
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | | | - Frances Griffiths
- Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
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15
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Bak E, Marcisz C, Nowak-Kapusta Z, Dobrzyn-Matusiak D, Marcisz E, Krzeminska S. Psychometric properties of the Audit of Diabetes-Dependent Quality of Life (ADDQoL) in a population-based sample of Polish adults with type 1 and 2 diabetes. Health Qual Life Outcomes 2018; 16:53. [PMID: 29587838 PMCID: PMC5870825 DOI: 10.1186/s12955-018-0878-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 03/15/2018] [Indexed: 11/23/2022] Open
Abstract
Background The aim of the present paper was the assessment of the psychometric properties of the Polish language version of the Audit of Diabetes-Dependent Quality of Life (ADDQoL) questionnaire applied in Poland among patients with type 1 (T1DM) or type 2 diabetes (T2DM). Methods The studies were carried out among 330 patients with diabetes including 115 with T1DM and 215 with T2DM. In all the patients the level of the quality of life was investigated using the Polish language version of the ADDQoL and the psychometric properties were determined taking into consideration internal consistency, the factor loading and intraclass correlations. Results It was demonstrated that the values of internal consistency determining the reliability of the Polish language version of the ADDQoL for the overall Cronbach’s alfa coefficient were 0.92 in the studied patients with T1DM and 0.93 in the studied patients with T2DM and the values of the loading factor were respectively 0.39–0.79 and 0.35–0.81. In the study of the correlation between the components of the ADDQoL the correlation coefficients proved to be highly statistically significant: in patients with T1DM r = 0.46–0.74 and in patients with T2DM – r = 0.42–0.80. Conclusion The Polish language version of the ADDQoL is a reliable tool useful for the assessment of the level of the quality of life of adult patients with T1DM or T2DM in Poland and is recommended to be used among Polish-speaking patients with diabetes.
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Affiliation(s)
- Ewelina Bak
- Department of Nursing, Faculty of Health Sciences, University of Bielsko-Biala, ul. Willowa 2, 43-309, Bielsko-Biala, Poland.
| | - Czeslaw Marcisz
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, ul. Ziolowa 45/47, 40-635, Katowice, Poland
| | - Zofia Nowak-Kapusta
- Department of Health Promotion and Community Nursing, School of Health Sciences, Medical University of Silesia, ul. Medykow 12, 40-752, Katowice, Poland
| | - Dorota Dobrzyn-Matusiak
- Department of Nursing Propaedeutics, School of Health Sciences, Medical University of Silesia, ul. Francuska 20/24, 40-027, Katowice, Poland
| | - Ewa Marcisz
- Department of Anxiety Disorders, Hospital of Ministry of Internal Affairs, ul. Glowackiego 10, 40-052, Katowice, Poland
| | - Sylwia Krzeminska
- Department of Clinical Nursing, Faculty of Health Sciences, Medical University, ul. Wybrzeze Ludwika Pasteura 1, 50-367, Wroclaw, Poland
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Tascini G, Berioli MG, Cerquiglini L, Santi E, Mancini G, Rogari F, Toni G, Esposito S. Carbohydrate Counting in Children and Adolescents with Type 1 Diabetes. Nutrients 2018; 10:E109. [PMID: 29361766 PMCID: PMC5793337 DOI: 10.3390/nu10010109] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 11/16/2022] Open
Abstract
Carbohydrate counting (CC) is a meal-planning tool for patients with type 1 diabetes (T1D) treated with a basal bolus insulin regimen by means of multiple daily injections or continuous subcutaneous insulin infusion. It is based on an awareness of foods that contain carbohydrates and their effect on blood glucose. The bolus insulin dose needed is obtained from the total amount of carbohydrates consumed at each meal and the insulin-to-carbohydrate ratio. Evidence suggests that CC may have positive effects on metabolic control and on reducing glycosylated haemoglobin concentration (HbA1c). Moreover, CC might reduce the frequency of hypoglycaemia. In addition, with CC the flexibility of meals and snacks allows children and teenagers to manage their T1D more effectively within their own lifestyles. CC and the bolus calculator can have possible beneficial effects in improving post-meal glucose, with a higher percentage of values within the target. Moreover, CC might be integrated with the counting of fat and protein to more accurately calculate the insulin bolus. In conclusion, in children and adolescents with T1D, CC may have a positive effect on metabolic control, might reduce hypoglycaemia events, improves quality of life, and seems to do so without influencing body mass index; however, more high-quality clinical trials are needed to confirm this positive impact.
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Affiliation(s)
- Giorgia Tascini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Maria Giulia Berioli
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Laura Cerquiglini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Elisa Santi
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Giulia Mancini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Francesco Rogari
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Giada Toni
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
| | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy.
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Emral R, Pathan F, Cortés CAY, El-Hefnawy MH, Goh SY, Gómez AM, Murphy A, Abusnana S, Rudijanto A, Jain A, Ma Z, Mirasol R. Self-reported hypoglycemia in insulin-treated patients with diabetes: Results from an international survey on 7289 patients from nine countries. Diabetes Res Clin Pract 2017; 134:17-28. [PMID: 28951336 DOI: 10.1016/j.diabres.2017.07.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 07/05/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
AIMS Hypoglycemia constitutes a significant barrier to achieving glycemic control with insulin in both type 1 and type 2 diabetes. Historically, it has been difficult to accurately verify the rates of hypoglycemia within a clinical setting and there is a need for high-quality, real-world data to ascertain the true rates of hypoglycemia in clinical practice. The global Hypoglycemia Assessment Tool (HAT) study was designed to assess the global incidence of hypoglycemia in patients with insulin-treated diabetes, and the results have indicated that the overall incidence of hypoglycemia is high, with large variations between geographical regions. METHODS The International Operations HAT (IO HAT) study retrospectively and prospectively assessed the incidence of hypoglycemia in patients with insulin-treated diabetes in Bangladesh, Colombia, Egypt, Indonesia, Philippines, Singapore, South Africa, Turkey, and United Arab Emirates. RESULTS During the prospective period, hypoglycemic events were reported by 97.4% of patients with type 1 diabetes and 95.3% of those with type 2 diabetes, with an estimated rate of 6.86 events per patient per month (PPPM) for patients with type 1 diabetes and 2.37 events PPPM for patients with type 2 diabetes. CONCLUSIONS These results represent the first patient-reported dataset on hypoglycemia in the participating countries and confirm that hypoglycemia is under-reported and more widespread than previously believed. Although the incidence of hypoglycemia was variable among patients on different treatment regimens, there were substantial impacts on both productivity and healthcare utilization following an episode of hypoglycemia. This trial is registered at clinicaltrials.gov: NCT02306681.
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Affiliation(s)
- Rifat Emral
- Ankara University, Faculty of Medicine, Department of Endocrinology and Metabolic Diseases, Ankara, Turkey.
| | | | - Carlos Augusto Yepes Cortés
- Department of Internal Medicine and Endocrinology, Hospital Universitario Clínica San Rafael, Bogotá, Colombia.
| | | | | | - Ana Maria Gómez
- Department of Internal Medicine and Endocrinology, Medical Faculty of Javeriana University, Head of Endocrinology Unit, San Ignacio Hospital, Bogotá, Colombia.
| | - Angela Murphy
- Sunward Park Centre for Diabetes Excellence, Boksburg, South Africa.
| | - Salah Abusnana
- Rashid Center for Diabetes and Research, Al Jurf Ajman, Ajman, United Arab Emirates.
| | - Achmad Rudijanto
- Department of Internal Medicine, Medical Faculty of Brawijaya University, Kota Malang, Jawa Timur 65145, Indonesia.
| | - Anand Jain
- Novo Nordisk Region International Operations AG, Zurich, Switzerland.
| | - Zhulin Ma
- Novo Nordisk Region International Operations AG, Zurich, Switzerland.
| | - Roberto Mirasol
- Section of Endocrinology, Diabetes and Metabolism, St. Luke's Medical Center, Quezon City, Philippines.
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Iga R, Uchino H, Kanazawa K, Usui S, Miyagi M, Kumashiro N, Yoshino H, Ando Y, Hirose T. Glycemic Variability in Type 1 Diabetes Compared with Degludec and Glargine on the Morning Injection: An Open-label Randomized Controlled Trial. Diabetes Ther 2017; 8:783-792. [PMID: 28547206 PMCID: PMC5544606 DOI: 10.1007/s13300-017-0269-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Optimal adjustment of basal insulin to overcome hypoglycemia and glycemic variability (GV) depends on its duration of action and peak-less profile. Owing to the ability of long-acting basal insulin to avoid hypoglycemia, we titrated pre-meal glucose to normal fasting blood glucose, 80-110 mg/dL (4.5-6.1 mmol/L), and post-meal glucose to 80-140 mg/dL (4.5-7.8 mmol/L). The purpose of this study was to evaluate two basal insulin analogues degludec (IDeg) and glargine (IGlar), injected in the morning, for GV using continuous glucose monitoring (CGM) in type 1 diabetes (T1DM). METHODS In this crossover study, 20 Japanese patients with T1DM (age 54 ± 16 years, disease duration 16 ± 8 years, BMI 24 ± 4 kg/m2, HbA1c 7.4 ± 0.8%) were randomized into one of two different starting regimens, and CGM was conducted on three consecutive days during the last week of each 12-week titration period. Treatment satisfaction was assessed at the end of each treatment period using the Diabetes Therapy-Related Quality of Life Questionnaire (DTR-QOL). RESULTS There were no differences in HbA1c, total insulin dosage, body weight changes, and basal to bolus ratio between the IDeg and IGlar arms. The day-to-day variability in fasting interstitial GV on the CGM curves was significantly less in the IDeg than IGlar treatment period (25.9 ± 22.0 vs. 43.8 ± 30.1 mg/dl, p = 0.04). Other markers of GV, calculated by the EasyGV software, including mean amplitude of glycemic excursions (MAGE), J-index, total and nocturnal hypoglycemia were not different between the two treatment periods. The score of "satisfaction with treatment", a subdomain of the DTR-QOL system, was higher in the IDeg period. CONCLUSION Thus, the morning injection of the two long-acting insulin analogues seemed similar with regard to the magnitude of hypoglycemia in T1DM, but treatment with IDeg was associated with lower day-to-day variation in glucose level. These results suggest that IDeg is safe with minimal morning GV in patients with T1DM. CLINICAL TRIAL REGISTRATION Japanese Clinical Trials Registry, UMIN000012358.
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Affiliation(s)
- Ryo Iga
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Hiroshi Uchino
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan.
| | - Ken Kanazawa
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Shuki Usui
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Masahiko Miyagi
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Naoki Kumashiro
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Hiroshi Yoshino
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Yasuyo Ando
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Takahisa Hirose
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
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Marengo D, Giannotta F, Settanni M. Assessing personality using emoji: An exploratory study. PERSONALITY AND INDIVIDUAL DIFFERENCES 2017. [DOI: 10.1016/j.paid.2017.02.037] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dennick K, Sturt J, Speight J. What is diabetes distress and how can we measure it? A narrative review and conceptual model. J Diabetes Complications 2017; 31:898-911. [PMID: 28274681 DOI: 10.1016/j.jdiacomp.2016.12.018] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/21/2016] [Accepted: 12/23/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Diabetes distress is the negative emotional impact of living with diabetes. It has tangible clinical importance, being associated with sub-optimal self-care and glycemic control. Diabetes distress has been operationalized in various ways and several measures exist. Measurement clarity is needed for both scientific and clinical reasons. OBJECTIVES To clarify the conceptualization and operationalization of diabetes distress, identify and distinguish relevant measures, and evaluate their appropriateness for this purpose. RESULTS Six measures were identified: Problem Areas in Diabetes (PAID) scale, Diabetes Distress Scale (DDS); Type I Diabetes Distress Scale (T1-DDS), Diabetes-specific Quality of Life Scale-Revised (DSQoLs-R) 'Burden and Restrictions-Daily Hassles' sub-scale, Well-being Questionnaire 28 (W-BQ 28) 'Diabetes Well-being' sub-scale, and Illness Perceptions Questionnaire-Revised (IPQ-R) 'Emotional Representations' sub-scale. Across these measures a broad spectrum of diabetes distress is captured, including distress associated with treatment regimen, food/eating, future/complications, hypoglycemia, social/interpersonal relationships, and healthcare professionals. No single measure appears fully comprehensive. Limited detail of the qualitative work informing scale design is reported, raising concerns about content validity. CONCLUSIONS Across the available measures diabetes distress is seemingly comprehensively assessed and measures should be considered in terms of their focus and scope to ensure the foci of interventions are appropriately targeted.
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MESH Headings
- Combined Modality Therapy/adverse effects
- Combined Modality Therapy/psychology
- Cost of Illness
- Diabetes Complications/prevention & control
- Diabetes Complications/psychology
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/psychology
- Diabetes Mellitus, Type 2/therapy
- Humans
- Models, Psychological
- Psychosocial Support Systems
- Quality of Life
- Self-Management/psychology
- Stress, Psychological/complications
- Stress, Psychological/etiology
- Stress, Psychological/psychology
- Validation Studies as Topic
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Affiliation(s)
- Kathryn Dennick
- Florence Nightingale Faculty of Nursing and Midwifery, Kings College London, 57 Waterloo Road, London, SE1 8WA, UK.
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing and Midwifery, Kings College London, 57 Waterloo Road, London, SE1 8WA, UK
| | - Jane Speight
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, Victoria 3220, Australia; The Australian Centre for Behavioral Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne, Victoria 3000, Australia; AHP Research, 16 Walden Way, Hornchurch, Essex, UK
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Modeling predictors of changes in glycemic control and diabetes-specific quality of life amongst adults with type 1 diabetes 1 year after structured education in flexible, intensive insulin therapy. J Behav Med 2015; 38:817-29. [PMID: 26072044 DOI: 10.1007/s10865-015-9649-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/02/2015] [Indexed: 12/15/2022]
Abstract
Few studies have identified determinants of glycemic control (HbA1c) and diabetes-specific quality of life (DSQoL) in adults with type 1 diabetes. To identify factors predicting outcomes following structured diabetes education. 262 participants completed biomedical and questionnaire assessments before, and throughout 1 year of follow-up. The proportion of variance explained ranged from 28 to 62 % (DSQoLS) and 14-20 % (HbA1c). When change in psychosocial variables were examined, reduced hypoglycemia fear, lower 'perceived diabetes seriousness', greater self-efficacy and well-being predicted QoL improvements from baseline to 3-months. Increased frequency of blood glucose testing predicted improvements in HbA1c from baseline to 6-months. Greater benefits may be achieved if programs focus explicitly on psychosocial factors. Self-care behaviours did not predict HbA1c suggesting existing assessment tools need refinement. Evaluation of treatment mechanisms in self-management programs is recommended.
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Caswell AJ, Bond R, Duka T, Morgan MJ. Further evidence of the heterogeneous nature of impulsivity. PERSONALITY AND INDIVIDUAL DIFFERENCES 2015; 76:68-74. [PMID: 25844002 PMCID: PMC4316178 DOI: 10.1016/j.paid.2014.11.059] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 11/20/2014] [Accepted: 11/28/2014] [Indexed: 12/03/2022]
Abstract
Impulsivity is not a unitary construct and instead comprises dissociable subtypes. Reflection-impulsivity is a distinct and well-defined facet of impulsivity. Additional characterisations of motor-impulsivity are required. Several tasks purported to index impulsivity should be treated with caution. Researchers should employ multiple measures of types of impulsivity simultaneously.
‘Impulsivity’ refers to a range of behaviours including preference for immediate reward (temporal-impulsivity) and the tendency to make premature decisions (reflection-impulsivity) and responses (motor-impulsivity). The current study aimed to examine how different behavioural and self-report measurements of impulsivity can be categorised into distinct subtypes. Exploratory factor analysis using full information maximum likelihood was conducted on 10 behavioural and 1 self-report measure of impulsivity. Four factors of impulsivity were indicated, with Factor 1 having a high loading of the Stop Signal Task, which measures motor-impulsivity, factor 2 representing reflection-impulsivity with loadings of the Information Sampling Task and Matching Familiar Figures Task, factor 3 representing the Immediate Memory Task, and finally factor 4 which represents the Delay Discounting Questionnaire and The Monetary Choice Questionnaire, measurements of temporal-impulsivity. These findings indicated that impulsivity is not a unitary construct, and instead represents a series of independent subtypes. There was evidence of a distinct reflection-impulsivity factor, providing the first factor analysis support for this subtype. There was also support for additional factors of motor- and temporal-impulsivity. The present findings indicated that a number of currently accepted tasks cannot be considered as indexing motor- and temporal-impulsivity suggesting that additional characterisations of impulsivity may be required.
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Key Words
- BIS-11, Barratt Impulsiveness Scale
- DDT, Delay Discounting Task
- Factor analysis
- GNG, Go/NoGo Task
- Human
- IMT, Immediate Memory Task
- ISTfw, Information Sampling Task (fixed win condition)
- ISTrc, Information Sampling Task (reward conflict condition)
- Impulsivity
- Inhibitory control
- Laboratory measures
- MCQ, Monetary Choice Questionnaire
- MFF20, Matching Familiar Figures Task
- MI, motor-impulsivity
- Motor impulsivity
- RI, reflection-impulsivity
- Reflection impulsivity
- SKIP, Single Key Impulsivity Paradigm
- SST, Stop Signal Task
- TCIP, Two Choice Impulsivity Paradigm
- TI, temporal-impulsivity
- Temporal impulsivity
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Affiliation(s)
- Amy J. Caswell
- School of Psychology, University of Sussex, Brighton, UK
- Center for Alcohol and Addiction Studies, Brown University, USA
- Corresponding author at: Center for Alcohol and Addiction Studies, Brown University, Box G-S121-4, Providence, RI 02912, USA. Tel.: +1 (401) 863 6637.
| | - Rod Bond
- School of Psychology, University of Sussex, Brighton, UK
| | - Theodora Duka
- Sussex Addiction Research and Intervention Centre (SARIC), School of Psychology, University of Sussex, Brighton, UK
| | - Michael J. Morgan
- Sussex Addiction Research and Intervention Centre (SARIC), School of Psychology, University of Sussex, Brighton, UK
- Norwegian Center for Addiction Research, University of Oslo, Norway
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Heller S, Lawton J, Amiel S, Cooke D, Mansell P, Brennan A, Elliott J, Boote J, Emery C, Baird W, Basarir H, Beveridge S, Bond R, Campbell M, Chater T, Choudhary P, Clark M, de Zoysa N, Dixon S, Gianfrancesco C, Hopkins D, Jacques R, Kruger J, Moore S, Oliver L, Peasgood T, Rankin D, Roberts S, Rogers H, Taylor C, Thokala P, Thompson G, Ward C. Improving management of type 1 diabetes in the UK: the Dose Adjustment For Normal Eating (DAFNE) programme as a research test-bed. A mixed-method analysis of the barriers to and facilitators of successful diabetes self-management, a health economic analysis, a cluster randomised controlled trial of different models of delivery of an educational intervention and the potential of insulin pumps and additional educator input to improve outcomes. PROGRAMME GRANTS FOR APPLIED RESEARCH 2014. [DOI: 10.3310/pgfar02050] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BackgroundMany adults with type 1 diabetes cannot self-manage their diabetes effectively and die prematurely with diabetic complications as a result of poor glucose control. Following the positive results obtained from a randomised controlled trial (RCT) by the Dose Adjustment For Normal Eating (DAFNE) group, published in 2002, structured training is recommended for all adults with type 1 diabetes in the UK.AimWith evidence that blood glucose control is not always improved or sustained, we sought to determine factors explaining why some patients benefit from training more than other patients, identifying barriers to successful self-management, while developing other models to make skills training more accessible and effective.FindingsWe confirmed that glycaemic outcomes are not always improved or sustained when the DAFNE programme is delivered routinely, although improvements in psychosocial outcomes are maintained. DAFNE courses and follow-up support is needed to help participants instil and habituate key self-management practices such as regular diary/record keeping. DAFNE graduates need structured professional support following training. This is currently either unavailable or provided ad hoc without a supporting evidence base. Demographic and psychosocial characteristics had minimal explanatory power in predicting glycaemic control but good explanatory power in predicting diabetes-specific quality of life over the following year. We developed a DAFNE course delivered for 1 day per week over 5 weeks. There were no major differences in outcomes between this and a standard 1-week DAFNE course; in both arms of a RCT, glycaemic control improved by less than in the original DAFNE trial. We piloted a course delivering both the DAFNE programme and pump training. The pilot demonstrated the feasibility of a full multicentre RCT and resulted in us obtaining subsequent Health Technology Assessment programme funding. In collaboration with the National Institute for Health Research (NIHR) Diabetes Research Programme at King’s College Hospital (RG-PG-0606-1142), London, an intervention for patients with hypoglycaemic problems, DAFNE HART (Dose Adjustment for Normal Eating Hypoglycaemia Awareness Restoration Training), improved impaired hypoglycaemia awareness and is worthy of a formal trial. The health economic work developed a new type 1 diabetes model and confirmed that the DAFNE programme is cost-effective compared with no structured education; indeed, it is cost-saving in the majority of our analyses despite limited glycated haemoglobin benefit. Users made important contributions but this could have been maximised by involving them with grant writing, delaying training until the group was established and funding users’ time off work to maximise attendance. Collecting routine clinical data to conduct continuing evaluated roll-out is possible but to do this effectively requires additional administrator support and/or routine electronic data capture.ConclusionsWe propose that, in future work, we should modify the current DAFNE curricula to incorporate emerging understanding of behaviour change principles to instil and habituate key self-management behaviours that include key DAFNE competencies. An assessment of numeracy, critical for insulin dose adjustment, may help to determine whether or not additional input/support is required both before and after training. Models of structured support involving professionals should be developed and evaluated, incorporating technological interventions to help overcome the barriers identified above and enable participants to build effective self-management behaviours into their everyday lives.Trial registrationClinicalTrials.gov NCT01069393.FundingThe NIHR Programme Grants for Applied Research programme.
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Affiliation(s)
- Simon Heller
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Julia Lawton
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Debbie Cooke
- Division of Psychology, University College London, London, UK
| | - Peter Mansell
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Alan Brennan
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jackie Elliott
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jonathan Boote
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
- Centre for Research into Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Celia Emery
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Wendy Baird
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Hasan Basarir
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Susan Beveridge
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rod Bond
- School of Psychology, University of Sussex, Brighton, UK
| | - Mike Campbell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Timothy Chater
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Marie Clark
- Division of Psychology, University College London, London, UK
| | | | - Simon Dixon
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | | | - Richard Jacques
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jen Kruger
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Susan Moore
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Lindsay Oliver
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Tessa Peasgood
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - David Rankin
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Sue Roberts
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | | | - Carolin Taylor
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Praveen Thokala
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Gill Thompson
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Candice Ward
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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