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Mihevc M, Virtič Potočnik T, Zavrnik Č, Šter MP, Klemenc-Ketiš Z, Poplas Susič A. Beyond diagnosis: Investigating factors influencing health-related quality of life in older people with type 2 diabetes in Slovenia. Prim Care Diabetes 2024; 18:157-162. [PMID: 38320938 DOI: 10.1016/j.pcd.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/11/2024] [Accepted: 01/21/2024] [Indexed: 02/08/2024]
Abstract
AIMS To examine the present state of health-related quality of life (HRQOL) among elderly individuals with type 2 diabetes (T2D) receiving integrated care and identify risk factors associated with low HRQOL. METHODS A multi-centre cross-sectional survey among elderly individuals with T2D, treated in Slovenian urban and rural primary care settings was performed. HRQOL was investigated using EuroQol 5-dimension (EQ-5D) questionnaire and Appraisal of Diabetes Scale (ADS). Furthermore, socio-demographic, clinical, and laboratory data were collected. Low HRQOL was defined as EQ-5D utility score <10%. Statistical analysis was performed using univariate and multivariate binary logistic regression statistics. RESULTS Examining 358 people with median age of 72 (range 65-98) years and with a mean EQ-5D utility score of 0.80, the study found that lower HRQOL correlated with older age, higher body mass index (BMI), lower education, elevated depressive symptoms, increased challenges across all EQ-5D dimensions, and less favourable appraisal of diabetes. When considering age, gender, education, and HbA1c, the main predictors of low HRQOL were BMI (OR 1.35, 95% CI 1.04-1.76, p = 0.025) and ADS score (OR 1.63, 95% CI 1.13-2.35, p = 0.009). CONCLUSIONS To improve HRQOL, integrated care models should consider interventions that target mental health, obesity prevention, chronic pain management, diabetes education, self-management, and treatment plan personalisation.
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Affiliation(s)
- Matic Mihevc
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, SI-1000 Ljubljana, Slovenia; Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Metelkova ulica 9, SI-1000 Ljubljana, Slovenia.
| | - Tina Virtič Potočnik
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Metelkova ulica 9, SI-1000 Ljubljana, Slovenia; University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska ulica 8, SI-2000 Maribor, Slovenia
| | - Črt Zavrnik
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, SI-1000 Ljubljana, Slovenia; Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Metelkova ulica 9, SI-1000 Ljubljana, Slovenia
| | - Marija Petek Šter
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, SI-1000 Ljubljana, Slovenia
| | - Zalika Klemenc-Ketiš
- Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Metelkova ulica 9, SI-1000 Ljubljana, Slovenia; University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska ulica 8, SI-2000 Maribor, Slovenia
| | - Antonija Poplas Susič
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, SI-1000 Ljubljana, Slovenia; Primary Healthcare Research and Development Institute, Community Health Centre Ljubljana, Metelkova ulica 9, SI-1000 Ljubljana, Slovenia
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Mikkonen U, Voutilainen A, Mikola T, Roponen J, Rajapolvi S, Lehto SM, Ruusunen A, Mäntyselkä P. The effects of motivational self-care promotion on depressive symptoms among adults with type 2 diabetes: A systematic review and meta-analysis. Prev Med Rep 2023; 36:102431. [PMID: 37771374 PMCID: PMC10523005 DOI: 10.1016/j.pmedr.2023.102431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/16/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
In individuals with type 2 diabetes (T2D), comorbid depression leads to increased health care costs and unsatisfactory treatment outcomes. Supporting healthy behaviors and self-efficacy might provide means to prevent depressive symptoms. We assessed the effects of motivational interviewing (MI) - based self-care promotion that specifically targets health behaviors, on depressive symptoms in adults with T2D. We followed PRISMA guidelines and searched Pubmed, Scopus, PsycINFO, Cinahl, and Cochrane Library to find randomized controlled trials (RCTs) published up to February 2023. Eligible RCTs had to target the T2D adult population, examine MI-based interventions that focus on multiple health behaviors, and measure depressive symptoms on a validated scale. Standardized mean differences (SMD) with 95% confidence intervals were calculated using a random-effects model. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of the evidence. After the screening, eleven studies with 2,682 individuals were eligible for the narrative synthesis. A meta-analysis of nine studies favored interventions with a pooled SMD of -0.19 (95% Cl = -0.34 to -0.05, p = 0.008, I2 = 52%). Due to the indirectness and imprecision of the evidence, we assessed the certainty of evidence based on GRADE as low. MI-based self-care promotion with a focus on health behaviors and implemented by a well MI-trained person had a preventive effect on depressive symptoms among adults with T2D. However, the certainty of evidence remained low. In future trials, the effect of MI-based self-care promotion on depression should be studied in clinically depressed populations.
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Affiliation(s)
- Ulla Mikkonen
- Institute Of Public Health and Clinical Nutrition, University Of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
- Primary Health Care Center, Wellbeing Services County of North Savo, P.O. Box 1711, FI-70211 Kuopio, Finland
| | - Ari Voutilainen
- Institute Of Public Health and Clinical Nutrition, University Of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Tuomas Mikola
- Institute Of Clinical Medicine, University Of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Johanna Roponen
- Institute Of Public Health and Clinical Nutrition, University Of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Sanna Rajapolvi
- Institute Of Public Health and Clinical Nutrition, University Of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Soili M. Lehto
- Institute Of Clinical Medicine, University Of Oslo, P.O. Box 1171 - Blindern, 0318 Oslo, Norway
- R&D Department, Division Of Mental Health Services, Akershus University Hospital, 1478 Lørenskog, Norway
- Department Of Psychiatry, University Of Helsinki, P.O. Box 22, FI-00014 University Of Helsinki, Finland
| | - Anu Ruusunen
- Institute Of Public Health and Clinical Nutrition, University Of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
- Department Of Psychiatry, Kuopio University Hospital, Wellbeing Services County of North Savo, P.O. Box 1711, FI-70211 Kuopio, Finland
- Deakin University, Institute For Mental And Physical Health And Clinical Translation (IMPACT), Food & Mood Centre, School Of Medicine, Barwon Health, P.O. Box 281 Geelong, Victoria 3220, Australia
| | - Pekka Mäntyselkä
- Institute Of Public Health and Clinical Nutrition, University Of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
- Clinical Research And Trials Centre, Kuopio University Hospital, Wellbeing Services County Of North Savo, P.O. Box 1711, FI-70211 Kuopio, Finland
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Sridhar GR. Can the management of depression in type 2 diabetes be democratized? World J Diabetes 2022; 13:203-212. [PMID: 35432759 PMCID: PMC8984566 DOI: 10.4239/wjd.v13.i3.203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/07/2022] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
Both type 2 diabetes and depression are common and are projected to increase. There is increasing evidence for a bidirectional relationship between the two. Diabetes is a risk factor for depression; contrariwise, individuals with depression are at greater risk of developing diabetes. They are a burden for both the individual and the society. Co-existent depression worsens diabetic control because of obesity, insulin resistance and the adverse metabolic effects of anti-diabetes medicines. In addition, compliance to lifestyle measures required for diabetes is also compromised such as following a specific diet, taking proper medications on time, getting metabolic parameters assessed and maintaining a sleep cycle. Depression occurs in many grades; mild depression is more common in diabetes than frank or full-blown depression leading to suicide. Unfortunately, there are not enough trained and accessible mental health professionals such as psychologists or psychiatrists to deal with the increasing burden of depression in diabetes. Therefore, alternate models for management of mild to moderate depression are required. There is evidence that a team-approach by employing health care assistants can lower the risk of cardiac risk factors. INtegrating DEPrEssioN and Diabetes treatmENT study was carried out to determine whether the team-approach using non-health care professionals could be effective in managing mild to moderate depression and to study its effects on metabolic parameters among subjects with type 2 diabetes mellitus. The international study, carried out in four independent centers in India assessed the impact of a trained but not qualified non-psychiatrist in coordinating and forming a fulcrum between the patient, the family and the consultant endocrinologist/diabetologist. The interventions were fine-tuned to be culturally appropriate by qualitative interviews before they began. It was shown that the outcomes of both depression and diabetes could be improved by the employment of a clinical care coordinator. It is possible to scale up the studies to wider geographical areas and health-care organizations.
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Affiliation(s)
- Gumpeny R Sridhar
- Department of Endocrinology, Endocrine & Diabet Ctr, Visakhapatnam 530002, India
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Lian WC, Livneh H, Huang HJ, Lu MC, Guo HR, Tsai TY. Adding Pay-for-Performance Program to Routine Care Was Related to a Lower Risk of Depression Among Type 2 Diabetes Patients in Taiwan. Front Public Health 2021; 9:650452. [PMID: 34722429 PMCID: PMC8548469 DOI: 10.3389/fpubh.2021.650452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Patients with type 2 diabetes (T2DM) often experience depression during treatment, negatively influencing their treatment compliance and clinical outcomes. Recently, the pay-for-performance (P4P) program for chronic diseases, with high-cost and high-risk feature, such as T2DM, has been implemented and has been operational for several years. Nevertheless, its effect on the risk of developing depression among T2DM cases is unknown. This study aims to explore the association of P4P use with the subsequent risk of developing depression among these patients. Methods: This cohort study used a nationwide health insurance database to identify patients 20-70 years of age newly diagnosed with T2DM who enrolled in the P4P program between 2001 and 2010. From this group, we enrolled 17,022 P4P users and then 17,022 non-P4P users who were randomly selected using propensity-score-matching. Enrolled patients were followed until the end of 2012 to record the occurrence of depression. The Cox proportional hazards regression was utilized to obtain the adjusted hazard ratio (aHR) for P4P use. Results: During the study period, a total of 588 P4P users and 1,075 non-P4P users developed depression at incidence rates of 5.89 and 8.41 per 1,000 person-years, respectively. P4P users had a lower depression risk than did non-P4P users (aHR, 0.73; 95% Confidence Interval, 0.65-0.80). This positive effect was particularly prominent in those receiving high-intensity use of the P4P program. Conclusion: Integrating P4P into routine care for patients with T2DM may have beneficial effects on curtailing the subsequent risk of depression.
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Affiliation(s)
- Wei-Cheng Lian
- Division of Metabolism and Endocrinology, Department of Internal Medicine, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Hanoch Livneh
- Rehabilitation Counseling Program, Portland State University, Portland, OR, United States
| | - Hui-Ju Huang
- Department of Nursing, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan
| | - Ming-Chi Lu
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Division of Allergy, Immunology and Rheumatology, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Occupational Safety, Health, and Medicine Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Tzung-Yi Tsai
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Medical Research, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan.,Department of Nursing, Tzu Chi University of Science and Technology, Hualien, Taiwan
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