The influence of depression and anxiety on outcomes after an intervention for prediabetes

Psychometric properties of the Diabetes Empowerment Scale Modified Version-Spanish, tested in an at-risk Latino immigrant population

BACKGROUND

Latino populations are at high risk of developing diabetes; however, few scales measure self-efficacy to change health behaviours in at-risk Latino individuals. The Diabetes Empowerment Scale was translated into Spanish, and its psychometric properties were tested.

METHODS

This descriptive investigation was conducted with adults in a predominately Latino Midwest community. Participants (N = 141) completed a modified version of the Diabetes Empowerment Scale, which measures self-efficacy in exercising and healthy eating. Factor analysis was performed on completed surveys. Recruitment in Latino cultural centres and parishes took place from June 2016 to May 2017.

RESULTS

Three factors emerged: self-efficacy to exercise, emotional eating and social eating. Three scale questions had low scores during analysis; however, overall, the tool demonstrated adequate validity.

CONCLUSIONS

The Diabetes Empowerment Scale Modified Version-Spanish demonstrated adequate reliability and validity. Healthy dietary preferences and physical activity in populations at-risk for diabetes should be assessed by nurses to ascertain level of self-efficacy in individuals by assessing confidence to engage in specific healthy behaviours.

Negative emotions in community-dwelling adults with prediabetes and hypertension

Objective

The purpose of this study was to investigate negative emotions and factors related to the risk of mental disorders in individuals with prediabetes and hypertension.

Methods

A total of 504 community-dwelling adult men and women in Suzhou, China, were enrolled and questionnaires used to obtain sociodemographic data, anxiety and depression scores, and current status of common metabolic indicators, including blood glucose level and blood pressure.

Results

Anxiety and depression scores in participants with prediabetes and hypertension were significantly higher than those in participants with normal blood glucose levels and normal blood pressure. Correlation analysis revealed that age, sex, smoking, duration of disease, physical activity, blood pressure and fasting plasma glucose levels were key factors accelerating the progression to both anxiety and depression in all participants.

Conclusions

More attention should be paid to negative emotions in individuals with prediabetes and hypertension. These findings could help to inform health providers in developing interventions for this population.

Comorbid elevated symptoms of anxiety and depression in adults with type 1 or type 2 diabetes: Results from the International Diabetes MILES Study

AIMS

We examined: (a) the prevalence of comorbid elevated symptoms of anxiety/depression; (b) its demographic/clinical correlates; (c) associations with self-care behaviors, by diabetes type.

METHODS

Cross-sectional self-report data of 6590 adults with diabetes (42% type 1; 58% type 2) from the Australian and Dutch Diabetes MILES studies were used. Elevated symptoms of anxiety/depression were defined as GAD-7 ≥ 10/PHQ-9 ≥ 10.

RESULTS

In both diabetes types, comorbid elevated symptoms of anxiety/depression were present in 9% and symptoms of anxiety alone in 2%; symptoms of depression alone were present in 8% of adults with type 1 diabetes and 11% with type 2 diabetes. Shorter diabetes duration (type 1 only) was the only characteristic that distinguished those with comorbid elevated symptoms of anxiety/depression but not those with symptoms of anxiety/depression alone from the reference group (no/minimal symptoms of anxiety/depression). Those with comorbid elevated symptoms of anxiety/depression had increased odds of sub-optimal diabetes self-care behaviors compared with the reference group, with higher odds than those with symptoms of anxiety or depression alone.

CONCLUSIONS

Comorbid elevated symptoms of anxiety/depression affected one in ten respondents, who also had increased odds of suboptimal diabetes self-care. Those with shorter type 1 diabetes duration may be at increased risk.

Psychosocial Predictors of Weight Loss among American Indian and Alaska Native Participants in a Diabetes Prevention Translational Project

The association of psychosocial factors (psychological distress, coping skills, family support, trauma exposure, and spirituality) with initial weight and weight loss among American Indians and Alaska Natives (AI/ANs) in a diabetes prevention translational project was investigated. Participants (n = 3,135) were confirmed as prediabetic and subsequently enrolled in the Special Diabetes Program for Indians Diabetes Prevention (SDPI-DP) demonstration project implemented at 36 Indian health care programs. Measures were obtained at baseline and after completing a 16-session educational curriculum focusing on weight loss through behavioral changes. At baseline, psychological distress and negative family support were linked to greater weight, whereas cultural spirituality was correlated with lower weight. Furthermore, psychological distress and negative family support predicted less weight loss, and positive family support predicted greater weight loss, over the course of the intervention. These bivariate relationships between psychosocial factors and weight remained statistically significant within a multivariate model, after controlling for sociodemographic characteristics. Conversely, coping skills and trauma exposure were not significantly associated with baseline weight or change in weight. These findings demonstrate the influence of psychosocial factors on weight loss in AI/AN communities and have substantial implications for incorporating adjunctive intervention components.

Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: A Systematic Review for the Community Preventive Services Task Force

BACKGROUND

Trials have shown efficacy of rigorous diet and physical activity promotion programs to reduce diabetes incidence and improve glycemic measures in adults at increased risk for type 2 diabetes.

PURPOSE

To evaluate diet and physical activity promotion programs for persons at increased risk for type 2 diabetes, primarily to reduce diabetes risk and decrease body weight and glycemia.

DATA SOURCES

MEDLINE, the Cochrane Central Register of Controlled Trials, CAB Abstracts, Global Health, and Ovid HealthSTAR from 1991 through 27 February 2015, with no language restriction.

STUDY SELECTION

8 researchers screened articles for single-group or comparative studies of combined diet and physical activity promotion programs with at least 2 sessions over at least 3 months in participants at increased risk for type 2 diabetes.

DATA EXTRACTION

7 researchers extracted data on study design; participant, intervention, and outcome descriptions; and results and assessed study quality.

DATA SYNTHESIS

53 studies (30 of diet and physical activity promotion programs vs. usual care, 13 of more intensive vs. less intensive programs, and 13 of single programs) evaluated 66 programs. Compared with usual care, diet and physical activity promotion programs reduced type 2 diabetes incidence (risk ratio [RR], 0.59 [95% CI, 0.52 to 0.66]) (16 studies), decreased body weight (net change, -2.2% [CI, -2.9% to -1.4%]) (24 studies) and fasting blood glucose level (net change, -0.12 mmol/L [-2.2 mg/dL] [CI, -0.20 to -0.05 mmol/L {-3.6 to -0.9 mg/dL}]) (17 studies), and improved other cardiometabolic risk factors. Evidence for clinical events was limited. More intensive programs were more effective.

LIMITATIONS

Wide variation in diet and physical activity promotion programs limited identification of features most relevant to effectiveness. Evidence on clinical outcomes and in children was sparse.

CONCLUSION

Combined diet and physical activity promotion programs are effective at decreasing diabetes incidence and improving cardiometabolic risk factors in persons at increased risk. More intensive programs are more effective.

PRIMARY FUNDING SOURCE

Centers for Disease Control and Prevention Community Preventive Services Task Force.

Can the Onset of Type 2 Diabetes Be Delayed by a Group-Based Lifestyle Intervention in Women with Prediabetes following Gestational Diabetes Mellitus (GDM)? Findings from a Randomized Control Mixed Methods Trial

OBJECTIVE

To evaluate a 12-week group-based lifestyle intervention programme for women with prediabetes following gestational diabetes (GDM).

DESIGN

A two-group, mixed methods randomized controlled trial in which 50 women with a history of GDM and abnormal glucose tolerance postpartum were randomly assigned to intervention (n = 24) or wait control (n = 26) and postintervention qualitative interviews with participants.

MAIN OUTCOME MEASURES

Modifiable biochemical, anthropometric, behavioural, and psychosocial risk factors associated with the development of type 2 diabetes. The primary outcome variable was the change in fasting plasma glucose (FPG) from study entry to one-year follow-up.

RESULTS

At one-year follow-up, the intervention group showed significant improvements over the wait control group on stress, diet self-efficacy, and quality of life. There was no evidence of an effect of the intervention on measures of biochemistry or anthropometry; the effect on one health behaviour, diet adherence, was close to significance.

CONCLUSIONS

Prevention programmes must tackle the barriers to participation faced by this population; home-based interventions should be investigated. Strategies for promoting long-term health self-management need to be developed and tested.

A smart web aid for preventing diabetes in rural China: preliminary findings and lessons

BACKGROUND

Increasing cases of diabetes, a general lack of routinely operational prevention, and a long history of separating disease prevention and treatment call for immediate engagement of frontier clinicians. This applies especially to village doctors who work in rural China where the majority of the nation's vast population lives.

OBJECTIVE

This study aims to develop and test an online Smart Web Aid for Preventing Type 2 Diabetes (SWAP-DM2) capable of addressing major barriers to applying proven interventions and integrating diabetes prevention into routine medical care.

METHODS

Development of SWAP-DM2 used evolutionary prototyping. The design of the initial system was followed by refinement cycles featuring dynamic interaction between development of practical and effective standardized operation procedures (SOPs) for diabetes prevention and Web-based assistance for implementing the SOPs. The resulting SOPs incorporated proven diabetes prevention practices in a synergetic way. SWAP-DM2 provided support to village doctors ranging from simple educational webpages and record maintenance to relatively sophisticated risk scoring and personalized counseling. Evaluation of SWAP-DM2 used data collected at baseline and 6-month follow-up assessment: (1) audio recordings of service encounters; (2) structured exit surveys of patients' knowledge, self-efficacy, and satisfaction; (3) measurement of fasting glucose, body mass index, and blood pressure; and (4) qualitative interviews with doctors and patients. Data analysis included (1) descriptive statistics of patients who received SWAP-DM2-assisted prevention and those newly diagnosed with prediabetes and diabetes; (2) comparison of the variables assessed between baseline and follow-up assessment; and (3) narratives of qualitative data.

RESULTS

The 17 participating village doctors identified 2219 patients with elevated diabetes risk. Of these, 84.85% (1885/2219) consented to a fasting glucose test with 1022 new prediabetes and 113 new diabetes diagnoses made within 6 months. The prediabetic patients showed substantial improvement from baseline to 6-month follow-up in vegetable intake (17.0%, 43/253 vs 88.7%, 205/231), calorie intake (1.6%, 4/253 vs 71.4%, 165/231), leisure-time exercises (6.3%, 16/253 vs 21.2%, 49/231), body weight (mean 62.12 kg, SD 9.85 vs mean 58.33 kg, SD 9.18), and body mass index (mean 24.80 kg/m(2), SD 3.21 vs mean 23.36 kg/m(2), SD 2.95). The prediabetic patients showed improvement in self-efficacy for modifying diet (mean 5.31, SD 2.81 vs mean 8.53, SD 2.25), increasing physical activities (mean 4.52, SD 3.35 vs mean 8.06, SD 2.38), engaging relatives (mean 3.93, SD 3.54 vs mean 6.93, SD 2.67), and knowledge about diabetes and risks of an imbalanced diet and inadequate physical activity. Most participating doctors and patients viewed SWAP-DM2 as useful and effective.

CONCLUSIONS

SWAP-DM2 is helpful to village doctors, acceptable to patients, and effective in modifying immediate determinants of diabetes at least in the short term, and may provide a useful solution to the general lack of participation in diabetes prevention by frontier clinicians in rural China.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number (ISRCTN): 66772711; http://www.controlled-trials.com/ISRCTN66772711.

'I saw what the future direction would be...': experiences of diabetes risk and physical activity after diabetes screening

OBJECTIVES

To improve understanding of how individuals at high risk of type 2 diabetes experience the risk of diabetes and how these experiences relate to the adoption of physical activity as a protective behaviour.

DESIGN

A qualitative study using semi-structured interview with individuals identified by screening as at high risk of type 2 diabetes.

METHODS

Fourteen individuals, aged 40-64, were interviewed twice, with a 2-year interval between. Participants' experiences of their risk of diabetes and physical activity were assessed. The transcribed interview data were analysed using inductive qualitative content analysis.

RESULTS

Two themes emerged from the data: a threatening risk perception and a rejected risk perception. The threatening risk perception occurred when the risk was unexpected by the participant, but became internalized through the screening procedure. The threatening perception also involved a commitment to increase physical activity to prevent diabetes. However, short-term anxiety and subsequently emerging hopelessness were also part of this perception. The rejected risk perception involved indifference and scepticism regarding the risk. Here, physical activity behaviour and cognitions appeared to remain unchanged. Rejection also involved difficulties in accepting one's high-risk identity. The rejecting group lacked motivation for increased physical activity, while the other group showed determination regarding increased physical activity, often leading to success.

CONCLUSION

Perceptions of the risk of diabetes emerged as threatening or as rejected. Participants' perceptions reflected varying and intertwining emotional, cognitive, and behavioural mechanisms for coping with the risk, all of which should be recognized in promoting physical activity among high-risk individuals. Statement of contribution What is already known on this subject? Diabetes screening has few adverse psychological effects on screened individuals. Diabetes can be prevented by increased physical activity and modest weight loss among high-risk individuals. The evidence on the effects of screening on protective behaviour is limited and inconsistent. What does this study add? High-risk individuals' threatening perception of risk appears encouraging increased physical activity. Individuals having problems in adjusting to high-risk identification may not be motivated to engage in physical activity for prevention. Failure to achieve the outcomes expected from lifestyle changes may lead people with threatening risk perception to a sense of hopelessness.

Positive psychological characteristics in diabetes: a review

Positive psychological characteristics, such as optimism, self-efficacy, and resilience, have been increasingly associated with improved outcomes in medically ill individuals. However, there has been minimal systematic review of these characteristics and their associations with outcomes in people with diabetes. We aim to review these associations, their potential mediating mechanisms, and the evidence supporting interventions targeting these qualities. In people with diabetes, positive psychological characteristics are significantly associated with improved glycemic control, fewer complications, and reduced rates of mortality. Potential mechanisms mediating these associations include behavioral factors (e.g., improved treatment adherence), reduced inflammation, and improved neuroendocrine and autonomic functioning. Most psychosocial treatments in this population have focused on improving self-efficacy and resilience; such interventions may improve quality of life, well-being, and diabetes self-care. While untested in diabetes, interventions to boost other positive characteristics have been effective in other medically ill patients and may warrant further study in this cohort.

Reducing psychological distress and obesity through Yoga practice

Background:

Yoga practice has been effectively prescribed in conjunction with other medical and yogic procedures in the management of severe psychosomatic diseases, including cancer, bronchial asthma, colitis, peptic and ulcer. It improves strength and flexibility, and may help control physiological variables such as blood pressure, lipids, respiration, heart rate, and metabolic rate to improve overall exercise capacity.

Aim of the study:

The aim of this study is to evaluate the effects of Yogic Practice on anxiety/depression associated with obesity.

Materials and Methods:

Patients were recruited from the Department of Physiology, C.S.M. Medical University (erstwhile KGMU), Lucknow, Uttar Pradesh, India. A total of 272 subjects were divided into two groups: 1) group of 205 subjects (with yogic practice) and 2) a control group of 67 subjects (with aerobic exercise). Assessment of anxiety and depression were done by Hamilton Rating Scale.

Result:

This study supports yoga as an effective tool with no diet restriction to improve anxiety and depression symptoms as well as obesity in obese subjects

Conclusion:

Incorporating yogic asana in the treatment protocol of patients suffering from anxiety and depression may prove beneficial in the long run

Reducing psychological distress and obesity in Australian farmers by promoting physical activity

BACKGROUND

Studies have confirmed that the rate of mental illness is no higher in rural Australians than that of urban Australians. However, the rate of poor mental health outcomes, and in particular suicide, is significantly raised in rural populations. This is thought to be due to lack of early diagnosis, health service access, the distance-decay effect, poor physical health determinants and access to firearms. Research conducted by the National Centre for Farmer Health between 2004 and 2009 reveals that there is a correlation between obesity and psychological distress among the farming community where suicide rates are recognised as high. Chronic stress overstimulates the regulation of the hypothalamic-pituitary-adrenal (HPA) axis that is associated with abdominal obesity. Increasing physical activity may block negative thoughts, increase social contact, positively influence brain chemistry and improve both physical and mental health. This paper describes the design of the Farming Fit study that aims to identify the effect of physical activity on psychological distress, obesity and health behaviours such as diet patterns and smoking in farm men and women.

METHODS/DESIGN

For this quasi-experimental (convenience sample) control-intervention study, overweight (Body Mass Index ≥25 kg/m(2)) farm men and women will be recruited from Sustainable Farm Families™ (SFF) programs held across Victoria, Australia. Baseline demographic data, health data, depression anxiety stress scale (DASS) scores, dietary information, physical activity data, anthropometric data, blood pressure and biochemical analysis of plasma and salivary cortisol levels will be collected. The intervention group will receive an exercise program and regular phone coaching in order to increase their physical activity. Analysis will evaluate the impact of the intervention by longitudinal data (baseline and post intervention) comparison of intervention and control groups.

DISCUSSION

This study is designed to examine the effect of physical activity on psychological health and other co-morbidities such as obesity, impaired glucose tolerance, hypertension and dyslipidaemia within a high-risk cohort. The outcomes of this research will be relevant to further research and service delivery programs, in particular those tailored to rural communities.

TRIAL REGISTRATION

ACTRN12610000827033.

Farming fit? Dispelling the Australian agrarian myth

Background

Rural Australians face a higher mental health and lifestyle disease burden (obesity, diabetes and cardiovascular disease) than their urban counterparts. Our ongoing research reveals that the Australian farming community has even poorer physical and mental health outcomes than rural averages. In particular, farm men and women have high rates of overweightness, obesity, abdominal adiposity, high blood pressure and psychological distress when compared against Australian averages. Within our farming cohort we observed a significant association between psychological distress and obesity, abdominal adiposity and body fat percentage in the farming population.

Presentation of hypothesis

This paper presents a hypothesis based on preliminary data obtained from an ongoing study that could potentially explain the complex correlation between obesity, psychological distress and physical activity among a farming population. We posit that spasmodic physical activity, changing farm practices and climate variability induce prolonged stress in farmers. This increases systemic cortisol that, in turn, promotes abdominal adiposity and weight gain.

Testing the hypothesis

The hypothesis will be tested by anthropometric, biochemical and psychological analysis matched against systemic cortisol levels and the physical activity of the subjects.

Implications of the hypothesis tested

Previous studies indicate that farming populations have elevated rates of psychological distress and high rates of suicide. Australian farmers have recently experienced challenging climatic conditions including prolonged drought, floods and cyclones. Through our interactions and through the media it is not uncommon for farmers to describe the effect of this long-term stress with feelings of 'defeat'. By gaining a greater understanding of the role cortisol and physical activity have on mental and physical health we may positively impact the current rates of psychological distress in farmers.

Trial registration

ACTRN12610000827033

Can the onset of type 2 diabetes be delayed by a group-based lifestyle intervention? A randomised control trial

This study was a randomised control trial with a waiting control group. It was designed to evaluate the effectiveness of a 6-month, group-based diabetes prevention programme, The Healthy Living Course and assess whether participation in the programme led to changes in modifiable risk factors for type 2 diabetes among an already at-risk pre-diabetic population. Individuals designated at risk for diabetes by their general practitioners (GPs) were screened using an Oral Glucose Tolerance Test. Volunteers (N = 307) with pre-diabetes were assigned to an intervention or wait-control group in the ratio of approximately 2 : 1. The sample was pre-tested on biochemical, anthropometric and self-report behavioural, cognitive and mood variables and post-tested either at the end of the educational/support-based lifestyle programme or the end of the wait period. The intervention group significantly improved their diabetes knowledge, motivation to change, positive affect, healthy eating and activity levels and showed significantly greater reductions in weight, body mass index, waist circumference, diastolic blood pressure and fasting plasma glucose in comparison with controls. The intervention group also changed their diagnostic status from pre-diabetes to non-diabetes at a greater rate than the wait group (43% vs. 26%) who received standard care from their GPs.