Associations Between Social Support and Diabetes-Related Distress in People With Type 2 Diabetes Mellitus

Predictors of Diabetes Self-Management Behaviour Among Type 2 Diabetics in Saudi Arabia: A Cross-Sectional Study

Background

Type 2 Diabetes Mellitus (T2DM) requires effective self-care behaviors and social support to manage the condition and prevent complications. This study aimed to examine the influence of demographic characteristics and perceived social support on diabetes self-management behaviors in individuals with T2DM.

Methods

An analytical cross-sectional design was employed to collect data from 300 T2DM patients using validated questionnaires from April to May 2023. Self-care behaviors were assessed using a Summary of Diabetes Self-Care Activities-Arabic (SDSCA-Arabic), while perceived social support was measured using a Diabetes Care Profile (DCP) using an Arabic Social Support subscale. Descriptive statistics, correlation analysis, and regression analysis were performed to examine the relationships and predictors of self-care behaviors.

Results

Patients exhibited varying levels of self-care behaviors, with exercise and blood sugar testing being the most frequently reported activities. Additionally, the findings revealed that health education on self-examining regarding the feet, exercising, comorbidities, perceived social support, medical insurance, and gender were significant predictors of diabetes self-management behaviors. These factors collectively accounted for 21.2% of the variance in self-management behavior levels. Specifically, health education on self-examining regarding the feet (β = -0.286, p = 0.001) and exercising (β = -0.175, p = 0.001) showed a negative association, while perceived social support (β = 0.235, p = 0.001) demonstrated a positive association with self-management behaviors.

Conclusion

The study highlights the importance of comprehensive health education programs that address multiple aspects of diabetes management and the role of social support in fostering better self-management behaviors. It also emphasizes the influence of demographic factors on self-management, with individuals with higher comorbidities exhibiting better self-management behaviors and those with medical insurance showing poorer self-management behaviors. These findings have implications for nursing practice, suggesting the need for tailored interventions, effective education, and support networks to enhance self-management behaviors in T2DM patients.

Older Chinese and Filipino American Immigrants with Type 2 Diabetes and their Adult Child: A Qualitative Dyadic Exploration of Family Support

Type 2 Diabetes (T2D) among older Asian American immigrants (AA) is a growing concern. Asian Americans represent 9% of diagnosed diabetes. Very little is known on how older Asian American immigrants with T2D navigate diabetes management, in particular the role of family support. This qualitative study examines Chinese and Filipino Americans, the two largest Asian subgroups in the US (4.2 million, and 3.6 million, respectively), and family support dynamics among adult children and their parents diagnosed with T2D. Ten dyads (n = 20) made up of adult children and aging parents participated in in-depth and dyadic interviews. Results indicate that family support occurs in a trajectory of stages. The following thematic patterns emerged in these dyads around support: independence, transitions, partnership, and stepping in. The findings point to various supportive stages that Asian American adult children and aging parents with T2D experience and the importance of developing supportive interventions for both adult children and aging parents at these various stages.

Relationship between delay discounting, delay aversion and psychosocial domains of diabetes care

PURPOSE

Delay discounting and aversion are important areas for diabetes management; however, little has been done to understand the relationship with psychosocial outcomes among adults with type 2 diabetes.

METHODS

This study used data from 365 adults with type 2 diabetes to evaluate relationships between delay discounting and aversion and psychosocial outcomes. Delay discounting and aversion were measured with the validated Quick Delay Questionnaire. Psychosocial outcomes included depression, measured by the PHQ, anxiety by the GAD scale, perceived stress by the PSS, and social support by the Duke Social Support and Stress Scale. Multiple linear regression was used to assess the relationship between delay discounting and aversion on psychological health and social support controlling for relevant covariates.

RESULTS

Mean age of the sample was 61.8 years, 54.5 % were NHB, 41.8 % NHW, and 3.7 % Hispanic/Other. After adjusting for covariates, delay aversion was significantly associated with depression (beta = 0.35; p < 0.001), anxiety (beta = 0.52; p < 0.001), perceived stress (beta = 0.22; p < 0.001), and lower family support (beta = -0.62; p < 0.05). Delay discounting was significantly associated with depression (beta = 0.32; p < 0.001), anxiety (beta = 0.46; p < 0.001), and perceived stress (beta = 0.26; p < 0.001).

LIMITATIONS

This data is cross-sectional, future work should examine the longitudinal relationship while also including additional psychosocial outcomes.

CONCLUSIONS

Delay discounting and aversion are significantly associated with poor psychosocial outcomes, including lower social support. As the body of evidence grows, additional research is needed to better understand the construct, mechanisms, and the impact of choice settings to better inform intervention development.

From Zero to Hero: Type 2 Diabetes Mellitus Patients Hike on the Way of St. James-A Feasibility Study with Analyses of Patients' Quality of Life, Diabetes Distress and Glucose Profile

This study investigates the feasibility of an accompanied 5-day hiking tour (Way of St. James) for type 2 diabetes mellitus (T2DM) patients and its impact on their quality of life/well-being, diabetes distress and glucose profile. Twenty-three T2DM patients (with and without insulin therapy) participated in the study. The 120 km pilgrimage (from Ferrol to Santiago de Compostela, Spain) was accompanied by three physicians, two diabetes counselors and one sports scientist. Quality of life/well-being was assessed by the World Health Organization’s (WHO)-5 questionnaire, and diabetes distress was evaluated based on the Problem Areas in Diabetes (PAID) scale. The glucose levels of six insulin-treated patients were measured using continuous glucose monitoring (CGM) devices, considering that insulin-treated patients can be at increased risk of exercise-induced hypoglycemia. A significant improvement in quality of life/well-being was reported (p < 0.001), while diabetes distress did not change significantly (p = 0.203). Only two of the six insulin-treated patients showed moderate hypoglycemic episodes between 0.97% and 5.21% time below range per day, with glucose levels between 53−70 mg/dL. Hiking tours such as the one organized for this study can improve quality of life/well-being without increasing diabetes distress and are considered relatively safe for T2DM patients, even for those being treated with insulin.

Sweet as Sugar-How Shared Social Identities Help Patients in Coping with Diabetes Mellitus

Social identification is health-beneficial as social groups provide social support (i.e., the social cure effect). We study this social cure effect in diabetes patients by focusing on two relevant sources of social support, namely medical practitioners (MP) and fellow patients. As both groups have diabetes-specific knowledge, we predict that sharing an identity with them provides access to specific support, which, in turn, optimizes individuals' diabetes management and reduces diabetes-related stress. We further predict that identifying with their MP or fellow patients will be more strongly related to perceived social support among individuals with lower diabetes-specific resilience because they pay more attention to supportive cues. We tested this moderated mediation model in a two-wave study with n = 200 diabetes patients. Identification with the MP related to more support, which, in turn, was related to better diabetes management and less diabetes-specific stress. Identification with fellow patients related to more support; however, social support was unrelated to diabetes management and stress. Resilience only moderated the relationship between MP identification and support, as people with lower resilience levels reported more support from their MP. This study shows the importance of social identification with the MP and other diabetes patients, especially for people with lower resilience levels.

Hypothesized Explanations for the Observed Lung Cancer Survival Benefit Among Hispanics/Latinos in the United States

Hispanic/Latino ethnicity is associated with improved survival from non-small cell lung cancer compared to that for non-Hispanic Whites even though Hispanics/Latinos are more likely to potentially have inferior access-to-care and experience greater health disparities. To this end, we conducted a literature review to identify possible explanations for this survival benefit, including the role of chronic obstructive pulmonary disease and cardiovascular diseases, genetic variation, cultural influences, and immigration factors. Overall, intermittent smoking patterns, genetic variation, co-morbidities, and cultural influences were all factors likely to partially explain this survival benefit. On the other hand, immigration factors, acculturation, and access-to-care were less likely to support the survival advantage. Future research should analyze relevant Hispanic/Latino subgroups (e.g., Mexican, Puerto Rican, Cuban, Dominican, Central American, South American) and specifically focus on the relationship between Hispanic/Latino ethnicity and different lung cancer subtypes. If the Hispanic/Latino mortality benefit observed in lung cancer truly exists, a better understanding of the underlying mechanism(s) may help extend these benefits to other ethnic and racial groups.

Impact of fear of hypoglycaemia on self-management in patients with type 2 diabetes mellitus: structural equation modelling

AIMS

This study aimed to explore the effect of fear of hypoglycaemia (FOH) on self-management and its specific action path in patients with type 2 diabetes mellitus (T2DM) to provide a basis for developing targeted nursing interventions.

DESIGN

A cross-sectional study.

METHODS

From June to October 2019, we recruited 258 patients with T2DM from the endocrinology department of three hospitals to complete questionnaires, including the Hypoglycaemia Fear Survey-II, Diabetes Distress Scale, Self-Stigma Scale, Social Support Rating Scale and Summary of Diabetes Self-Care Activities, in Jiangsu Province, China. Pearson's correlation analyses and structural equation modelling were conducted to explore the relationship and influence path among the above variables.

RESULTS

The correlation analysis of FOH, distress, self-stigma, social support and self-management showed that, except for social support not being correlated with FOH and distress (P > 0.05), all variables were correlated in pairs (r = - 0.19-0.77, P < 0.01). The final model fit well, and the fitting indexes of the model were as follows: χ²/df = 2.191, GFI = 0.934, CFI = 0.954, TLI = 0.934, RMSEA = 0.068, and SRMR = 0.0649. The effects of FOH on self-management in patients with T2DM included one direct path and two indirect paths: (a) FOH had a direct impact on self-management (P < 0.05); (b) FOH had an indirect impact on self-management through distress (P < 0.05); and (c) FOH had an indirect impact on self-management through self-stigma and social support (P < 0.05).

CONCLUSIONS

FOH could directly influence self-management in patients with T2DM. Furthermore, distress, self-stigma and social support were important mediating variables of FOH influencing self-management. Researchers can develop personalized interventions to improve the self-management of patients with T2DM by regulating distress, self-stigma and social support levels.

Factors Associated with Diabetes-Related Distress in Patients with Type 2 Diabetes Mellitus

Introduction: The aim of this study was to identify factors associated with diabetes-related distress (DRD) in adult patients with type 2 diabetes mellitus (T2DM).

Material and Methods: This was an analysis of data previously obtained from two cross-sectional studies, in which medical charts review and direct interviews were employed to obtain medical and demographic data. Vital status assessment and anthropometric measurements were performed. The patients filled out specific questionnaires for DRD (DDS-17), symptoms of depression (PHQ-9), and of anxiety (GAD-7). A clinical meaningful threshold for DRD was set at ≥2.0 points. Symptoms of depression and anxiety, number of chronic complications, therapy for T2DM, anthropometric and cardio-metabolic parameters, as well as demographic, socio-economic data, and lifestyle habits were evaluated as factors possibly associated with DRD by univariate and multiple regression analyses.

Results: A total of 271 patients with T2DM were included in this analysis, of whom 25.1% presented a DDS-17 score ≥2 points (and 9.96% a DDS-17 score ≥3). Subjects with a DDS-17 score ≥2 had higher HbA1c levels (p = 0.018), PHQ-9 and GAD-7 scores (p <0.0001 for both). The multiple regression model indicated that anxiety (p = 0.026), depression (p = 0.001), and ethnicity (p = 0.002) were significantly correlated with DRD (p <0.0001). With regards to subscales, the HbA1c (p = 0.005) and PHQ-9 score (p <0.0001) were significantly associated with emotional burden, ethnicity (p = 0.001) and depression (p = 0.004) with regimen-related distress, whereas ethnicity (p = 0.010) and GAD-7 score (p = 0.012) with interpersonal distress.

Conclusions: Psychosocial factors like depression, anxiety, or ethnicity significantly contribute to DRD in patients with T2DM, and worse glycemic control is associated with emotional burden.