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Snoek FJ, Anarte-Ortiz MT, Anderbro T, Cyranka K, Hendrieckx C, Hermanns N, Indelicato L, McGuire BE, Mocan A, Nefs G, Polonsky WH, Stewart R, Vallis M. Roles and competencies of the clinical psychologist in adult diabetes care-A consensus report. Diabet Med 2024; 41:e15312. [PMID: 38385984 DOI: 10.1111/dme.15312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/29/2024] [Accepted: 02/06/2024] [Indexed: 02/23/2024]
Abstract
AIMS Psychological care is recognised as an integral part of quality diabetes care. We set out to describe the roles and competencies of the clinical psychologist as a member of the multidisciplinary adult diabetes care team, focused on secondary care. METHODS The authors are clinically experienced psychologists involved in adult diabetes care, from Australia, Europe and North America, and active members of the international psychosocial aspects of diabetes study group. Consensus was reached as a group on the roles and competencies of the clinical psychologist working in adult diabetes secondary care, building both on expert opinion and a selective review and discussion of the literature on psychological care in diabetes, clinical guidelines and competency frameworks. RESULTS The clinical psychologist fulfils multiple roles: (1) as a clinician (psychological assessment and therapy), (2) as advisor to the healthcare team (training, consulting), (3) as a communicator and promotor of person-centred care initiatives and (4) as a researcher. Four competencies that are key to successfully fulfilling the above-mentioned roles in a diabetes setting are as follows: (a) specialised knowledge, (b) teamwork and advice, (c) assessment, (d) psychotherapy (referred to as STAP framework). CONCLUSIONS The roles and competencies of clinical psychologists working in diabetes extend beyond the requirements of most university and post-graduate curricula. There is a need for a comprehensive, accredited specialist post-graduate training for clinical psychologists working in diabetes care, building on the proposed STAP framework. This calls for a collaborative effort involving diabetes organisations, clinical psychology societies and diabetes psychology interest groups.
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Affiliation(s)
- Frank J Snoek
- Department of Medical Psychology, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Maria Teresa Anarte-Ortiz
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología, Universidad de Málaga, Málaga, Spain
- Departamento de Personalidad, Evaluacion y Tratamiento Psicologico, Instituto de Investigación Biomedica de Málaga (IBIMA), Málaga, Spain
| | - Therese Anderbro
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Katarzyna Cyranka
- Department of Psychiatry, Jagiellonian University Medical College, Krakow, Poland
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Christel Hendrieckx
- The Australian Centre for Behavioural Research in Diabetes, Carlton, Victoria, Australia
- School of Psychology, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Norbert Hermanns
- Forschungsinstitut Diabetes-Akademie Bad Mergentheim (FIDAM GmbH), Bad Mergentheim, Germany
- Department of Clinical Psychology, Psychotherapy of the University of Bamberg, Bamberg, Germany
| | - Liliana Indelicato
- Divission od Endocrinology, Diabetes and Metabolic Diseases, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Brian E McGuire
- School of Psychology, University of Galway and Centre for Diabetes, Endocrinology & Metabolism, Galway University Hospital, Galway, Ireland
| | - Andreia Mocan
- Center for Diabetes, Nutrition and Metabolic Diseases, Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - Giesje Nefs
- Department of Medical Psychology, Radboud UMC, Nijmegen, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Diabeter, National Treatment and Research Center for Children, Adolescents and Adults with Type 1 Diabetes, Rotterdam, The Netherlands
| | - William H Polonsky
- Behavioral Diabetes Institute, San Diego, California, USA
- Department of Medicine, University of California, San Diego, California, USA
| | - Rose Stewart
- Betsi Cadwaladr University Health Board, Hospitals and Health Care, North Wales, UK
| | - Michael Vallis
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Altıkardeş DK, Nefs G, Hacışahinoğulları H, Smeets T, Pouwer F. Reliability and validity of the Turkish version of the problem areas in diabetes (PAID) survey: Results from diabetes MILES - Turkey. Prim Care Diabetes 2024; 18:218-223. [PMID: 38220557 DOI: 10.1016/j.pcd.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/24/2023] [Accepted: 01/02/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND AND AIMS To 1) assess the reliability and validity of the Turkish version of the Problem Areas in Diabetes (PAID), PAID-5 and PAID-1 survey among Turkish adults with type 1 or type 2 diabetes, 2) estimate the level of elevated diabetes-specific distress (DD), and 3) determine the demographic and clinical correlates of DD-symptom severity. METHODS AND RESULTS From 2017-2019, 252 adults with type 1(n = 80) (T1DM) or type 2 diabetes (n = 172) (T2DM) self-reported demographic factors, DD(PAID) and related psychological and clinical questionnaires. We examined PAID internal consistency, structural and convergent validity. Associations of measures with DD were explored with hierarchical linear regression analysis. PCA yielded a 3-factor solution for PAID-20 and a 2-factor solution for PAID-5. Cronbach's α for PAID/PAID-5 subscales ranged from 0.63-0.90. All PAID versions correlated most strongly to BIPQ and HFS. The prevalence of elevated distress (PAID-20 ≥33) was 40% in T1DM and 15% in T2DM. DD severity was significantly positively associated (p < 0.01) with more negative diabetes perceptions (BIPQ) and type 1 diabetes. CONCLUSIONS The Turkish translation of the PAID and its short forms appeared to have satisfactory psychometric properties. Elevated diabetes distress was more common in T1DM.
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Affiliation(s)
- Dilara Karşıdağ Altıkardeş
- Department of Medical and Clinical Psychology, Tilburg University, Center of Research on Psychological disorders and Somatic diseases (CoRPS), Tilburg, the Netherlands
| | - Giesje Nefs
- Department of Medical and Clinical Psychology, Tilburg University, Center of Research on Psychological disorders and Somatic diseases (CoRPS), Tilburg, the Netherlands; Radboud university medical center, Radboud Institute for Health Sciences, Department of Medical Psychology, Nijmegen, the Netherlands; National treatment and research center for children, adolescents and adults with type 1 diabetes, Diabeter, Rotterdam, the Netherlands.
| | | | - Tom Smeets
- Department of Medical and Clinical Psychology, Tilburg University, Center of Research on Psychological disorders and Somatic diseases (CoRPS), Tilburg, the Netherlands
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark; Steno Diabetes Center Odense, Odense, Denmark
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Schmitt A, Beran M, Geraets A, Iversen MM, Nefs G, Nouwen A, Pouwer F, Huber JW, Schram MT. Associations between HbA1c Reduction and Change in Depressive Symptoms following Glucose-lowering Treatment in Adults: A Systematic Review of Intervention Studies. Curr Diabetes Rev 2024; 20:e020623217607. [PMID: 37278034 DOI: 10.2174/1573399820666230602124223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 04/18/2023] [Accepted: 05/03/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Hyperglycemia constitutes a likely pathway linking diabetes and depressive symptoms; lowering glycemic levels may help reduce diabetes-comorbid depressive symptoms. Since randomized controlled trials can help understand temporal associations, we systematically reviewed the evidence regarding the potential association of hemoglobin HbA1c lowering interventions with depressive symptoms. METHODS PubMed, PsycINFO, CINAHL, and EMBASE databases were searched for randomized controlled trials evaluating HbA1c-lowering interventions and including assessment of depressive symptoms published between 01/2000-09/2020. Study quality was evaluated using the Cochrane Risk of Bias tool. PROSPERO registration: CRD42020215541. RESULTS We retrieved 1,642 studies of which twelve met our inclusion criteria. Nine studies had high and three unclear risks of bias. Baseline depressive symptom scores suggest elevated depressive symptoms in five studies. Baseline HbA1c was <8.0% (<64 mmol/mol) in two, 8.0-9.0% (64-75 mmol/mol) in eight, and ≥10.0% (≥86 mmol/mol) in two studies. Five studies found greater HbA1c reduction in the treatment group; three of these found greater depressive symptom reduction in the treatment group. Of four studies analyzing whether the change in HbA1c was associated with the change in depressive symptoms, none found a significant association. The main limitation of these studies was relatively low levels of depressive symptoms at baseline, limiting the ability to show a lowering in depressive symptoms after HbA1c reduction. CONCLUSIONS We found insufficient available data to estimate the association between HbA1c reduction and depressive symptom change following glucose-lowering treatment. Our findings point to an important gap in the diabetes treatment literature. Future clinical trials testing interventions to improve glycemic outcomes might consider measuring depressive symptoms as an outcome to enable analyses of this association.
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Affiliation(s)
- Andreas Schmitt
- Research Institute Diabetes Academy Mergentheim (FIDAM), Diabetes Center Mergentheim (DZM), Johann-Hammer- Straße 24, 97980 Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764, Oberschleißheim, Germany
| | - Magdalena Beran
- Department of Internal Medicine, School for Cardiovascular Diseases (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
| | - Anouk Geraets
- Department of Internal Medicine, School for Cardiovascular Diseases (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
- Department of Psychiatry and Neuropsychology, MHeNs School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Marjolein M Iversen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063 Bergen, Norway
| | - Giesje Nefs
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 27, 6525 EZ Nijmegen, The Netherlands
- Diabeter, National Treatment and Research Center for Children, Adolescents and Young Adults with Type 1 Diabetes, Blaak 6, 3011 TA Rotterdam, The Netherlands
| | - Arie Nouwen
- Department of Psychology, Middlesex University London, The Burroughs, London NW4 4BT, United Kingdom
- School of Health, Wellbeing and Social Care, The Open University, Walton Hall, Milton Keynes MK7 6AA, United Kingdom
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Steno Diabetes Center Odense (SDCO), Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Jörg W Huber
- School of Sport and Health Sciences, University of Brighton, Westlain House, Brighton BN1 9PH, United Kingdom
| | - Miranda T Schram
- Department of Internal Medicine, School for Cardiovascular Diseases (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
- Department of Psychiatry and Neuropsychology, MHeNs School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
- Heart and Vascular Centre, Maastricht University Medical Center, Professor Debyelaan 25, 6229HX Maastricht, The Netherlands
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Speight J, Holmes-Truscott E, Garza M, Scibilia R, Wagner S, Kato A, Pedrero V, Deschênes S, Guzman SJ, Joiner KL, Liu S, Willaing I, Babbott KM, Cleal B, Dickinson JK, Halliday JA, Morrissey EC, Nefs G, O'Donnell S, Serlachius A, Winterdijk P, Alzubaidi H, Arifin B, Cambron-Kopco L, Santa Ana C, Davidsen E, de Groot M, de Wit M, Deroze P, Haack S, Holt RIG, Jensen W, Khunti K, Kragelund Nielsen K, Lathia T, Lee CJ, McNulty B, Naranjo D, Pearl RL, Prinjha S, Puhl RM, Sabidi A, Selvan C, Sethi J, Seyam M, Sturt J, Subramaniam M, Terkildsen Maindal H, Valentine V, Vallis M, Skinner TC. Bringing an end to diabetes stigma and discrimination: an international consensus statement on evidence and recommendations. Lancet Diabetes Endocrinol 2024; 12:61-82. [PMID: 38128969 DOI: 10.1016/s2213-8587(23)00347-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 12/23/2023]
Abstract
People with diabetes often encounter stigma (ie, negative social judgments, stereotypes, prejudice), which can adversely affect emotional, mental, and physical health; self-care, access to optimal health care; and social and professional opportunities. To accelerate an end to diabetes stigma and discrimination, an international multidisciplinary expert panel (n=51 members, from 18 countries) conducted rapid reviews and participated in a three-round Delphi survey process. We achieved consensus on 25 statements of evidence and 24 statements of recommendations. The consensus is that diabetes stigma is driven primarily by blame, perceptions of burden or sickness, invisibility, and fear or disgust. On average, four in five adults with diabetes experience diabetes stigma and one in five experience discrimination (ie, unfair and prejudicial treatment) due to diabetes, such as in health care, education, and employment. Diabetes stigma and discrimination are harmful, unacceptable, unethical, and counterproductive. Collective leadership is needed to proactively challenge, and bring an end to, diabetes stigma and discrimination. Consequently, we achieved unanimous consensus on a pledge to end diabetes stigma and discrimination.
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Affiliation(s)
- Jane Speight
- School of Psychology and Institute for Health Transformation, Deakin University, Geelong, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia.
| | - Elizabeth Holmes-Truscott
- School of Psychology and Institute for Health Transformation, Deakin University, Geelong, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | | | - Renza Scibilia
- Diabetogenic, Melbourne, VIC, Australia; JDRF International, New York, NY, USA
| | - Sabina Wagner
- Department of Prevention, Health Promotions & Community Care, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Asuka Kato
- Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Victor Pedrero
- Faculty of Nursing, Universidad Andrés Bello, Santiago, Chile
| | - Sonya Deschênes
- School of Psychology, University College Dublin, Dublin, Ireland
| | | | - Kevin L Joiner
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Shengxin Liu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Ingrid Willaing
- Department of Prevention, Health Promotions & Community Care, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Copenhagen, Denmark; Institute of Public Health, Department of Health Services Research, University of Copenhagen, Copenhagen, Denmark
| | - Katie M Babbott
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Bryan Cleal
- Department of Prevention, Health Promotions & Community Care, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Jane K Dickinson
- Department of Health Studies & Applied Educational Psychology, Teachers College Columbia University, New York, NY, USA
| | - Jennifer A Halliday
- School of Psychology and Institute for Health Transformation, Deakin University, Geelong, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Eimear C Morrissey
- Health Behavior Change Research Group, School of Psychology, University of Galway, Galway, Ireland
| | - Giesje Nefs
- Department of Medical Psychology, Radboudumc, Nijmegen, Netherlands; Center of Research on Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands; Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, Netherlands
| | - Shane O'Donnell
- Birmingham Law School, University of Birmingham, Birmingham, UK
| | - Anna Serlachius
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Per Winterdijk
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, Netherlands
| | - Hamzah Alzubaidi
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Bustanul Arifin
- Faculty of Pharmacy, Universitas Hasanuddin, Makassar, Indonesia
| | | | | | - Emma Davidsen
- Department of Prevention, Health Promotions & Community Care, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Mary de Groot
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Maartje de Wit
- Medical Psychology, Amsterdam Public Health, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | - Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK; National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Kamlesh Khunti
- Leicester Diabetes Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Karoline Kragelund Nielsen
- Department of Prevention, Health Promotions & Community Care, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Tejal Lathia
- Department of Endocrinology, Apollo Hospitals, Navi Mumbai, India
| | | | | | - Diana Naranjo
- Department of Pediatrics, Division of Endocrinology, Stanford School of Medicine, Palo Alto, CA, USA
| | - Rebecca L Pearl
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Suman Prinjha
- Leicester Diabetes Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Rebecca M Puhl
- Department of Human Development & Family Sciences, College of Liberal Arts & Sciences, University of Connecticut, Storrs, CT, USA
| | | | - Chitra Selvan
- Department of Endocrinology, Ramaiah Medical College, Bengaluru, India
| | - Jazz Sethi
- The Diabesties Foundation, Ahmedabad, India
| | - Mohammed Seyam
- Faculty of Medicine, Al-Quds University, Abu Dis, Palestine
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Mythily Subramaniam
- Institute of Mental Health Singapore, Singapore; Saw Swee Hock School of Public Health, National University Singapore, Singapore
| | - Helle Terkildsen Maindal
- Department of Prevention, Health Promotions & Community Care, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Copenhagen, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Michael Vallis
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Timothy C Skinner
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia; La Trobe Rural Health School, La Trobe University, Flora Hill, VIC, Australia; Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Liu Y, Verdonk P, de Wit M, Nefs G, Dedding C. Observing, 'doing' and 'making' gender in Dutch paediatric type 1 diabetes care, at home and in the clinic: Multiple-stakeholder perspectives. J Adv Nurs 2023; 79:4697-4706. [PMID: 37377143 DOI: 10.1111/jan.15757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/27/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023]
Abstract
AIM To investigate the perspectives of Dutch care professionals, parents and experts by experience on gender dynamics in paediatric type 1 diabetes care. DESIGN Qualitative research design. METHODS Fifteen semi-structured interviews were held with care professionals, supplemented by two focus groups with parents of children with diabetes (n = 12 parents) and three semi-structured interviews with two experts by experience and a mother. Two respondent validation interviews were conducted, one with two care professionals and one with an expert by experience. Participant observations were conducted at three clinics, a diabetes sports day, weekend for young people and their families, and a high-school. An inductive framework analysis was done, informed by relational theory on gender. RESULTS Care professionals 'did' and 'made' gender differences together with young people, manifesting as communicative difficulties, in particular between female care professionals and young boys. Boys were considered less skilled in articulating their needs compared to girls. At home, care professionals and parents observed, 'did' and 'made' gender differences by perpetuating gendered divisions of labour. As traditional caretakers, mothers risk focusing excessively on the diabetes of their child whilst fathers remained more at a distance. CONCLUSION Gender patterns have negative implications on those involved in paediatric type 1 diabetes. Leaving tacit the gendered communicative issues across child-parent and child-care professional dyads, can sustain invisible friction in a care system that normatively expects verbal participation and increased self-management. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE Findings may encourage care professionals and parents to engage with the potential impact of gender dynamics on diabetes practices. Incorporating these dynamics as conversational tools would contribute to improving type 1 diabetes care for young people.
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Affiliation(s)
- Yosheng Liu
- Department of Ethics, Law and Humanities, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
| | - Petra Verdonk
- Department of Ethics, Law and Humanities, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
| | - Maartje de Wit
- Department of Medical Psychology, Amsterdam University Medical Center, Location VUmc, Vrije Universiteit, Amsterdam, The Netherlands
- Public Health Research Institute, Amsterdam, The Netherlands
| | - Giesje Nefs
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Diabeter, Center for Type 1 Diabetes Care and Research, Rotterdam, The Netherlands
- Department of Medical and Clinical Psychology, CoRPS-Center of Research on Psychological Disorders and Somatic Diseases, Tilburg University, Tilburg, The Netherlands
| | - Christine Dedding
- Department of Ethics, Law and Humanities, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
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Nefs G, Feinn R, Chang AM, Wagner J. Longitudinal relations of sleep quality with depressive symptoms, diabetes distress and self-efficacy in young people with type 1 diabetes. J Psychosom Res 2023; 173:111457. [PMID: 37634323 PMCID: PMC10592068 DOI: 10.1016/j.jpsychores.2023.111457] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE To examine the longitudinal, bidirectional associations of sleep quality with depressive symptoms, diabetes-specific distress and diabetes management self-efficacy among adolescents and young adults with type 1 diabetes. METHODS Cross-lagged analyses used baseline, three-, six- and nine-month data from a randomized trial among 60 young people. Self-report measures included the Pittsburgh Sleep Quality Index, Center for Epidemiological Studies - Depressed Mood scale, Problem Areas in Diabetes Teen version, and Diabetes Management Self-efficacy Scale. RESULTS Lower sleep quality at baseline was associated with higher three-month depressive symptoms (b = 0.21, p = 0.005) and lower diabetes self-efficacy (b = -0.18, p = 0.014), but not diabetes distress (b = 0.06, p = 0.403). Similar patterns were found at six and nine months. Three-month psychological functioning was not associated with six-month sleep quality. CONCLUSIONS Among adolescents and young adults with type 1 diabetes, lower sleep quality predicted subsequent depressive symptoms and lower diabetes self-efficacy rather than vice versa. Sleep deserves a central place in diabetes care.
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Affiliation(s)
- Giesje Nefs
- Radboud University Medical Center, Department of Medical Psychology, Huispost 926, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Diabeter, National Treatment and Research Center for Children, Adolescents and Adults with Type 1 Diabetes, Blaak 6, 3011 TA Rotterdam, the Netherlands; Tilburg University, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, PO Box 90153, 5000 LE Tilburg, the Netherlands.
| | - Richard Feinn
- School of Medicine, Medical Sciences, Quinnipiac University, 275 Mount Carmel Avenue, Hamden, CT, USA.
| | - Anne-Marie Chang
- Pennsylvania State University, Biobehavioral Health Department, 219 Biobehavioral Health Building, University Park, PA, USA.
| | - Julie Wagner
- University of Connecticut Schools of Medicine and Dental Medicine, Department of Behavioral Sciences and Community Health, UConn Health, 263 Farmington Ave., Farmington, CT, USA.
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7
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Ali N, El Hamdaoui S, Nefs G, Walburgh Schmidt JWJ, Tack CJ, de Galan BE. High diabetes-specific distress among adults with type 1 diabetes and impaired awareness of hypoglycaemia despite widespread use of sensor technology. Diabet Med 2023; 40:e15167. [PMID: 37347681 DOI: 10.1111/dme.15167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023]
Abstract
AIMS Impaired awareness of hypoglycaemia (IAH) has been associated with increased diabetes distress and use of sensor technology can reduce diabetes distress. The aim of this study was to examine diabetes-specific distress (emotions, cognitions, behaviours) in relation to IAH status and use of glucose sensors in people with type 1 diabetes. METHODS Individuals with type 1 diabetes from an academic diabetes outpatient clinic completed the Clarke questionnaire (to assess hypoglycaemic awareness), Problem Areas in Diabetes (PAID-5), Hypoglycaemia Fear Survey-II (HFS-II), Attitudes to Awareness of Hypoglycaemia Survey (A2A), Nijmegen Clinical Screening Instrument Survey (NCSI) and Hyperglycaemia Avoidance Scale (HAS). RESULTS Of the 422 participants (51.9% male, diabetes duration 30 [16-40] years, HbA1c 60 ± 11 mmol/mol [7.6 ± 1.0%], 351 [88.2%] used a glucose sensor; 82 [19.4%]) had IAH. Compared to individuals with normal awareness, those with IAH more often had PAID-5 scores ≥8 (35.4% vs. 21.5%, p = 0.008) and higher scores on all HFS-II subscores (total [40.2 ± 21.5 vs. 27.9 ± 17.2, p < 0.001]), HFS-II behaviour (18.5 ± 10.0 vs. 15.1 ± 8.0, p = 0.005), HFS-II worry (21.8 ± 13.5 vs. 12.7 ± 10.9, p < 0.001), HAS worries (17.5 ± 7.3 vs. 14.3 ± 7.0, p < 0.001) and NCSI hypoglycaemia items. HAS behaviour, A2A and NCSI hyperglycaemia scores did not differ between individuals with or without IAH. Restricting the analyses to individuals using a glucose sensor did not materially change the results. CONCLUSIONS Diabetes-specific distress remains a major problem among individuals with type 1 diabetes, particularly those with IAH, despite the widespread use of (intermittently scanned) sensor technology. Further studies are needed to examine strategies to lower diabetes-specific distress in individuals with IAH.
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Affiliation(s)
- Namam Ali
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Soumia El Hamdaoui
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Giesje Nefs
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
- Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Diabeter, Center for Type 1 Diabetes Care and Research, Rotterdam, The Netherlands
| | | | - Cees J Tack
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bastiaan E de Galan
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- CARIM School for Cardiovascular Disease, Maastricht University, Maastricht, The Netherlands
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8
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Winterdijk P, Aanstoot HJ, Nefs G. The impact of real-time sensor technology on quality of life for adults with type 1 diabetes: A Dutch national survey. Diabetes Res Clin Pract 2023; 203:110886. [PMID: 37604282 DOI: 10.1016/j.diabres.2023.110886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/19/2023] [Accepted: 08/18/2023] [Indexed: 08/23/2023]
Abstract
AIMS To examine the impact of real-time continuous glucose monitoring (RT-CGM) on quality of life in Dutch adults with type 1 diabetes, inside/outside automated insulin delivery (AID) systems. METHODS In this cross-sectional retrospective observational study, RT-CGM users completed an online survey including (adapted) validated questionnaires, study-specific items and open-ended questions. RESULTS Of 893 participating adults, 69% used the RT-CGM as part of AID. The overall sample reported improvements in quality of life related to RT-CGM use (irrespective of initial indication), particularly with respect to physical health, emotional wellbeing and energy. Merits for sleep, intimacy and cognitive diabetes load lagged somewhat behind, mostly when RT-CGM was not integrated in AID. Users of AID had significantly larger improvements in overall quality of life, fatigue and diabetes-specific distress than users of sensor-augmented pump or Open Loop treatment. In regression analyses, user evaluations were associated with perceptions of benefit and burden. In qualitative content analysis, benefits (e.g. life 'normalization', increased perceptions of control) outweighed burdens (e.g. technology frustrations, confrontation with diabetes). CONCLUSIONS RT-CGM positively impacted the quality of life of adults with type 1 diabetes. This justifies a (re-)consideration of broader access. Increased support to maximize device benefits and minimize burdens is also warranted.
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Affiliation(s)
- Per Winterdijk
- Diabeter, Center for Type 1 Diabetes Care and Research, Blaak 6, 3011 TA Rotterdam, the Netherlands.
| | - Henk-Jan Aanstoot
- Diabeter, Center for Type 1 Diabetes Care and Research, Blaak 6, 3011 TA Rotterdam, the Netherlands.
| | - Giesje Nefs
- Diabeter, Center for Type 1 Diabetes Care and Research, Blaak 6, 3011 TA Rotterdam, the Netherlands; Radboud University Medical Center, Department of Medical Psychology, Huispost 926, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Tilburg University, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, PO Box 90153, 5000 LE Tilburg, the Netherlands.
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9
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Dekker P, Aanstoot HJ, Sas T, de Vries M, Birnie E, Mul D, Nefs G. Prevalence of and reasons for discontinuation of continuous subcutaneous insulin infusion in people with type 1 diabetes: a systematic review. Diabetes Technol Ther 2023. [PMID: 37053533 DOI: 10.1089/dia.2023.0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
INTRODUCTION The introduction of CSII in clinical care has led to more optimal glycemic and quality of life outcomes, compared with MDI. Despite this, some insulin pump users revert back to MDI. The aim of this review was to include the most recent rates of insulin pump discontinuation among people with type 1 diabetes and to identify reasons for and factors associated with discontinuation. MATERIALS AND METHODS A systematic literature search was conducted using the Embase.com, MEDLINE (via OVID), PsycINFO and CINAHL databases. Titles and abstracts of eligible publications were screened and baseline characteristics of the included studies were extracted, as were variables in the context of insulin pump. Data were synthesized into themes: indications for insulin pump initiation, PWD-reported reasons for and factors associated with insulin pump discontinuation. RESULTS A total of 826 eligible publications were identified and 67 were included. Discontinuation percentages ranged from 0% to 30% (median 7%). The most frequently mentioned reasons for discontinuing were wear-related issues (e.g. device attached to the body, interference with daily activities, discomfort, affected body image). Related factors included HbA1c (17%), issues with following treatment recommendations (14%), age (11%), gender (9%), side-effects (7%), comorbidity- and complication-related factors (6%). CONCLUSIONS Despite many developments in technology insulin pump, discontinuation rates and PWD-reported reasons for and factors associated with insulin pump discontinuation in more recent studies were not that different from earlier reviews/meta-analyses. Successful insulin pump treatment depends on a knowledgeable and willing HCP team and a close match with PWDs wishes and needs.
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Affiliation(s)
- Pim Dekker
- Diabeter, 586255, Blaak 6, Rotterdam, Rotterdam, --- Select One ---, Netherlands, 3011 TA;
| | | | - Theo Sas
- Diabeter, 586255, Rotterdam, Netherlands;
| | | | - Erwin Birnie
- Diabeter, 586255, Rotterdam, Netherlands
- UMCG, 10173, Department of Genetics, Groningen, Groningen, Netherlands;
| | - Dick Mul
- Diabeter, 586255, Rotterdam, Netherlands;
| | - Giesje Nefs
- Radboudumc Radboud Institute for Health Sciences, 601896, Department of Medical Psychology, Nijmegen, Gelderland, Netherlands
- Tilburg University Center of Research on Psychological and Somatic disorders, 214829, Department of Medical and Clinical Psychology, Tilburg, Noord-Brabant, Netherlands
- Diabeter, 586255, Rotterdam, Netherlands;
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10
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Chatwin H, Broadley M, de Galan B, Bazelmans E, Speight J, Pouwer F, Nefs G. Effectiveness of educational and behavioural interventions for reducing fear of hypoglycaemia among adults with type 1 diabetes: Systematic review and meta-analyses. Diabet Med 2023; 40:e15071. [PMID: 36807935 DOI: 10.1111/dme.15071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/02/2023] [Accepted: 02/16/2023] [Indexed: 02/20/2023]
Abstract
AIMS To summarize and critically appraise evidence regarding the effectiveness of educational and/or behavioural interventions in reducing fear of hypoglycaemia among adults with type 1 diabetes. METHODS Systematic searches of medical and psychology databases were conducted. Risk-of-bias was assessed using the Joanna Briggs Institute Critical Appraisal Tools. Data were synthesized using random-effects meta-analyses for randomized controlled trials (RCTs) and narrative synthesis for observational studies. RESULTS Five RCTs (N = 682) and seven observational studies (N = 1519) met the inclusion criteria, reporting on behavioural, structured education and cognitive-behavioural therapy (CBT) interventions. Most studies assessed fear of hypoglycaemia using the Hypoglycaemia Fear Survey Worry (HFS-W) and Behaviour (HFS-B) subscales. Mean fear of hypoglycaemia at baseline was relatively low across studies. Meta-analyses showed a significant effect of interventions on HFS-W (SMD = -0.17, p = 0.032) but not on HFS-B scores (SMD = -0.34, p = 0.113). Across RCTs, Blood Glucose Awareness Training (BGAT) had the largest effect on HFS-W and HFS-B scores, and one CBT-based program was as effective as BGAT in reducing HFS-B scores. Observational studies showed that Dose Adjustment for Normal Eating (DAFNE) was associated with significant fear of hypoglycaemia reductions. CONCLUSIONS Current evidence suggests that educational and behavioural interventions can reduce fear of hypoglycaemia. However, no study to date has examined these interventions among people with high fear of hypoglycaemia.
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Affiliation(s)
- Hannah Chatwin
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Melanie Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Bastiaan de Galan
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
- CARIM School for Cardiovascular Disease, Maastricht University, Maastricht, Netherlands
| | - Ellen Bazelmans
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | - Jane Speight
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense, Denmark
- Department of Medical Psychology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Giesje Nefs
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Center of Research on Psychological disorders and Somatic diseases (CoRPS), Tilburg, Netherlands
- Diabeter, Center for Type 1 Diabetes Care and Research, Rotterdam, Netherlands
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11
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Aalders J, Nefs G, Hartman E, A Nguyen L, Winterdijk P, van Mil E, Aanstoot HJ, Pouwer F. A Systematic Review of Instruments Measuring the Division of Care Responsibilities between Children with Type 1 Diabetes and their Parents. Curr Diabetes Rev 2023; 19:59-93. [PMID: 35538797 DOI: 10.2174/1573399818666220510172511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/09/2021] [Accepted: 01/25/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The division of care responsibilities between parents and children with type 1 diabetes, and an optimal transfer of responsibilities from parent to child over time are assumed to be key for optimal diabetes outcomes during childhood and adolescence. However, an overview of instruments assessing this division as well as their psychometric qualities is currently lacking. OBJECTIVE The study aims to 1) identify all existing instruments, 2) evaluate their psychometric properties, and 3) provide an overview of scoring methods. METHODS Pubmed and PsycINFO were searched using a priori-defined search string. Peerreviewed studies in English using an instrument assessing the division of diabetes care responsibilities between children (6-18 years) and parents were included. In total, 84 of 725 articles qualified, covering 62 unique samples. RESULTS Thirteen questionnaires were identified. The Diabetes Family Responsibility Questionnaire (DFRQ) was most frequently used across studies. Instructions, content and number of tasks, response options, and scoring methods varied across questionnaires. Recent studies often adapted questionnaires, contributing to the heterogeneity across measures. Overall, reporting and quality of psychometric properties was suboptimal. CONCLUSION The division of diabetes care responsibilities can be operationalized with various instruments, each having its strengths and weaknesses but all with limited psychometric support. To measure the division of diabetes care responsibilities more adequately, an updated version of the popular DFRQ or a new scale needs to be developed and evaluated.
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Affiliation(s)
- Jori Aalders
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders [CoRPS], Tilburg University, Tilburg, The Netherlands
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense, Denmark
| | - Giesje Nefs
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders [CoRPS], Tilburg University, Tilburg, The Netherlands
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Psychology, Nijmegen, The Netherlands
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, The Netherlands
| | - Esther Hartman
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders [CoRPS], Tilburg University, Tilburg, The Netherlands
| | - Linh A Nguyen
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders [CoRPS], Tilburg University, Tilburg, The Netherlands
| | - Per Winterdijk
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, The Netherlands
| | - Edgar van Mil
- Kidz&Ko, Jeroen Bosch Hospital's- Hertogenbosch, The Netherlands
| | - Henk-Jan Aanstoot
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, The Netherlands
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense, Denmark
- School of Psychology, Deakin University, Geelong, Australia
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12
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Huisman SD, Hendrieckx C, Bot M, Pouwer F, Nefs G. Prevalence, associations and health outcomes of binge eating in adults with type 1 or type 2 diabetes: Results from Diabetes MILES - The Netherlands. Diabet Med 2023; 40:e14953. [PMID: 36084309 PMCID: PMC10087813 DOI: 10.1111/dme.14953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 11/27/2022]
Abstract
AIMS To examine the prevalence and health risks of binge eating in people with diabetes. METHODS Self-report data were analysed from a subsample (n = 582 type 1 diabetes/735 type 2 diabetes) of Diabetes MILES - the Netherlands, an online survey. Prevalence of binge eating was compared across diabetes type and treatment and between participants with and without binges for eating styles, diabetes treatment and outcomes, weight, BMI and psychological comorbidity. Associations between binge eating, HbA1c , BMI, diabetes distress were assessed using hierarchical linear regression analyses. RESULTS 23% (n = 308) of participants reported eating binges, with 16% at least monthly, and 6% at least weekly. Prevalence and frequency of binges did not differ across diabetes type or treatment. People reporting binges scored higher on dietary restraint, emotional and external eating and reported higher weight and BMI than those without binges. Only people with type 1 diabetes and eating binges had a higher HbA1c . Hierarchical regression analyses demonstrated that binge eating was independently associated with higher HbA1c (β = 0.12, p=0.001), BMI (β = 0.13, p < 0.001) but not with diabetes distress. CONCLUSIONS This study found binge eating to be associated with eating styles, BMI and HbA1c . However, our cross-sectional data do not allow for conclusions on causality. Future studies could further examine the directions of these associations and their clinical implications.
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Affiliation(s)
- Sasja D Huisman
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Mariska Bot
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - François Pouwer
- School of Psychology, Deakin University, Geelong, Australia
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense, Denmark
| | - Giesje Nefs
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg, The Netherlands
- Diabeter, National Treatment and Research Center for Children, Adolescents and Adults with Type 1 Diabetes, Rotterdam, The Netherlands
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13
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Søholm U, Broadley M, Zaremba N, Divilly P, Nefs G, Carlton J, Mader JK, Baumann PM, Gomes M, Martine-Edith G, Pollard DJ, Rath D, Heller S, Pedersen-Bjergaard U, McCrimmon RJ, Renard E, Evans M, de Galan B, Forkmann T, Amiel SA, Hendrieckx C, Speight J, Choudhary P, Pouwer F. Psychometric properties of an innovative smartphone application to investigate the daily impact of hypoglycemia in people with type 1 or type 2 diabetes: The Hypo-METRICS app. PLoS One 2023; 18:e0283148. [PMID: 36930585 PMCID: PMC10022775 DOI: 10.1371/journal.pone.0283148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/02/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION The aim of this study was to determine the acceptability and psychometric properties of the Hypo-METRICS (Hypoglycemia MEasurement, ThResholds and ImpaCtS) application (app): a novel tool designed to assess the direct impact of symptomatic and asymptomatic hypoglycemia on daily functioning in people with insulin-treated diabetes. MATERIALS AND METHODS 100 adults with type 1 diabetes mellitus (T1DM, n = 64) or insulin-treated type 2 diabetes mellitus (T2DM, n = 36) completed three daily 'check-ins' (morning, afternoon and evening) via the Hypo-METRICs app across 10 weeks, to respond to 29 unique questions about their subjective daily functioning. Questions addressed sleep quality, energy level, mood, affect, cognitive functioning, fear of hypoglycemia and hyperglycemia, social functioning, and work/productivity. Completion rates, structural validity, internal consistency, and test-retest reliability were explored. App responses were correlated with validated person-reported outcome measures to investigate convergent (rs>±0.3) and divergent (rs<±0.3) validity. RESULTS Participants' mean±SD age was 54±16 years, diabetes duration was 23±13 years, and most recent HbA1c was 56.6±9.8 mmol/mol. Participants submitted mean±SD 191±16 out of 210 possible 'check-ins' (91%). Structural validity was confirmed with multi-level confirmatory factor analysis showing good model fit on the adjusted model (Comparative Fit Index >0.95, Root-Mean-Square Error of Approximation <0.06, Standardized Root-Mean-square Residual<0.08). Scales had satisfactory internal consistency (all ω≥0.5), and high test-retest reliability (rs≥0.7). Convergent and divergent validity were demonstrated for most scales. CONCLUSION High completion rates and satisfactory psychometric properties demonstrated that the Hypo-METRICS app is acceptable to adults with T1DM and T2DM, and a reliable and valid tool to explore the daily impact of hypoglycemia.
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Affiliation(s)
- Uffe Søholm
- Medical & Science, Patient Focused Drug Development, Novo Nordisk A/S, Søborg, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Faculty of Life Sciences and Medicine, Department of Diabetes, School of Cardiovascular Medicine and Sciences, King’s College London, London, United Kingdom
- * E-mail:
| | - Melanie Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Natalie Zaremba
- Faculty of Life Sciences and Medicine, Department of Diabetes, School of Cardiovascular Medicine and Sciences, King’s College London, London, United Kingdom
| | - Patrick Divilly
- Faculty of Life Sciences and Medicine, Department of Diabetes, School of Cardiovascular Medicine and Sciences, King’s College London, London, United Kingdom
| | - Giesje Nefs
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
- National Treatment and Research Center for Children, Adolescents and Adults with Type 1 Diabetes, Rotterdam, The Netherlands
| | - Jill Carlton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Julia K. Mader
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | | | - Mikel Gomes
- Digital Therapeutics, Scientific Modelling, Novo Nordisk A/S, Søborg, Denmark
| | - Gilberte Martine-Edith
- Faculty of Life Sciences and Medicine, Department of Diabetes, School of Cardiovascular Medicine and Sciences, King’s College London, London, United Kingdom
| | - Daniel J. Pollard
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Dajana Rath
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Simon Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Ulrik Pedersen-Bjergaard
- Department of Endocrinology and Nephrology, Nordsjællands Hospital Hillerød, Hillerød, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Rory J. McCrimmon
- Systems Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Mark Evans
- Welcome Trust-MRC Institute of Metabolic Science and Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Bastiaan de Galan
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Internal Medicine, Division of Endocrinology and Metabolic Disease, Maastricht University Medical Centre, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Stephanie A. Amiel
- Faculty of Life Sciences and Medicine, Department of Diabetes, School of Cardiovascular Medicine and Sciences, King’s College London, London, United Kingdom
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Jane Speight
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Pratik Choudhary
- Faculty of Life Sciences and Medicine, Department of Diabetes, School of Cardiovascular Medicine and Sciences, King’s College London, London, United Kingdom
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- School of Psychology, Deakin University, Geelong, Australia
- Steno Diabetes Center Odense (SDCO), Odense, Denmark
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14
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Abstract
Sleep and circadian rhythm disturbances are less-known risk factors for the development and suboptimal outcomes of diabetes. The goal of this narrative review is to highlight the importance of sleep and circadian rhythm disturbances in the development and outcomes of type 1 diabetes (T1D) and type 2 diabetes (T2D), assess current treatment options and the possible mediating mechanisms. We performed a literature search using PubMed and selected relevant English and Dutch papers. Disturbances of sleep and circadian rhythm are common in people with diabetes. They are associated with an increased risk of developing T2D as well as with suboptimal diabetes outcomes (including higher HbA1c levels and reduced quality of life) for T1D and T2D. Preliminary data suggest that treatment of sleep and circadian rhythm disturbances could improve diabetes outcomes in people with T1D and T2D. Finally, the association with medical parameters appears to be mediated by disturbance in hormones, and by suboptimal self-care including forgetting or postponing glucose monitoring or medication use as well as higher consumption of high fat/high sugary foods. Diabetes may also disturb sleep, for example through nocturnal hypoglycemia and nocturia. We concluded that sleep and circadian rhythm disturbances are closely linked with diabetes. More attention to sleep in regular diabetes care is warranted, while further research is needed on treatment of sleep and circadian rhythm disturbances in the prevention of diabetes and its suboptimal outcomes.
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Affiliation(s)
- Femke Rutters
- Department of Epidemiology and Data Science, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Giesje Nefs
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Diabeter, Center for Type 1 Diabetes Care and Research, Rotterdam, the Netherlands
- Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychological Disorders and Somatic Diseases, Tilburg University, Tilburg, the Netherlands
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15
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Verhulst CEM, Fabricius TW, Nefs G, Kessels RPC, Pouwer F, Teerenstra S, Tack CJ, Broadley MM, Kristensen PL, McCrimmon RJ, Heller S, Evans ML, Pedersen-Bjergaard U, de Galan BE. Consistent Effects of Hypoglycemia on Cognitive Function in People With or Without Diabetes. Diabetes Care 2022; 45:2103-2110. [PMID: 35876660 PMCID: PMC9472511 DOI: 10.2337/dc21-2502] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/31/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Hypoglycemia poses an immediate threat for cognitive function. Due to its association with acute cognitive impairment, the International Hypoglycemia Study Group (IHSG) defines a blood glucose level <3.0 mmol/L as "level 2 hypoglycemia." In the current study we investigated whether having diabetes, type of diabetes, or hypoglycemia awareness moderates this association. RESEARCH DESIGN AND METHODS Adults with type 1 diabetes with normal (n = 26) or impaired (n = 21) hypoglycemic awareness or with insulin-treated type 2 diabetes (n = 15) and age-matched control subjects without diabetes (n = 32) underwent a hyperinsulinemic-euglycemic-hypoglycemic glucose clamp (2.80 ± 0.13 mmol/L [50.2 ± 2.3 mg/dL]). At baseline and during hypoglycemia, calculation ability, attention, working memory and cognitive flexibility were measured with the Paced Auditory Serial Addition Test (PASAT) and the Test of Attentional Performance (TAP). RESULTS For the whole group, hypoglycemia decreased the mean ± SD proportion of correct answers on the PASAT by 8.4 ± 12.8%, increased reaction time on the TAP Alertness task by 32.1 ± 66.6 ms, and increased the sum of errors and omissions on the TAP Working Memory task by 2.0 ± 5.5 (all P < 0.001). Hypoglycemia-induced cognitive declines were largely irrespective of the presence or type of diabetes, level of symptomatic awareness, diabetes duration, or HbA1c. CONCLUSIONS IHSG level 2 hypoglycemia impairs cognitive function in people with and without diabetes, irrespective of type of diabetes or hypoglycemia awareness status. These findings support the cutoff value of hypoglycemia <3.0 mmol/L (<54 mg/dL) as being clinically relevant for most people with diabetes.
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Affiliation(s)
- Clementine E M Verhulst
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Therese W Fabricius
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Hillerød, Denmark
| | - Giesje Nefs
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychological disorders and Somatic diseases (CoRPS), Tilburg University, Tilburg, the Netherlands.,Diabeter, Rotterdam, the Netherlands
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands.,Department of Medical Psychology and Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands.,Vincent van Gogh Institute for Psychiatry, Venray, the Netherlands
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,School of Psychology, Deakin University, Geelong, Australia.,Steno Diabetes Center Odense, Odense, Denmark
| | - Steven Teerenstra
- Biostatistics, Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Cees J Tack
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Melanie M Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Peter L Kristensen
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Hillerød, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Simon Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, U.K
| | - Mark L Evans
- Wellcome Trust/MRC Institute of Metabolic Science, University of Cambridge, Cambridge, U.K
| | - Ulrik Pedersen-Bjergaard
- Department of Endocrinology and Nephrology, Nordsjællands Hospital, Hillerød, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bastiaan E de Galan
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
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16
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Polhuis KCMM, van Bennekom E, Bot M, Nefs G, Vaandrager L, Habibovic M, Geleijnse JM, Pouwer F, Soedamah-Muthu SS. Flourishing mental health and lifestyle behaviours in adults with Type 1 and Type 2 Diabetes Mellitus: results from the Diabetes MILES - The Netherlands Study. J Psychosom Res 2022; 160:110950. [PMID: 35691119 DOI: 10.1016/j.jpsychores.2022.110950] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the associations between mental health and lifestyle in adults with type 1 and type 2 diabetes mellitus (T1DM and T2DM). METHODS Online survey data from the cross-sectional Diabetes MILES - The Netherlands Study was analysed, including 270 adults with T1DM and 325 with T2DM. Mental health status (flourishing, moderate and languishing) in relation to diet, physical activity, alcohol consumption and smoking was analysed with ANCOVA and logistic regressions (adjusted for confounders). RESULTS 47% of T1DM-, and 55% of T2DM participants reported flourishing mental health. Due to an insufficient number, participants with languishing mental health were excluded. In T2DM, participants with flourishing mental health had more optimal diet quality (mean ± SEM: 70 ± 1 vs 68 ± 1 diet quality score, p = 0.015), and physical activity levels (mean ± SEM: 3484 ± 269 vs 2404 ± 273 MET minutes/week, p = 0.001) than those with moderate mental health, but did not differ with respect to alcohol consumption and smoking. In T1DM, no significant associations were found. CONCLUSION Only in T2DM, people with flourishing mental health had more optimal lifestyle behaviours compared to people with moderate mental health. Further research is needed to determine if mental health is more important for specific lifestyle behaviours, and if the mental health effect differs across diabetes types.
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Affiliation(s)
- Kristel C M M Polhuis
- Health and Society, Social Sciences, Wageningen University and Research, Hollandseweg 1, P.O. Box 8130, 6707 KN Wageningen, the Netherlands.
| | - Eline van Bennekom
- Health and Society, Social Sciences, Wageningen University and Research, Hollandseweg 1, P.O. Box 8130, 6707 KN Wageningen, the Netherlands; Department of Medical and Clinical Psychology, Center of Research on Psychological disorders and Somatic diseases (CoRPS), Tilburg University, Warandelaan 2, PO Box 90153, 5000 LE, Tilburg, the Netherlands
| | - Mariska Bot
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands.
| | - Giesje Nefs
- Department of Medical and Clinical Psychology, Center of Research on Psychological disorders and Somatic diseases (CoRPS), Tilburg University, Warandelaan 2, PO Box 90153, 5000 LE, Tilburg, the Netherlands; Department of Medical Psychology, Radboud university medical center, Radboud Institute for Health Sciences, Huispost 926, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Diabeter, National Treatment and Research Center for Children, Adolescents and Adults With Type 1 Diabetes, Blaak 6, 3011 TA Rotterdam, the Netherlands.
| | - Lenneke Vaandrager
- Health and Society, Social Sciences, Wageningen University and Research, Hollandseweg 1, P.O. Box 8130, 6707 KN Wageningen, the Netherlands.
| | - Mirela Habibovic
- Department of Medical and Clinical Psychology, Center of Research on Psychological disorders and Somatic diseases (CoRPS), Tilburg University, Warandelaan 2, PO Box 90153, 5000 LE, Tilburg, the Netherlands.
| | - Johanna M Geleijnse
- Division of Human Nutrition and Health, Wageningen University and Research, Stippeneng 4, P.O. Box 176700, AA Wageningen, 6708 WE Wageningen, The Netherlands.
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Campusvej 55, Odense M DK-5230, Denmark; Steno Diabetes Center Odense (SDCO), Odense Universitetshospital, Kløvervænget 10, 5000 Odense C, Denmark; School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, Victoria 3220, Australia.
| | - Sabita S Soedamah-Muthu
- Department of Medical and Clinical Psychology, Center of Research on Psychological disorders and Somatic diseases (CoRPS), Tilburg University, Warandelaan 2, PO Box 90153, 5000 LE, Tilburg, the Netherlands; Institute for Food, Nutrition and Health (IFNH), University of Reading, Whiteknights, Pepper Lane Whiteknights, RG6 6AR Reading, United Kingdom.
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17
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Nefs G. The Psychological Implications of Automated Insulin Delivery Systems in Type 1 Diabetes Care. Front Clin Diabetes Healthc 2022; 3:846162. [PMID: 36992780 PMCID: PMC10012062 DOI: 10.3389/fcdhc.2022.846162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/25/2022] [Indexed: 01/15/2023]
Abstract
Automated insulin delivery (AID) systems have brought important glycemic benefits to type 1 diabetes management. The present paper provides an overview of their psychological implications. Trials and real-world observational studies report improvements in diabetes-specific quality of life, with qualitative work describing reduced management burden, increased flexibility and improved relationships. Not all experiences are positive, however, evidenced by dropping algorithm use soon after device initiation. Apart from finance and logistics, reasons for discontinuation include technology frustrations, wear-related issues and unmet glycemic and work load expectations. New challenges include distrust in proper AID functioning, overreliance and deskilling, compensatory behaviors to override or trick the system and optimize time in range, and concerns related to wearing multiple devices on the body. Research efforts may focus on incorporating a diversity perspective, updating existing person-reported outcome measures according to new technology developments, addressing implicit or explicit health professional bias in technology access, examining the merits of incorporating stress reactivity in the AID algorithm, and developing concrete approaches for psychological counseling and support related to technology use. An open dialogue with health professionals and peers about expectations, preferences and needs may foster the collaboration between the person with diabetes and the AID system.
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Affiliation(s)
- Giesje Nefs
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
- Diabeter, National Treatment and Research Center for Children, Adolescents and Adults With Type 1 Diabetes, Rotterdam, Netherlands
- Department of Medical and Clinical Psychology, Center of Research On Psychological Disorders and Somatic Diseases (CoRPS), Tilburg University, Tilburg, Netherlands
- *Correspondence: Giesje Nefs,
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18
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Ali N, El Hamdaoui S, Nefs G, Tack CJ, De Galan BE. Improved glucometrics in people with type 1 diabetes 1 year into the COVID-19 pandemic. BMJ Open Diabetes Res Care 2022; 10:10/3/e002789. [PMID: 35606020 PMCID: PMC9125382 DOI: 10.1136/bmjdrc-2022-002789] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/01/2022] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Various studies have shown a number of glycemic parameters to improve over several weeks in people with type 1 diabetes during the first surge of the COVID-19 pandemic. Whether and to what extent such improvement is sustained during following COVID-19 surges remains unknown. Therefore, the aim of this study was to investigate glycemic parameters during the first year of the COVID-19 pandemic in people with type 1 diabetes and to determine factors associated with glycemic improvement. RESEARCH DESIGN AND METHODS This was an observational cohort study in people with type 1 diabetes, aged ≥16 years. We compared glycated hemoglobin (HbA1c) and flash glucose monitoring (FGM) downloads between the prelockdown period and approximately 1 year thereafter. Using logistic regression analysis, we assessed associations between an HbA1c reduction of at least 0.5% (~5.5 mmol/mol) with baseline clinical characteristics and self-reported changes in psychological well-being and lifestyle behavior related to COVID-19. RESULTS A total of 437 participants were included. As compared with prepandemic data, 1 year after the start of the COVID-19 pandemic and associated lockdowns, HbA1c had decreased from 7.9%±1.1% (63±12 mmol/mol) to 7.5%±1.0% (59±11 mmol/mol) (p<0.001), whereas time in range increased from 55.8%±16.7% to 58.6%±16.7% (p=0.004) and time below (<3.9 mmol/L) and above (>13.9 mmol/L) range and glucose variability all decreased (all p<0.05). FGM use, higher HbA1c at baseline and current smoking were independently associated with an HbA1c decrease of at least 0.5%, whereas self-reported changes in psychological well-being and lifestyle behavior related to the first surge of the COVID-19 pandemic and associated lockdowns were not. CONCLUSIONS The COVID-19 pandemic and related lockdown measures were associated with improvement in glucometrics, including HbA1c and FGM data, in individuals with type 1 diabetes, particularly in FGM users, those with higher HbA1c at baseline or current smokers.
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Affiliation(s)
- Namam Ali
- Department of Internal Medicine, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Soumia El Hamdaoui
- Department of Internal Medicine, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Giesje Nefs
- Department of Medical Psychology, Radboudumc Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Center of Research on Psychological disorders and Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Diabeter, National Treatment and Research Center for Children, Adolescents and Adults with Type 1 Diabetes, Rotterdam, Netherlands
| | - Cornelis J Tack
- Department of Internal Medicine, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Bastiaan E De Galan
- Department of Internal Medicine, Radboud University Nijmegen, Nijmegen, The Netherlands
- Internal Medicine/Endocrinology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM School for Cardiovascular Disease, Maastricht University, Maastricht, Netherlands
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19
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Speight J, Skinner TC, Huber JW, Lake AJ, Messina R, Mocan A, Nefs G, Newson L, Povey R, Vallis M, Willaing I. A PSAD Group response to the consensus report on the definition and interpretation of remission in type 2 diabetes: a psychosocial perspective is needed. Diabetologia 2022; 65:406-408. [PMID: 34778926 DOI: 10.1007/s00125-021-05615-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Jane Speight
- School of Psychology, Deakin University, Geelong, VIC, Australia.
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia.
| | - Timothy C Skinner
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
- La Trobe Rural Health School, La Trobe University, Flora Hill, VIC, Australia
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Jörg W Huber
- School of Health Sciences, University of Brighton, Brighton, UK
| | - Amelia J Lake
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Rossella Messina
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Andreia Mocan
- Center for Diabetes, Nutrition and Metabolic Diseases, Emergency Clinical County Hospital Cluj, Cluj, Romania
| | - Giesje Nefs
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Center of Research on Psychological Disorders and Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
- Diabeter, National Treatment and Research Center for Children, Adolescents and Adults with Type 1 Diabetes, Rotterdam, the Netherlands
| | - Lisa Newson
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Rachel Povey
- Department of Psychology, Staffordshire University, Stoke-on-Trent, UK
| | - Michael Vallis
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ingrid Willaing
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
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20
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Beran M, Muzambi R, Geraets A, Albertorio‐Diaz JR, Adriaanse MC, Iversen MM, Kokoszka A, Nefs G, Nouwen A, Pouwer F, Huber JW, Schmitt A, Schram MT. The bidirectional longitudinal association between depressive symptoms and HbA 1c : A systematic review and meta-analysis. Diabet Med 2022; 39:e14671. [PMID: 34407250 PMCID: PMC9292323 DOI: 10.1111/dme.14671] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/17/2021] [Accepted: 08/16/2021] [Indexed: 12/11/2022]
Abstract
AIM To investigate whether there is a bidirectional longitudinal association of depression with HbA1c . METHODS We conducted a systematic literature search in PubMed, PsycINFO, CINAHL and EMBASE for observational, longitudinal studies published from January 2000 to September 2020, assessing the association between depression and HbA1c in adults. We assessed study quality with the Newcastle-Ottawa-Scale. Pooled effect estimates were reported as partial correlation coefficients (rp ) or odds ratios (OR). RESULTS We retrieved 1642 studies; 26 studies were included in the systematic review and eleven in the meta-analysis. Most studies (16/26) focused on type 2 diabetes. Study quality was rated as good (n = 19), fair (n = 2) and poor (n = 5). Of the meta-analysed studies, six investigated the longitudinal association between self-reported depressive symptoms and HbA1c and five the reverse longitudinal association, with a combined sample size of n = 48,793 and a mean follow-up of 2 years. Higher levels of baseline depressive symptoms were associated with subsequent higher levels of HbA1c (partial r = 0.07; [95% CI 0.03, 0.12]; I2 38%). Higher baseline HbA1c values were also associated with 18% increased risk of (probable) depression (OR = 1.18; [95% CI 1.12,1.25]; I2 0.0%). CONCLUSIONS Our findings support a bidirectional longitudinal association between depressive symptoms and HbA1c . However, the observed effect sizes were small and future research in large-scale longitudinal studies is needed to confirm this association. Future studies should investigate the role of type of diabetes and depression, diabetes distress and diabetes self-management behaviours. Our results may have clinical implications, as depressive symptoms and HbA1c levels could be targeted concurrently in the prevention and treatment of diabetes and depression. REGISTRATION PROSPERO ID CRD42019147551.
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Affiliation(s)
- Magdalena Beran
- School for Cardiovascular Disease (CARIM)Department of Internal MedicineMaastricht UniversityMaastrichtThe Netherlands
| | - Rutendo Muzambi
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Anouk Geraets
- School for Cardiovascular Disease (CARIM)Department of Internal MedicineMaastricht UniversityMaastrichtThe Netherlands
- Department of Psychiatry and NeuropsychologyMHeNs School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
| | | | - Marcel C. Adriaanse
- Department of Health Sciences and Amsterdam Public Health Research InstituteFaculty of ScienceVrije UniversiteitAmsterdamThe Netherlands
| | - Marjolein M. Iversen
- Department of Health and Caring SciencesFaculty of Health and Social SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Andrzej Kokoszka
- II Department of PsychiatryMedical University of WarsawWarszawaPoland
| | - Giesje Nefs
- Department of Medical PsychologyRadboud University Medical CenterRadboud Institute for Health SciencesNijmegenThe Netherlands
- Center of Research on Psychology in Somatic Diseases (CoRPS)Department of Medical and Clinical PsychologyTilburg UniversityTilburgThe Netherlands
- DiabeterNational Treatment and Research Center for Children, Adolescents and Young Adults with Type 1 DiabetesRotterdamThe Netherlands
| | - Arie Nouwen
- Department of PsychologyMiddlesex UniversityLondonUnited Kingdom
- School of Health, Wellbeing and Social CareThe Open UniversityMilton KeynesUnited Kingdom
| | - Frans Pouwer
- Department of PsychologyUniversity of Southern DenmarkOdenseDenmark
- STENO Diabetes CenterOdense University HospitalOdenseDenmark
| | - Jörg W. Huber
- School of Health SciencesUniversity of BrightonBrightonUnited Kingdom
| | - Andreas Schmitt
- German Center for Diabetes Research (DZDMünchen‐NeuherbergGermany
- Research Institute of the Diabetes Academy Mergentheim (FIDAMBad MergentheimGermany
| | - Miranda T. Schram
- School for Cardiovascular Disease (CARIM)Department of Internal MedicineMaastricht UniversityMaastrichtThe Netherlands
- Department of Psychiatry and NeuropsychologyMHeNs School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands
- Heart and Vascular CentreMaastricht University Medical Center+MaastrichtThe Netherlands
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21
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Søholm U, Broadley M, Zaremba N, Divilly P, Nefs G, Mahmoudi Z, de Galan B, Pedersen-Bjergaard U, Brennan A, Pollard DJ, McCrimmon RJ, A Amiel S, Hendrieckx C, Speight J, Choudhary P, Pouwer F. Investigating the day-to-day impact of hypoglycaemia in adults with type 1 or type 2 diabetes: design and validation protocol of the Hypo-METRICS application. BMJ Open 2022; 12:e051651. [PMID: 35105572 PMCID: PMC8808414 DOI: 10.1136/bmjopen-2021-051651] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Hypoglycaemia is a frequent adverse event and major barrier for achieving optimal blood glucose levels in people with type 1 or type 2 diabetes using insulin. The Hypo-RESOLVE (Hypoglycaemia-Redefining SOLutions for better liVEs) consortium aims to further our understanding of the day-to-day impact of hypoglycaemia. The Hypo-METRICS (Hypoglycaemia-MEasurement, ThResholds and ImpaCtS) application (app) is a novel app for smartphones. This app is developed as part of the Hypo-RESOLVE project, using ecological momentary assessment methods that will minimise recall bias and allow for robust investigation of the day-to-day impact of hypoglycaemia. In this paper, the development and planned psychometric analyses of the app are described. METHODS AND ANALYSIS The three phases of development of the Hypo-METRICS app are: (1) establish a working group-comprising diabetologists, psychologists and people with diabetes-to define the problem and identify relevant areas of daily functioning; (2) develop app items, with user-testing, and implement into the app platform; and (3) plan a large-scale, multicountry study including interviews with users and psychometric validation. The app includes 7 modules (29 unique items) assessing: self-report of hypoglycaemic episodes (during the day and night, respectively), sleep quality, well-being/cognitive function, social interactions, fear of hypoglycaemia/hyperglycaemia and work/productivity. The app is designed for use within three fixed time intervals per day (morning, afternoon and evening). The first version was released mid-2020 for use (in conjunction with continuous glucose monitoring and activity tracking) in the Hypo-METRICS study; an international observational longitudinal study. As part of this study, semistructured user-experience interviews and psychometric analyses will be conducted. ETHICS AND DISSEMINATION Use of the novel Hypo-METRICS app in a multicountry clinical study has received ethical approval in each of the five countries involved (Oxford B Research Ethics Committee, CMO Region Arnhem-Nijmegen, Ethikkommission der Medizinischen Universität Graz, Videnskabsetisk Komite for Region Hovedstaden and the Comite Die Protection Des Personnes SUD Mediterranne IV). The results from the study will be published in peer review journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER NCT04304963.
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Affiliation(s)
- Uffe Søholm
- Department of Diabetes, King's College London, School of Life Course Sciences, London, UK
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Melanie Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Natalie Zaremba
- Department of Diabetes, King's College London, School of Life Course Sciences, London, UK
| | - Patrick Divilly
- Department of Diabetes, King's College London, School of Life Course Sciences, London, UK
| | - Giesje Nefs
- Department of Medical Psychology, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Noord-Brabant, The Netherlands
- Diabeter, National treatment and research center for children, adolescents and adults with type 1 diabetes, Rotterdam, Netherlands
| | - Zeinab Mahmoudi
- Department of Diabetes, King's College London, School of Life Course Sciences, London, UK
- Digital Therapeutics, Novo Nordisk A/S, Søborg, Denmark
| | - Bastiaan de Galan
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, Division of Endocrinology and Metabolic Disease, Maastricht, Limburg, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Ulrik Pedersen-Bjergaard
- Department of Endocrinology & Nephrology, Endocrine Section, Nordsjællands Hospital, Hillerød, Hillerød, Denmark
- Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark
| | - Alan Brennan
- School of Health & Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Daniel John Pollard
- School of Health & Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Rory J McCrimmon
- Systems Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Stephanie A Amiel
- Department of Diabetes, King's College London, School of Life Course Sciences, London, UK
| | - Christel Hendrieckx
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia Victoria, Melbourne, Victoria, Australia
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Jane Speight
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia Victoria, Melbourne, Victoria, Australia
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Pratik Choudhary
- Department of Diabetes, King's College London, School of Life Course Sciences, London, UK
- Diabetes Research Centre, University of Leicester, UK LE5 4PW, Leicester, UK
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Steno Diabetes Center Odense (SDCO), Odense, Denmark
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22
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Nguyen LA, Pouwer F, Lodder P, Hartman E, Winterdijk P, Aanstoot HJ, Nefs G. Depression and anxiety in adolescents with type 1 diabetes and their parents. Pediatr Res 2022; 91:188-196. [PMID: 33664478 DOI: 10.1038/s41390-021-01392-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 12/24/2020] [Accepted: 01/06/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Longitudinal studies including parental distress when examining adverse health outcomes in adolescents with type 1 diabetes are lacking. This study examined whether parental depression and anxiety predict adolescent emotional distress and glycated hemoglobin A1c (HbA1c) 1 year later and whether a relation between parental distress and HbA1c is mediated by the level of parental involvement in diabetes care and by treatment behaviors. METHODS Longitudinal path modeling was applied to data from 154 adolescents and parents from diabetes centers participating in the Longitudinal study of Emotional problems in Adolescents with type 1 diabetes and their Parents/caregivers (Diabetes LEAP). At baseline and 1-year follow-up, participants completed measures of depression and anxiety. HbA1c was extracted from medical charts. Responsibility and treatment behavior questionnaires were completed by adolescents at baseline. RESULTS Baseline parental depressive and anxiety symptoms were not associated with 1-year adolescent depressive symptoms, anxiety symptoms, and HbA1c. Responsibility division and treatment behaviors did not mediate associations between parental emotional distress and 1-year HbA1c. CONCLUSIONS Parental depressive and anxiety symptoms did not predict adolescent health outcomes 1 year later. Future studies may determine whether the link is present in case of mood/anxiety disorders or severe diabetes-specific distress, or whether adolescents are resilient in the face of parental distress. IMPACT Adolescents with T1D are a vulnerable group in terms of psychological and health outcomes. Whether parental emotional distress (i.e., depressive and anxiety symptoms) is prospectively associated with adolescent emotional distress and/or HbA1c has been understudied. Our results show that parental distress was not related to adolescent distress or HbA1c 1 year later. Responsibility division and treatment behaviors did not mediate associations between parental emotional distress and 1-year HbA1c. Future studies could determine whether these links are present in case of mood/anxiety disorders or severe diabetes-specific distress, or whether adolescents are resilient in the face of parental distress.
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Affiliation(s)
- Linh A Nguyen
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands.,Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,STENO Diabetes Center Odense, Odense, Denmark.,School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Paul Lodder
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands.,Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - Esther Hartman
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Per Winterdijk
- National Treatment and Research Center for Children, Adolescents and Adults with Type 1 Diabetes, Rotterdam, The Netherlands
| | - Henk-Jan Aanstoot
- National Treatment and Research Center for Children, Adolescents and Adults with Type 1 Diabetes, Rotterdam, The Netherlands
| | - Giesje Nefs
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands. .,Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands. .,National Treatment and Research Center for Children, Adolescents and Adults with Type 1 Diabetes, Rotterdam, The Netherlands.
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23
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Van Cauwenberghe J, Enzlin P, Nefs G, Ruige J, Hendrieckx C, De Block C, Pouwer F. Prevalence of and risk factors for sexual dysfunctions in adults with type 1 or type 2 diabetes: Results from Diabetes MILES - Flanders. Diabet Med 2022; 39:e14676. [PMID: 34432909 DOI: 10.1111/dme.14676] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/13/2021] [Accepted: 08/24/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS The prevalence of sexual dysfunctions in people with diabetes is still debated and understudied in women. This study examines the prevalence of sexual dysfunction in men and women with type 1 or type 2 diabetes (T1D or T2D) and the associations with clinical and psychological variables. METHODS Adults with diabetes (n = 756) completed an online survey including questions on sexual functioning (adapted Short Sexual Functional Scale), general emotional well-being (WHO-5), symptoms of anxiety (GAD-7) and diabetes distress (PAID-20). RESULTS One third of participants reported a sexual dysfunction. Men reported erectile dysfunction (T1D: 20%; T2D: 33%), and orgasmic dysfunction (T1D: 22%; T2D: 27%). In men, sexual dysfunction was independently associated with, older age (OR = 1.05, p = 0.022), higher waist circumference (OR = 1.04; p < 0.001) and longer duration of diabetes (OR = 1.04; p = 0.007). More men with sexual dysfunction reported diabetes distress (20% vs. 12%, p = 0.026). Women reported decreased desire (T1D: 22%; T2D: 15%) and decreased arousal (T1D: 9%; T2D: 11%). More women with sexual dysfunction reported diabetes distress (36% vs. 21%, p = 0.003), impaired emotional well-being (36% vs. 25%, p = 0.036) and anxiety symptoms (20% vs. 11%, p = 0.026). CONCLUSION Sexual dysfunctions are common in both men and women with diabetes. In men, sexual dysfunctions were associated with clinical factors. More women with sexual dysfunction reported low emotional well-being and anxiety symptoms compared to women without sexual dysfunction. For both men and women, sexual dysfunctions were associated with diabetes distress.
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Affiliation(s)
- Jolijn Van Cauwenberghe
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, Edegem, Belgium
- Laboratorium of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Paul Enzlin
- Department of Neurosciences, Institute for Family and Sexuality Studies, KU Leuven, Leuven, Belgium
- Centre for Clinical Sexology and Sex Therapy, UPC KU Leuven, Leuven, Belgium
| | - Giesje Nefs
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Diabeter, National Treatment and Research Center for Children, Adolescents and Adults With Type 1 Diabetes, Rotterdam, The Netherlands
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Johannes Ruige
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, Edegem, Belgium
- Centrum Diabeteszorg, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- The Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
| | - Christophe De Block
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, Edegem, Belgium
- Laboratorium of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Frans Pouwer
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
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Bonhof CS, Van de Poll-Franse LV, de Hingh IH, Nefs G, Vreugdenhil G, Mols F. Association between peripheral neuropathy and sleep quality among colorectal cancer patients from diagnosis until 2-year follow-up: results from the PROFILES registry. J Cancer Surviv 2021; 17:894-905. [PMID: 34799785 DOI: 10.1007/s11764-021-01130-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/05/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Studies on the association between peripheral neuropathy (PN) and patient-reported outcomes have mostly overlooked sleep quality. Therefore, we aimed to assess the association between PN and sleep quality in a population-based sample of colorectal cancer (CRC) patients up 2 years after diagnosis. METHODS All newly diagnosed CRC patients from four Dutch hospitals were eligible for participation. Patients (N = 340) completed questionnaires about PN (EORTC QLQ-CIPN20) and sleep (PSQI) before initial treatment (baseline) and 1 and 2 years after diagnosis. RESULTS Patients who developed sensory PN (n = 76) or motor PN (n = 79) after treatment more often reported poor sleeping scores (PSQI > 5) compared with those who did not develop SPN or MPN at 1-year (SPN: 38% vs. 261%, MPN: 37% vs. 14%) and 2-year follow-up (SPN: 38 vs. 23%, MPN: 37% vs. 18%) (all p < 0.05). Overall, results showed that among patients who did not develop SPN or MPN, sleep quality improved after baseline, while among patients with SPN or MPN, sleep quality did not improve at one and two years after diagnosis. CONCLUSIONS Both SPN and MPN were significantly associated with the course of sleep quality among CRC patients up to 2 years after diagnosis. Clinicians should be encouraged to discuss sleep quality with their patients who either report PN or are at risk of developing PN. IMPLICATIONS FOR CANCER SURVIVORS Improving sleep quality among survivors with PN is important, either by reducing PN symptoms or directly targeting sleep.
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Affiliation(s)
- Cynthia S Bonhof
- CoRPS - Center of Research On Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands. .,Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
| | - Lonneke V Van de Poll-Franse
- CoRPS - Center of Research On Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ignace H de Hingh
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.,Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Giesje Nefs
- CoRPS - Center of Research On Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands.,Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Diabeter, National Treatment and Research Center for Children, Adolescents and Adults With Type 1 Diabetes, Rotterdam, The Netherlands
| | - Gerard Vreugdenhil
- Department of Internal Medicine, Máxima Medical Centre, Eindhoven, The Netherlands
| | - Floortje Mols
- CoRPS - Center of Research On Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
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Wellens MJ, Vollenbrock CE, Dekker P, Boesten LSM, Geelhoed-Duijvestijn PH, de Vries-Velraeds MMC, Nefs G, Wolffenbuttel BHR, Aanstoot HJ, van Dijk PR. Residual C-peptide secretion and hypoglycemia awareness in people with type 1 diabetes. BMJ Open Diabetes Res Care 2021; 9:9/1/e002288. [PMID: 34526306 PMCID: PMC8444236 DOI: 10.1136/bmjdrc-2021-002288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 08/27/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION This study aimed to assess the association between fasting serum C-peptide levels and the presence of impaired awareness of hypoglycemia (IAH) in people with type 1 diabetes. RESEARCH DESIGN AND METHODS We performed a cross-sectional study among 509 individuals with type 1 diabetes (diabetes duration 5-65 years). Extensive clinical data and fasting serum C-peptide concentrations were collected and related to the presence or absence of IAH, which was evaluated using the validated Dutch version of the Clarke questionnaire. A multivariable logistic regression model was constructed to investigate the association of C-peptide and other clinical variables with IAH. RESULTS In 129 (25%) individuals, residual C-peptide secretion was detected, while 75 (15%) individuals reported IAH. The median (IQR) C-peptide concentration among all participants was 0.0 (0.0-3.9) pmol/L. The prevalence of severe hypoglycemia was lower in people with demonstrable C-peptide versus those with absent C-peptide (30% vs 41%, p=0.025). Individuals with IAH were older, had longer diabetes duration, more frequently had macrovascular and microvascular complications, and more often used antihypertensive drugs, antiplatelet agents and cholesterol-lowering medication. There was a strong association between IAH and having a severe hypoglycemia in the preceding year. In multivariable regression analysis, residual C-peptide, either continuously or dichotomous, was associated with lower prevalence of IAH (p=0.040-0.042), while age at diabetes onset (p=0.001), presence of microvascular complications (p=0.003) and body mass index (BMI) (p=0.003) were also independently associated with the presence of IAH. CONCLUSIONS Higher BMI, the presence of microvascular complications and higher age at diabetes onset were independent risk factors for IAH in people with type 1 diabetes, while residual C-peptide secretion was associated with lower risk of this complication.
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Affiliation(s)
- Martine J Wellens
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Charlotte E Vollenbrock
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Pim Dekker
- Diabeter, Center for Paediatric and Adolescent Diabetes Care and Research, Rotterdam, The Netherlands
| | - Lianne S M Boesten
- Department of Clinical Chemistry, IJsselland Hospital, Capelle aan den IJssel, Netherlands
| | | | | | - Giesje Nefs
- Diabeter, Center for Paediatric and Adolescent Diabetes Care and Research, Rotterdam, The Netherlands
| | - Bruce H R Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Henk-Jan Aanstoot
- Diabeter, Center for Paediatric and Adolescent Diabetes Care and Research, Rotterdam, The Netherlands
| | - Peter R van Dijk
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Coolen M, Aalders J, Broadley M, Aanstoot HJ, Hartman E, Hendrieckx C, Nefs G, Pouwer F. Hypoglycaemia and diabetes-specific quality of life in adolescents with type 1 diabetes. Diabet Med 2021; 38:e14565. [PMID: 33774871 DOI: 10.1111/dme.14565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/15/2021] [Accepted: 03/24/2021] [Indexed: 12/14/2022]
Abstract
AIMS To examine whether frequency, perceived severity and fear of hypoglycaemia are independently associated with diabetes-specific quality of life in adolescents with type 1 diabetes. METHODS Cross-sectional self-reported data on demographics, frequency and perceived severity of both self-treated and severe hypoglycaemia, fear of hypoglycaemia (Hypoglycaemia Fear Survey-Child version) and diabetes-specific quality of life (Pediatric Quality of Life Diabetes Module; PedsQL-DM) were obtained from the project 'Whose diabetes is it anyway?'. Hierarchical regression analyses were performed for the total scale and recommended summary scores of the PedsQL-DM as dependent variables; independent variables were entered in the following steps: (1) age, gender and HbA1c , (2) frequency of hypoglycaemia, (3) perceived severity of hypoglycaemia and (4) fear of hypoglycaemia. RESULTS Adolescents (12-18 years; n = 96) completed questionnaires. In the first three steps, female gender (p < 0.05), higher HbA1c (p < 0.05), higher frequency of severe hypoglycaemia (p < 0.05) and higher perceived severity of severe (p < 0.05) and self-treated hypoglycaemia (p < 0.001) were significantly associated with lower diabetes-specific quality of life (β ranging from 0.20 to 0.35). However, in the final model only fear of hypoglycaemia was significantly associated with QoL (p < 0.001). Adolescents with greater fear reported lower diabetes-specific quality of life, with 52% explained variance. This pattern was observed across subdomains of diabetes-specific quality of life. CONCLUSIONS Fear of hypoglycaemia was the only factor independently associated with diabetes-specific quality of life, whereas frequency and perceived severity of hypoglycaemia were not. These findings highlight the importance of awareness and assessment of fear of hypoglycaemia in clinical practice.
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Affiliation(s)
- Manon Coolen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Jori Aalders
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Steno Diabetes Center Odense, Odense, Denmark
| | - Melanie Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Henk-Jan Aanstoot
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, The Netherlands
| | - Esther Hartman
- Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, Vic., Australia
- The Australian Centre for Behavioural Research in Diabetes (ACBRD, Melbourne, Vic., Australia
| | - Giesje Nefs
- Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, The Netherlands
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Department of Medical Psychology, Nijmegen, The Netherlands
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense, Denmark
- School of Psychology, Deakin University, Geelong, Vic., Australia
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Lindekilde N, Rutters F, Erik Henriksen J, Lasgaard M, Schram MT, Rubin KH, Kivimäki M, Nefs G, Pouwer F. Psychiatric disorders as risk factors for type 2 diabetes: An umbrella review of systematic reviews with and without meta-analyses. Diabetes Res Clin Pract 2021; 176:108855. [PMID: 33965448 DOI: 10.1016/j.diabres.2021.108855] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/19/2021] [Accepted: 05/04/2021] [Indexed: 12/14/2022]
Abstract
Having a psychiatric disorder may increase the risk of developing type 2 diabetes[T2D] and this umbrella review aims to determine whether people with a psychiatric disorder have an increased risk of developing T2D and to investigate potential underlying mechanisms. A literature search was performed to identify systematic reviews of longitudinal studies investigating different psychiatric disorders as risk factors for incident T2D in humans (≥18 years). A total of 8612 abstracts were identified, 180 full-text articles were read, and 25 systematic reviews were included. Six categories of psychiatric disorders were identified. Except for eating disorders, all psychiatric disorders were associated with increased risk of incident T2D ranging from RR = 1.18 [95% CI 1.12-1.24] to RR = 1.60 [95% CI 1.37-1.88] for depression; from RR = 1.27 [95% CI 1.19-1.35] to OR = 1.50 [95% CI 1.08-2.10] for use of antidepressant medication; from OR = 1.93 [1.37-2.73] to OR = 1.94 [1.34-2.80] for use of antipsychotic medication; from RR = 1.55 [95% CI 1.21-1.99] to RR = 1.74 [95% CI 1.30-2.34] for insomnia, and finally showed OR = 1.47 [95% CI 1.23-1.75] for anxiety disorders. Plausible underlying mechanisms were discussed, but in most reviews corrections for mechanisms did not explain the association. Notable, only 16% of the systematic reviews had a high methodological quality.
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Affiliation(s)
- Nanna Lindekilde
- Department of Psychology, University of Southern Denmark, Odense, Denmark.
| | - Femke Rutters
- Department Epidemiology and Biostatistics, Amsterdam Public Health Institute, Amsterdam UMC, location VUMC, Amsterdam, the Netherlands.
| | - Jan Erik Henriksen
- STENO Diabetes Centre Odense, Odense University Hospital, Odense, Denmark.
| | - Mathias Lasgaard
- DEFACTUM - Public Health and Health Services Research, Central Denmark Region, Aarhus, Denmark.
| | - Miranda T Schram
- Department of Internal Medicine, CARIM School for Cardiovascular Diseases, MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.
| | - Katrine Hass Rubin
- OPEN - Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark.
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University of College London, London, United Kingdom; Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Giesje Nefs
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, the Netherlands; Diabeter, National treatment and research center for children, adolescents and young adults with type 1 diabetes, Rotterdam, the Netherlands; Radboud university medical center, Radboud Institute for Health Sciences, Department of Medical Psychology, Nijmegen, the Netherlands.
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark; STENO Diabetes Centre Odense, Odense University Hospital, Odense, Denmark; School of Psychology, Deakin University, Geelong, Australia.
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Nguyen LA, Pouwer F, Winterdijk P, Hartman E, Nuboer R, Sas T, de Kruijff I, Bakker‐Van Waarde W, Aanstoot H, Nefs G. Prevalence and course of mood and anxiety disorders, and correlates of symptom severity in adolescents with type 1 diabetes: Results from diabetes LEAP. Pediatr Diabetes 2021; 22:638-648. [PMID: 33331108 PMCID: PMC8251968 DOI: 10.1111/pedi.13174] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 09/15/2020] [Accepted: 11/11/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES We aim to determine the prevalence and the course of anxiety and mood disorders in Dutch adolescents (12-18 years old) with type 1 diabetes, and to examine correlates of symptom severity, including parental emotional distress. METHODS Participants were 171 adolescents and 149 parents. The Diagnostic Interview Schedule for Children-IV was used to assess current, past year and lifetime anxiety and mood disorders in adolescents. Symptom severity and diabetes distress were measured with validated questionnaires. Correlates of these symptoms were examined using hierarchical regression analyses and included demographics (adolescent sex and age), clinical factors (diabetes duration, treatment modality, most recent glycated hemoglobin A1c ; all extracted from medical charts), adolescent diabetes distress, and parent emotional distress. RESULTS Twenty-four (14%) adolescents met the criteria for ≥1 disorder(s) in the previous 12 months. Anxiety disorders were more prevalent than mood disorders (13% vs. 4%). Lifetime prevalence of anxiety and mood disorders was 29% (n = 49). The presence of any of these disorders earlier in life (from 5 years old up to 12 months prior to assessment) was associated with disorders in the past 12 months (OR = 4.88, p = 0.001). Higher adolescent diabetes distress was related to higher symptoms of anxiety (b = 0.07, p = 0.001) and depression (b = 0.13, p = 0.001), while demographics, clinical characteristics, and parental emotional distress were not related. CONCLUSIONS Anxiety and mood disorders are common among adolescents and related to earlier disorders. Higher diabetes distress was related to higher symptom severity. Clinicians are advised to address past psychological problems and remain vigilant of these problems.
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Affiliation(s)
- Linh Anh Nguyen
- Department of Medical and Clinical PsychologyCenter of Research on Psychological and Somatic disorders (CoRPS), Tilburg UniversityTilburgThe Netherlands,Department of Medical PsychologyRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands
| | - Frans Pouwer
- Department of PsychologyUniversity of Southern DenmarkOdenseDenmark,School of PsychologyDeakin UniversityGeelongVictoriaAustralia,STENO Diabetes Center OdenseOdenseDenmark
| | | | - Esther Hartman
- Department of Medical and Clinical PsychologyCenter of Research on Psychological and Somatic disorders (CoRPS), Tilburg UniversityTilburgThe Netherlands
| | - Roos Nuboer
- Department of PediatricsMeander Medical CentreAmersfoortThe Netherlands
| | - Theo Sas
- DIABETER, Diabetes CenterRotterdamThe Netherlands,Department of PediatricsAlbert Schweitzer HospitalDordrechtThe Netherlands,Department of Pediatric EndocrinologyErasmus Medical Center – Sophia Children's HospitalRotterdamThe Netherlands
| | - Ineke de Kruijff
- Department of PediatricsDiabetes Central, St. Antonius HospitalNieuwegeinThe Netherlands
| | | | | | - Giesje Nefs
- Department of Medical and Clinical PsychologyCenter of Research on Psychological and Somatic disorders (CoRPS), Tilburg UniversityTilburgThe Netherlands,Department of Medical PsychologyRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands,DIABETER, Diabetes CenterRotterdamThe Netherlands
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Hogervorst S, Adriaanse MC, Hugtenburg JG, Bot M, Speight J, Pouwer F, Nefs G. Medication Intake, Perceived Barriers, and Their Correlates Among Adults With Type 1 and Type 2 Diabetes: Results From Diabetes MILES – The Netherlands. Front Clin Diabetes Healthc 2021; 2:645609. [PMID: 36994341 PMCID: PMC10012124 DOI: 10.3389/fcdhc.2021.645609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/24/2021] [Indexed: 11/13/2022]
Abstract
PurposeThe purpose of this study is to investigate medication intake, perceived barriers and their correlates in adults with type 1 or type 2 diabetes.MethodsIn this cross-sectional study, 3,383 Dutch adults with diabetes (42% type 1; 58% type 2) completed the 12-item ‘Adherence Starts with Knowledge’ questionnaire (ASK-12; total score range: 12-60) and reported socio-demographics, clinical and psychological characteristics and health behaviors. Univariable and multivariable logistic regression analyses were used.ResultsAdults with type 1 diabetes had a slightly lower mean ASK-12 score (i.e. more optimal medication intake and fewer perceived barriers) than adults with non-insulin-treated type 2 diabetes. After adjustment for covariates, correlates with suboptimal intake and barriers were fewer severe hypoglycemic events and more depressive symptoms and diabetes-specific distress. In type 2 diabetes, correlates were longer diabetes duration, more depressive symptoms and diabetes-specific distress.ConclusionsAdults with type 1 diabetes showed slightly more optimal medication intake and fewer perceived barriers than adults with non-insulin treated type 2 diabetes. Correlates differed only slightly between diabetes types. The strong association with depressive symptoms and diabetes-specific distress in both diabetes types warrants attention, as improving these outcomes in some people with diabetes might indirectly improve medication intake.
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Affiliation(s)
- Stijn Hogervorst
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute (APH), Amsterdam University Medical Centre, Amsterdam, Netherlands
- *Correspondence: Stijn Hogervorst, , orcid.org/0000-0001-9276-2675
| | - Marce C. Adriaanse
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute (APH), Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Jacqueline G. Hugtenburg
- Amsterdam Public Health Research Institute (APH), Amsterdam University Medical Centre, Amsterdam, Netherlands
- Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Centres (UMC), Amsterdam, Netherlands
| | - Mariska Bot
- Department of Psychiatry and the Amsterdam Public Health Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Frans Pouwer
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense (SDCO), Odense, Denmark
| | - Giesje Nefs
- Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
- Diabeter, National Treatment and Research Center for Children, Adolescents and Adults With Type 1 Diabetes, Rotterdam, Netherlands
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Aalders J, Hartman E, Pouwer F, Winterdijk P, van Mil E, Roeleveld-Versteegh A, Mommertz-Mestrum E, Aanstoot HJ, Nefs G. The division and transfer of care responsibilities in paediatric type 1 diabetes: A qualitative study on parental perspectives. J Adv Nurs 2021; 77:1968-1979. [PMID: 33591623 PMCID: PMC8048668 DOI: 10.1111/jan.14781] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/04/2021] [Accepted: 01/27/2021] [Indexed: 12/17/2022]
Abstract
Aim To determine which factors other than child age play a role in the division and transfer of diabetes care responsibilities between parents and children with type 1 diabetes. Design Qualitative focus group study. Methods Across four sites in the Netherlands, 18 parents (13 mothers) of children (9–14 years) with type 1 diabetes participated in four focus groups in 2015–2016, as part of the research project 'Whose diabetes is it anyway?'. Qualitative content analysis and the constant comparison method were used to analyse the data. Results According to parents, the transfer process included both direct and indirect tasks, had different levels (remembering, deciding, performing), was at times a difficult and stressful process, and showed large variation between families. A large number of child, parent and context factors were identified that affected the division and transfer of diabetes care responsibilities according to parents. Both positive and negative consequences of the transfer process were described for parental and child health, behaviour and well‐being. Parental final evaluations of the division and transfer of diabetes care responsibilities appeared to be dependent on parenting values. Conclusion How families divide and transfer diabetes care tasks appeared to be affected by a complex interplay of child, parent and context characteristics, which had an impact on several parent and child domains. Impact Parents struggle with the right timing of transfer, which calls for more support from diabetes nurses. The identified factors can be used as input for integrating a more family‐based approach into current age‐based guidelines, to improve regular care.
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Affiliation(s)
- Jori Aalders
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders [CoRPS], Tilburg University, Tilburg, The Netherlands.,Department of Psychology, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center Odense, Odense, Denmark
| | - Esther Hartman
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders [CoRPS], Tilburg University, Tilburg, The Netherlands
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center Odense, Odense, Denmark.,School of Psychology, Deakin University, Geelong, Australia
| | - Per Winterdijk
- Diabeter, Center for pediatric and adolescent diabetes care and research, Rotterdam, The Netherlands
| | - Edgar van Mil
- Kidz&Ko, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | | | | | - Henk-Jan Aanstoot
- Diabeter, Center for pediatric and adolescent diabetes care and research, Rotterdam, The Netherlands
| | - Giesje Nefs
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders [CoRPS], Tilburg University, Tilburg, The Netherlands.,Diabeter, Center for pediatric and adolescent diabetes care and research, Rotterdam, The Netherlands.,Department of Medical Psychology, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Vogtschmidt YD, Nefs G, Speight J, Bot M, Pouwer F, Soedamah-Muthu SS. Depressive and anxiety symptoms and following of the Dutch Dietary Guidelines 2015 in adults with diabetes: Results from Diabetes MILES-The Netherlands. J Psychosom Res 2020; 135:110160. [PMID: 32521359 DOI: 10.1016/j.jpsychores.2020.110160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aims to examine the associations between following of the Dutch dietary guidelines 2015 and elevated depressive and anxiety symptoms in adults with diabetes. METHODS Cross-sectional data of 3174 people (47% men, mean age 55 ± 14 years) with type 1 diabetes (n = 1369) and type 2 diabetes (n = 1805) participating in Diabetes MILES-The Netherlands were analysed. Following of the Dutch dietary guidelines 2015 was quantified using the Dutch Healthy Diet 2015 (DHD15)-index (12 food components; total score range 0-120 points), calculated from a 32-item food frequency questionnaire. Cases with elevated depressive and anxiety symptoms (cutoff ≥ 10) were measured using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7, respectively. Cox regression models were used to estimate the prevalence ratios (PRs) adjusted for demographical, lifestyle related, clinical and biomedical factors. RESULTS Elevated depressive and anxiety symptoms were present in 167 (12%) and 89 (7%) of participants with type 1 diabetes and 215 (12%) and 97 (5%) of those with type 2 diabetes, respectively. In the total sample (n = 3174), a DHD15-index score in the highest quartile was associated with lower prevalence of elevated depressive symptoms, compared to the lowest quartile with an adjusted PR [95% CI] of 0.73 [0.55-0.98]. The inverse association was more pronounced among participants with type 2 diabetes and among non-smokers. There was no association with elevated anxiety symptoms (adjusted PR [95% CI]: 1.03 [0.68-1.55]). CONCLUSION Closer following of the Dutch dietary guidelines 2015 was associated with a lower likelihood of elevated depressive symptoms in adults with type 2 diabetes.
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Affiliation(s)
- Yakima D Vogtschmidt
- Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
| | - Giesje Nefs
- Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands; Department of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands; Diabeter, National Treatment and Research Center for Children, Adolescents and Young Adults With Type 1 Diabetes, Rotterdam, the Netherlands.
| | - Jane Speight
- The Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia; School of Psychology, Deakin University, Geelong, Victoria, Australia; Department of Psychology, University of Southern Denmark, Odense, Denmark.
| | - Mariska Bot
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Frans Pouwer
- School of Psychology, Deakin University, Geelong, Victoria, Australia; Department of Psychology, University of Southern Denmark, Odense, Denmark; STENO Diabetes Center Odense (SDCO), Odense, Denmark.
| | - Sabita S Soedamah-Muthu
- Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands; Institute for Food, Nutrition and Health (IFNH), University of Reading, Reading RG6 6AR, UK.
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Nefs G, Albright-Pierce MR, Kanc K, Feinn R, Wagner J. Diabetes Self-Management Decrements Mediate the Relation of Stressful Life Events and Hemoglobin A1c-Differences by Race/Ethnicity in Adolescents. J Adolesc Health 2020; 67:282-285. [PMID: 32265085 DOI: 10.1016/j.jadohealth.2020.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/03/2020] [Accepted: 02/03/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE The aim of the study was to establish whether suboptimal self-management explains the relationship between stressful life events and hemoglobin A1c (HbA1c) in adolescents with type 1 diabetes and whether these relationships differ across race/ethnicity. METHODS Participants were 6,368 adolescents enrolled in the U.S. T1D Exchange registry. The outcome, HbA1c, was chart-based; predictors and covariates were self-reported. Moderated mediation was tested using Mplus, adjusting for gender, age, insulin treatment modality, and socioeconomic status. RESULTS Higher frequency of missed insulin doses and lower frequency of daily self-monitoring of blood glucose partially explained the relationship between past-year stressful life events and higher HbA1c. Mediation by self-monitoring of blood glucose was detected for those who identified as white non-Hispanic and Hispanic, but not for those who identified as African American. CONCLUSIONS In adolescents, there is some evidence for a behavioral mechanism in the stressor-HbA1c relationship. African American youth may be more resilient against some detrimental behavioral effects of stressors.
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Affiliation(s)
- Giesje Nefs
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands; Diabeter, National Treatment and Research Center for Children, Adolescents and Young Adults With Type 1 Diabetes, Rotterdam, The Netherlands.
| | | | - Karin Kanc
- jazindiabetes (Diabetes&Me), Private Diabetes Centre, Ljubljana, Slovenia
| | - Richard Feinn
- Medical Sciences, School of Medicine, Quinnipiac University, Hamden, Connecticut
| | - Julie Wagner
- Department of Behavioral Sciences and Community Health, University of Connecticut Schools of Medicine and Dental Medicine, Farmington, Connecticut
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Nouwen A, Adriaanse MC, van Dam K, Iversen MM, Viechtbauer W, Peyrot M, Caramlau I, Kokoszka A, Kanc K, de Groot M, Nefs G, Pouwer F. Longitudinal associations between depression and diabetes complications: a systematic review and meta-analysis. Diabet Med 2019; 36:1562-1572. [PMID: 31215077 DOI: 10.1111/dme.14054] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2019] [Indexed: 01/10/2023]
Abstract
To conduct a systematic review and meta-analysis of longitudinal studies assessing the bi-directional association between depression and diabetes macrovascular and microvascular complications. Embase, Medline and PsycINFO databases were searched from inception through 27 November 2017. A total of 4592 abstracts were screened for eligibility. Meta-analyses used multilevel random/mixed-effects models. Quality was assessed using the Newcastle-Ottawa scale. Twenty-two studies were included in the systematic review. Sixteen studies examined the relationship between baseline depression and incident diabetes complications, of which nine studies involving over one million participants were suitable for meta-analysis. Depression was associated with an increased risk of incident macrovascular (HR = 1.38; 95% CI: 1.30-1.47) and microvascular disease (HR = 1.33; 95% CI: 1.25-1.41). Six studies examined the association between baseline diabetes complications and subsequent depression, of which two studies involving over 230 000 participants were suitable for meta-analysis. The results showed that diabetes complications increased the risk of incident depressive disorder (HR = 1.14; 95% CI: 1.07-1.21). The quality analysis showed increased risk of bias notably in the representativeness of selected cohorts and ascertainment of exposure and outcome. Depression in people with diabetes is associated with an increased risk of incident macrovascular and microvascular complications. The relationship between depression and diabetes complications appears bi-directional. However, the risk of developing diabetes complications in depressed people is higher than the risk of developing depression in people with diabetes complications. The underlying mechanisms warrant further research.
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Affiliation(s)
- A Nouwen
- Middlesex University, London, UK
| | | | | | - M M Iversen
- Western Norway University of Applied Sciences, Bergen, Norway
| | | | - M Peyrot
- Western Norway University of Applied Sciences, Bergen, Norway
- Loyola University Maryland, Baltimore, USA
| | | | | | - K Kanc
- Jazindiabetes (Diabetes & Me), Private Diabetes Centre, Ljubljana, Slovenia
| | - M de Groot
- Indiana University School of Medicine, Indianapolis, USA
| | - G Nefs
- Tilburg University, The Netherlands
- Radboud University Medical Center, Nijmegen, The Netherlands
- Diabeter, Rotterdam, The Netherlands
| | - F Pouwer
- University of Southern Denmark, Odense, Denmark
- STENO Diabetes Center Odense, Odense, Denmark
- School of Psychology, Deakin University, Geelong, Australia
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Nefs G, Bazelmans E, Marsman D, Snellen N, Tack CJ, de Galan BE. RT-CGM in adults with type 1 diabetes improves both glycaemic and patient-reported outcomes, but independent of each other. Diabetes Res Clin Pract 2019; 158:107910. [PMID: 31678626 DOI: 10.1016/j.diabres.2019.107910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
Abstract
AIMS To examine in adults with type 1 diabetes (a) the effect of initiation of real-time continuous glucose monitoring (RT-CGM) on glycaemic and patient-reported outcomes (PROs), and (b) factors related to clinically relevant improvements and sustained device use. METHODS 60 persons initiating RT-CGM completed questionnaires at device start and six months later. Demographics and clinical characteristics including (dis)continuation up until July 31st 2018 were obtained from medical records. RESULTS After six months, 54 adults were still using RT-CGM. Short-term discontinuation (10%) was mainly related to end of pregnancy (wish). Longer-term discontinuation in those with an initial non-pregnancy indication was related to changes in the medical condition and behavioural/psychological reasons. After six months, HbA1c, diabetes-specific worries and self-efficacy improved (range d = |0.4|-|0.8|), while hypoglycaemia rate or awareness and more general distress did not change. More suboptimal scores at baseline were related to meaningful improvements in HbA1c (≥10 mmol/mol; 0.9%) and PROs (≥0.5 SD). Changes in glycaemic variables and PROs were not related. CONCLUSIONS People with more suboptimal HbA1c and PRO values appear to benefit most from RT-CGM. Given the lack of association between improvements in medical outcomes and PROs, both should be included in evaluations of RT-CGM therapy on an individual level.
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Affiliation(s)
- Giesje Nefs
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Medical Psychology, Nijmegen, the Netherlands; Tilburg University, Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg, the Netherlands; Diabeter, National Treatment and Research Center for Children, Adolescents and Young Adults with Type 1 Diabetes, Rotterdam, the Netherlands.
| | - Ellen Bazelmans
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Medical Psychology, Nijmegen, the Netherlands
| | - Diane Marsman
- Radboud university medical center, Department of Internal Medicine, 463, Nijmegen, the Netherlands
| | - Niels Snellen
- Radboud university medical center, Department of Internal Medicine, 463, Nijmegen, the Netherlands
| | - Cees J Tack
- Radboud university medical center, Department of Internal Medicine, 463, Nijmegen, the Netherlands
| | - Bastiaan E de Galan
- Radboud university medical center, Department of Internal Medicine, 463, Nijmegen, the Netherlands
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Nefs G, Nguyen L, Winterdijk P, Hartman E, Sas T, Nuboer R, De Kruijff I, Bakker-van Waarde W, Aanstoot HJ, Pouwer F. Study protocol of Diabetes LEAP: a longitudinal study examining emotional problems in adolescents with type 1 diabetes and their parents/caregivers. BMC Pediatr 2019; 19:377. [PMID: 31651275 PMCID: PMC6813041 DOI: 10.1186/s12887-019-1743-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 09/20/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Type 1 diabetes (T1D) is a chronic metabolic condition requiring intensive daily self-care to avoid both high and low blood glucose levels. Self-care and glycemic outcomes are particularly problematic in adolescence, a period known for its increased risk of emotional problems. However, the true scope of mood and anxiety disorders in adolescents with T1D is unknown. Earlier studies are limited by a small sample size, lack of diagnostic interview data, a focus on depression only, non-adolescent specific estimates, lack of information about parental emotional problems and/or a cross-sectional design. Diabetes LEAP is a two-year prospective observational cohort study examining (a) the prevalence and course of depression and anxiety in adolescents with T1D and their parents/caregivers, (b) the risk factors predicting the presence of these emotional problems, (c) their longitudinal relation with diabetes outcomes, and (d) the psychosocial care currently in place. METHODS Adolescents (12-18 years) from 8 Dutch pediatric diabetes clinics are interviewed using the DISC-IV to establish the presence of mood and anxiety disorders in the previous 4 weeks, the previous 12 months, and lifetime. They also complete questionnaires, including CDI-2, GAD-7, and PAID-T. Parents/caregivers complete PHQ-9, GAD-7, and PAID-PR. Follow-up assessments take place after 1 and 2 years. DISCUSSION This longitudinal study with diagnostic interviews in a large cohort of adolescents with T1D in the Netherlands will provide much needed information regarding the prevalence and course of depression and anxiety in this group, thereby opening avenues for proper recognition, prevention and timely treatment.
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Affiliation(s)
- Giesje Nefs
- Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands. .,Diabeter, National Treatment and Research Center for Children, Adolescents and Young Adults with type 1 diabetes, Blaak 6, 3011, TA, Rotterdam, The Netherlands. .,Radboud university medical center, Radboud Institute for Health Sciences, Department of Medical Psychology, Huispost 840, Postbus 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Linh Nguyen
- Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands
| | - Per Winterdijk
- Diabeter, National Treatment and Research Center for Children, Adolescents and Young Adults with type 1 diabetes, Blaak 6, 3011, TA, Rotterdam, The Netherlands
| | - Esther Hartman
- Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands
| | - Theo Sas
- Diabeter, National Treatment and Research Center for Children, Adolescents and Young Adults with type 1 diabetes, Blaak 6, 3011, TA, Rotterdam, The Netherlands.,Department of Pediatrics, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318, AT, Dordrecht, The Netherlands.,Department of Pediatric Endocrinology, Erasmus Medical Center - Sophia Childrens' Hospital, Rotterdam, The Netherlands
| | - Roos Nuboer
- Department of Pediatrics, Meander Medical Center, Maatweg 3, 3813, Amersfoort, TZ, Netherlands
| | - Ineke De Kruijff
- Department of Pediatrics, Diabetes Centraal, St. Antonius Hospital, Soestwetering 1, 3543, AZ, Utrecht, The Netherlands
| | - Willie Bakker-van Waarde
- Diabeter, National Treatment and Research Center for Children, Adolescents and Young Adults with type 1 diabetes, Blaak 6, 3011, TA, Rotterdam, The Netherlands
| | - Henk-Jan Aanstoot
- Diabeter, National Treatment and Research Center for Children, Adolescents and Young Adults with type 1 diabetes, Blaak 6, 3011, TA, Rotterdam, The Netherlands
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.,School of Psychology, Deakin University, Locked Bag 20001, Geelong, VIC, 3220, Australia.,STENO Diabetes Center Odense, Odense University Hospital, Odense, Denmark
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Affiliation(s)
- Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark.
- STENO Diabetes Center Odense, Odense, Denmark.
- School of Psychology, Deakin University, Geelong, Australia.
| | - Giesje Nefs
- Radboud University Medical Center, Department of Medical Psychology, Radboud Institute for Health Sciences, Nijmegen, Netherlands
- Diabeter, National Treatment and Research Center for Children, Adolescents and Adults with Type 1 Diabetes, Rotterdam, Netherlands
- Tilburg University, Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
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Lodder P, Denollet J, Emons WHM, Nefs G, Pouwer F, Speight J, Wicherts JM. Modeling Interactions Between Latent Variables in Research on Type D Personality: A Monte Carlo Simulation and Clinical Study of Depression and Anxiety. Multivariate Behav Res 2019; 54:637-665. [PMID: 30977400 DOI: 10.1080/00273171.2018.1562863] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Several approaches exist to model interactions between latent variables. However, it is unclear how these perform when item scores are skewed and ordinal. Research on Type D personality serves as a good case study for that matter. In Study 1, we fitted a multivariate interaction model to predict depression and anxiety with Type D personality, operationalized as an interaction between its two subcomponents negative affectivity (NA) and social inhibition (SI). We constructed this interaction according to four approaches: (1) sum score product; (2) single product indicator; (3) matched product indicators; and (4) latent moderated structural equations (LMS). In Study 2, we compared these interaction models in a simulation study by assessing for each method the bias and precision of the estimated interaction effect under varying conditions. In Study 1, all methods showed a significant Type D effect on both depression and anxiety, although this effect diminished after including the NA and SI quadratic effects. Study 2 showed that the LMS approach performed best with respect to minimizing bias and maximizing power, even when item scores were ordinal and skewed. However, when latent traits were skewed LMS resulted in more false-positive conclusions, while the Matched PI approach adequately controlled the false-positive rate.
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Affiliation(s)
- Paul Lodder
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, The Netherlands
- Department of Methodology and Statistics, Tilburg University, The Netherlands
| | - Johan Denollet
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, The Netherlands
| | - Wilco H M Emons
- Department of Methodology and Statistics, Tilburg University, The Netherlands
| | - Giesje Nefs
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, The Netherlands
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Denmark
- STENO Diabetes Center Odense, Odense, Denmark
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
- AHP Research, Hornchurch, UK
| | - Jelte M Wicherts
- Department of Methodology and Statistics, Tilburg University, The Netherlands
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Nefs G, Hendrieckx C, Reddy P, Browne JL, Bot M, Dixon J, Kyrios M, Speight J, Pouwer F. Comorbid elevated symptoms of anxiety and depression in adults with type 1 or type 2 diabetes: Results from the International Diabetes MILES Study. J Diabetes Complications 2019; 33:523-529. [PMID: 31129003 DOI: 10.1016/j.jdiacomp.2019.04.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/05/2019] [Accepted: 04/22/2019] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- Giesje Nefs
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Psychology, Nijmegen, the Netherlands; Tilburg University, Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg, the Netherlands; Diabeter, National treatment and research center for children, adolescents and young adults with type 1 diabetes, Rotterdam, the Netherlands.
| | - Christel Hendrieckx
- Deakin University, School of Psychology, Geelong, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Prasuna Reddy
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom; University of Technology Sydney, Australia; Swinburne University of Technology, Hawthorn, Australia
| | | | - Mariska Bot
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health, Amsterdam, the Netherlands
| | - John Dixon
- Human Neurotransmitters, Baker Heart and Diabetes Institute, Melbourne, Australia; Primary Care Research, Monash University, Melbourne, Australia
| | - Michael Kyrios
- College of Education, Psychology and Social Work, Flinders University, Australia
| | - Jane Speight
- Deakin University, School of Psychology, Geelong, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia; AHP Research, Hornchurch, United Kingdom; Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - François Pouwer
- Deakin University, School of Psychology, Geelong, Australia; Department of Psychology, University of Southern Denmark, Odense, Denmark; STENO Diabetes Center Odense
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Lindekilde N, Nefs G, Henriksen JE, Lasgaard M, Schram M, Rubin K, Rutters F, Kivimaki M, Pouwer F. Psychiatric disorders as risk factors for the development of type 2 diabetes mellitus: an umbrella review protocol. BMJ Open 2019; 9:e024981. [PMID: 31152031 PMCID: PMC6549739 DOI: 10.1136/bmjopen-2018-024981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Numerous longitudinal studies, systematic reviews and meta-analyses have examined psychiatric disorders as risk factors for the development of type 2 diabetes mellitus. A more comprehensive overview of the area is warranted to summarise current evidence and discuss strengths and weaknesses to guide future research. AIM The aim of this umbrella review is to determine whether and to what extent different psychiatric disorders are associated with the development of type 2 diabetes mellitus. Furthermore, the umbrella review also assesses the evidence on potential mediating mechanisms. METHODS AND ANALYSIS The present umbrella review will consist of a comprehensive systematic search of published systematic reviews and meta-analyses of observational longitudinal studies investigating whether a psychiatric disorder is associated with the risk of developing type 2 diabetes. PubMed, Embase, PsychINFO and the Cochrane Database of Systematic Reviews will be searched, and the results will be screened for inclusion by two independent reviewers. Furthermore, the reference lists of included publications will be manually searched. Two independent reviewers will extract data and assess the methodological quality in the included systematic reviews and meta-analyses. Evidence on potential mediating mechanisms included in the systematic reviews and meta-analyses will also be reviewed. The implications of the overview will be discussed in light of the quality of the included studies, and suggestions for clinical practice and future research will be made. ETHICS AND DISSEMINATION Ethical approval is not required for this umbrella review. Our review will be submitted for publication in a peer-reviewed international journal using open access option if available. The results will also be disseminated at international conferences. PROSPERO REGISTRATION NUMBER CRD42018096362.
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Affiliation(s)
- Nanna Lindekilde
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Giesje Nefs
- Diabeter, National Treatment and Research Center for Children, Adolescents and Young Adults with Type 1 Diabetes, Rotterdam, The Netherlands
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Jan Erik Henriksen
- Steno Diabetes Centre Odense, Odense University Hospital, Odense, Denmark
| | - Mathias Lasgaard
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- DEFACTUM Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Miranda Schram
- Department of Internal Medicine, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Katrine Rubin
- Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Femke Rutters
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University of College London, London, UK
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Centre Odense, Odense University Hospital, Odense, Denmark
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Stoop C, Pouwer F, Pop V, Den Oudsten B, Nefs G. Psychosocial health care needs of people with type 2 diabetes in primary care: Views of patients and health care providers. J Adv Nurs 2019; 75:1702-1712. [PMID: 30883846 PMCID: PMC6850404 DOI: 10.1111/jan.13996] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/22/2018] [Accepted: 02/18/2019] [Indexed: 01/28/2023]
Abstract
Aims This study examined (a) psychosocial health care needs of people with type 2 diabetes from the perspective of patients and diabetes healthcare providers in primary care, in terms of topics, attention in diabetes care and preferences and (b) factors associated with a positive attitude towards specialized psychosocial health care. Design Qualitative focus group study. Methods Using purposive sampling, participants were selected from general practices. In 2012–2013, three focus groups were conducted in people with type 2 diabetes (N = 20) and three with healthcare providers (N = 18). Results Opinions differed considerably on whether there was a need for psychosocial health care. Topics focused mainly on diabetes‐specific issues ranging from a need for additional diabetes education to attention and support in regular diabetes care. However, not all healthcare providers felt competent enough to address psychosocial problems. Some participants reported a need for specialized psychosocial help. A positive attitude towards specialized psychosocial health care appeared to be influenced by care setting (e.g., in the primary care practice or ‘outside’ mental health care), care accessibility, proactive discussion of psychosocial issues with and referral by healthcare providers and previous experiences with psychosocial health care. Conclusion Although only few participants expressed a need for specialized psychosocial care, attention for psychosocial well‐being in regular diabetes care was generally appreciated. Impact People with type 2 diabetes generally felt psychosocial care could be provided as part of regular diabetes care. Suggestions for healthcare providers to meet psychosocial health care needs include training and discussion tools.
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Affiliation(s)
- Corinne Stoop
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands.,PoZoB, Veldhoven, The Netherlands
| | - François Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,School of Psychology, Deakin University, Geelong, Australia
| | - Victor Pop
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Brenda Den Oudsten
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Giesje Nefs
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands.,Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, The Netherlands
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Spek V, Nefs G, Mommersteeg PMC, Speight J, Pouwer F, Denollet J. Type D personality and social relations in adults with diabetes: results from diabetes MILES - The Netherlands. Psychol Health 2018; 33:1456-1471. [PMID: 30295085 DOI: 10.1080/08870446.2018.1508684] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To examine whether individual differences in Type D personality (combination of negative affectivity (NA) and social inhibition (SI)) could explain heterogeneity in perceived social support and relationship adjustment (intimate partner relationship) among people living with diabetes. DESIGN In the Diabetes MILES-The Netherlands survey, 621 adults with type 1 or type 2 diabetes (54% female, age: 56 ± 14 years) completed measures of Type D personality (DS14), perceived social support and relationship adjustment. We used established DS14 cut-off scores to indicate Type D personality, high NA only, high SI only and reference groups. RESULTS Participants from the Type D and NA only groups perceived lower levels of social support (Welch[3,259] = 37.27, p < 0.001), and relationship adjustment (Welch[3,191] = 14.74; p < 0.01) than those from the SI only and reference groups. Type D was associated with lower social support (lowest quartile; adjusted OR = 8.73; 95%CI = 5.05 ∼ 15.09; p < 0.001) and lower relationship adjustment (lowest quartile; adjusted OR = 3.70; 95%CI = 2.10 ∼ 6.53; p < 0.001). Type D was also associated with increased levels of loneliness. CONCLUSION Participants with Type D and participants with high NA only tend to experience less social support and less relationship adjustment. Type D personality was also associated with more loneliness. Experiencing lower social support and relationship adjustment may complicate coping and self-management in people with diabetes.
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Affiliation(s)
- Viola Spek
- a CoRPS , Tilburg University , Tilburg , The Netherlands
| | - Giesje Nefs
- a CoRPS , Tilburg University , Tilburg , The Netherlands.,b Department of Medical Psychology , Radboud University Medical Center , Nijmegen , The Netherlands.,c Diabeter, National diabetes treatment center for children, adolescents and young adults , Rotterdam , The Netherlands
| | | | - Jane Speight
- d School of Psychology , Deakin University , Geelong , VIC , Australia.,e The Australian Centre for Behavioural Research in Diabetes , Melbourne VIC , Australia
| | - Frans Pouwer
- e The Australian Centre for Behavioural Research in Diabetes , Melbourne VIC , Australia.,f University of Southern Denmark , Odense , Denmark
| | - Johan Denollet
- a CoRPS , Tilburg University , Tilburg , The Netherlands
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Aalders J, Hartman E, Nefs G, Nieuwesteeg A, Hendrieckx C, Aanstoot H, Winterdijk P, van Mil E, Speight J, Pouwer F. Mindfulness and fear of hypoglycaemia in parents of children with Type 1 diabetes: results from Diabetes MILES Youth - The Netherlands. Diabet Med 2018; 35:650-657. [PMID: 29385240 PMCID: PMC5947298 DOI: 10.1111/dme.13594] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2018] [Indexed: 01/10/2023]
Abstract
AIMS To identify the sociodemographic and clinical correlates of fear of hypoglycaemia among parents of children (aged 4-18 years) with Type 1 diabetes and to examine the relationships between parental fear of hypoglycaemia, mindfulness and mindful parenting. METHODS Sociodemographic, self-reported clinical and psychological data were extracted from the cross-sectional Diabetes MILES Youth - The Netherlands dataset. Questionnaires included the Hypoglycaemia Fear Survey - Parent Worry (parental fear of hypoglycaemia), the Freiburg Mindfulness Inventory - Short version (mindfulness) and the Interpersonal Mindfulness in Parenting Scale (mindful parenting). RESULTS A total of 421 parents (359 mothers) participated. Hierarchical linear regression analyses showed that greater parental fear of hypoglycaemia was related to younger parental age, low educational level, non-Dutch nationality, more frequent blood glucose monitoring, and less general mindfulness. Adding mindful parenting to the model negated the previous contribution of general mindfulness. In this model, lower mindful parenting was related to greater parental fear of hypoglycaemia. In particular, parents with an increased ability to be less judgemental of themselves as parents and less reactive to emotions within parenting interactions reported less fear of hypoglycaemia. In total, 21% of the variance in parental fear of hypoglycaemia was explained. CONCLUSION Parental fear of hypoglycaemia was associated largely with parental characteristics, including non-modifiable sociodemographics (i.e. age, education, nationality) and modifiable psychological factors (i.e. mindful parenting). These findings suggest that it is important to further explore mindfulness-based interventions for parents to reduce fear of hypoglycaemia next to interventions to reduce hypoglycaemia.
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Affiliation(s)
- J. Aalders
- Department of Medical and Clinical PsychologyCenter of Research on Psychological and Somatic Dsorders (CoRPS)Tilburg UniversityTilburgThe Netherlands
| | - E. Hartman
- Department of Medical and Clinical PsychologyCenter of Research on Psychological and Somatic Dsorders (CoRPS)Tilburg UniversityTilburgThe Netherlands
| | - G. Nefs
- Department of Medical and Clinical PsychologyCenter of Research on Psychological and Somatic Dsorders (CoRPS)Tilburg UniversityTilburgThe Netherlands
- Diabeter Centre for Pediatric and Adolescent Diabetes Care and ResearchRotterdamThe Netherlands
- Department of Medical PsychologyRadboud University Medical CentreRadboud Institute for Health ScienceNijmegenThe Netherlands
| | - A. Nieuwesteeg
- Department of Medical and Clinical PsychologyCenter of Research on Psychological and Somatic Dsorders (CoRPS)Tilburg UniversityTilburgThe Netherlands
- Máxima Medical CentreVeldhovenThe Netherlands
| | - C. Hendrieckx
- School of PsychologyDeakin UniversityGeelong, MelbourneAustralia
- Australian Centre for Behavioural Research in DiabetesDiabetes VictoriaMelbourneAustralia
| | - H.‐J. Aanstoot
- Diabeter Centre for Pediatric and Adolescent Diabetes Care and ResearchRotterdamThe Netherlands
| | - P. Winterdijk
- Diabeter Centre for Pediatric and Adolescent Diabetes Care and ResearchRotterdamThe Netherlands
| | - E. van Mil
- Kidz&Ko, Jeroen Bosch Hospital‘s‐HertogenboschThe Netherlands
| | - J. Speight
- School of PsychologyDeakin UniversityGeelong, MelbourneAustralia
- Australian Centre for Behavioural Research in DiabetesDiabetes VictoriaMelbourneAustralia
- AHP ResearchHornchurchUK
- Department of PsychologyUniversity of Southern DenmarkOdenseDenmark
| | - F. Pouwer
- School of PsychologyDeakin UniversityGeelong, MelbourneAustralia
- Department of PsychologyUniversity of Southern DenmarkOdenseDenmark
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Nefs G, Pouwer F. The role of hypoglycemia in the burden of living with diabetes among adults with diabetes and family members: results from the DAWN2 study in The Netherlands. BMC Public Health 2018; 18:156. [PMID: 29347915 PMCID: PMC5774142 DOI: 10.1186/s12889-018-5064-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 01/10/2018] [Indexed: 11/15/2022] Open
Abstract
Background To examine the relation between self-reported hypoglycemic events, worries about these episodes, and the burden of diabetes in adults with diabetes and family members from The Netherlands. Methods As part of the second multinational Diabetes Attitudes, Wishes and Needs (DAWN2) study, 412 Dutch adults with type 1 or type 2 diabetes and 86 family members completed questions about the burden of living with diabetes, the frequency of hypoglycemia, worries about these events, and several demographic and clinical factors. Analyses included hierarchical logistic regression. Results In total, 41% of people with diabetes and 56% of family members considered diabetes at least somewhat of a burden. In people with diabetes, diabetes burden was independently associated with self-reported current insulin use (fully adjusted OR = 2.75, 95% CI 1.49–5.10), self-reported frequent non-severe hypoglycemia in the past year (OR = 2.45, 1.25–4.83), self-reported severe hypoglycemia in the past year (OR = 1.91, 1.02–3.58), and being very worried about hypoglycemia at least occasionally (OR = 3.64, 2.18–6.10). For family members, the odds of experiencing living with diabetes as a burden was increased only for participants who were at least occasionally very worried about hypoglycemia (adjusted OR = 5.07, 1.12–23.00). Conclusions Approximately half of adults with diabetes and adult family members experienced at least some diabetes burden. In both groups, diabetes burden appeared to be associated with being very worried about hypoglycemia at least occasionally. If these results are replicated, new intervention studies could test new ways of decreasing the traumatic consequences of previous or anticipated hypoglycemic events for people with diabetes and family members.
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Affiliation(s)
- Giesje Nefs
- CoRPS - Center of Research on Psychological and Somatic disorders, Department of Medical and Clinical Psychology, Tilburg University, PO BOX 90153, 5000 LE, Tilburg, the Netherlands. .,Diabeter, National treatment and research center for children, adolescents and young adults with type 1 diabetes, Rotterdam, The Netherlands. .,Radboud university medical center, Radboud Institute for Health Sciences, Department of Medical Psychology, Nijmegen, The Netherlands.
| | - François Pouwer
- CoRPS - Center of Research on Psychological and Somatic disorders, Department of Medical and Clinical Psychology, Tilburg University, PO BOX 90153, 5000 LE, Tilburg, the Netherlands.,Department of Psychology, University of Southern Denmark, Odense, Denmark
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Halliday JA, Hendrieckx C, Busija L, Browne JL, Nefs G, Pouwer F, Speight J. Validation of the WHO-5 as a first-step screening instrument for depression in adults with diabetes: Results from Diabetes MILES - Australia. Diabetes Res Clin Pract 2017; 132:27-35. [PMID: 28783530 DOI: 10.1016/j.diabres.2017.07.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/29/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
Abstract
AIMS Screening for depression is recommended internationally. The World Health Organization's 5-item Well-being Index (WHO-5) is used clinically to screen for depression but its empirical suitability for this purpose is not well documented. We investigated the psychometric properties of the WHO-5 and its suitability for identifying likely depression in Australian adults with diabetes. METHODS The Diabetes MILES - Australia study dataset provided a sample of N=3249 who completed the WHO-5 (positively-worded 5-item measure of emotional well-being) and the PHQ-9 (9-item measure of depressive symptoms). Analyses were conducted for the full sample, and separately by diabetes type and treatment (type 1, non-insulin-treated type 2, and insulin-treated type 2 diabetes). Construct (convergent and factorial) validity and reliability of the WHO-5 were examined. ROC analyses were used to examine the sensitivity and specificity of the WHO-5 as a depression screening instrument, comparing two commonly used WHO-5 cut-off values (≤7 and <13) with the PHQ-9. RESULTS For the whole sample, the WHO-5 demonstrated satisfactory internal consistency reliability (α=0.90) and convergent validity with the PHQ-9 (r=-0.73, p<0.001). Confirmatory factor analysis partially supported factorial validity: Χ2(5)=834.94, p<0.001; RMSEA=0.23, 90% CI 0.21-0.24; CFI=0.98, TLI=0.96; factor loadings=0.78-0.92. The AUC was 0.87 (95% CI: 0.86-0.89, p<0.001). The sensitivity/specificity of the WHO-5 for detecting likely depression was 0.44/0.96 for the ≤7 cut-off, and 0.79/0.79 for the <13 cut-off, with similar findings by diabetes type and treatment. CONCLUSIONS These findings support use of a WHO-5 cut-point of <13 to identify likely depression in Australian adults with diabetes, regardless of type/treatment.
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Affiliation(s)
- Jennifer A Halliday
- School of Psychology, Deakin University, 1 Geringhap Street, Geelong 3220, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia.
| | - Christel Hendrieckx
- School of Psychology, Deakin University, 1 Geringhap Street, Geelong 3220, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia
| | - Lucy Busija
- Institute for Health and Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne 3000, VIC, Australia
| | - Jessica L Browne
- School of Psychology, Deakin University, 1 Geringhap Street, Geelong 3220, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia
| | - Giesje Nefs
- Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands; Diabeter, Center for pediatric and adolescent diabetes care and research, Blaak 6, 3011 TA Rotterdam, The Netherlands
| | - François Pouwer
- Department of Psychology, University of Southern Denmark, Campusvej 55, Odense M 5230, Denmark
| | - Jane Speight
- School of Psychology, Deakin University, 1 Geringhap Street, Geelong 3220, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia; AHP Research, Hornchurch, Essex, UK
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Stoop CH, Nefs G, Pop VJ, Pouwer F. Screening for and subsequent participation in a trial for depression and anxiety in people with type 2 diabetes treated in primary care: Who do we reach? Prim Care Diabetes 2017; 11:273-280. [PMID: 28330680 DOI: 10.1016/j.pcd.2017.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 02/26/2017] [Indexed: 01/28/2023]
Abstract
AIMS This study investigated (factors related to) (a) the response to a screening procedure for depression and anxiety in people with type 2 diabetes in primary care, and (b) participation in a subsequent randomised controlled trial targeting depressive or anxiety symptoms. METHODS People with type 2 diabetes (n=1837) received a screening questionnaire assessing depressive symptoms (PHQ-9) and anxiety symptoms (GAD-7). Eligible persons who scored above the cut-off score (PHQ-9≥7 or GAD-7≥8) were offered to participate in the trial. RESULTS In total, 798 people (43%) returned the screening questionnaire. Non-responders were more often female (53% vs 44%, p<0.001), had higher LDL cholesterol levels (Cohen's d=0.17, p=0.001) and a higher albumin/creatinine ratio (Cohen's d=0.08, p=0.01). In total, 130 people (18%) reported elevated depressive or anxiety symptoms. Twenty-seven persons agreed to participate in the trial. Factors related to participation were a high education level, a higher level of diabetes distress and a history of psychological problems. CONCLUSIONS Using screening as recruitment resulted in a small number of participants in a treatment trial for anxiety and depression. Research is needed to investigate whether screening is also followed by a low uptake of treatment in primary care outside a RCT setting.
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Affiliation(s)
- Corinne H Stoop
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands; PoZoB, PO Box 312, 5500 AH Veldhoven, The Netherlands
| | - Giesje Nefs
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands.
| | - Victor J Pop
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
| | - François Pouwer
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
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Nguyen L, Nefs G, Pouwer F. Comment on Butwicka et al. Psychiatric Disorders and Health-Related Quality of Life in Children With Type 1 Diabetes Mellitus. Psychosomatics 2016; 58:214-215. [PMID: 28139248 DOI: 10.1016/j.psym.2016.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Linh Nguyen
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands.
| | - Giesje Nefs
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands; Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, The Netherlands
| | - François Pouwer
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands; Department of Psychology, South Danish University, Odense, Denmark
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Nefs G, Pouwer F, Holt RIG, Skovlund S, Hermanns N, Nicolucci A, Peyrot M. Correlates and outcomes of worries about hypoglycemia in family members of adults with diabetes: The second Diabetes Attitudes, Wishes and Needs (DAWN2) study. J Psychosom Res 2016; 89:69-77. [PMID: 27663113 DOI: 10.1016/j.jpsychores.2016.07.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/28/2016] [Accepted: 07/29/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We examined (a) the demographic and clinical correlates of worries about hypoglycemia in adult family members of adults with diabetes, and (b) the association of these worries with measures of diabetes support. METHODS The second multinational Diabetes Attitudes, Wishes and Needs (DAWN2) study cross-sectionally surveyed 2057 family members from 17 countries. Participants completed questions about demographics, diabetes, and psychosocial functioning, including worry about overall and nocturnal hypoglycemia. Analyses included hierarchical ordinal and linear regression. RESULTS Eighty-five percent of family members (n=1661) were at least occasionally very worried about the risk of hypoglycemic events overall. Correlates of worries about hypoglycemia included female gender, higher age and lower education in the family member, younger age of the person with diabetes and this person being a parent or another adult (versus spouse or partner), insulin or non-insulin injectable treatment, severe or non-severe hypoglycemia in the past 12months, and family member recognition of hypoglycemia. Elevated worries about hypoglycemia had a significant independent association with increased odds of diabetes-related family arguments and family member frustration in providing helpful support (OR range 1.60-3.72). High levels of worries about hypoglycemia were associated with increased odds of attending diabetes-related health-care visits. Worries about hypoglycemia were not associated with family member involvement in diabetes care. Similar results were found for worries about nocturnal events. CONCLUSION Worries about hypoglycemia were common in family members and were associated with suboptimal diabetes support. This issue therefore deserves increased clinician attention.
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Affiliation(s)
- Giesje Nefs
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
| | - François Pouwer
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Richard I G Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK; University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Søren Skovlund
- Global Health Economics and Outcomes Research, Novo Nordisk, Denmark
| | - Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM) Diabetes Centre Mergentheim, Germany; University of Bamberg, Germany
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Mark Peyrot
- Department of Sociology, Loyola University Maryland, Baltimore, MD, USA
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Iversen MM, Nefs G, Tell GS, Espehaug B, Midthjell K, Graue M, Pouwer F. Anxiety and Depressive Symptoms as Predictors of All-Cause Mortality among People with Insulin-Naïve Type 2 Diabetes: 17-Year Follow-Up of the Second Nord-Trøndelag Health Survey (HUNT2), Norway. PLoS One 2016; 11:e0160861. [PMID: 27537359 PMCID: PMC4990320 DOI: 10.1371/journal.pone.0160861] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/26/2016] [Indexed: 11/18/2022] Open
Abstract
AIM To examine whether elevated anxiety and/or depressive symptoms are related to all-cause mortality in people with Type 2 diabetes, not using insulin. METHODS 948 participants in the community-wide Nord-Trøndelag Health Survey conducted during 1995-97 completed the Hospital Anxiety and Depression Scale with subscales of anxiety (HADS-A) and depression (HADS-D). Elevated symptoms were defined as HADS-A or HADS-D ≥8. Participants with type 2 diabetes, not using insulin, were followed until November 21, 2012 or death. Cox regression analyses were used to estimate associations between baseline elevated anxiety symptoms, elevated depressive symptoms and mortality, adjusting for sociodemographic factors, HbA1c, cardiovascular disease and microvascular complications. RESULTS At baseline, 8% (n = 77/948) reported elevated anxiety symptoms, 9% (n = 87/948) elevated depressive symptoms and 10% (n = 93/948) reported both. After a mean follow-up of 12 years (SD 5.1, range 0-17), 541 participants (57%) had died. Participants with elevated anxiety symptoms only had a decreased mortality risk (unadjusted HR 0.66, 95% CI 0.46-0.96). Adjustment for HbA1c attenuated this relation (HR 0.73, 95% CI 0.50-1.07). Those with elevated depression symptoms alone had an increased mortality risk (fully adjusted model HR 1.39, 95% CI 1.05-1.84). Having both elevated anxiety and depressive symptoms was not associated with increased mortality risk (adjusted HR 1.30, 95% CI 0.96-1.74). CONCLUSIONS Elevated depressive symptoms were associated with excess mortality risk in people with Type 2 diabetes not using insulin. No significant association with mortality was found among people with elevated anxiety symptoms. Having both elevated anxiety and depressive symptoms was not associated with mortality. The hypothesis that elevated levels of anxiety symptoms leads to behavior that counteracts the adverse health effects of Type 2 diabetes needs further investigation.
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Affiliation(s)
- Marjolein M. Iversen
- Department of Health and Social Sciences, Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway
- * E-mail:
| | - Giesje Nefs
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, the Netherlands
| | - Grethe S. Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Birgitte Espehaug
- Department of Health and Social Sciences, Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway
| | - Kristian Midthjell
- Department of Community Medicine and General Practice, Norwegian University of Science and Technology, HUNT Research Centre, Levanger, Norway
| | - Marit Graue
- Department of Health and Social Sciences, Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway
| | - Frans Pouwer
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, the Netherlands
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Nefs G, Pop VJM, Denollet J, Pouwer F. Depressive symptoms and all-cause mortality in people with type 2 diabetes: a focus on potential mechanisms. Br J Psychiatry 2016; 209:142-9. [PMID: 26846613 DOI: 10.1192/bjp.bp.114.154781] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 04/20/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Depression has been associated with increased all-cause mortality in people with type 2 diabetes. AIMS To test whether anhedonia, dysphoria and anxiety are differentially associated with all-cause mortality and examine symptom-specific behavioural or pathophysiological mechanisms. METHOD A total of 1465 people completed the Edinburgh Postnatal Depression Scale in 2005 and were followed until death or 31 December 2010. Cox regression analyses compared survival time for people with a low v. high baseline dysphoria/anhedonia/anxiety score and identified mediating mechanisms. RESULTS After a mean follow-up of 1878 days (s.d. = 306), 139 participants had died. At all time points, people with anhedonia had an almost twofold increased mortality risk compared with those without anhedonia. Physical activity met criteria for mediation. Symptoms of dysphoria and anxiety were not associated with survival time. CONCLUSIONS Symptoms of anhedonia predicted shorter survival time, whereas dysphoria/anxiety did not. Mechanistic pathways, in particular physical activity, should be explored further.
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Affiliation(s)
- Giesje Nefs
- Giesje Nefs, PhD, Victor J. M. Pop, PhD, MD, Johan Denollet, PhD, François Pouwer, PhD, CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Victor J M Pop
- Giesje Nefs, PhD, Victor J. M. Pop, PhD, MD, Johan Denollet, PhD, François Pouwer, PhD, CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Johan Denollet
- Giesje Nefs, PhD, Victor J. M. Pop, PhD, MD, Johan Denollet, PhD, François Pouwer, PhD, CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - François Pouwer
- Giesje Nefs, PhD, Victor J. M. Pop, PhD, MD, Johan Denollet, PhD, François Pouwer, PhD, CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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van Broekhoven K, Nefs G. Comment on Nunley et al. Clinically Relevant Cognitive Impairment in Middle-Aged Adults With Childhood-Onset Type 1 Diabetes. Diabetes Care 2015;38:1768-1776. Diabetes Care 2016; 39:e24. [PMID: 26798153 DOI: 10.2337/dc15-2163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Kiki van Broekhoven
- Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Giesje Nefs
- Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
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