|
1
|
Li C, Sun L, Zhu J, Wang X, Liang S, Li N, Shao L. Relationship between glycaemic control and frailty in older Chinese patients: The mediating role of diabetes distress. J Clin Nurs 2025; 34:2194-2202. [PMID: 39164959 DOI: 10.1111/jocn.17394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 07/07/2024] [Accepted: 07/16/2024] [Indexed: 08/22/2024]
Abstract
PURPOSE This study aimed to investigate the effects of glycaemic control and diabetes distress on frailty in older Chinese patients with diabetes, and to explore the mediating role of diabetes distress between glycaemic control and frailty. DESIGN This is a descriptive, cross-sectional study. A total of 209 older patients with diabetes were recruited from a teaching hospital in Zhejiang Province. Data were collected from February to September 2022. METHODS A self-designed questionnaire was used to collect demographic and disease-related data. The Fried Scale and Diabetes Distress Scale were employed to assess frailty and diabetes distress, respectively The bootstrap method was used to examine the mediating effects of diabetes distress on glycaemic control and frailty. The STROBE checklist was adhered to in the reporting of this study (see details in File S1). RESULTS The findings indicated a positive correlation between the level of glycaemic control and frailty, as well as between diabetes distress and frailty. Furthermore, diabetes distress was found to play a complete mediating role between glycaemic control and frailty. CONCLUSIONS The study findings highlight the relationship between glycaemic control, diabetes distress and frailty offering a valuable reference for enhancing the management of frailty in older patients with diabetes. RELEVANCE TO CLINICAL PRACTICE This study emphasizes the significance of managing glycaemic control and diabetes distress in older patients with diabetes to prevent frailty, and may contribute for healthcare professionals to developing effective measures to improve the frailty of older diabetic patients in clinical settings. PATIENT OR PUBLIC CONTRIBUTION This study was conducted with the participation of older patients with diabetes who contributed data by completing study questionnaires and undergoing physical assessments.
Collapse
Affiliation(s)
- Chenyang Li
- Department of Nursing, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Lili Sun
- Department of Geriatrics, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jing Zhu
- Department of Endocrinology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xin Wang
- Department of Nursing, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Shiyu Liang
- Department of Nursing, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Nuo Li
- Department of Nursing, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Lewen Shao
- Department of Nursing, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
|
2
|
Egede LE, Campbell JA, Walker RJ, Fraser RA, Ekwunife O. Understanding the Roles of Fatalism and Self-Efficacy on Clinical and Behavioral Outcomes for African American with Type 2 Diabetes: A Systematic Review. Curr Diab Rep 2025; 25:31. [PMID: 40307503 DOI: 10.1007/s11892-025-01586-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2025] [Indexed: 05/02/2025]
Abstract
PURPOSE OF REVIEW To evaluate the evidence on the relationship between fatalism, self-efficacy, and clinical and behavioral diabetes outcomes among African American adults with type 2 diabetes and to recommend areas for future work. RECENT FINDINGS Evidence suggests that psychosocial factors including fatalism and self-efficacy are essential for optimizing diabetes outcomes and may be important considerations for reducing health disparities in type 2 diabetes. A reproducible search using OVID Medline, PubMed, and EBSCOHost was conducted from database creation up to February 2025. Medical Subject Heading terms and key words representing fatalism, self-efficacy, and diabetes were used. Outcomes included: hemoglobin A1c, LDL, Blood Pressure, Self-Care, and Quality of Life. A total of 17 studies were identified, 5 examining fatalism and 12 examining self-efficacy. All 5 fatalism studies demonstrated that fatalism is statistically significantly related to self-care behaviors and HbA1c, however this relationship may be impacted by other psychosocial and social risk factors. Among the self-efficacy studies, 11 demonstrated statistically significant relationships between self-efficacy and one or more clinical and behavioral outcomes including HbA1c, diet, physical activity, medication adherence, blood glucose testing, and quality of life. All studies were cross-sectional analyses. Given the small number of studies focused on fatalism and the largely correlational results for self-efficacy, there is a need for more targeted research to understand contributors to and moderators of the influence of the factors on outcomes.
Collapse
Affiliation(s)
- Leonard E Egede
- Division of Populaton Health, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
- Buffalo General Medical Center, 100 High Street, D2-76, Buffalo, NY, USA.
| | - Jennifer A Campbell
- Division of Populaton Health, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Rebekah J Walker
- Division of Populaton Health, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Raphael A Fraser
- Division of Populaton Health, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Obinna Ekwunife
- Division of Populaton Health, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| |
Collapse
|
|
3
|
Dalsgaard E, Graversen SB, Bjerg L, Sandbaek A, Laurberg T. Diabetes distress and depression in type 2 diabetes. A cross-sectional study in 18,000 individuals in the Central Denmark region. Diabet Med 2025; 42:e15463. [PMID: 39533536 PMCID: PMC11823346 DOI: 10.1111/dme.15463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 10/11/2024] [Accepted: 10/18/2024] [Indexed: 11/16/2024]
Abstract
AIMS Type 2 diabetes is linked to psychological distress and a doubled risk of depression. This study aims to characterize individuals with type 2 diabetes experiencing diabetes distress and/or depression in relation to lifestyle and metabolic outcomes. METHODS A population-based survey in 2020 targeted individuals with type 2 diabetes (aged 18-75 years) in the Central Denmark Region. This cross-sectional study assessed diabetes distress (using Problem-Area-in-Diabetes-scale) and depression (via hospital diagnosis and prescribed medication) as exposures. Logistic regression, adjusting for potential confounders, compared exposed and non-exposed groups on lifestyle habits, metabolic factors and medication usage related to cardio-metabolic risks. RESULTS Of 18,222 respondents with type 2 diabetes (46% response rate), 11% had depression, 14% had diabetes distress and 4% had both. Compared to those with neither condition, those with depression were more often smokers (OR: 2.0, 95% CI: 1.8; 2.3) and sedentary in leisure time (OR: 2.0, 95% CI: 1.8; 2.2). Diabetes distress was associated with elevated HbA1c (OR: 1.8, 95% CI: 1.5; 2.0) and treatment with insulin (OR: 1.8, 95% CI: 1.6; 2.0). Half with diabetes distress displayed stable blood glucose levels. Those with both conditions had a higher risk of sedentary behaviour (OR: 2.7, 95% CI: 2.3; 3.2), clinical insomnia (OR: 6.5, 95% CI: 5.5; 7.7) and low self-rated health (OR: 7.5, 95% CI: 6.3; 9.0) than those with either psychological condition in isolation. CONCLUSIONS This study emphasizes the importance of recognizing distinct features and risk factors associated with diabetes distress and depression in individuals with type 2 diabetes. Tailored care strategies for comorbid mental health issues are crucial for comprehensive management.
Collapse
Affiliation(s)
| | | | - Lasse Bjerg
- Steno Diabetes Center AarhusAarhus University HospitalAarhusDenmark
| | - Annelli Sandbaek
- Steno Diabetes Center AarhusAarhus University HospitalAarhusDenmark
- Department of Public HealthAarhus UniversityAarhusDenmark
| | - Tinne Laurberg
- Steno Diabetes Center AarhusAarhus University HospitalAarhusDenmark
| |
Collapse
|
|
4
|
Wojujutari Ajele K, Sunday Idemudia E. The role of depression and diabetes distress in glycemic control: A meta-analysis. Diabetes Res Clin Pract 2025; 221:112014. [PMID: 39892818 DOI: 10.1016/j.diabres.2025.112014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Revised: 01/16/2025] [Accepted: 01/20/2025] [Indexed: 02/04/2025]
Abstract
AIMS This study evaluated the associations between depression, diabetes distress, glycemic control (HbA1c), and self-care behaviours in individuals with diabetes. Findings on these relationships have been inconsistent, highlighting the need for systematic evaluation. METHODS Data from 61 studies involving 19,537 participants conducted between 2001 and 2024 were analysed using random-effects models. Subgroup analyses examined variations by diabetes type, geographic location, and measurement tools. Heterogeneity was assessed using I2 statistics. RESULTS Depression and diabetes distress were significantly associated with poorer glycemic control (r = 0.23, 95 % CI [0.15 to 0.31], p < 0.001) and reduced self-care behaviours (r = -0.19, 95 % CI [-0.28 to -0.10], p < 0.001). Stronger correlations were observed in mixed diabetes populations (r = 0.35, 95 % CI [0.30 to 0.40], I2 = 0 %) and in studies conducted in Europe (r = 0.28) and North America (r = 0.34). High heterogeneity (I2 = 97.24 %) was identified. CONCLUSIONS Depression and diabetes distress are associated with poorer glycemic control and reduced self-care behaviours. Findings highlight the need for standardized measures and longitudinal studies to explore mechanisms underlying these associations.
Collapse
|
|
5
|
Silver SR, Jones KC, Kim EM, Khaw-Marchetta S, Thornton S, Kremer K, Walkey A, Drainoni ML, Fantasia KL. Disparities in Diabetes Distress and Nutrition Management Among Black and Hispanic Adults: A Mixed Methods Exploration of Social Determinants. Sci Diabetes Self Manag Care 2025; 51:24-35. [PMID: 39901603 PMCID: PMC11881106 DOI: 10.1177/26350106241311085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2025]
Abstract
PURPOSE The purpose of this study was to explore self-reported diabetes management strategies, social determinants of health (SDOH), and barriers to care among people with diabetes receiving care in a safety-net setting to identify factors contributing to disparities in outcomes for Black and Hispanic adults and inform future interventions. METHODS Sequential, explanatory, mixed methods study comprised a survey of adults with diabetes seen in primary care at a safety-net hospital in New England, followed by qualitative semistructured interviews with a subset of the Black and Hispanic respondents. Descriptive statistics, chi-square and t tests were used to analyze quantitative data. The health equity implementation framework was used to guide qualitative data collection and directed content analysis. RESULTS A total of 496 respondents completed the survey; 48 Black and Hispanic adults participated in interviews. Diabetes-related distress was significantly higher among Black and Hispanic participants compared to White participants. Nutrition management use was significantly lower among Black and Hispanic participants. Qualitative findings suggest that SDOH and lack of education and support, specifically, nutrition and access to self-management resources, contributed to diabetes-related distress and prevented optimal self-management. CONCLUSIONS High rates of diabetes-related distress and low rates of nutrition management were identified in Black and Hispanic adults in a safety-net setting. Qualitative interviews demonstrated a relationship between adverse SDOH and lack of nutrition education with diabetes distress and challenges to self-management, potentially contributing to disparities in outcomes. Findings suggest that increased uptake of nutrition therapy and self-management education and support may be critical for improving diabetes outcomes and promoting health equity.
Collapse
Affiliation(s)
- Santana R Silver
- Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Kayla C Jones
- Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Emily M Kim
- Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | | | - Sophia Thornton
- Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts
| | - Kristen Kremer
- Ambulatory Operations, Boston Medical Center, Boston, Massachusett
| | - Allan Walkey
- Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Division of Health Systems Science, Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts
| | - Mari-Lynn Drainoni
- Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Health Law Policy & Management, Boston University School of Public Health, Boston, Massachusetts
| | - Kathryn L Fantasia
- Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Section of Endocrinology Diabetes and Nutrition, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| |
Collapse
|
|
6
|
Mirghani HO. Diabetes distress, the mediator of the poor glycemic control and depression: A meta-analysis. World J Meta-Anal 2024; 12:97779. [DOI: 10.13105/wjma.v12.i4.97779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 11/01/2024] [Accepted: 12/05/2024] [Indexed: 12/12/2024] Open
Abstract
BACKGROUND Diabetes-related distress (DRD) is a common psychological disorder specifically associated with diabetes, its cross-talk with depression, and glycated hemoglobin (HbA1c) was discussed controversially. Interventions addressing DRD were shown to improve HbA1c. However, the primary concern is to investigate the association of DRD with glycemic control. No meta-analyses have compared the effects of depression and diabetes distress on HbA1c.
AIM To assess the relationship between DRD, depression, and glycemic control.
METHODS We systematically searched PubMed MEDLINE, Google Scholar, and Cochrane Library from inception up to May 2024. The keywords diabetes distress, depression, psychopathology, glycemic control, HbA1c, glycated hemoglobin, fasting, and postprandial blood glucose were used. A datasheet was used to extract the author’s name year and country of publication, diabetes distress, depression, and HbA1c among patients with DRD, depression, and control subjects.
RESULTS Out of the 2046 studies retrieved, 55 full texts were screened and 22 studies were included in the final meta-analysis. Diabetes distress was associated with poor glycemic control, odd ratio = 0.42, 95% confidence interval (CI): 0.17-0.67, and P value < 0.001, and odd ratio = 0.52, 95%CI: 0.38-0.72, and P value < 0.001 respectively. No significant difference was observed between depression and DRD regarding the impact on HbA1c, odd ratio = 0.13, 95%CI: 0.15-0.41, P value = 0.37, I2 for heterogeneity = 76%. However, when heterogeneity was eliminated, diabetes distress influenced the HbA1c more compared to depression, odd ratio = 0.29, 95%CI: 0.17-0.41, and P value < 0.001.
CONCLUSION DRD negatively influenced the HbA1c and glycemic control more than depression. Further studies using more specific measures (ecological momentary assessment) to assess DRD are recommended.
Collapse
Affiliation(s)
- Hyder O Mirghani
- Department of Internal Medicine, University of Tabuk, Tabuk 51941, Tabuk Province, Saudi Arabia
| |
Collapse
|
|
7
|
Smalls BL, Adegboyega AO, Ortz CL, Simon-Okube PE, Westgate PM, Schoenberg NE. Assessing the relationship between multimorbidity, psychosocial variables, and clinical outcomes among older adults living in rural Appalachia. J Health Psychol 2024:13591053241302131. [PMID: 39665410 DOI: 10.1177/13591053241302131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2024] Open
Abstract
The objective of this study was to assess the relationship between multimorbidity, psychosocial variables, and clinical outcomes among older adults with type 2 diabetes (T2D) in rural Appalachia. Point-of-care clinical data (e.g. A1c, systolic blood pressure, diastolic blood pressure) and self-reported survey data, that includes psychosocial factors (e.g. distress, depressive symptoms, social support, perceived stress), chronic conditions, and sociodemographic variables were obtained from older adults living in rural Appalachia. Clinical data and psychosocial variables were treated as outcome variables, whereas the number of comorbid conditions was treated as the predictor variable. Stress was significantly associated with multimorbidity (β = 0.24, SE = 0.08, p = 0.01). However, T2D distress, social support, disability, and depression did not have statistically significant relationships with multimorbidity. Further research should assess the role of stress on psychosocial factors and clinical outcomes in rural-dwelling older adults.
Collapse
|
|
8
|
Ramli SA, Draman N, Muhammad J, Mohd Yusoff SS. Diabetes self-care and its associated factors among type 2 diabetes mellitus with chronic kidney disease patients in the East Coast of Peninsular Malaysia. PeerJ 2024; 12:e18303. [PMID: 39430555 PMCID: PMC11491061 DOI: 10.7717/peerj.18303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 09/23/2024] [Indexed: 10/22/2024] Open
Abstract
Introduction Diabetes self-care among diabetic patients is crucial as it determines how patients care for their illness in their daily routine for better diabetes control. This study aims to calculate the average score for diabetes self-care among patients with type 2 diabetes mellitus and chronic kidney disease and to identify factors that are associated with this score. Materials and Methods This cross-sectional study enrols patients over 18 years old with type 2 diabetes mellitus and chronic renal disease with an eGFR of less than 60 mL/min/1.73 m2 in a tertiary hospital in Malaysia. The Malay version of the Summary of Diabetic Self-Care Activities (SDSCA) was used to assess diabetes self-care, the Malay version of the diabetes-related distress questionnaire (DDS-17) was used to assess diabetes distress, and the Malay version of the Patient Health Questionnaire-9 (PHQ-9) was used to assess depression. Data analysis was performed using both simple and multiple linear regression models to determine the associations between variables. Result One hundred and seventy-six eligible patients were recruited for this study. The mean score for diabetes self-care is 3.62. The eGFR (p = 0.002) and diabetes distress (p = 0.004) are the significant associated factors for diabetes self-care among type 2 diabetes mellitus patients with chronic kidney disease. Conclusion The mean score for diabetes self-care indicated a moderate level of self-care. The eGFR level and diabetes distress were important factors influencing diabetes self-care practices.
Collapse
Affiliation(s)
- Siti Aisyah Ramli
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Nani Draman
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Juliawati Muhammad
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Siti Suhaila Mohd Yusoff
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| |
Collapse
|
|
9
|
Anataca G, Celik S, Taskin Yilmaz F. Fatalism in Turkish women with gestational diabetes: Its relationship with diabetes self-management and perception of risk to maternal and fetal health in pregnancy. J Health Psychol 2024:13591053241283953. [PMID: 39340411 DOI: 10.1177/13591053241283953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2024] Open
Abstract
Fatalism is one of the variables associated with disease management. This descriptive-correlational study aimed to determine the level of fatalism in women with gestational diabetes mellitus (GDM) and its relationship with diabetes self-management and perception of risk to maternal and fetal health in pregnancy. The study included 531 pregnant women. The data were collected using a pregnancy information form, the Fatalism Scale, the Perception of Pregnancy Risk Questionnaire, and the Diabetes Self-Management Questionnaire. Fatalism explained 25% of the total variance on risk perception in pregnancy and 7% of the total variance on diabetes self-management. Fatalism had a fully mediating role in the effect of risk perception in pregnancy on diabetes self-management. It is important for health professionals to evaluate the effects of women's perceptions of fatalism on their health behaviors in order to maintain a healthy pregnancy process.
Collapse
Affiliation(s)
| | - Selda Celik
- University of Health Sciences Turkey, Turkey
| | | |
Collapse
|
|
10
|
Ly AL, Flynn PM, Betancourt HM. Cultural Beliefs About Diabetes-Related Social Exclusion and Diabetes Distress Impact Self-Care Behaviors and HbA1c Among Patients with Type 2 Diabetes. Int J Behav Med 2024; 31:491-502. [PMID: 37254029 PMCID: PMC11269335 DOI: 10.1007/s12529-023-10179-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) disproportionally impacts Latin Americans (Latinos) in the U.S. compared to non-Latino Whites, as reflected by an increased risk for disease complications and higher mortality rates. Guided by an Integrative Model of Culture, Psychological Processes, and Health Behavior, the purpose of the present study was to examine the role of cultural beliefs and diabetes distress as determinants of self-care behaviors and HbA1c among Latino patients with T2DM. METHODS Participants included 109 Latino patients with T2DM recruited from a diabetes treatment center located in a region of Southern California with high diabetes mortality rates. Structural equation modeling was employed to examine the extent to which cultural beliefs about diabetes-related social exclusion and diabetes distress impact self-care behaviors and self-reported HbA1c. RESULTS Consistent with the study hypotheses, cultural beliefs about diabetes-related social exclusion predicted diabetes distress, which in turn predicted poor diabetes self-care. CONCLUSIONS Findings suggest an important need for intervention efforts that address both cultural and psychological factors in order to improve diabetes self-care behaviors and associated disease outcomes among Latino patients with T2DM. Future research could benefit from investigating protective aspects of culture that could help counter the negative implications of cultural beliefs about social exclusion and diabetes distress associated with poor self-care.
Collapse
Affiliation(s)
- Albert L Ly
- Department of Psychology, Loma Linda University, Loma Linda, CA, 92350, USA
| | - Patricia M Flynn
- Department of Psychology, Loma Linda University, Loma Linda, CA, 92350, USA.
- Department of Preventive Medicine, Loma Linda University, Loma Linda, CA, 92350, USA.
| | | |
Collapse
|
|
11
|
Buckert M, Streibel C, Hartmann M, Monzer N, Kopf S, Szendrödi J, Wild B. Cross-sectional associations of self-perceived stress and hair cortisol with metabolic outcomes and microvascular complications in type 2 diabetes. Front Public Health 2024; 12:1289689. [PMID: 38813430 PMCID: PMC11133512 DOI: 10.3389/fpubh.2024.1289689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 04/29/2024] [Indexed: 05/31/2024] Open
Abstract
Introduction Increasing evidence supports chronic psychological stress as a risk factor for the development of type 2 diabetes. Much less is known, however, about the role of chronic stress in established diabetes. Methods The aim of the current study was to comprehensively assess chronic stress in a sample of 73 patients with type 2 diabetes and 48 non-diabetic control participants, and to investigate associations with indicators of glycemic control (HbA1c), insulin resistance (HOMA-IR), β-cell functioning (C-peptide), illness duration, and the presence of microvascular complications. Chronic stress was measured using questionnaires [the Perceived Stress Scale (PSS), the Screening Scale of the Trier Inventory of Chronic Stress (SSCS), the Perceived Health Questionnaire (PHQ) as well as the Questionnaire on Stress in Patients with Diabetes-Revised (QSD-R)]; hair cortisol was used as a biological indicator. Results We found that patients with type 2 diabetes had higher levels of hair cortisol in comparison to the control group (F(1,112) = 5.3; p = 0.023). Within the diabetic group, higher hair cortisol was associated with a longer duration of the illness (r = 0.25, p = 0.04). General perceived stress did not show significant associations with metabolic outcomes in type 2 diabetes patients. In contrast, higher diabetes-related distress, as measured with the QSD-R, was associated with lower glycemic control (r = 0.28, p = 0.02), higher insulin resistance (r = 0.26, p = 0.03) and a longer duration of the illness (r = 0.30, p = 0.01). Discussion Our results corroborate the importance of chronic psychological stress in type 2 diabetes. It appears, however, that once type 2 diabetes has developed, diabetes-specific distress gains in importance over general subjective stress. On a biological level, increased cortisol production could be linked to the course of the illness.
Collapse
Affiliation(s)
- Magdalena Buckert
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Carmen Streibel
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Nelly Monzer
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Kopf
- Department of Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
| | - Julia Szendrödi
- Department of Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Diabetes Research (DZD), Heidelberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
|
12
|
Zhu X, Lee ES, Chan FHF, Lim PXH, Chen YC, Griva K. Foot self-care behaviour in primary care patients with diabetic foot ulcers: Structural equation modelling of psychological predictors. Int Wound J 2024; 21:e14897. [PMID: 38757211 PMCID: PMC11099767 DOI: 10.1111/iwj.14897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 05/18/2024] Open
Abstract
Diabetic foot ulcers (DFUs) are one of the most prevalent and costly diabetes complications, associated with diminished quality of life and poor prognosis. Management of DFUs relies heavily on patients' foot self-care behaviour. This study aims to explore psychological determinants of this important behaviour among primary care patients. A total of 186 patients with active DFUs self-reported their illness perception, diabetes distress, self-efficacy, and foot self-care behaviour. Structural equation modelling was performed to examine interrelationships among measured variables. The final model demonstrated satisfactory fit, CFI = 0.933, TLI = 0.913, RMSEA = 0.050, SRMR = 0.073, χ2(95) = 132.256 (p = 0.004), and explained 51.1% of the variance of foot self-care. Illness threat perceptions (i.e., consequence, timeline, identity, concern, and emotion) had a direct positive effect on foot self-care behaviours, but also indirectly decreased foot self-care through increasing diabetes distress. Control perceptions (i.e., personal control, treatment control, and coherence) were not directly associated with foot self-care behaviours, but indirectly improved foot self-care by reducing diabetes distress and increasing foot care confidence. These findings suggest illness perceptions, diabetes distress, and self-care confidence as modifiable predictors to be targeted in self-management interventions for patients with DFUs.
Collapse
Affiliation(s)
- Xiaoli Zhu
- National Healthcare Group PolyclinicsSingaporeSingapore
- Population/Global Health, Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
| | - Eng Sing Lee
- National Healthcare Group PolyclinicsSingaporeSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
| | - Frederick H. F. Chan
- Population/Global Health, Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
| | - Phoebe X. H. Lim
- Population/Global Health, Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
| | - Yee Chui Chen
- National Healthcare Group PolyclinicsSingaporeSingapore
| | - Konstadina Griva
- Population/Global Health, Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
| |
Collapse
|
|
13
|
Thapa A, Chung ML, Wu JR, Latimer A, Lennie TA, Mudd-Martin G, Lin CY, Thompson JH, Kang J, Moser DK. Mediation by Fatalism of the Association Between Symptom Burden and Self-care Management in Patients With Heart Failure. J Cardiovasc Nurs 2024; 39:229-236. [PMID: 37830904 PMCID: PMC11014896 DOI: 10.1097/jcn.0000000000001053] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Clinicians and researchers often assume that symptom burden is associated with self-care management (SCM) in patients with heart failure (HF). However, that association is often not borne out in simple regression analyses and may be because another variable mediates the association. Fatalism is an appropriate candidate for mediation and is the belief that circumstances are predetermined without opportunity for control by individuals. OBJECTIVE Our objective was to determine whether fatalism mediated the relationship of symptom burden with SCM among adults with HF. METHODS We conducted a secondary analysis (N = 95) from a clinical trial. We used Self-care of HF Index to measure SCM, the Memorial Symptom Assessment Scale-HF for symptom burden, and the Cardiovascular Disease Fatalism Instrument to measure fatalism. We used the PROCESS macro to evaluate mediation. RESULTS Symptom burden was not directly associated with SCM (effect coefficient [ C '] = 0.0805; 95% confidence interval, -0.048 to 0.209; P = .217). There was, however, an indirect pathway between symptom burden and SCM through fatalism ( ab = -0.040; 95% confidence interval, -0.097 to -0.002). Those with higher symptom burden were more fatalistic ( a = 0.004, P = .015), and greater fatalism was associated with worse SCM ( b = -9.132, P = .007). CONCLUSION Symptom burden, not directly associated with SCM, is associated through the mediator of fatalism. Interventions to improve SCM should include strategies to mitigate fatalistic views. Self-care management interventions should focus on promoting internal locus of control or increasing perceptions of perceived control to decrease fatalism and improve engagement in self-care.
Collapse
Affiliation(s)
- Ashmita Thapa
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY, 40536, USA
| | - Misook L. Chung
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY, 40536, USA
| | - Jia-Rong Wu
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY, 40536, USA
| | - Abigail Latimer
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY, 40536, USA
| | - Terry A. Lennie
- Senior Associate Dean and Marion E. McKenna Professor in Nursing Leadership College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY, 40536, USA
| | - Gia Mudd-Martin
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY, 40536, USA
| | - Chin-Yen Lin
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY, 40536, USA
| | | | - JungHee Kang
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY, 40536, USA
| | - Debra K. Moser
- Assistant Dean of PhD Program & Scholarly Affairs & Linda C. Gill, Professor in Nursing, College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY, 40536, USA
| |
Collapse
|
|
14
|
Liu YT, Wu WH, Tseng WT, Lin HC, Wu MS, Chen PF, Wu IC. Lower HbA1C of glycemic control is associated with higher risk of depressive symptoms in elderly with type 2 diabetes mellitus-A Nationwide Community-based study. J Psychosom Res 2023; 174:111492. [PMID: 37708592 DOI: 10.1016/j.jpsychores.2023.111492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE We investigated the correlation between glycemic control status and depressive symptoms in type 2 diabetes elderly. METHODS A total of 1527 participants with type 2 diabetes aged 55 years and older from the Healthy Aging Longitudinal Study in Taiwan study were included in this cross-sectional study. The Center for Epidemiologic Studies Depression Scale (CESD) (20 items) score of ≥16 was indicative of depressive symptoms. The participants were divided into HbA1c ≥ 6.5% and < 6.5% representing the glycemic control. Multiple logistic regression (MLR) and Generalized linear model (GLM) were used. RESULTS The MLR analysis showed that the low HbA1c group had significant two-fold increased odds of depressive symptoms compared to the high HbA1c group (OR 1.89, 95% CI 1.17-3.05). The risk of depressive symptoms was lower among males (OR 0.49, 95% CI 0.30-0.80) and those with higher BMI (OR 0.93, 95% CI 0.86-1.00); whereas the risk was higher among those who lived alone (OR 2.37, 95% CI 1.31-4.27) and with ADL disability (OR 3.01, 95% CI 1.85-4.89). The GLM showed that the dimension of depressive affect reached statistical significance with lower HbA1c. CONCLUSION This nationwide community-based study shows that depressive symptoms are associated with lower HbA1C, reminding us that more attention should be paid to the presence of depressive symptoms in those with lower HbA1C. Further research is needed to clarify the causal relationship.
Collapse
Affiliation(s)
- Yen-Tze Liu
- Department of Family Medicine, Changhua Christian Hospital, Changhua, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; Big Data Center, Changhua Christian Hospital, Changhua, Taiwan.
| | - Wan-Hui Wu
- Department of Family Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Wei-Ting Tseng
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Hsien-Chih Lin
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Ming-Shiang Wu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Taiwan
| | - Pei-Fen Chen
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - I-Chien Wu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan; Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| |
Collapse
|
|
15
|
Okeke NM, Onah BN, Ekwealor NE, Ekwueme SC, Ezugwu JO, Edeh EN, Okeke PM, Ndille R, Onwuadi CC, Amedu AN, Nwaogaidu JC, Nnamani RG, Okolie CN, Okoro K, Solomon KC, Owonibi OE. Effect of a religious coping intervention of rational emotive behavior therapy on mental health of adult learners with type II diabetes. Medicine (Baltimore) 2023; 102:e34485. [PMID: 37773818 PMCID: PMC10545252 DOI: 10.1097/md.0000000000034485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/03/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Some previous studies have highlighted the high rate of mental health problems associated with type II diabetes (T2DM). The primary purpose of this study was to investigate the effect of a religious coping intervention of rational emotive behavior therapy (REBT) on the mental health of adult learners with T2DM. METHODS This study utilized a randomized controlled trial to select 146 adult learners with T2DM and mental health-related problems. The treatment group was made up of 73 adult learners, while the control group was also made up of 73 adult learners. The experimental group received 8 sessions of a religious coping intervention of REBT, while the control group received usual care. Data were collected using the patient health questionnaire, Warwick-Edinburgh mental well-being scale, and Kessler psychological distress scale. Repeated ANOVA and univariate analysis of covariance were used for data analyses. RESULTS The religious coping intervention of REBT substantially enhanced the mental health of adult learners with T2DM as measured by Warwick-Edinburgh mental well-being scale (P < .000) and patient health questionnaire (P < .000). The religious coping intervention of REBT significantly alleviated the psychological distress of adult learners with T2DM as measured by Kessler psychological distress scale (P < .000). CONCLUSION In this study, it has been demonstrated that a religious coping intervention of REBT effectively improves the mental health of adult learners with T2DM. The study concludes that the religious coping intervention of REBT is a practical alternative medicine approach to enhancing the mental health of adult learners with T2DM.
Collapse
Affiliation(s)
- Nkechi Mercy Okeke
- Department of Adult Education & Extra-Mural Studies, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Beatrice N. Onah
- Department of Adult Education & Extra-Mural Studies, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Nwakaego Ebele Ekwealor
- Department of Adult Education & Extra-Mural Studies, University of Nigeria, Nsukka, Enugu State, Nigeria
| | | | | | - Esther Nwarube Edeh
- Department of Adult Education & Extra-Mural Studies, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Polycarp M.D. Okeke
- Department of Adult Education & Extra-Mural Studies, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Roland Ndille
- Department of History, University of Buea Cameroon, Buea, Cameroon
| | - Charles C. Onwuadi
- Department of Adult Education & Extra-Mural Studies, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Amos N. Amedu
- Department of Educational Psychology, University of Johannesburg, Johannesburg, South Africa
| | - John Chidubem Nwaogaidu
- Institute of African Studies/Department of Sociology and Anthropology, University of Nigeria, Nsukka, Enugu State, Nigeria
| | | | - Charles Nkem Okolie
- Department of Philosophy and Religious and Cultural Studies, Alex Ekwueme Federal University Ndufu-Alike Ikwo, Ebonyi State, Nigeria
| | - Kingsley Okoro
- Department of Philosophy and Religious and Cultural Studies, Alex Ekwueme Federal University Ndufu-Alike Ikwo, Ebonyi State, Nigeria
| | - Kingsley Christopher Solomon
- Department of Philosophy and Religious and Cultural Studies, Alex Ekwueme Federal University Ndufu-Alike Ikwo, Ebonyi State, Nigeria
| | - Ola Elizabeth Owonibi
- Department of Sociology, Ibrahim Badamasi Babangida University, Lapai, Niger State, Nigeria
| |
Collapse
|
|
16
|
Mendoza-Catalán G, Figueroa-Perea JG, Gallegos-Cabriales EC, Salazar-González BC, Onofre-Rodríguez DJ, González-Ramírez J. Fatalistic beliefs, self-care, and HbA1c in Mexican men with type 2 diabetes mellitus: A cross-sectional study. Medicine (Baltimore) 2023; 102:e34594. [PMID: 37543768 PMCID: PMC10403003 DOI: 10.1097/md.0000000000034594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 08/07/2023] Open
Abstract
The aim of this study is to examine the relationship between fatalistic beliefs, self-care, and glycemic control among Mexican men with type 2 diabetes mellitus. This is a cross-sectional study in men diagnosed with type 2 diabetes mellitus from 18 to 59 years of age from the Northeast of Mexico. Fatalistic beliefs, self-care, medication adherence, and HbA1C were evaluated. Patients were divided into glycemic control (<7% HbA1c) and without glycemic control (>7% HbA1c). Tests were performed to compare 2 independent groups, Student's t and U Mann Whitney. Correlation tests and multiple linear regression models were also performed. For statistical analysis, the SPSS v27 program was used. Forty-nine percent of the men had glycemic control (<7% HbA1c). Fatalistic beliefs were negatively correlated with self-care and medication adherence, but not with HbA1c. In multiple linear regression models, fatalistic beliefs were a negative predictor of self-care and medication adherence. In the model for HbA1c, the pessimism subdimension and self-care were the predictors. Fatalistic beliefs negatively affect self-care compliance and medication adherence, while the pessimism subdimension was related to the increase in HbA1c.
Collapse
|
|
17
|
Roddy MK, Nelson LA, Spieker AJ, Greevy RA, Mayberry LS. Family involvement and diabetes distress across dyads for adults with type 2 diabetes. PATIENT EDUCATION AND COUNSELING 2023; 112:107719. [PMID: 37018880 PMCID: PMC10332408 DOI: 10.1016/j.pec.2023.107719] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/08/2023] [Accepted: 03/28/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Family/friend involvement and diabetes distress are associated with outcomes for persons with type 2 diabetes (PWDs), but little is known about how they relate to each other. We aim to (1) describe associations between PWD and support person (SP) distress; (2) describe associations between involvement and diabetes distress for PWDs, for SPs, and across the dyad; and (3) explore whether associations differ by PWD-SP cohabitation. METHODS PWDs and SPs co-enrolled in a study evaluating the effects of a self-care support intervention and completed self-report measures at baseline. RESULTS PWDs and SPs (N = 297 dyads) were, on average, in their mid-50s and around one-third identified as racial or ethnic minorities. The association between PWD and SP diabetes distress was small (Spearman's ρ = 0.25, p < 0.01). For PWDs, experienced harmful involvement from family/friends was associated with more diabetes distress (standardized β = 0.23, p < 0.001) independent of helpful involvement in adjusted models. Separately, SPs' self-reported harmful involvement was associated with their own diabetes distress (standardized β = 0.35, p < 0.001) and with PWDs' diabetes distress (standardized β = 0.25, p = 0.002), independent of SPs' self-reported helpful involvement. CONCLUSION AND PRACTICE IMPLICATIONS Findings suggest dyadic interventions may need to address both SP harmful involvement and SP diabetes distress, in addition to PWD distress.
Collapse
Affiliation(s)
- McKenzie K Roddy
- Quality Scholars Program, VA Tennessee Valley Healthcare System, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lyndsay A Nelson
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lindsay S Mayberry
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| |
Collapse
|
|
18
|
Rodriguez B, Aikens JK. Advancing Health Equity in Diabetes: Tools to Help Remove Barriers to Health. J Acad Nutr Diet 2023; 43:12-17. [PMID: 39049975 PMCID: PMC11267966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
People living with diabetes and their health care teams face an endless number of care decisions that are often compounded by limited access to needed resources, especially adequate food, medications, and monitoring tools.1 Registered dietitians, as diabetes care and education specialists and as members of care teams, can help assess what barriers exist and how they can best be mitigated both in the short- and long term.2 Examples of health equity challenges and tools to support efforts in type 2 diabetes (T2D) prevention and diabetes management are presented.
Collapse
Affiliation(s)
- Betsy Rodriguez
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - J Keith Aikens
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
|
19
|
Smalls BL, Adegboyega A, Combs E, Travis EW, De La Barra F, Williams LB, Schoenberg N. Evaluating the Association Between Depressive Symptoms and Glycemic Control Among Residents of Rural Appalachia. JOURNAL OF APPALACHIAN HEALTH 2023; 4:39-55. [PMID: 38026049 PMCID: PMC10655730 DOI: 10.13023/jah.0403.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Introduction Type 2 diabetes mellitus (T2DM) is associated with a range of co-morbid physical and psychological conditions, including depression. Yet there is a dearth of evidence regarding the prevalence of depression among those in Appalachia living with T2DM; this gap persists despite the higher regional prevalence of T2DM and challenging social determinants of health. Purpose This study aimed to provide greater detail about the relationships between T2DM and depressive symptoms in adults living in Appalachia Kentucky. Methods The present study was a cross-sectional analysis of baseline data derived from an ongoing study of Appalachia Kentucky adults living with T2DM. Outcome data included demographics, Center for Epidemiologic Studies Depression Scale, point-of-care HbA1c, and the Summary of Diabetes Self-Care Activities. Bivariate analysis was conducted using Pearson's correlation to determine the statistically significant relationships between variables which were then included in a multiple regression model. Results The sample (N=365), consisted primarily of women (n=230, 64.6%) of mean age 64 years (±10.6); almost all (98%) were non-Hispanic White (n=349), and most were married (n=208, 59.1%). The majority (47.2%) reported having two comorbid conditions (n=161), including T2DM, and the mean HbA1c was 7.7% (1.7). Nearly 90% were nonsmokers (n=319). Depressive symptoms were reported in 25% (n=90) of participants. A higher number of comorbid conditions, increased age, Medicaid insurance, tobacco use, lower financial status, female sex, and disability compared to fully employed status all were correlated with a higher rate of depressive symptoms (r ≤ 0.2). The regression indicated that depressive symptoms were associated with age (β = -0.010, p = 0.001); full-time employment status compared to those who are disabled (β = -.0209, p = 0.18); men compared to women (β = -0.122, p = 0.042), and those who smoke compared to nonsmokers (β = 0.175, p = 0.038). Implications Depressive symptoms were correlated with T2DM among this sample of Appalachian residents with poorly controlled T2DM, especially among women. Given the vast number of social determinants (e.g., poverty, food insecurity, and rurality) affecting this population, healthcare providers must assess for depression and consider its negative influence on the patient's ability to achieve glycemic control.
Collapse
|
|
20
|
Elotla SF, Fouad AM, Mohamed SF, Joudeh AI, Mostafa M, Hayek SE, Shah J, Ahmed HAS. Association between diabetes-related distress and glycemic control in primary care patients with Type 2 diabetes during the coronavirus disease 2019 (COVID-19) pandemic in Egypt. J Family Community Med 2023; 30:42-50. [PMID: 36843865 PMCID: PMC9954422 DOI: 10.4103/jfcm.jfcm_238_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/19/2022] [Accepted: 10/17/2022] [Indexed: 02/28/2023] Open
Abstract
BACKGROUND Diabetes-related distress and glycemic control are of a particular concern to primary care physicians because of the impact of the coronavirus disease 2019 pandemic on diabetic patients' lifestyle, psychological well-being and healthcare access. Our aim was to evaluate the relationship between diabetes-related distress and glycemic control in diabetic patients with Type 2 diabetes mellitus (T2DM) in primary care settings during the pandemic. MATERIALS AND METHODS This cross-sectional study was conducted at primary healthcare clinics in a rural area in Egypt among 430 patients with T2DM during the period from September 2020 to June 2021. All patients were interviewed for their sociodemographic, lifestyle, and clinical characteristics. Diabetes-related distress was measured by the problem areas in the diabetes scale (PAID), where a total score of ≥40 indicated a severe diabetes-related distress. The most recent glycosylated hemoglobin (HbA1c) measurements were used to indicate the glycemic control. Quantile regression model (0.50 quantile) was used to perform the multivariate analysis to identify significant factors associated with HbA1c level. RESULTS Most of the participants had a suboptimal glycemic control (92.3%), while 13.3% had severe diabetes-related distress. HbA1c level was significantly and positively correlated with the total PAID score and all its sub-domains. Multivariate quantile regression revealed that obesity, multi-morbidity, and severe diabetes-related distress were the only significant determinants of the HbA1c median level. Obese patients had significantly higher median HbA1c compared to patients who were not obese (coefficient = 0.25, P < 0.001). Patients with two or more comorbidities (i.e., multimorbidity) had a significantly higher median HbA1c than patients with single or no chronic comorbidities (coefficient = 0.41, P < 0.001). Severe diabetes-related distress was significantly associated with higher median HbA1c compared to nonsevere diabetes-related distress (coefficient = 0.20, P = 0.018). CONCLUSION Diabetes-related distress had a significant association with HbA1c level. Family physicians should implement multifaceted programs to optimize diabetes control and reduce any associated distress.
Collapse
Affiliation(s)
- Sally F. Elotla
- Department of Public Health, Occupational and Environmental Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ahmed M. Fouad
- Department of Public Health, Occupational and Environmental Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Samar F. Mohamed
- Department of Family Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Anwar I. Joudeh
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
- Department of Internal Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mona Mostafa
- Department of Internal Medicine, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Samer El Hayek
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Jackson Health System, Miami, Florida, USA
| | - Jaffer Shah
- Department of Public Health, New York State Department of Health, NY, USA
| | - Hazem A. S. Ahmed
- Department of Family Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| |
Collapse
|
|
21
|
Lee EH, Lee YW, Chae D, Kang EH, Kang HJ. Relationship between Type D personality and adverse health outcomes in people with type 2 diabetes: The parallel mediating roles of diabetes distress and social isolation. Nurs Open 2022; 10:3347-3355. [PMID: 36576733 PMCID: PMC10077398 DOI: 10.1002/nop2.1587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/17/2022] [Accepted: 12/16/2022] [Indexed: 12/29/2022] Open
Abstract
AIM To investigate the relationship between Type D personality and adverse health outcomes [glycated haemoglobin (HbA1c) and health-related quality of life (HRQOL)] directly, and indirectly via diabetes distress and social isolation in people with type 2 diabetes. DESIGN A secondary analysis of 524 participant's data derived from a cross-sectional, correlational study with people with type 2 diabetes. METHODS Data were analysed using the PROCESS macro of SPSS. RESULTS Type D personality was present in 31.3% of the participants, and exerted a direct effect on HRQOL but not on HbA1c. Type D personality indirectly affected both HbA1c and HRQOL via the mediators of diabetes distress and social isolation. Nurses need to monitor people with type 2 diabetes to determine whether Type D personality is present. Those with Type D personality should be provided with interventions to reduce diabetes distress and alleviate social isolation in order to improve HbA1c and HRQOL.
Collapse
Affiliation(s)
- Eun-Hyun Lee
- Graduate School of Public Health, Ajou University, Suwon, Republic of Korea
| | - Young Whee Lee
- Department of Nursing, Inha University, Incheon, Republic of Korea
| | - Duckhee Chae
- College of Nursing, Chonnam National University, Gwangju, Republic of Korea
| | - Eun Hee Kang
- Graduate School of Public Health, Ajou University, Suwon, Republic of Korea
| | - Hyun-Jung Kang
- Graduate School of Public Health, Ajou University, Suwon, Republic of Korea
| |
Collapse
|
|
22
|
Yang N, Masingboon K, Samartkit N. Factors influencing diabetes self-management among adults with type 2 diabetes mellitus in China. BELITUNG NURSING JOURNAL 2022; 8:389-395. [PMID: 37554488 PMCID: PMC10405646 DOI: 10.33546/bnj.2199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/04/2022] [Accepted: 10/04/2022] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND In China, the prevalence of Type 2 Diabetes Mellitus (T2DM) continues to rise, and Diabetes Self-Management (DSM) is generally suboptimal. Thus, identifying the factors influencing DSM in adults with T2DM is crucial for healthcare providers. OBJECTIVES This study aimed to 1) describe DSM among adults with T2DM in Wenzhou, China, 2) examine the correlations between diabetes knowledge, perceived self-efficacy, fatalism, social support, and DSM, and 3) determine how much power of the correlated independent variables could predict DSM. METHODS This study adopted the cross-sectional design and included 108 adults with T2DM who were randomly selected from the outpatient clinic of a hospital in Wenzhou, China. Data were recruited using a demographic questionnaire, and standardized tools were utilized to determine the correlation between DSM, diabetes knowledge, perceived self-efficacy, fatalism, and social support. Data were analyzed using descriptive statistics, Pearson correlation, and multiple regression analysis. RESULTS 62% of participants had poor blood glucose control (HbA1c ≥8.0%) and suboptimal DSM. Significant factors related to DSM were diabetes knowledge (r = 0.594, p <0.001), perceived self-efficacy (r = 0.447, p <0.001), and social support (r = 0.312, p = 0.001). The regression analysis revealed that all variables significantly explained 38.2% of the variance in DSM among adults with T2DM. However, only diabetes knowledge and perceived self-efficacy significantly predicted DSM (β = 0.468, p <0.001; β = 0.184, p = <0.05, respectively). CONCLUSION The findings indicated that increasing diabetes knowledge and perceived self-efficacy could help improve DSM in T2DM to ascertain the ultimate treatment outcomes. Nurses and healthcare providers should improve the ability of patients and their families to think critically and act autonomously.
Collapse
Affiliation(s)
- Ni Yang
- Master of Nursing Science Program Adult Nursing (International Program), Faculty of Nursing, Burapha University, Chon Buri, Thailand
| | | | | |
Collapse
|
|
23
|
Ozyalcin B, Sanlier N. EVALUATION OF DISEASE ACCEPTANCE, DEPRESSION, AND QUALITY OF LIFE IN PEOPLE WITH TYPE 2 DIABETES MELLITUS. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2022; 18:474-479. [PMID: 37152883 PMCID: PMC10162829 DOI: 10.4183/aeb.2022.474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Context Diabetes is a serious public health problem that is increasing worldwide. Objectives The aim of this study is to evaluate acceptance of the illness, emotional distress, depression and quality of life in individuals with type 2 diabetes mellitus. Subjects and Methods This study was conducted in 145 individuals with type 2 diabetes mellitus, 73 males (50.3%) and 72 females (49.7%), ranging in age from 20 to 65 years old. Research data were collected using the face-to-face interview technique by the researchers. The Acceptance of Illness Scale for the determination of individuals' acceptance of the illness, Problem Areas in Diabetes Scale for emotional distress, Beck Depression Inventory for depression and Short Form-36 scales for quality of life was used. Results The mean score of individuals' Acceptance of Illness Scale was 30.2±5.62. Compared to women, men had lower emotional distress, depression levels (p<0.05), higher physical, mental quality of life (p<0.001). Correlations among acceptance of illness, emotional distress, depression and quality of life were found to be significant (p<0.05). Also, models of multiple linear regression analysis were statistically significant (p=0.000). Conclusions The main goal in the treatment of diabetes should be to eliminate complaints in patients, to reduce, prevent or delay the development of complications, to increase the quality of life, to ensure that the individual has a physically, emotionally, spiritually and mentally regular life in addition to metabolic control. For this reason, it is beneficial to carry out the treatment with a multidisciplinary approach in type 2 diabetes mellitus.
Collapse
Affiliation(s)
- B. Ozyalcin
- Ankara Medipol University − Nutrition and Dietetic, Ankara, Turkey
| | - N. Sanlier
- Ankara Medipol University − Nutrition and Dietetic, Ankara, Turkey
| |
Collapse
|
|
24
|
Abbott L, Graven L, Schluck G, Lemacks J. A Structural Equation Modeling Analysis to Explore Diabetes Self-Care Factors in a Rural Sample. Healthcare (Basel) 2022; 10:1536. [PMID: 36011193 PMCID: PMC9407851 DOI: 10.3390/healthcare10081536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/07/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Diabetes is a public health problem that requires management to avoid health sequelae. Little is known about the determinants that influence diabetes self-care activities among rural populations. The purpose of this analysis was to explore the relationships among diabetes self-care activities, diabetes knowledge, perceived diabetes self-management, diabetes fatalism, and social support among an underserved rural group in the southern United States. A diabetes health promotion program was tested during a cluster randomized trial that tested a disease risk reduction program among adults living with prediabetes and diabetes. A structural equation model was fit to test psychosocial factors that influence diabetes self-care activities using the Information-Motivation-Behavioral Skills Model of Diabetes Self-Care (IMB-DSC) to guide the study. Perceived diabetes self-management significantly predicted self-care behaviors, and there was also a correlation between perceived diabetes self-management and diabetes fatalism. Perceived diabetes self-management influenced diabetes self-care activities in this rural sample and had an association with diabetes fatalism. The findings of this study can facilitate clinical care and community programs targeting diabetes and advance health equity among underserved rural groups.
Collapse
Affiliation(s)
- Laurie Abbott
- College of Nursing, Florida State University, Tallahassee, FL 32306, USA
| | - Lucinda Graven
- College of Nursing, Florida State University, Tallahassee, FL 32306, USA
| | - Glenna Schluck
- College of Nursing, Florida State University, Tallahassee, FL 32306, USA
| | - Jennifer Lemacks
- College of Nursing and Health Professions, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| |
Collapse
|
|
25
|
Zara S, Kruse J, Leveling AM, Schmitz J, Hempler I, Kampling H. Capturing Diabetes-Related Distress and Burden From the Perspective of Patients With Type 1 or Type 2 Diabetes: Protocol for an Explorative Mixed Methods Study. JMIR Res Protoc 2022; 11:e38477. [PMID: 35916703 PMCID: PMC9379798 DOI: 10.2196/38477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Diabetes is one of the most common diseases worldwide and is associated with increased morbidity, mortality, and reduced quality of life. Many patients experience high diabetes-related distress as well as depression and anxiety symptoms, which are associated with poor diabetes self-management. As disease management is a central component in diabetes treatment, poor management enhances the occurrence of micro- and macrovascular complications. This emphasizes the relevance of reducing diabetes-related distress and providing adequate treatment options addressing the individual psychosocial burden of patients with diabetes. Since patients' perspectives diverge significantly from those of practitioners in terms of relevant treatment aspects, the patient perspective on, for example, barriers to and facilitators of diabetes treatment is crucial for adequate and effective treatment as well as improvements to self-management and therefore, needs to be further explored. OBJECTIVE This study aims to examine diabetes-related distress, the course of distress throughout diabetes management, as well as barriers and facilitating factors in dealing with diabetes from the individual perspective of patients with type 1 and type 2 diabetes. METHODS The study employs a mixed methods design combining qualitative and quantitative data. Semistructured interviews (N=40) will be conducted with patients with type 1 diabetes (n=20) and patients with type 2 diabetes (n=20). The primary outcomes comprise (1) diabetes-related distress, (2) the severity of distress, (3) the course of distress throughout diabetes management, (4) barriers, and (5) facilitating factors. Questionnaires will provide data on the following secondary outcomes: diabetes-related emotional distress (the Problem Areas in Diabetes scale), symptoms of depression and anxiety (Patient Health Questionnaire, German version), personality functioning (Operationalized Psychodynamic Diagnosis-Structure Questionnaire), mentalizing capacities (Mentalization Questionnaire), epistemic trust (Epistemic Trust, Mistrust and Credulity Questionnaire) and experiences of child maltreatment (Childhood Trauma Questionnaire), and the overall health status of the patient (routine medical data). RESULTS As of April 2022, the conceptualization phase of the study was finalized. Ethics approval was received in January 2022 from the local ethics committee of the Justus Liebig University Giessen - Faculty of Medicine (AZ 161/21). CONCLUSIONS This study will provide insights into the individual perspective of patients with type 1 and type 2 diabetes regarding their experiences with diabetes management and what they perceive to be relevant, obstructive, or beneficial. The insights gained could help further tailor diabetes treatment to the individual needs of patients with diabetes and therefore optimize diabetes self-management. TRIAL REGISTRATION German Clinical Trial Register DRKS00024999; https://tinyurl.com/2wb4xdh8. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/38477.
Collapse
Affiliation(s)
- Sandra Zara
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany.,Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, Marburg, Germany
| | - Anna Maria Leveling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Jana Schmitz
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Isabelle Hempler
- Institute of General Practice / Family Medicine, Medical Center - University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Hanna Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| |
Collapse
|
|
26
|
Levy NK, Park A, Solis D, Hu L, Langford AT, Wang B, Rogers ES. Social Determinants of Health and Diabetes-Related Distress in Patients with Insulin-Dependent Type 2 Diabetes: A Cross-Sectional, Mixed Methods Approach (Preprint). JMIR Form Res 2022; 6:e40164. [PMID: 36222807 PMCID: PMC9607916 DOI: 10.2196/40164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/02/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Social determinants of health (SDOH) refer to the social, economic, and psychosocial conditions that influence health. Lower levels of SDOH factors including income, education, and employment are associated with a higher prevalence of diabetes, poorer glycemic control, and increased diabetes-related mortality. Few studies have conducted a comprehensive evaluation of multiple SDOH factors in a population with type 2 diabetes mellitus (T2DM). Objective This study aimed to identify the range of SDOH challenges—including diabetes-related distress—that impact patients with insulin-dependent diabetes at an urban safety-net clinic using the 5-domain SDOH framework developed by the Healthy People 2020 initiative. Methods The pilot study used a cross-sectional, mixed methods approach. Participants were recruited from 3 programs within a general internal medicine clinic that provides ambulatory care for patients with uncontrolled T2DM. We administered an investigator-developed SDOH survey based on the Healthy People 2020 framework and the validated Diabetes Distress Scale (DDS), which assesses 4 domains of diabetes-related distress. One-on-one interviews were conducted to gain in-depth information about challenges. Results In total, 57 participants had an average hemoglobin A1c level of 11.0% (SD 2.6%). Overall, 92% (52/57) of participants had a barrier in at least one SDOH domain. SDOH challenges were most commonly reported in the domain of Health and Health Care (84%, 48/57), followed by Economic Stability (54%, n=31), Neighborhood and Built Environment (53%, n=30), Education and Health Literacy (47%, n=27), and Social and Community context (37%, n=21). The mean overall DDS score was 2.09 (SD 0.84), where scores of ≥2 indicate distress. Further, 79% (45/57) of participants had at least moderate diabetes-related distress in one of the 4 DDS domains. General themes that emerged from participant interviews included job interference with healthy behaviors, concerns about burdening others, challenges communicating with providers, and difficulty getting appointments in a timely manner. Conclusions We found high levels of SDOH barriers across all 5 domains of the Center for Disease Control and Prevention’s Healthy People 2020 framework, including significant levels of diabetes-related distress. Future programs to address SDOH barriers in patients with uncontrolled insulin-dependent diabetes should consider screening for and focusing on a wide range of challenges.
Collapse
Affiliation(s)
- Natalie K Levy
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Agnes Park
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Daniela Solis
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Lu Hu
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Aisha T Langford
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Binhuan Wang
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Erin S Rogers
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| |
Collapse
|
|
27
|
Kintzoglanakis K, Gkousiou A, Vonta P, Sagmatopoulos A, Copanitsanou P. Depression, anxiety, and diabetes-related distress in type 2 diabetes in primary care in Greece: Different roles for glycemic control and self-care. SAGE Open Med 2022; 10:20503121221096605. [PMID: 35600704 PMCID: PMC9118887 DOI: 10.1177/20503121221096605] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/05/2022] [Indexed: 12/28/2022] Open
Abstract
Objectives: The psychological distress of people living with diabetes is increased and associated with poorer glycemic outcomes and self-care. We aimed to examine the frequency of depression, anxiety, and diabetes-related distress (DRD) of individuals with type 2 diabetes (T2D) in primary care (PC) and their comparative associations with clinical, self-care, and socio-demographic characteristics, testing for possible different roles on glycemic control and self-care. Methods: This is a cross-sectional study of 182 adults with a T2D diagnosis of at least six months, recruited between August 2019-March 2020 and May-October 2020, from an urban PC unit. Participants were screened for symptoms of depression (Patient Health Questionnaire-9 (PHQ-9)), anxiety (Generalized Anxiety Disorder-7 (GAD-7)), and DRD (Diabetes Distress Scale (DDS)). Clinical, self-care, and socio-demographic parameters were recorded. Results: The frequency of clinically significant symptoms of depression was 16.6%, (PHQ-9 score ⩾10), anxiety 17.7% (GAD-7 score ⩾10), and DRD 22.6% (DDS score ⩾2). All PHQ-9, GAD-7, and DDS scores intercorrelated, and higher scores were found to be associated with female gender, lower income, and prior diagnosis of depression. Higher PHQ-9 and GAD-7 scores were found to be associated with lower education, more hypoglycemia episodes, more blood glucose self-tests and antidepressant or benzodiazepine use. The retired/housewives scored significantly lower in GAD-7 and DDS compared to the unemployed participants. Higher DDS scores were associated with higher glycated hemoglobin, higher fasting plasma glucose, and insulin use. It was also noted that higher PHQ-9 scores were associated with lower uric acid levels and were significantly higher in the sedentary lifestyle group. Conclusion: DRD was associated with poorer glycemic outcomes while depressive symptoms were associated with lower physical activity perhaps sharing different roles for glycemic control and self-care. The psychological burden of individuals with T2D may be considered in PC.
Collapse
Affiliation(s)
| | | | | | | | - Panagiota Copanitsanou
- General Hospital of Piraeus “Tzaneio,” Piraeus, Greece
- Department of Nursing Science, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
|
28
|
Davis J, Fischl AH, Beck J, Browning L, Carter A, Condon JE, Dennison M, Francis T, Hughes PJ, Jaime S, Lau KHK, McArthur T, McAvoy K, Magee M, Newby O, Ponder SW, Quraishi U, Rawlings K, Socke J, Stancil M, Uelmen S, Villalobos S. 2022 National Standards for Diabetes Self-Management Education and Support. Diabetes Spectr 2022; 35:137-149. [PMID: 35668879 PMCID: PMC9160547 DOI: 10.2337/ds22-ps02] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | - Joni Beck
- The University of Oklahoma Health Science Center, Oklahoma City, OK
| | | | | | - Jo Ellen Condon
- Anne Arundel Medical Center, Annapolis, MD
- Diabetes Alliance Network, Naples, FL
| | | | | | | | | | | | | | | | - Michelle Magee
- MedStar Diabetes and Research Institutes, Georgetown University School of Medicine, Washington, DC
| | - Olivia Newby
- The Healthy Living Center Diabetes Education Program, Norfolk, VA
| | | | | | | | | | | | - Sacha Uelmen
- Association of Diabetes Care & Education Specialists, Chicago, IL
| | | |
Collapse
|
|
29
|
All in the Family: A Qualitative Study of the Early Experiences of Adults with Younger Onset Type 2 Diabetes. J Am Board Fam Med 2022; 35:341-351. [PMID: 35379721 PMCID: PMC9605685 DOI: 10.3122/jabfm.2022.02.210223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/19/2021] [Accepted: 10/05/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Adults with type 2 diabetes diagnosed at a younger age are at increased risk for poor outcomes. We examined life stage-related facilitators and barriers to early self-management among younger adults with newly diagnosed type 2 diabetes. RESEARCH DESIGN AND METHODS We conducted 6 focus groups that each met twice between November 2017 and May 2018. Participants (n = 41) were aged 21 to 44 years and diagnosed with type 2 diabetes during the prior 2 years. Transcripts were coded using thematic analysis and themes were mapped to the Capability-Opportunity-Motivation-Behavior framework. RESULTS Participants were 38.4 (±5.8) years old; 10 self-identified as Latinx, 12 as Black, 12 as White, and 7 as multiple or other races. We identified 9 themes that fell into 2 categories: (1) the impact of having an adult family member with diabetes, and (2) the role of nonadult children. Family members with diabetes served as both positive and negative role models, and, for some, personal familiarity with the disease made adjusting to the diagnosis easier. Children facilitated their parents' self-management by supporting self-management activities and motivating their parents to remain healthy. However, the stress and time demands resulting from parental responsibilities and the tendency to prioritize children's needs were perceived as barriers to self-management. CONCLUSIONS Our results highlight how the life position of younger-onset individuals with type 2 diabetes influences their early experiences. Proactively addressing perceived barriers to and facilitators of self-management in the context of family history and parenthood may aid in efforts to support these high-risk, younger patients.
Collapse
|
|
30
|
Comer-HaGans D, Austin S, Ramamonjiarivelo Z, Sherman LD. Preventative diabetes self-care management practices among individuals with diabetes and mental health stress. J Affect Disord 2022; 298:24-34. [PMID: 34780862 DOI: 10.1016/j.jad.2021.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/09/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The study purpose examines diabetes self-care management practices among individuals diagnosed with diabetes with and without mental health stress. METHODS Pooled cross-sectional data (2011-2016) from the Household Component of the Medical Expenditure Panel Survey (HC-MEPS) were used. The sample consisted of individuals ages 25-85 years (n = 13,193; weighted n = 23,559,975). Dependent variables were engagement in moderate/vigorous physical exercise five times weekly, receiving dilated eye exams, foot checks, treating diabetes with diet modification or insulin injections, and eating fewer high fat/cholesterol foods. The independent variable was diabetes with and without mental health stress. The study controlled for predisposing, enabling, and need factors. RESULTS Compared with individuals with diabetes without mental health stress, findings indicate individuals with diabetes and low or mild/moderate mental health stress were more likely to treat diabetes with diet modification and to restrict high fat/cholesterol food. Individuals with diabetes and severe mental health stress were more likely to restrict high fat/cholesterol. Additionally, individuals with mild/moderate to severe mental health stress were less likely to engage in diabetes care behavior. LIMITATIONS Mental health stress is represented as a non-specific psychological distress index summary during the past 30 days and may not be an actual representation of overall distress in a person's life. There were no variables distinguishing diabetes type or severity. The study uses self-reported data and is cross-sectional. CONCLUSIONS Mental health stress may contribute to individuals not engaging in self-management practices. It would be beneficial to incorporate psychosocial services for individuals with diabetes and mental health stress.
Collapse
Affiliation(s)
- DeLawnia Comer-HaGans
- Governors State University, Health Administration, 1 University Parkway, University Park, IL 60484-0975, United States.
| | - Shamly Austin
- Gateway Health, Four Gateway Center, Research Development and Analytics, 444 Liberty Avenue -1222, Pittsburgh, PA 15222, United States.
| | - Zo Ramamonjiarivelo
- Texas State University, School of Health Administration, University Drive, Encino Hall, Suite 250, Office 254, 601, San Marcos, TX 78666, United States.
| | - Ledric D Sherman
- Department of Health and Kinesiology, Texas A&M University, 4243 TAMU, College Station, TX 77843, United States.
| |
Collapse
|
|
31
|
Davis J, Fischl AH, Beck J, Browning L, Carter A, Condon JE, Dennison M, Francis T, Hughes PJ, Jaime S, Lau KHK, McArthur T, McAvoy K, Magee M, Newby O, Ponder SW, Quraishi U, Rawlings K, Socke J, Stancil M, Uelmen S, Villalobos S. 2022 National Standards for Diabetes Self-Management Education and Support. Diabetes Care 2022; 45:484-494. [PMID: 35050365 DOI: 10.2337/dc21-2396] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/17/2021] [Indexed: 02/03/2023]
Affiliation(s)
| | | | - Joni Beck
- The University of Oklahoma Health Science Center, Oklahoma City, OK
| | | | | | - Jo Ellen Condon
- Anne Arundel Medical Center, Annapolis, MD
- Diabetes Alliance Network, Naples, FL
| | | | | | | | | | | | | | | | - Michelle Magee
- 15MedStar Diabetes and Research Institutes, Georgetown University School of Medicine, Washington, D.C
| | - Olivia Newby
- 16The Healthy Living Center Diabetes Education Program, Norfolk, VA
| | | | | | | | | | | | - Sacha Uelmen
- 22Association of Diabetes Care & Education Specialists, Chicago, IL
| | | |
Collapse
|
|
32
|
Davis J, Fischl AH, Beck J, Browning L, Carter A, Condon JE, Dennison M, Francis T, Hughes PJ, Jaime S, Lau KHK, McArthur T, McAvoy K, Magee M, Newby O, Ponder SW, Quraishi U, Rawlings K, Socke J, Stancil M, Uelmen S, Villalobos S. 2022 National Standards for Diabetes Self-Management Education and Support. Sci Diabetes Self Manag Care 2022; 48:44-59. [PMID: 35049403 DOI: 10.1177/26350106211072203] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The National Standards for Diabetes Self-Management Education and Support (DSMES) provide guidance and evidence-based, quality practice for all DSMES services. Due to the dynamic nature of health care and diabetes research, the National Standards are reviewed and revised approximately every 5 years by key stakeholders and experts within the diabetes care and education community. For each revision, the Task Force is charged with reviewing the current National Standards for appropriateness, relevance, and scientific basis and making updates based on current evidence and expert consensus. In 2021, the group was tasked with reducing administrative burden related to DSMES implementation across diverse care settings. CONCLUSION The evidence supporting the 2022 National Standards clearly identifies the need to provide person-centered services that embrace cultural differences, social determinants of health, and the ever-increasing technological engagement platforms and systems. Payers are invited to review the National Standards as a tool to inform and modernize DSMES reimbursement requirements and to align with the evolving needs of people with diabetes (PWD) and physicians/other qualified health care professionals. The American Diabetes Association and the Association of Diabetes Care & Education Specialists strongly advocate for health equity to ensure all PWD have access to this critical service proven to improve outcomes both related to and beyond diabetes. The 2022 National Standards update is meant to be a universal document that is easy to understand and can be implemented by the entire health care community. DSMES teams in collaboration with primary care have been shown to be the most effective approach to overcome therapeutic inertia.
Collapse
Affiliation(s)
| | | | - Joni Beck
- The University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | | | | | - Jo Ellen Condon
- Anne Arundel Medical Center, Annapolis, Maryland, and Diabetes Alliance Network, Naples, Florida
| | | | | | | | - Stephen Jaime
- El Centro Regional Medical Center, El Centro, California
| | | | | | - Karen McAvoy
- Yale New Haven Health System, New Haven, Connecticut
| | - Michelle Magee
- MedStar Diabetes and Research Institutes, Georgetown University School of Medicine, Washington, DC
| | - Olivia Newby
- The Healthy Living Center Diabetes Education Program, Norfolk, Virginia
| | | | | | | | | | | | - Sacha Uelmen
- Association of Diabetes Care & Education Specialists, Chicago, Illinois
| | | |
Collapse
|
|
33
|
Factors Associated with Diabetes-Related Distress in Patients with Type 2 Diabetes Mellitus. JOURNAL OF INTERDISCIPLINARY MEDICINE 2021. [DOI: 10.2478/jim-2021-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction: The aim of this study was to identify factors associated with diabetes-related distress (DRD) in adult patients with type 2 diabetes mellitus (T2DM).
Material and Methods: This was an analysis of data previously obtained from two cross-sectional studies, in which medical charts review and direct interviews were employed to obtain medical and demographic data. Vital status assessment and anthropometric measurements were performed. The patients filled out specific questionnaires for DRD (DDS-17), symptoms of depression (PHQ-9), and of anxiety (GAD-7). A clinical meaningful threshold for DRD was set at ≥2.0 points. Symptoms of depression and anxiety, number of chronic complications, therapy for T2DM, anthropometric and cardio-metabolic parameters, as well as demographic, socio-economic data, and lifestyle habits were evaluated as factors possibly associated with DRD by univariate and multiple regression analyses.
Results: A total of 271 patients with T2DM were included in this analysis, of whom 25.1% presented a DDS-17 score ≥2 points (and 9.96% a DDS-17 score ≥3). Subjects with a DDS-17 score ≥2 had higher HbA1c levels (p = 0.018), PHQ-9 and GAD-7 scores (p <0.0001 for both). The multiple regression model indicated that anxiety (p = 0.026), depression (p = 0.001), and ethnicity (p = 0.002) were significantly correlated with DRD (p <0.0001). With regards to subscales, the HbA1c (p = 0.005) and PHQ-9 score (p <0.0001) were significantly associated with emotional burden, ethnicity (p = 0.001) and depression (p = 0.004) with regimen-related distress, whereas ethnicity (p = 0.010) and GAD-7 score (p = 0.012) with interpersonal distress.
Conclusions: Psychosocial factors like depression, anxiety, or ethnicity significantly contribute to DRD in patients with T2DM, and worse glycemic control is associated with emotional burden.
Collapse
|
|
34
|
Lau CYK, Kong APS, Lau JTF, Chan V, Mo PKH. Coping skills and glycaemic control: the mediating role of diabetes distress. Acta Diabetol 2021; 58:1071-1079. [PMID: 33768380 DOI: 10.1007/s00592-021-01679-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 01/11/2021] [Indexed: 10/21/2022]
Abstract
AIMS The present study examined the mediating role of diabetes distress on the relationship between coping and glycaemic control, and evaluated if the afore-mentioned mediation was moderated by insulin treatment in people with type 2 diabetes. METHODS A total of 473 adults with type 2 diabetes were recruited from an outpatient clinic in Hong Kong and invited to take part in a survey that measured adaptive coping, maladaptive coping, and diabetes stress. Glycaemic control was measured by glycated haemoglobin values extracted from medical records. PROCESS v3.4 macro was used to test the moderated mediation model. RESULTS Adaptive coping was negatively associated with diabetes distress (-0.29, 95% CI: -0.53, -0.06), whereas maladaptive coping was positively associated with diabetes distress (1.82, 95% CI: 1.12, 2.51). Diabetes distress had a positive relationship with glycated haemoglobin (0.04, 95% CI: 0.02, 0.05), but no correlations were found between glycated haemoglobin and adaptive coping or maladaptive coping. Insulin treatment not only weakened the diabetes distress-glycaemic control relationship (-0.04, 95% CI: -0.06, -0.01), but also weakened the mediation effect of maladaptive coping-glycaemic control relationship via diabetes distress (-0.07, 95% CI: -0.12, -0.02). CONCLUSIONS The study findings revealed the role of diabetes distress and insulin treatment in the link between coping skills and glycaemic control. Interventions to help boost confidence and autonomy in people with diabetes could help them lessen diabetes distress.
Collapse
Affiliation(s)
- Christine Y K Lau
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Alice P S Kong
- Division of Endocrinology and Diabetes, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Joseph T F Lau
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Virginia Chan
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Phoenix K H Mo
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR.
| |
Collapse
|
|
35
|
Kadıoğlu N, Sert UY, Sariaslan SG, Mursel K, Celen S. Sleep Disorders in Pregnancy, Influencing Factors and Quality of Life. Z Geburtshilfe Neonatol 2021; 226:34-40. [PMID: 34311492 DOI: 10.1055/a-1519-7517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM In our study, the frequency of sleep disturbances in pregnancy, the reasons underlying the low quality of sleep, clinical factors, and the effects on quality of life were investigated. METHODS The study was planned as a prospective study and included 189 pregnant women. Clinical features, laboratory results, socio-demographic status, obstetric and medical anamnesis were evaluated. The Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, the Berlin Questionnaire, Beck Depression Inventory, SF-36 quality-of-life questionnaire, and restless leg syndrome (RLS) diagnosis criteria were used for data collection. RESULTS We investigated sleep disorders in 110 pregnant women (58.2%). A history of premenstrual syndrome and patients with hyperemesis gravidarum, obstructive sleep apnea syndrome, Vitamin B12 deficiency, and higher TSH levels in the laboratory were found to be associated with sleep disorders. Sleep disorders and daytime sleepiness were associated with depression, physical and social functioning, pain, and disturbance in general health perception. The number of pregnant women who had two or more RLS complaints was 84 (44%). CONCLUSION The results of our study show that sleep disorders in pregnancy can be managed with easily applicable methods according to the risk factors and related problems.
Collapse
Affiliation(s)
- Nezaket Kadıoğlu
- Department of Obstetrics and Gynecology, University of Yuksek ihtisas, Ankara, Turkey
| | - Umit Yasemin Sert
- Department of Obstetrics and Gynecology, Ankara City Hospital, Cankaya, Ankara
| | | | - Konul Mursel
- Department of Obstetrics and Gynecology, Lokman Hekim Hospital, Ankara, Turkey
| | - Sevki Celen
- Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Education and Research Hospital, Ankara, Turkey
| |
Collapse
|
|
36
|
Fatalism, Social Support and Self-Management Perceptions among Rural African Americans Living with Diabetes and Pre-Diabetes. NURSING REPORTS 2021; 11:242-252. [PMID: 34968202 PMCID: PMC8608061 DOI: 10.3390/nursrep11020024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/29/2021] [Accepted: 04/08/2021] [Indexed: 02/01/2023] Open
Abstract
Diabetes is a public health problem and a major risk factor for cardiovascular disease, the leading cause of death in the United States. Diabetes is prevalent among underserved rural populations. The purposes of this study were to perform secondary analyses of existing clinical trial data to determine whether a diabetes health promotion and disease risk reduction intervention had an effect on diabetes fatalism, social support, and perceived diabetes self-management and to provide precise estimates of the mean levels of these variables in an understudied population. Data were collected during a cluster randomized trial implemented among African American participants (n = 146) in a rural, southern area and analyzed using a linear mixed model. The results indicated that the intervention had no significant effect on perceived diabetes management (p = 0.8), diabetes fatalism (p = 0.3), or social support (p = 0.4). However, the estimates showed that, in the population, diabetes fatalism levels were moderate (95% CI = (27.6, 31.3)), and levels of social support (CI = (4.0, 4.4)) and perceived diabetes self-management (CI = (27.7, 29.3)) were high. These findings suggest that diabetes fatalism, social support, and self-management perceptions influence diabetes self-care and rural health outcomes and should be addressed in diabetes interventions.
Collapse
|
|
37
|
Presley CA, Mondesir FL, Juarez LD, Agne AA, Riggs KR, Li Y, Pisu M, Levitan EB, Bronstein JM, Cherrington AL. Social support and diabetes distress among adults with type 2 diabetes covered by Alabama Medicaid. Diabet Med 2021; 38:e14503. [PMID: 33351189 PMCID: PMC7979501 DOI: 10.1111/dme.14503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 12/10/2020] [Accepted: 12/16/2020] [Indexed: 11/30/2022]
Abstract
AIMS Diabetes distress affects approximately 36% of adults with diabetes and is associated with worse diabetes self-management and poor glycaemic control. We characterized participants' diabetes distress and studied the relationship between social support and diabetes distress. METHODS In this cross-sectional study, we surveyed a population-based sample of adults with type 2 diabetes covered by Alabama Medicaid. We used the Diabetes Distress Scale assessing emotional burden, physician-related, regimen-related and interpersonal distress. We assessed participants' level of diabetes-specific social support and satisfaction with this support, categorized as low or moderate-high. We performed multivariable logistic regression of diabetes distress by level of and satisfaction with social support, adjusting for demographics, disease severity, self-efficacy and depressive symptoms. RESULTS In all, 1147 individuals participated; 73% were women, 41% White, 58% Black and 3% Hispanic. Low level of or satisfaction with social support was reported by 11% of participants; 7% of participants had severe diabetes distress. Participants with low satisfaction with social support were statistically significantly more likely to have severe diabetes distress than those with moderate-high satisfaction, adjusted odds ratio 2.43 (95% CI 1.30, 4.54). CONCLUSIONS Interventions addressing diabetes distress in adults with type 2 diabetes may benefit from a focus on improving diabetes-specific social support.
Collapse
Affiliation(s)
- Caroline A. Presley
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Favel L. Mondesir
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, USA
| | - Lucia D. Juarez
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - April A. Agne
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kevin R. Riggs
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yufeng Li
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maria Pisu
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Emily B. Levitan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Janet M. Bronstein
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrea L. Cherrington
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
|
38
|
Jiang XJ, Jiang H, Chen Y, Wu XA, Yu XL, Liu L, Li MZ. The Effectiveness of a Self-Efficacy-Focused Structured Education Program (SSEP) in Improving Metabolic Control and Psychological Outcomes of Type 2 Diabetes Patients: A 12-Month Follow-Up of a Multicenter Randomized Controlled Trial. Diabetes Metab Syndr Obes 2021; 14:305-313. [PMID: 33519219 PMCID: PMC7837544 DOI: 10.2147/dmso.s290029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/10/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The 12-month follow-up effect of the self-efficacy-focused structured education program (SSEP) requires in-depth confirmation. This study aims to verify whether the benefits of SSEP can be maintained in 12 months. MATERIALS AND METHODS A multicenter randomized controlled trial with 12-month follow-up conducted among 265 type 2 diabetes patients not on insulin from 4 hospitals in mainland China. The intervention group (n = 133) was administrated with SSEP, and the control group (n = 132) received the routine education. The indicators of metabolic and psychosocial aspects of the patients were assessed at baseline and 12 months. RESULTS As opposed to the control group, the primary outcomes of HbA1c in the intervention group were improved obviously in the 12th month during the 12-month follow-up (-1.13%, P < 0.001). The secondary outcomes (ie, waist circumference, total cholesterol, low-density lipoprotein cholesterol, diabetes self-efficacy, diabetes self-management behaviors, diabetes knowledge and diabetes distress) were improved significantly in the intervention group as compared with the control group in the 12th month during the 12-month follow-up (-3.14 cm, P = 0.001; -0.30 mmol/L, P = 0.032; -0.25 mmol/L, P = 0.008; 0.87, P < 0.001; 10.67, P < 0.001; 3.42, P < 0.001; -4.97, P < 0.001). The non-significant difference in the secondary outcomes (ie, systolic pressure, diastolic pressure, triglycerides and high-density lipoprotein cholesterol) was identified between the two groups in the 12th month during the 12-month follow-up (P > 0.05). CONCLUSION The SSEP provided sustainable benefits in outcomes of HbA1c, waist circumference, total cholesterol, low-density lipoprotein cholesterol, diabetes knowledge, diabetes distress, diabetes self-efficacy and diabetes self-management behaviors for type 2 diabetes patients not on insulin in the 12th month during the 12-month follow-up. Thus, it will be an effective education model capable of being generalized nationwide, and it can be referenced for the nations and regions under consistent conditions. CLINICAL TRIAL REGISTRY Chinese Clinical Trial Registry (ChiCTR-IOR-17011007).
Collapse
Affiliation(s)
- Xin-Jun Jiang
- Department of Adults Nursing, School of International Nursing, Hainan Medical University, Haikou, People’s Republic of China
- Department of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, People’s Republic of China
- Key Laboratory of Emergency and Trauma Ministry of Education, Hainan Medical University, Haikou, People’s Republic of China
- Key Laboratory of Trauma of Hainan Medical University, Hainan Medical University, Haikou, People’s Republic of China
- Key Laboratory of Tropical Cardiovascular Diseases Research of Hainan Province, The First Affiliated Hospital of Hainan Medical University, Haikou, People’s Republic of China
| | - Hua Jiang
- Department of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, People’s Republic of China
| | - Yuan Chen
- Department of Endocrinology, Wuyishan Municipal Hospital, Wuyishan, People’s Republic of China
| | - Xiao-An Wu
- Department of Endocrinology, People’s Hospital of Leping City, Leping, People’s Republic of China
| | - Xue-Lian Yu
- Department of Endocrinology, Yanhua Hospital, Beijing, People’s Republic of China
| | - Lei Liu
- Department of Health Education, Jimenli Primary Hospital, Beijing, People’s Republic of China
| | - Ming-Zi Li
- Department of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, People’s Republic of China
- Correspondence: Ming-Zi Li Department of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, People’s Republic of ChinaTel +86-10-82805230 Email
| |
Collapse
|
|
39
|
Naguib R, Soliman ES, Neimatallah FM, AlKhudhairy NS, ALGhamdi AM, Almosa RS, Aldashash KA, Alkhalifah BY, Elmorshedy H. Cognitive impairment among patients with diabetes in Saudi Arabia: a cross-sectional study. MIDDLE EAST CURRENT PSYCHIATRY 2020. [DOI: 10.1186/s43045-020-00058-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The incidence of cognitive impairment (CI) is higher in patients with diabetes mellitus (DM). The association between DM and CI and the risk factors for CI need to be addressed to estimate the prevalence of cognitive impairment in patients with DM and to identify the potential risk factors. The study is a cross-sectional study using a convenient sample of 269 subjects. Sociodemographic diabetes-related variables including biochemical markers were collected. CI and diabetes-related distress (DRD) were assessed using the Arabic version of Montreal Cognitive Assessment scale (MoCA) and the Diabetes Distress Screening Scale respectively.
Results
Overall, 80.3% had cognitive impairment while 33.8% had severe impairment. Older age, female gender, low level of education, and low income were associated with CI; duration of diabetes and DRD were associated with CI while ophthalmic complications were associated with severe CI. Duration of diabetes was inversely associated with CI. Level of HbA1c was significantly higher in patients with severe CI, and the probability of CI increased as the level of HbA1c increased. Low level of education was associated with severe CI, and CI was two times more likely among patients with DRD.
Conclusion
CI was higher than worldwide figures. Elderly females with low educational level, long duration of DM, and low socioeconomic status are at more risk. The probability of severe CI increased with increased level of HbA1c. Screening for CI in patients with diabetes along with intervention programs while considering the DRD and the level of HbA1c is crucial.
Collapse
|
|
40
|
Chepulis L, Morison B, Lao C, Keenan R, Paul R, Lawrenson R. The prevalence of mental health medication use in a cohort of New Zealand patients with diabetes. Prim Care Diabetes 2020; 14:703-708. [PMID: 32723664 DOI: 10.1016/j.pcd.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 06/08/2020] [Accepted: 07/16/2020] [Indexed: 11/18/2022]
Abstract
AIMS Diabetes is associated with depression, anxiety and psychosis via complex bidirectional relationships that are affected by factors such as the type of diabetes and socioeconomic status. The aim of the study was to estimate the prevalence of mental health conditions in patients with diabetes in a New Zealand primary care population using proxy medication dispensing data. METHODS Primary care data (July 1 2016 - June 30, 2018) was collected from the Patient Management System of 15 different general practices, and was linked via National Health Index number to clinical records at the Waikato District Health Board and the New Zealand Ministry of Health Pharmaceutical database. RESULTS A total of 3978 patients with diabetes were identified from an enrolled patient population of 74,250. Of these, 18.0% of patients with diabetes were dispensed an antidepressant, anxiolytic, or antipsychotic. These medications were prescribed more in New Zealand Europeans (20.9% versus 13.9% in Māori), women, type 2 diabetes, those on insulin, and those with a higher BMI (all P<0.001). CONCLUSIONS Approximately one fifth of patients with diabetes in primary care have mental health disorders. Appropriate management requires concomitant treatment of both the diabetes and the mental health disorder to improve patient outcomes.
Collapse
Affiliation(s)
- Lynne Chepulis
- Waikato Medical Research Centre, University of Waikato, Hamilton, New Zealand.
| | - Brittany Morison
- Waikato Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Chunhuan Lao
- Waikato Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Rawiri Keenan
- Waikato Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Ryan Paul
- Waikato Medical Research Centre, University of Waikato, Hamilton, New Zealand; Waikato Regional Diabetes Service, Waikato District Health Board, Hamilton, New Zealand
| | - Ross Lawrenson
- Waikato Medical Research Centre, University of Waikato, Hamilton, New Zealand; Waikato Regional Diabetes Service, Waikato District Health Board, Hamilton, New Zealand
| |
Collapse
|
|
41
|
Fisekovic Kremic MB. Factors associated with depression, anxiety and stress among patients with diabetes mellitus in primary health care: Many questions, few answers. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2020; 15:54-61. [PMID: 33329863 PMCID: PMC7735874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION People with diabetes mellitus (DM) may have concurrent mental health disorders and have been shown to have poorer disease outcomes. OBJECTIVE The aim of this study to determine the prevalence of DASS in patients with diabetes mellitus without mental disorders, aged 20 years or more, in primary health care, and to determine any association between DASS and patients' sociodemographic and clinical attributes. METHODS This was a cross-sectional study conducted in a primary health care center, in the department of general practice. Patients with DM who visited the doctor and agreed to fill in the questionnaire were included in the study. Data were collected using the questionnaire DASS-21. Descriptive statistics, the Pearson chi-square test, and logistic regression analysis were used to analyze the data. RESULTS Out of a total of 102 respondents with DM, 29 (28.4%) had some form of psychological symptoms. The prevalence of DASS was 16.7%, 16.6%, and 23.5%, respectively. There was no significant difference between sociodemographic variables according to stress status. Respondents aged 40-49 years more often showed emotional states of depression and anxiety. There was a significant association between emotional status of DASS and HbA1c values. Logistic regression analysis indicated that age (OR=2.57, 95% CI: 1.59-4.13) was a predictor of depression and anxiety. CONCLUSION Unpleasant emotional states DASS are common in patients with DM, depression (16.7%), anxiety (16.6%), and stress (23.5%). Age is the strongest predictor of DASS status. The screening and monitoring of unpleasant emotional states in people with diabetes should be performed from a young age.
Collapse
|
|
42
|
Bawa H, Poole L, Cooke D, Panagi L, Steptoe A, Hackett RA. Diabetes-related distress and daily cortisol output in people with Type 2 diabetes. Diabetes Res Clin Pract 2020; 169:108472. [PMID: 33002546 DOI: 10.1016/j.diabres.2020.108472] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 09/03/2020] [Accepted: 09/21/2020] [Indexed: 01/17/2023]
Abstract
AIMS Diabetes-related distress is common in Type 2 Diabetes and is linked with poor diabetes control. However, mechanisms underlying this association are unclear. One pathway that could be involved is neuroendocrine dysfunction, as Type 2 Diabetes is associated with altered diurnal cortisol output. This study investigated the link between diabetes-related distress and diurnal cortisol output. METHODS 134 people with Type 2 Diabetes provided 5 cortisol samples over the course of a day. Multivariate linear regression models were used to assess whether overall and sub-domains of diabetes-related distress measured by the Diabetes Distress Scale, predicted cortisol parameters (waking cortisol, cortisol awakening response, cortisol slope and evening cortisol). RESULTS Physician-related distress was associated with greater waking (B = 2.747, p = .015) and evening cortisol (B = 1.375, p = .014), and a blunted cortisol awakening response (B = -3.472, p = .038) adjusting for age, sex, income, body mass index, smoking and time of awakening. No associations were detected for overall distress, emotional, interpersonal or regimen distress. CONCLUSION Physician-related distress was associated with alterations in daily cortisol output. Longitudinal research is required to understand how physician-related distress is associated with diurnal cortisol patterning over time.
Collapse
Affiliation(s)
- Hetashi Bawa
- Department of Behavioural Science and Health, University College London, London, UK.
| | - Lydia Poole
- Department of Behavioural Science and Health, University College London, London, UK.
| | - Debbie Cooke
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK.
| | - Laura Panagi
- Department of Behavioural Science and Health, University College London, London, UK.
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK.
| | - Ruth A Hackett
- Department of Behavioural Science and Health, University College London, London, UK; Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| |
Collapse
|
|
43
|
Kintzoglanakis K, Vonta P, Copanitsanou P. Diabetes-Related Distress and Associated Characteristics in Patients With Type 2 Diabetes in an Urban Primary Care Setting in Greece. CHRONIC STRESS 2020; 4:2470547020961538. [PMID: 33029569 PMCID: PMC7522819 DOI: 10.1177/2470547020961538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/06/2020] [Indexed: 11/27/2022]
Abstract
Background Diabetes-related distress (DRD) is a common psychological issue of people living with diabetes. International guidelines advise to take DRD into consideration in diabetes care but evidence for Greece is scarce. In the present study we aimed to estimate the frequency of DRD as assessed by Diabetes Distress Scale (DDS) and to examine its connections with clinical and sociodemographic characteristics among patients with type 2 diabetes mellitus (T2D) in urban primary care (PC) in Greece. Methods This descriptive survey included adults with a diagnosis of T2D of at least six months under medication treatment attending a novel, public urban PC unit. Patients with other forms of diabetes, dementia, and psychosis were excluded. Patients were screened for DRD with DDS instrument and correlations were made between DRD and clinical and sociodemographic characteristics. Results In 135 eligible participants the frequency of moderate to high levels of DRD (DDS ≥ 2) was 24.4% and of high levels of DRD (DDS ≥ 3) was 7.4%. Emotional burden (EB) subscale was significantly correlated with younger age, insulin use, duration of insulin use, and the number of insulin injections per day. Longer diabetes duration showed significant correlation with DDS total, EB, and regimen distress. Participants with lower income, sedentary lifestyle, micro-vascular complications, more episodes of hypoglycaemia, and higher levels of glycated haemoglobin (HbA1c) experienced significantly higher distress. Conclusion DRD screening is important in urban PC and in more susceptible patients as those on more insulin injections per day, with longer diabetes duration, higher levels of HbA1c, lower income, sedentary lifestyle, and more episodes of hypoglycaemia.
Collapse
Affiliation(s)
| | | | - Panagiota Copanitsanou
- General Hospital of Piraeus "Tzaneio", Piraeus, Greece.,Department of Nursing Science, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
|
44
|
Jackson LV, Carpenter DM, Postlethwaite DA, Castro LC, Kim E, Herrera RA. Evaluating the Impact of Mobile Phone Technology on Health Outcomes for Latinos with Type 2 Diabetes. J Racial Ethn Health Disparities 2020; 8:532-536. [PMID: 32638340 DOI: 10.1007/s40615-020-00810-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess whether a Spanish-language text messaging program helps Latinos with diabetes better manage their disease. METHODS Spanish-speaking Latinos with type 2 diabetes and HbA1c ≥ 8% (N = 38) were recruited January 1, 2016-May 31, 2016, at a large integrated healthcare delivery system. Participants received 1-3 Spanish-language text messages about diabetes self-care per day for 3 months with an optional 3-month extension. The Wilcoxon signed-rank test for paired data was used to compare pre-post intervention HbA1c. The Wilcoxon-Mann-Whitney nonparametric test was used to compare changes in HbA1c across groups. RESULTS After 3 months, the median HbA1c reduction overall was 1.4 percentage points (IQR: 0.5-3.3, p < 0.01). Latinos having pre-intervention HbA1c > 10.0% had a greater reduction in median HbA1c (3.8, IQR: 0.5-5.3) compared with those having pre-intervention HbA1c ≤ 10.0% (0.9, IQR: 0.1-1.9, p < 0.05). This reduction in median HbA1c persisted after 6 months (1.3, IQR: 0.2-2.9, p < 0.01). CONCLUSION A Spanish-language text messaging program was an effective way to improve glycemic control for Latinos with type 2 diabetes. POLICY IMPLICATIONS Culturally and linguistically tailored text messaging programs for managing diabetes should be considered.
Collapse
Affiliation(s)
- Laura V Jackson
- Kaiser Permanente South Sacramento Medical Center, 6600 Bruceville Road, Sacramento, CA, 95823, USA.
| | - Diane M Carpenter
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Debbie A Postlethwaite
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Lorena C Castro
- Kaiser Permanente South Sacramento Medical Center, 6600 Bruceville Road, Sacramento, CA, 95823, USA
| | - Eileen Kim
- Kaiser Permanente Oakland Medical Center, 3701 Broadway, Oakland, CA, 94612, USA
| | - Ralph A Herrera
- Kaiser Permanente South Sacramento Medical Center, 6600 Bruceville Road, Sacramento, CA, 95823, USA
| |
Collapse
|
|
45
|
Power T, Kelly R, Usher K, East L, Travaglia J, Robertson H, Wong A, Jackson D. Living with diabetes and disadvantage: A qualitative, geographical case study. J Clin Nurs 2020; 29:2710-2722. [PMID: 32298498 DOI: 10.1111/jocn.15295] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 02/22/2020] [Accepted: 04/07/2020] [Indexed: 12/29/2022]
Abstract
AIMS AND OBJECTIVES To elucidate the experiences of people living with diabetes, residing in an urban diabetogenic area. BACKGROUND Community-level social and environmental factors have a role to play in the development of type 2 diabetes mellitus. Socio-economic deprivation; high obesity rates; high access to fast foods; and multiculturalism contribute to higher rates of diabetes in some geographical areas. However, there is a lack of research examining people's experiences of living with diabetes in diabetogenic areas. The word diabetogenic implies that the phenomenon of interest contributes to the development of diabetes. DESIGN Qualitative, geographical case study approach. METHODS A convenience sample of 17 people living with diabetes in a diabetogenic, low-socio-economic urban area participated in face-to-face, semi-structured interviews. Interviews were audio-recorded, transcribed and analysed thematically. This paper adheres to the COREQ guidelines. FINDINGS Four main themes were identified: 1. Diabetes fatalism: Inevitability and inertia; 2. Living with Inequity: Literacy and intersectionality; 3. Impersonal services: Intimidating and overwhelming; and, 4. Education in the community: Access and anecdotes. CONCLUSIONS This study has highlighted the need to develop local solutions for local problems. In this geographical area, solutions need to address generally lower health literacy, how the community would prefer to receive diabetes education and the issue of diabetes fatalism. RELEVANCE TO CLINICAL PRACTICE Findings from this study have highlighted a need to re-examine how diabetes education is delivered in communities that are already experiencing multiple disadvantages. There are research and practice connotations for how fatalism is positioned for people at high risk of developing diabetes.
Collapse
Affiliation(s)
- Tamara Power
- Faculty of Health, University of Technology Sydney (UTS), Broadway, NSW, Australia
| | - Ray Kelly
- Faculty of Health, University of Technology Sydney (UTS), Broadway, NSW, Australia
| | - Kim Usher
- School of Health, University of New England, Armidale, NSW, Australia
| | - Leah East
- School of Health, University of New England, Armidale, NSW, Australia
| | - Jo Travaglia
- Faculty of Health, University of Technology Sydney (UTS), Broadway, NSW, Australia
| | - Hamish Robertson
- Faculty of Health, University of Technology Sydney (UTS), Broadway, NSW, Australia
| | - Ann Wong
- Faculty of Health, University of Technology Sydney (UTS), Broadway, NSW, Australia
| | - Debra Jackson
- Faculty of Health, University of Technology Sydney (UTS), Broadway, NSW, Australia
| |
Collapse
|
|
46
|
Findlay-White F, Slevin M, Carey ME, Coates V. "What's the Point?": Understanding Why People With Type 2 Diabetes Decline Structured Education. Clin Diabetes 2020; 38:166-175. [PMID: 32327889 PMCID: PMC7164994 DOI: 10.2337/cd19-0030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Structured diabetes education (SDE) is an evidence-based intervention that supports self-management in people with type 2 diabetes. In the United Kingdom, health care providers working in primary care settings are responsible for referring people with type 2 diabetes to SDE programs. However, national audits record a high percentage of nonattenders. We explored the personal experience of living with type 2 diabetes that led to individuals declining invitations to attend SDE programs. The themes suggested that emotional, cognitive, and social issues related to diagnosis and living with diabetes may be responsible for declining to attend SDE and that these factors may be masked by explanations of practical barriers. A person-centered approach to understanding the personal meaning of being diagnosed and living with type 2 diabetes may help to identify individuals' psychosocial barriers to attending SDE.
Collapse
Affiliation(s)
| | - Mary Slevin
- Institute of Nursing and Health Research, Ulster University, Coleraine, UK
| | - Marian E. Carey
- Leicester Diabetes Centre (Air Wing), Leicester General Hospital, Leicester, UK
| | - Vivien Coates
- Institute of Nursing and Health Research, Ulster University, Magee Campus, Londonderry, UK
- Western Health and Social Care Trust, Londonderry, UK
| |
Collapse
|
|
47
|
Chen SM, Lin HS, Atherton JJ, MacIsaac RJ, Wu CJJ. Effect of a mindfulness programme for long-term care residents with type 2 diabetes: A cluster randomised controlled trial measuring outcomes of glycaemic control, relocation stress and depression. Int J Older People Nurs 2020; 15:e12312. [PMID: 32103635 DOI: 10.1111/opn.12312] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 01/09/2020] [Accepted: 01/18/2020] [Indexed: 12/12/2022]
Abstract
AIMS The aim of this study was to determine physical, behavioural and psychosocial effects of a newly developed mindfulness programme for older adults with type 2 diabetes relocating to long-term care facility. BACKGROUND Taiwan is viewed as an "aged society" with significant proportion of the population living in a long-term care facility. Approximately one third of residents living in long-term care facilities have been diagnosed with type 2 diabetes, and disruption to management of their glycaemic levels is at risk for up to one year after relocating to a long-term care facility. DESIGN A cluster randomised controlled trial was used to examine the effects of a newly developed mindfulness programme on outcomes of glycaemic levels, relocation stress and depression. METHODS A total of 140 participants were recruited from six long-term care facilities in Southern Taiwan. A mindfulness programme was delivered over 9 weeks and consisted of meditations, education and exercise techniques that were delivered by a Registered Nurse trained in mindfulness strategies. Participants in the control group received routine care as provided in the facilities, including routine check-ups at diabetes clinics as necessary. Data were analysed by Johnson-Neyman technique and generalised estimating equations. RESULTS In total, 120 residents completed the study. The majority of patients were female (64.8%), and 83.5% of the sample were financially supported by their children. The results showed significant improvements in glycated haemoglobin (HbA1c), relocation stress (Wald χ2 = 78.91) and depression (Wald χ2 = 45.70) between groups. In the intervention group, the mean of HbA1c levels showed 16.4% reduction (Mean differences = 1.3; SD = 0.3). However, there were no significant differences in relocation stress and depression within groups. CONCLUSION The results provided positive effects of the mindfulness programme for older people with diabetes moving into long-term care facilities. The programme will assist in future planning for diabetes care in long-term care facilities. IMPLICATIONS FOR PRACTICE To incorporate the mindfulness program into existing diabetes education programs for older people living in LTCFs. Further investigation on the sustainability of the mindfulness program is warranted.
Collapse
Affiliation(s)
- Shu-Ming Chen
- Department of Nursing, School of Nursing, Fooyin University, Kaohsiung, Taiwan
| | - Huey-Shyan Lin
- Department of Health-Business Administration, Fooyin University, Kaohsiung, Taiwan
| | - John J Atherton
- Department of Cardiology, Royal Brisbane and Women's Hospital (RBWH), Herston, Qld, Australia.,Queensland University of Technology (QUT), Brisbane, Qld, Australia.,University of the Sunshine Coast (USC), Sippy Downs, Qld, Australia.,University of Queensland (UQ), St Lucia, Qld, Australia
| | - Richard J MacIsaac
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne & University of Melbourne, Fitzroy, Vic, Australia
| | - Chiung-Jung Jo Wu
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast (USC), Sippy Downs, Qld, Australia.,Royal Brisbane and Women's Hospital (RBWH), Herston, Qld, Australia.,Mater Medical Research Institute-University of Queensland (MMRI-UQ), South Brisbane, Qld, Australia
| |
Collapse
|
|
48
|
Guzman SJ. A Behavioral Perspective of Therapeutic Inertia: A Look at the Transition to Insulin Therapy. Diabetes Spectr 2020; 33:38-43. [PMID: 32116452 PMCID: PMC7026761 DOI: 10.2337/ds19-0024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
From a behavioral perspective, therapeutic inertia can happen when obstacles to changing a diabetes treatment plan outweigh perceived benefits. There is a complex interaction of important treatment-related obstacles for people with diabetes (PWD), their treating health care professional (HCP), and the clinical setting in which they interact. Tipping the scales toward more effective action involve strategies that increase perceptions of the benefits of treatment intensification while addressing important obstacles so that treatment changes are seen by both PWD and HCPs as worthwhile and achievable.
Collapse
|
|
49
|
Crook ED, Pierre K, Arrieta MA. Identifying and Overcoming Roadblocks that Limit the Translation of Research Findings to the Achievement of Health Equity. J Health Care Poor Underserved 2019; 30:43-51. [PMID: 31735717 DOI: 10.1353/hpu.2019.0114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Almost two decades ago, the Institute of Medicine's Clinical Research Roundtable commented on the major challenges of moving health related basic science discovery to the clinical setting. The roadblocks identified included challenges in evaluating a discovery's application to human disease, and, if justified, getting that application out to the general population. The obstacles to achieving this translation of discovery to improvements in human health remain today and are most evident in populations at highest risk for inequitably poor health. We address four potential roadblocks which, if solved, will have a great impact on achieving health equity. They are expanding the definition of basic discovery to include all facets of health disparities science, understanding the daily factors that affect a community's well-being, including diverse populations in clinical trials, and training the right scientists to perform the community-engaged research required to move discovery to application in the community.
Collapse
|
|
50
|
Li CI, Liu CS, Lin CH, Lin WY, Lee YD, Yang SY, Li TC, Lin CC. Competing risk analysis on visit-to-visit glucose variations and risk of depression: The Taiwan Diabetes Study. DIABETES & METABOLISM 2019; 46:223-229. [PMID: 31472230 DOI: 10.1016/j.diabet.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/09/2019] [Accepted: 08/20/2019] [Indexed: 10/26/2022]
Abstract
AIM Patients with diabetes have higher rates of depression than does the general population, but diabetes management mainly aims to maintain glucose stability. For this reason, our study assessed the relationship between 1-year variations in fasting plasma glucose (FPG) and risk of depression in Chinese patients with type 2 diabetes (T2D). METHODS This retrospective cohort study was conducted on 32,829 patients aged ≥30 years who were diagnosed with T2D and who participated in the National Diabetes Case Management Program in Taiwan. Their 1-year FPG variation as a predictor was determined by coefficient of variation (CV), whereas depressive events were analyzed by Cox's proportional hazards models. RESULTS During a mean 8.23 years of follow-up, 1041 new cases of depression were diagnosed. When patients were grouped based on quartiles of FPG-CV, incidence rates were 3.23, 3.49, 3.96 and 4.80 per 1000 person-years in the first, second, third and fourth quartile subgroups, respectively. After adjusting for traditional risk factors, baseline fasting glucose and HbA1c levels, and diabetes complications, FPG-CV was independently linked with incident depression. Hazard ratios of depression for FPG-CV in the fourth vs first quartile subgroups was 1.33 (95% CI: 1.11-1.59), respectively. CONCLUSION Patients whose 1-year FPG variations were>42.6% had an increased risk of depression, thus suggesting that FPG variations may be a predictor of depression in patients with T2D. Also, glucose variation during outpatient visits may be an indicator for individualized diabetes management in clinical practice.
Collapse
Affiliation(s)
- C-I Li
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - C-S Liu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - C-H Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - W-Y Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Y-D Lee
- Department of Psychiatry, Medical College, National Cheng-Kung University, Tainan, Taiwan
| | - S-Y Yang
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - T-C Li
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
| | - C-C Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
| |
Collapse
|