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Ehrmann D, Schmitt A, Reimer A, Haak T, Kulzer B, Hermanns N. The affective and somatic side of depression: subtypes of depressive symptoms show diametrically opposed associations with glycemic control in people with type 1 diabetes. Acta Diabetol 2017; 54:749-756. [PMID: 28555338 DOI: 10.1007/s00592-017-1006-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/19/2017] [Indexed: 01/26/2023]
Abstract
AIMS While depression has been linked to serious adverse outcomes in diabetes, associations with glycemic control are not conclusive. Inconsistencies could be due to the complex symptomatology of depression. Aim of this study was to analyze the associations of depressive subtypes with glycemic control in people with type 1 and type 2 diabetes. METHODS Patients completed the Center for Epidemiological Studies-Depression scale which comprises affective, somatic, and anhedonic symptoms. These subtypes were analyzed in a joint linear regression analysis with glycemic control as a dependent variable. Subtype scores were calculated as mean item scores. Separate analyses for people with type 1 and type 2 diabetes were conducted. All analyses were controlled for demographic and medical confounders. RESULTS The sample comprised 604 patients with type 1 and 382 patients with type 2 diabetes. In people with type 1 diabetes, the somatic and affective subtype showed diametrically opposed associations with glycemic control (somatic: β =+0.23, p < .05; affective: β = -0.23, p < .05). Anhedonia was not significantly associated with glycemic control. In people with type 2 diabetes, none of the depressive subtypes was significantly associated with glycemic control. CONCLUSIONS For people with type 1 diabetes, the distinction of subtypes offered a detailed picture of the associations of depressive symptoms with glycemic control. However, due to the cross-sectional design, inferences about the direction of these associations cannot be made. In clinical practice, instead of focusing on overall depression, healthcare providers should examine the nature of depressive symptoms and how they might be related to having diabetes.
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Affiliation(s)
- Dominic Ehrmann
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980, Bad Mergentheim, Germany.
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany.
| | - Andreas Schmitt
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980, Bad Mergentheim, Germany
- Diabetes Clinic Mergentheim, Theodor-Klotzbuecher-Str. 12, 97980, Bad Mergentheim, Germany
| | - André Reimer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980, Bad Mergentheim, Germany
- Diabetes Clinic Mergentheim, Theodor-Klotzbuecher-Str. 12, 97980, Bad Mergentheim, Germany
| | - Thomas Haak
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980, Bad Mergentheim, Germany
- Diabetes Clinic Mergentheim, Theodor-Klotzbuecher-Str. 12, 97980, Bad Mergentheim, Germany
| | - Bernhard Kulzer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980, Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany
- Diabetes Clinic Mergentheim, Theodor-Klotzbuecher-Str. 12, 97980, Bad Mergentheim, Germany
| | - Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980, Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany
- Diabetes Clinic Mergentheim, Theodor-Klotzbuecher-Str. 12, 97980, Bad Mergentheim, Germany
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Reimer A, Schmitt A, Ehrmann D, Kulzer B, Hermanns N. Reduction of diabetes-related distress predicts improved depressive symptoms: A secondary analysis of the DIAMOS study. PLoS One 2017; 12:e0181218. [PMID: 28700718 PMCID: PMC5507326 DOI: 10.1371/journal.pone.0181218] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/27/2017] [Indexed: 11/25/2022] Open
Abstract
Objective Depressive symptoms in people with diabetes are associated with increased risk of adverse outcomes. Although successful psychosocial treatment options are available, little is known about factors that facilitate treatment response for depression in diabetes. This prospective study aims to examine the impact of known risk factors on improvement of depressive symptoms with a special interest in the role of diabetes-related distress. Methods 181 people with diabetes participated in a randomized controlled trial. Diabetes-related distress was assessed using the Problem Areas In Diabetes (PAID) scale; depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Multiple logistic and linear regression analyses were used to assess associations between risk factors for depression (independent variables) and improvement of depressive symptoms (dependent variable). Reliable change indices were established as criteria of meaningful reductions in diabetes distress and depressive symptoms. Results A reliable reduction of diabetes-related distress (15.43 points in the PAID) was significantly associated with fourfold increased odds for reliable improvement of depressive symptoms (OR = 4.25, 95% CI: 2.05–8.79; P<0.001). This result was corroborated using continuous measures of diabetes distress and depressive symptoms, showing that greater reduction of diabetes-related distress independently predicted greater improvement in depressive symptoms (ß = -0.40; P<0.001). Higher age had a positive (Odds Ratio = 2.04, 95% CI: 1.21–3.43; P<0.01) and type 2 diabetes had a negative effect on the meaningful reduction of depressive symptoms (Odds Ratio = 0.12, 95% CI: 0.04–0.35; P<0.001). Conclusions The reduction of diabetes distress is a statistical predictor of improvement of depressive symptoms. Diabetes patients with comorbid depressive symptomatology might benefit from treatments to reduce diabetes-related distress.
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Affiliation(s)
- André Reimer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Diabetes Center Mergentheim (DZM), Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- * E-mail:
| | - Andreas Schmitt
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Diabetes Center Mergentheim (DZM), Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Dominic Ehrmann
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Diabetes Center Mergentheim (DZM), Bad Mergentheim, Germany
- Otto-Friedrich-University of Bamberg, Department for Psychology, Bamberg, Germany
| | - Bernhard Kulzer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Diabetes Center Mergentheim (DZM), Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Otto-Friedrich-University of Bamberg, Department for Psychology, Bamberg, Germany
| | - Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Diabetes Center Mergentheim (DZM), Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Otto-Friedrich-University of Bamberg, Department for Psychology, Bamberg, Germany
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53
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Schmitt A, Reimer A, Kulzer B, Icks A, Paust R, Rölver KM, Kaltheuner M, Ehrmann D, Schipfer M, Hermanns N, Haak T. Suboptimale Diabetesakzeptanz ist mit einer schlechteren Diabetes-Selbstbehandlung und darüber mit einer schlechteren glykämischen Kontrolle assoziiert: Eine Mediationsanalyse. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- A Schmitt
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
| | - A Reimer
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
| | - B Kulzer
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
| | - A Icks
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherberg, Germany
| | - R Paust
- Institut für Psychosoziale Medizin, Elisabeth-Krankenhaus Essen, Essen, Germany
| | - KM Rölver
- Diabetes-Zentrum Quakenbrück, Christliches Krankenhaus Quakenbrück, Quakenbrück, Germany
| | - M Kaltheuner
- Gemeinschaftspraxis für Innere Medizin, Diabetologie und Allgemeinmedizin, Leverkusen, Germany
| | - D Ehrmann
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
| | - M Schipfer
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
| | - N Hermanns
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
| | - T Haak
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
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Schmitt A, Reimer A, Hermanns N, Ehrmann D, Schipfer M, Haak T, Kulzer B. Prävalenzen und Prädiktoren klinisch relevanter diabetesbezogener Belastung bei Patienten mit Typ-1- und Typ-2-Diabetes in der tertiären Versorgung: Ergebnisse der ECCE HOMO-Studie. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- A Schmitt
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
| | - A Reimer
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
| | - N Hermanns
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
| | - D Ehrmann
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
| | - M Schipfer
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
| | - T Haak
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
| | - B Kulzer
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
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Ehrmann D, Kulzer B, Schipfer M, Lippmann-Grob B, Haak T, Hermanns N. Unterschiede zwischen Patienten mit einer Insulinpumpe und Patienten mit intensivierter Insulintherapie. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- D Ehrmann
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - B Kulzer
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - M Schipfer
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Bad Mergentheim, Germany
| | | | - T Haak
- Diabetes Zentrum Mergentheim, Bad Mergentheim, Germany
| | - N Hermanns
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Bad Mergentheim, Germany
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56
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Reimer A, Schmitt A, Ehrmann D, Kulzer B, Haak T, Hermanns N. Depressivität und diabetesbezogene Belastungen bei Behandlung mit Antidepressiva: Screening-Ergebnisse der DDCT-Studie. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- A Reimer
- Forschungsinstitut der Diabetes-Akademie Mergentheim, Bad Mergentheim, Germany
| | - A Schmitt
- Forschungsinstitut der Diabetes-Akademie Mergentheim, Bad Mergentheim, Germany
| | - D Ehrmann
- Forschungsinstitut der Diabetes-Akademie Mergentheim, Bad Mergentheim, Germany
| | - B Kulzer
- Forschungsinstitut der Diabetes-Akademie Mergentheim, Bad Mergentheim, Germany
| | - T Haak
- Diabetes Zentrum Mergentheim, Bad Mergentheim, Germany
| | - N Hermanns
- Forschungsinstitut der Diabetes-Akademie Mergentheim, Bad Mergentheim, Germany
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Schmitt A, Reimer A, Hermanns N, Ehrmann D, Haak T, Kulzer B. Depression and Diabetes Control Trial (DCCT): Baseline-Ergebnisse einer randomisiert-kontrollierten Studie zur Behandlung von Diabetespatienten mit erhöhten affektiven Symptomen und suboptimaler glykämischer Kontrolle. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- A Schmitt
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
| | - A Reimer
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
| | - N Hermanns
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
| | - D Ehrmann
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
| | - T Haak
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
| | - B Kulzer
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
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Kulzer B, Ehrmann D, Schipfer M, Hermanns N, Haak T. Wie effektiv ist die strukturierte Diabetesschulung bei Menschen mit Typ-1-Diabetes und Insulinpumpentherapie (CSII)? DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- B Kulzer
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - D Ehrmann
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - M Schipfer
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - N Hermanns
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - T Haak
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Bad Mergentheim, Germany
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Hermanns N, Ehrmann D, Schipfer M, Kulzer B, Haak T. Wie häufig nutzen Patienten mit einer Insulinpumpentherapie (CSII) die Features ihrer Insulinpumpe? DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- N Hermanns
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - D Ehrmann
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - M Schipfer
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - B Kulzer
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - T Haak
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Bad Mergentheim, Germany
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Hermanns N, Ehrmann D, Schipfer M, Kulzer B, Haak T. Wie misst man Erfahrungen und Einstellungen zur Insulinpumpentherapie: Eine psychometrische Analyse des Fragebogens zu Erfahrungen und Einstellungen zur CSII-Therapie (CSII-EE). DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- N Hermanns
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - D Ehrmann
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - M Schipfer
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - B Kulzer
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - T Haak
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Bad Mergentheim, Germany
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Hermanns N, Freckmann G, Ehrmann D, Faber-Heinemann G, Heinemann L. Kann man durch CGM-Profile Menschen mit Typ 1-Diabetes und einem hohen Risiko für schwere Hypoglykämien identifizieren? Erste Ergebnisse der Baseline-Erhebung der bundesweiten HypoDE-Studie. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- N Hermanns
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - G Freckmann
- Institut für Diabetes-Technologie Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - D Ehrmann
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Bad Mergentheim, Germany
| | | | - L Heinemann
- Science-Consulting in Diabetes GmbH, Düsseldorf, Germany
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Schmitt A, Reimer A, Kulzer B, Baumeister H, Ehrmann D, Schipfer M, Haak T, Hermanns N. Erfassung von Angst vor diabetischen Folgekrankheiten: Reliabilität und Validität der deutschen Version des Fear of Complications Questionnaire (FCQ). DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- A Schmitt
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
| | - A Reimer
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
| | - B Kulzer
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
| | - H Baumeister
- Abteilung für Klinische Psychologie und Psychotherapie, Universität Ulm, Ulm, Germany
| | - D Ehrmann
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
| | - M Schipfer
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
| | - T Haak
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
| | - N Hermanns
- Forschungsinstitut der Diabetes-Akademie Bad Mergentheim (FIDAM), Diabetes Zentrum Mergentheim (DZM), Bad Mergentheim, Germany
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Schmitt A, Reimer A, Hermanns N, Kulzer B, Ehrmann D, Krichbaum M, Huber J, Haak T. Depression is linked to hyperglycaemia via suboptimal diabetes self-management: A cross-sectional mediation analysis. J Psychosom Res 2017; 94:17-23. [PMID: 28183398 DOI: 10.1016/j.jpsychores.2016.12.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/22/2016] [Accepted: 12/27/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To analyse if the association between depressive symptoms and hyperglycaemia is mediated by diabetes self-management. METHODS 430 people with diabetes (57.7% type 1, 42.3% type 2) were cross-sectionally assessed using validated self-report scales for depressive symptoms (Center for Epidemiologic Studies Depression Scale (CES-D)) and diabetes self-management (Diabetes Self-Management Questionnaire (DSMQ)); HbA1c was analysed simultaneously in a central laboratory. Structural equation modelling was used to test if the association between depressive symptoms and hyperglycaemia (HbA1c) was mediated by suboptimal self-management in people with type 1 and type 2 diabetes. RESULTS The hypothesised model of depressive symptoms, diabetes self-management and hyperglycaemia fit the data well for both diabetes types (SRMR≤0.04, TLI≥0.99, CFI>0.99, RMSEA≤0.02 for both models). In both the type 1 and type 2 diabetes group, higher depressive symptoms were associated with lower self-management (P<0.001) and lower self-management was associated with higher HbA1c (P<0.001). Results indicated that the association between depressive symptoms and hyperglycaemia was significantly mediated by suboptimal diabetes self-management in both type 1 and type 2 diabetes patients (P<0.001). Significant direct associations between depressive symptoms and hyperglycaemia, not mediated by self-management, could not be observed. CONCLUSIONS This study provides good evidence supporting that depression is linked to hyperglycaemia via suboptimal diabetes self-management in both major diabetes types.
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Affiliation(s)
- Andreas Schmitt
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Diabetes Center Mergentheim (DZM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany; German Center for Diabetes Research (DZD), 85764 München-Neuherberg, Germany.
| | - André Reimer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Diabetes Center Mergentheim (DZM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany; German Center for Diabetes Research (DZD), 85764 München-Neuherberg, Germany.
| | - Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Diabetes Center Mergentheim (DZM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany; German Center for Diabetes Research (DZD), 85764 München-Neuherberg, Germany; Otto-Friedrich-University of Bamberg, Department for Psychology, Markusplatz 3, 96047 Bamberg, Germany.
| | - Bernhard Kulzer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Diabetes Center Mergentheim (DZM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany; German Center for Diabetes Research (DZD), 85764 München-Neuherberg, Germany; Otto-Friedrich-University of Bamberg, Department for Psychology, Markusplatz 3, 96047 Bamberg, Germany.
| | - Dominic Ehrmann
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Diabetes Center Mergentheim (DZM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany.
| | - Michael Krichbaum
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Diabetes Center Mergentheim (DZM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany.
| | - Jorg Huber
- Centre for Health Research, University of Brighton, Falmer, BN1 9PH, United Kingdom.
| | - Thomas Haak
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Diabetes Center Mergentheim (DZM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany.
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Abstract
This analytical comment discusses what standards are needed for the evaluation of the accuracy of glucose measurement systems continuously measuring glucose in the interstitial fluid. Since accuracy standards for continuous glucose monitoring (CGM)/flash glucose monitoring (FGM) systems are currently based on modeling studies or consensus of experts, we raised the question whether non-inferiority trials evaluating the safety and efficacy of CGM/FGM measurements compared to capillary blood glucose measurement with point-of-care devices could help to establish clarity about the needed accuracy standards of CGM/FGM. Such trials could also support the replacement of capillary blood glucose measurements by modern CGM/FGM systems.
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Affiliation(s)
- Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Diabetes Center Mergentheim, Bad Mergentheim, Germany
- Institute of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | - Dominic Ehrmann
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Institute of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | - Bernhard Kulzer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Diabetes Center Mergentheim, Bad Mergentheim, Germany
- Institute of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
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Schmitt A, Reimer A, Kulzer B, Haak T, Ehrmann D, Hermanns N. How to assess diabetes distress: comparison of the Problem Areas in Diabetes Scale (PAID) and the Diabetes Distress Scale (DDS). Diabet Med 2016; 33:835-43. [PMID: 26287511 DOI: 10.1111/dme.12887] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2015] [Indexed: 12/30/2022]
Abstract
AIMS To compare the properties of the two most commonly used assessment tools for diabetes distress, the Problem Areas in Diabetes Scale (PAID) and the Diabetes Distress Scale (DDS), in order to discriminate their psychometric capabilities and functions. METHODS Six hundred and twenty-eight people with diabetes (67% Type 1, 33% Type 2) were cross-sectionally assessed with the PAID, the DDS and further self-report scales regarding coping, quality of life, depressive symptoms and self-care, and medical data were gained. We analysed the PAID and DDS for areas of contentual/psychometric divergence in assessing diabetes distress and compared their associations with criteria of interest. RESULTS Content analysis: The PAID covers a greater variety of emotional concerns and shows a stronger focus on food-related problems and complications. The DDS is more reflective of physician-related distress and problems concerning diabetes self-management. Psychometric analysis: Exploratory factor analyses revealed four-factor structures of both scales, explaining 60% (PAID) and 67% (DDS) of variance. Confirmatory factor analyses confirmed that single-factor and four-factor models fit the data. Total scales proved high and subscales mostly satisfactory reliability. Associations with criteria of interest: The PAID was significantly more strongly associated with dysfunctional coping styles, quality of life and depressive symptoms. The DDS showed significantly stronger associations with diabetes self-care and metabolic outcomes. CONCLUSION Our results support both PAID and DDS as good self-report measures of diabetes distress. The observed contentual/psychometric differences suggest that a justified choice with regard to the intended clinical or scientific purpose can improve the acquisition of the required data.
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Affiliation(s)
- A Schmitt
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - A Reimer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - B Kulzer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - T Haak
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - D Ehrmann
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - N Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
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Schipfer M, Ehrmann D, Haak T, Hermanns N, Kulzer B. Evaluation des Fragebogens zur Erfassung der Zufriedenheit des Glukosemonitorings bei Typ-1-Diabetes (T1-GMSS). DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ehrmann D, Hermanns N, Bergis-Jurgan N, Haak T, Kulzer B. Wer profitiert von strukturierten Schulungs- und Behandlungsprogrammen? DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ehrmann D, Schmitt A, Reimer A, Haak T, Kulzer B, Hermanns N. Zusammenhang von Depression auf die glykämische Kontrolle in Abhängigkeit des Schweregrades der depressiven Symptomatik. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Reimer A, Schmitt A, Ehrmann D, Hermanns N, Haak T, Kulzer B. Erhöhte Depressivität bei Menschen mit Diabetes trotz Antidepressivatherapie: Ergebnisse der Ecce Homo-Studie. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schipfer M, Ehrmann D, Schmitt A, Kulzer B, Haak T, Hermanns N. Evaluation einer deutschen Fassung der Diabetes Distress Scale für Typ-1-Diabetes (T1-DDS). DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Reimer A, Schmitt A, Ehrmann D, Hermanns N, Kulzer B, Haak T. Hohe Diabetesbelastung bei Menschen mit Typ-1-Diabetes vor allem in den ersten Jahren nach Manifestation. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schmitt A, Reimer A, Kulzer B, Icks A, Paust R, Rölver KM, Matthaei S, Kaltheuner M, Ehrmann D, Krichbaum M, Haak T, Hermanns N. Validierung eines Fragebogens zu Problemen der Krankheitsakzeptanz bei Diabetes mellitus: Diabetes Acceptance Scale (DAS). DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schipfer M, Ehrmann D, Hermanns N, Kulzer B, Haak T. Evaluation des Fragebogens zu Unterzuckerungen bei Erwachsenen mit Typ-1-Diabetes (HFS). DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schmitt A, Reimer A, Hermanns N, Kulzer B, Ehrmann D, Krichbaum M, Huber J, Haak T. Die Assoziation zwischen Depressivität und schlechter glykämischer Kontrolle wird durch eine reduzierte Diabetes-Selbstbehandlung vermittelt: Eine Strukturgleichungsanalyse. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schmitt A, Reimer A, Hermanns N, Huber J, Ehrmann D, Schall S, Kulzer B. Assessing Diabetes Self-Management with the Diabetes Self-Management Questionnaire (DSMQ) Can Help Analyse Behavioural Problems Related to Reduced Glycaemic Control. PLoS One 2016; 11:e0150774. [PMID: 26938980 PMCID: PMC4777391 DOI: 10.1371/journal.pone.0150774] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/18/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To appraise the Diabetes Self-Management Questionnaire (DSMQ)'s measurement of diabetes self-management as a statistical predictor of glycaemic control relative to the widely used SDSCA. METHODS 248 patients with type 1 diabetes and 182 patients with type 2 diabetes were cross-sectionally assessed using the two self-report measures of diabetes self-management DSMQ and SDSCA; the scales were used as competing predictors of HbA1c. We developed a structural equation model of self-management as measured by the DSMQ and analysed the amount of variation explained in HbA1c; an analogue model was developed for the SDSCA. RESULTS The structural equation models of self-management and glycaemic control showed very good fit to the data. The DSMQ's measurement of self-management showed associations with HbA1c of -0.53 for type 1 and -0.46 for type 2 diabetes (both P < 0.001), explaining 21% and 28% of variation in glycaemic control, respectively. The SDSCA's measurement showed associations with HbA1c of -0.14 (P = 0.030) for type 1 and -0.31 (P = 0.003) for type 2 diabetes, explaining 2% and 10% of glycaemic variation. Predictive power for glycaemic control was significantly higher for the DSMQ (P < 0.001). CONCLUSIONS This study supports the DSMQ as the preferred tool when analysing self-reported behavioural problems related to reduced glycaemic control. The scale may be useful for clinical assessments of patients with suboptimal diabetes outcomes or research on factors affecting associations between self-management behaviours and glycaemic control.
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Affiliation(s)
- Andreas Schmitt
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), 85764 München-Neuherberg, Germany
| | - André Reimer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), 85764 München-Neuherberg, Germany
| | - Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), 85764 München-Neuherberg, Germany
- Otto-Friedrich-University of Bamberg, Department for Psychology, Markusplatz 3, 96047 Bamberg, Germany
| | - Jörg Huber
- Centre for Health Research, University of Brighton, Falmer, BN1 9PH, United Kingdom
| | - Dominic Ehrmann
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany
| | - Sabine Schall
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany
| | - Bernhard Kulzer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Theodor-Klotzbücher-Str. 12, 97980 Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), 85764 München-Neuherberg, Germany
- Otto-Friedrich-University of Bamberg, Department for Psychology, Markusplatz 3, 96047 Bamberg, Germany
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Abstract
BACKGROUND Carbohydrate estimation and bolus calculation are two important skills for handling intensive insulin therapy and effectively using bolus calculators. Structured assessment of both skills is lacking. A new tool for the assessment of skills in carbohydrate estimation and bolus calculation was developed and evaluated. MATERIALS AND METHODS A new assessment tool (SMART) was developed that included 10 items for bolus calculation and 12 items for carbohydrate estimation. In total, 411 patients on intensive insulin treatment were recruited. Different parameters of glycemic control were used as validity criteria. RESULTS The SMART tool achieved good reliability for the assessment of bolus calculation (Cronbach's α = 0.78) and sufficient reliability for the assessment of carbohydrate estimation (Cronbach's α = 0.67). A good bolus calculation skill was significantly associated with lower glycated hemoglobin values (r = -0.27), lower mean blood glucose levels (r = -0.29), and higher fluctuation of blood glucose control (r = -0.43). A good carbohydrate estimation skill was significantly associated with a lower frequency of severe hyperglycemia (r = -0.27) and a higher frequency of euglycemia (r = 0.26). CONCLUSIONS SMART is a reliable and valid tool for the assessment of both skills. Bolus calculation as well as carbohydrate estimation was associated with glycemic control. With the help of SMART, important skills for the management of intensive insulin therapy can be assessed separately. Thus, in clinical practice patients in need of assistance from a bolus calculator can be identified.
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Affiliation(s)
- Dominic Ehrmann
- 1 Research Institute of the Diabetes Academy Mergentheim , Bad Mergentheim, Germany
- 2 Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg , Germany
| | - Norbert Hermanns
- 1 Research Institute of the Diabetes Academy Mergentheim , Bad Mergentheim, Germany
- 2 Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg , Germany
- 3 Diabetes Clinic Mergentheim , Bad Mergentheim, Germany
| | - André Reimer
- 1 Research Institute of the Diabetes Academy Mergentheim , Bad Mergentheim, Germany
- 3 Diabetes Clinic Mergentheim , Bad Mergentheim, Germany
| | - Jörg Weißmann
- 4 Roche Diabetes Care , Roche Diagnostics Germany, Mannheim, Germany
| | - Thomas Haak
- 1 Research Institute of the Diabetes Academy Mergentheim , Bad Mergentheim, Germany
- 3 Diabetes Clinic Mergentheim , Bad Mergentheim, Germany
| | - Bernhard Kulzer
- 1 Research Institute of the Diabetes Academy Mergentheim , Bad Mergentheim, Germany
- 2 Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg , Germany
- 3 Diabetes Clinic Mergentheim , Bad Mergentheim, Germany
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Affiliation(s)
- Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany; Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany; Diabetes Clinic Mergentheim, Bad Mergentheim, Germany.
| | - Dominic Ehrmann
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany; Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany; Diabetes Clinic Mergentheim, Bad Mergentheim, Germany
| | - Bernhard Kulzer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany; Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany; Diabetes Clinic Mergentheim, Bad Mergentheim, Germany
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Ehrmann D, Bergis-Jurgan N, Haak T, Kulzer B, Hermanns N. Comparison of the Efficacy of a Diabetes Education Programme for Type 1 Diabetes (PRIMAS) in a Randomised Controlled Trial Setting and the Effectiveness in a Routine Care Setting: Results of a Comparative Effectiveness Study. PLoS One 2016; 11:e0147581. [PMID: 26799064 PMCID: PMC4723092 DOI: 10.1371/journal.pone.0147581] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 01/04/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The effectiveness of an intervention in clinical practice is often reduced compared to the efficacy demonstrated in a randomised controlled trial (RCT). In this comparative effectiveness study, the RCT-proven efficacy of a diabetes education programme for type 1 diabetic patients (PRIMAS) was compared to the effectiveness observed in an implementation trial (IT) under routine care conditions. METHODS 75 patients with type 1 diabetes received PRIMAS through an RCT, whereas 179 patients were observed in an implementation trial. Baseline characteristics and treatment outcomes at the 6-month follow-up (improvement of HbA1c, hypoglycaemia problems, and diabetes-related distress) were compared. RESULTS At baseline, the type 1 diabetic patients in the RCT had a significant longer diabetes duration (18.7 ± 12.3 vs. 13.8 ± 12.7 yrs., p = .005), lower self-efficacy scores (21.9 ± 4.7 vs. 23.7 ± 6.1, p = .02) and a greater number of diabetes complications (0.8 ± 1.3 vs. 0.4 ± 0.9, p = .02). After 6 months, PRIMAS achieved comparable effects under RCT and implementation trial conditions, as demonstrated by improvement in HbA1c (-0.36% ± 1.1 vs. -0.37 ± 1.2; Δ -0.01, 95% CI -0.33 to 0.31) and hypoglycaemia unawareness (-0.5 ± 1.4 vs. -0.3 ± 1.4; Δ 0.18, 95% CI -0.21 to 0.57). The likelihood of clinical improvement did not depend on the trial setting (RCT vs. IT: OR 1.18, 95% CI 0.60 to 2.33). The participants with worse glycaemic control (OR 1.40, 95% CI 1.02 to 1.92), hypoglycaemia problems (OR 2.13, 95% CI 1.53 to 2.97) or elevated diabetes distress (OR 1.40, 95% CI 1.03 to 1.89) had a better chance of clinical improvement. CONCLUSIONS The effectiveness of PRIMAS under routine care conditions was comparable to the efficacy demonstrated in the RCT. Clinical improvement was independent of the setting in which PRIMAS was evaluated. The PRIMAS education programme for type 1 diabetes can be delivered under conditions of routine care without a loss of effectiveness, compared to its original evaluation in an RCT.
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Affiliation(s)
- Dominic Ehrmann
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann Hammer-Str. 24, 97980, Bad Mergentheim, Germany
- Otto-Friedrich-University of Bamberg, Department of Clinical Psychology and Psychotherapy, Bamberg, Germany
| | - Nikola Bergis-Jurgan
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann Hammer-Str. 24, 97980, Bad Mergentheim, Germany
| | - Thomas Haak
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann Hammer-Str. 24, 97980, Bad Mergentheim, Germany
- Diabetes Centre Mergentheim, Diabetes Clinic, Theodor-Klotzbuecher-Str. 12, 97980, Bad Mergentheim, Germany
| | - Bernhard Kulzer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann Hammer-Str. 24, 97980, Bad Mergentheim, Germany
- Diabetes Centre Mergentheim, Diabetes Clinic, Theodor-Klotzbuecher-Str. 12, 97980, Bad Mergentheim, Germany
- Otto-Friedrich-University of Bamberg, Department of Clinical Psychology and Psychotherapy, Bamberg, Germany
| | - Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann Hammer-Str. 24, 97980, Bad Mergentheim, Germany
- Diabetes Centre Mergentheim, Diabetes Clinic, Theodor-Klotzbuecher-Str. 12, 97980, Bad Mergentheim, Germany
- Otto-Friedrich-University of Bamberg, Department of Clinical Psychology and Psychotherapy, Bamberg, Germany
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Hermanns N, Schmitt A, Reimer A, Ehrmann D, Haak T, Kulzer B. Response to Comment on Hermanns et al. The Effect of a Diabetes-Specific Cognitive Behavioral Treatment Program (DIAMOS) for Patients With Diabetes and Subclinical Depression: Results of a Randomized Controlled Trial. Diabetes Care 2015;38:551-560. Diabetes Care 2016; 39:e13-4. [PMID: 26696662 DOI: 10.2337/dci15-0017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim, Bad Mergentheim, Germany Diabetes Centre Mergentheim, Bad Mergentheim, Germany Institute of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | - Andreas Schmitt
- Research Institute of the Diabetes Academy Mergentheim, Bad Mergentheim, Germany
| | - Andre Reimer
- Research Institute of the Diabetes Academy Mergentheim, Bad Mergentheim, Germany
| | - Dominic Ehrmann
- Research Institute of the Diabetes Academy Mergentheim, Bad Mergentheim, Germany
| | - Thomas Haak
- Research Institute of the Diabetes Academy Mergentheim, Bad Mergentheim, Germany Diabetes Centre Mergentheim, Bad Mergentheim, Germany
| | - Bernhard Kulzer
- Research Institute of the Diabetes Academy Mergentheim, Bad Mergentheim, Germany Diabetes Centre Mergentheim, Bad Mergentheim, Germany Institute of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
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Abstract
AIM To investigate the longitudinal bi-directionality of diabetes-related distress and depressive symptoms. METHODS A total of 509 patients receiving intensified insulin therapy completed the Centre for Epidemiological Studies Depression scale questionnaire for the assessment of depressive symptoms as well as the Problem Areas in Diabetes questionnaire for the assessment of diabetes-related distress at baseline and at 6-month follow-up. Separate logistic and linear regression analyses for incidence and persistence were performed with demographic (age, gender, BMI) and medical (diabetes type, HbA1c , diabetes duration, late complications) control variables. RESULTS Diabetes-related distress at baseline increased the risk of the incidence of elevated depressive symptoms by 2.56-fold (odds ratio 2.56; 95% CI 1.15-5.72; P = 0.02) when controlling for demographic and medical variables. In addition, diabetes-related distress at baseline doubled the chance of the persistence of elevated depressive symptoms (odds ratio 2.04, 95% CI 1.04-3.99; P = 0.04) when controlling for demographic and medical variables. The chance of having persistent elevated diabetes-related distress was increased 5.94-fold (odds ratio 5.94, 95% CI 2.60-13.59; P < 0.0001) when elevated depressive symptoms were present at baseline. None of the medical variables had an influence on incidence or persistence. CONCLUSIONS Diabetes-related distress was identified as a risk factor for the incidence and persistence of depressive symptoms. Reducing diabetes-related distress could help to prevent the development of elevated depressive symptoms. Furthermore, depressive symptoms were identified as an amplifier for diabetes-related distress. Diabetes-related distress and depressive symptoms were independent risk factors for each other and should be monitored in routine care to disentangle their influence.
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Affiliation(s)
- D Ehrmann
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Diabetes Clinic, Bad Mergentheim, Germany
| | - B Kulzer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Diabetes Clinic, Bad Mergentheim, Germany
- Diabetes Centre Mergentheim, Diabetes Clinic, Bad Mergentheim, Germany
| | - T Haak
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Diabetes Clinic, Bad Mergentheim, Germany
- Diabetes Centre Mergentheim, Diabetes Clinic, Bad Mergentheim, Germany
| | - N Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Diabetes Clinic, Bad Mergentheim, Germany
- Diabetes Centre Mergentheim, Diabetes Clinic, Bad Mergentheim, Germany
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Reimer A, Schmitt A, Ehrmann D, Hermanns N, Kulzer B, Haak T. Geringere Lebensqualität und höhere gesundheitsökonomische Kosten bei Menschen mit Diabetes und erhöhter Depressivität. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Schmitt A, Reimer A, Kulzer B, Ehrmann D, Haak T, Hermanns N. Hohe Prävalenz depressiver Störungen bei Diabetespatienten im tertiären Versorgungssektor. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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83
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Schmitt A, Reimer A, Ehrmann D, Kulzer B, Haak T, Hermanns N. Entwicklung und erste Evaluation eines Fragebogens zur Erfassung von Abwehr/Vermeidung versus Akzeptanz/Integration des Diabetes: „Denial versus Integration of Diabetes Scale (DIDS)“. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Schmitt A, Reimer A, Kulzer B, Haak T, Ehrmann D, Hermanns N. Diabetesspezifische Risikofaktoren depressiver Stimmung in querschnittlichen und prospektiven Analysen. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ehrmann D, Hermanns N, Schmitt A, Haak T, Kulzer B. Subtypen der Depression und deren Assoziation mit glykämischer Kontrolle. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ehrmann D, Spengler M, Jahn M, Siebert H, Niebuhr D, Haak T, Kulzer B, Hermanns N. Wie häufig tragen Risikopatienten Schuhe mit diabetesadaptierter Fußbettung? DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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87
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Kulzer B, Ehrmann D, Bergis N, Haak T, Hermanns N. Differentielle Effekte der strukturierten Gruppenschulung bei Patienten mit einer ICT und CSII. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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88
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Hermanns N, Ehrmann D, Schall S, Kulzer B, Haak T. Entwicklung und Evaluation eines Assessment-Tools zur Erfassung von Barrieren der Blutzuckerselbstkontrolle. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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89
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Ehrmann D, Bergis-Jurgan N, Haak T, Kulzer B, Hermanns N. Erfassung des Umgangs mit den Auswirkungen der Diabeteserkrankung in wichtigen Lebensbereichen. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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90
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Ehrmann D, Hermanns N, Müller A, Weissmann J, Haak T, Kulzer B. Fragebogen zur Zufriedenheit von Ärzten mit der Diabetestherapie. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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91
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Ehrmann D, Hermanns N, Reimer A, Weissmann J, Haak T, Kulzer B. Kohlenhydratschätzung und Boluskalkulation zeigen differenzierte Assoziationen mit verschiedenen Indikatoren der glykämischen Kontrolle. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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92
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Ehrmann D, Siebert H, Spengler N, Jahn M, Niebuhr D, Kulzer B, Haak T, Hermanns N. Diabetesadaptierte Schuhversorgung: Erfassung der Patientenzufriedenheit zur Charakterisierung des patientenrelevanten Nutzens. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1374944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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93
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Bergis-Jurgan N, Ehrmann D, Kulzer B, Hermanns N, Haak T. Die Effektivität eines Schulungs-und Behandlungsprogramms für Typ-1-Diabetiker (PRIMAS) unter Versorgungsbedingungen. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hermanns N, Kulzer B, Ehrmann D, Bergis-Jurgan N, Haak T. The effect of a diabetes education programme (PRIMAS) for people with type 1 diabetes: results of a randomized trial. Diabetes Res Clin Pract 2013; 102:149-57. [PMID: 24210673 DOI: 10.1016/j.diabres.2013.10.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 07/22/2013] [Accepted: 10/02/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE In a randomized, multi-centre trial, the efficacy of a self-management-oriented education programme (PRIMAS) for people with type 1 diabetes was compared with an established education programme as control group (CG). Primary outcome was the effect on glycaemic control in a 6-month follow-up. Secondary outcomes were the impact on emotional aspects, self-management related aspects and hypoglycaemia problems. METHODS The study was conducted in an outpatient setting. 160 participants were randomized. Baseline characteristics in PRIMAS and CG were similar (age 45.1±13.5 vs. 45.9±13.1 years, p=.716; diabetes duration 18.8±12.3 vs. 19.8±13.4 years, p=.615; BMI 26.5±4.6 vs. 27.5±5.0kg/m(2), p=.236; HbA1c 8.3±1.1 vs. 8.1±1.0%, p=.236). RESULTS At follow-up there was a significant 0.4 percentage points greater reduction of HbA1c in PRIMAS compared to CG (Δ -0.4±1.0% vs. Δ 0.0±0.6%; p=.012). Also, diabetes-related distress (Δ -0.3±0.7 vs. -0.1±0.4, p=.032) and dissatisfaction with diabetes treatment (Δ -3.3±6.9 vs. -1.9±5.6, p=.024) decreased more in PRIMAS. Diabetes empowerment (Δ 2.6±5.9 vs. 0.8±5.1, p=.037) and diabetes self-efficacy (Δ 1.4±3.6 vs. 0.2±4.0, p=.013) increased in PRIMAS. Incidence of severe hypoglycemia, hypoglycemia awareness, diabetes knowledge, and self-care behaviour improved in both groups with no significant differences between groups. CONCLUSION PRIMAS is more effective in lowering HbA1c than a previously established education programmes and also showed superiority in reducing diabetes-related distress and increasing diabetes empowerment, diabetes self-efficacy and satisfaction with insulin therapy.
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Affiliation(s)
- Norbert Hermanns
- Research Institute Diabetes Academy Mergentheim (FIDAM), Theodor-Klotzbuecher-Strasse 12, 97980 Bad Mergentheim, Germany; University of Bamberg, Markusplatz 3, 96047 Bamberg, Germany; Diabetes Center Mergentheim, Theodor-Klotzbuecher-Strasse 12, D-97980 Bad Mergentheim, Germany.
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Bergis-Jurgan N, Hermanns N, Kulzer B, Ehrmann D, Haak T. Einfluss der Selbstwirksamkeit auf die glykämische Kontrolle bei Typ-1 und Typ-2-Diabetikern mit einer intensivierten Insulintherapie. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1341794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ehrmann D, Hermanns N, Kulzer B, Bergis-Jurgan N, Haak T. Einfluss von Folgeerkrankungen und Depressivität auf die qualitätsadjustierten Lebensjahre (QALY) von Menschen mit Typ-1-Diabetes. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1341894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hermanns N, Kulzer B, Ehrmann D, Bergis-Jurgan N, Haak T. Effektivität eines neu entwickelten Schulungs- und Behandlungsprogramms (PRIMAS) für Menschen mit Typ-1-Diabetes. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1341696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ehrmann D, Kulzer B, Hermanns N, Hasche S, Silbermann S, Thoma S, Haak T. Hoher Schulungsbedarf bei Typ-2-Diabetes: Ergebnisse einer Erhebung zur Schulungssituation in diabetologischen Schwerpunktpraxen. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1341796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Reimer A, Ehrmann D, Kulzer B, Hermanns N, Weissmann J, Haak T. Psychometrische Validierung eines Assessmenttools zur Einschätzung von Kohlenhydraten und Boluskalkulation für Diabetespatienten mit einer intensivierten Insulintherapie. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1341805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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