Validation of the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Diabetes Mellitus in patients with diabetic nephropathy

Methodological considerations in cross-sectional studies validating the International Classification of Functioning, Disability and Health (ICF) Core-Sets: a systematic review

PURPOSE

To describe and analyze the methodological characteristics and quality of cross-sectional studies that have validated an ICF-CS.

MATERIALS AND METHODS

A systematic review was conducted to identify empirical studies published in English that validated any ICF-CS using a cross-sectional design. Databases searched included Web of Science, Scopus, CINAHL, PubMed, Embase, and PsycINFO. The search was conducted in November 2022 with an update in October 2023. Two independent reviewers coded studies that met the inclusion criteria and assessed their methodological quality and risk of bias using the AXIS tool. Synthesis was performed by calculating frequencies and percentages.

RESULTS

87 articles validating 24 ICF-CSs were analyzed. Most articles showed strengths in consistency between study objectives and the outcome variables measured. However, a large majority did not report sample size calculation (up to 94.2% in Delphi studies), and few validation studies were conducted in the WHO regions of Africa and the Eastern Mediterranean.

CONCLUSIONS

The quality of cross-sectional studies validating ICF-CSs was satisfactory, although several articles did not describe aspects such as sample size calculation. Validity evidence for ICF-CS studies could be improved by conducting more multicenter studies, replicating ICF-CS validation studies in different WHO regions, and through synthesis of existing research.

Depressive symptoms and daily living dependence in older adults with type 2 diabetes mellitus: the mediating role of positive and negative perceived stress

BACKGROUND

Higher stress is associated with higher levels of depression and instrumental-activities-of-daily-living (IADL) dependence, and depression is strongly associated with specific IADL disabilities. Accordingly, the aim of this study was to investigate the mediating effect of perceived stress on the association between depression and IADL dependence among older adults with diabetes mellitus (DM).

METHODS

We examined baseline data collected from a longitudinal study that recruited 110 patients with DM aged ≥ 65 years from the endocrinology outpatient clinic of a district hospital. The instruments used for our measurement processes comprised a demographic data sheet and Chinese versions of the Perceived Stress Scale (PSS), the short form of the Geriatric Depression Scale (GDS-S), and the Lawton IADL Scale. We assessed the mediating effects of positive perceived stress (PPS) and negative perceived stress (NPS) after controlling for five covariates by using a regression-based model run through the SPSS macro PROCESS.

RESULTS

We observed negative correlations between GDS-S scores and PPS and between PPS and IADL dependence; we noted positive correlations between GDS-S scores and NPS and between NPS and IADL dependence (all P < 0.01). The indirect effect is coefficient = 0.12, [95% confidence interval = (0.0, 0.33)], suggesting that PPS achieves a mediating effect between depressive symptoms and IADL dependence. However, the NPS does not achieve a mediating effect in the relationship between depressive symptoms and IADL dependence (coefficient = 0.06, 95% CI = - 0.03, 0.15).

CONCLUSIONS

Personal PPS mediates the association between depression and IADL dependence in older adults with DM. This finding suggests that providing patients with psychological education to promote their PPS may help prevent their functional decline.

Relation of environmental factors with activity limitations and participation restrictions in older adults with diabetes mellitus over time: an international classification of functioning framework perspective

BACKGROUND

Activity limitations and participation restrictions were observed in patients with diabetes, which may impact their quality of life. Environmental factors such as seasonal effects, resources and perceived stress may play important role in activity limitations and participation restrictions. In this study, a variant of International Classification of Functioning (ICF) model was used to clarify the associations of function/structure factors, personal factors and environmental factors with activity limitations and participation restrictions.

METHODS

This was a longitudinal design with 1 year follow-up. The Mini-Mental State Examination (MMSE), Geriatric Depression Scale- short form, Perceived Stress Scale, and Instrumental Activities of Daily Living assessments were measured at 3-month intervals for long-term follow-up in 110 patients with diabetes aged ≥ 65 years.

RESULTS

Hierarchical linear regression models revealed that age (p = 0.001), perceived health status, MMSE scores (p < 0.01), and positive perceived stress (p < 0.001) were predictors of activity limitations (adjusted R2 = 53%). GDS-S (p < 0.05) and positive perceived stress (p < 0.01) were predictors of participation restrictions (adjusted R2 = 30%). Generalized estimating equation analysis indicated that seasonal effects, age, perceived health status, MMSE predicted the changes of slopes in activity limitations. Seasonal effects and GDS-S were predictors of the changes of slopes for participation restrictions (all p < 0.001).

CONCLUSIONS

The ICF can be used to identify the risk factors for activity limitations and participation restrictions in older adults with diabetes. Practitioners should provide individualized interventions with consideration of these risk factors.

Effect of edaravone in diabetes mellitus-induced nephropathy in rats

Edaravone, a synthetic-free radical scavenger, has been reported to reduce ischemia-reperfusion-induced renal injury by improving tubular cell function, and lowering serum creatinine and renal vascular resistance. The present study investigated the effect of edaravone in diabetes mellitus-induced nephropathy in rats. A single administration of streptozotocin (STZ, 55 mg/kg, i.p.) was employed to induce diabetes mellitus in rats. The STZ-administered diabetic rats were allowed for 10 weeks to develop nephropathy. Mean body weight, lipid alteration, renal functional and histopathology were analysed. Diabetic rats developed nephropathy as evidenced by a significant increase in serum creatinine and urea, and marked renal histopathological abnormalities like glomerulosclerosis and tubular cell degeneration. The kidney weight to body weight ratio was increased. Moreover, diabetic rats showed lipid alteration as evidenced by a signifi cant increase in serum triglycerides and decrease in serum high-density lipoproteins. Edaravone (10 mg/kg, i.p., last 4-weeks) treatment markedly prevented the development of nephropathy in diabetic rats by reducing serum creatinine and urea and preventing renal structural abnormalities. In addition, its treatment, without significantly altering the elevated glucose level in diabetic rats, prevented diabetes mellitus-induced lipid alteration by reducing serum triglycerides and increasing serum high-density lipoproteins. Interestingly, the renoprotective effect of edaravone was comparable to that of lisinopril (5 mg/kg, p.o, 4 weeks, standard drug). Edaravone prevented renal structural and functional abnormalities and lipid alteration associated with experimental diabetes mellitus. Edaravone has a potential to prevent nephropathy without showing an anti-diabetic action, implicating its direct renoprotection in diabetic rats.

Gender differences in the perception of difficulty of self-management in patients with diabetes mellitus: a mixed-methods approach

Aim

The aim of this study was to examine the challenges of self-management of diabetes comparing gender.

Methods

Sixty-four women and 129 men (mean age 63 vs. 60 years) with diabetes mellitus (DM) were interviewed using 12 categories (classification codes b1300, d240, d570, d620, d845, d920, e410 + e414, e420, e425, e465, e560) related to self-care management selected from 99 categories of the International Classification of Functioning, Disability and Health (ICF) Core Set for DM. In a mixed-methods analysis, interviews were analyzed according to the Grounded Theory approach, and gender effects on ICF categories related to self-care management were investigated using logistic models.

Results

In quantitative data, compared with men, women tended to experience greater difficulty obtaining foods/ingredients for well-balanced meals to maintain appropriate glucose level (P = 0.004); handling stress and other psychological demands around diabetes treatment (P = 0.034); and social norms, practices, and ideologies that defined an experience of unpleasant treatment after disclosure of DM diagnosis to close family and friends (P = 0.023). Qualitative data shows that women perceived prejudice against people with DM from close family, friends, and neighbors. In contrast, men reported excessive media information on diabetes treatment, which induced prejudice by family members and at the workplace.

Conclusions

Women were more likely to be sensitive to attention from close family and friends, whereas men were more likely to be occupied by work and daily living concerns. Health professionals should pay attention to such gender differences in a patient-professional relationship.