1
|
He J, Liu F, Xu P, Xu T, Yu H, Wu B, Wang H, Chen J, Zhang K, Zhang J, Meng K, Yan X, Yang Q, Zhang X, Sun D, Chen X. Aerobic Exercise Improves the Overall Outcome of Type 2 Diabetes Mellitus Among People With Mental Disorders. Depress Anxiety 2024; 2024:6651804. [PMID: 40226688 PMCID: PMC11918971 DOI: 10.1155/da/6651804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 12/09/2024] [Indexed: 04/15/2025] Open
Abstract
The escalating global prevalence of type 2 diabetes mellitus (T2DM) and mental disorder (MD) including schizophrenia, bipolar disorder, major depressive disorder, and anxiety highlights the urgency for comprehensive therapeutic strategies. Aerobic exercise (AE) is a viable adjunct therapy, providing significant benefits for individuals dealing with both T2DM and MD. This review consolidates evidence on AE's role in alleviating the physiological and psychological effects of these comorbid conditions. It delves into the pathophysiological connections between T2DM and various MD, including depression, schizophrenia, anxiety, and bipolar disorder-emphasizing their reciprocal exacerbation. Key neurophysiological mechanisms through which AE confers benefits are explored, including neuroinflammation modulation, brain structure and neuroplasticity enhancement, growth factor expression regulation, and hypothalamic-pituitary-adrenal (HPA)/microbiota-gut-brain (MGB) axis normalization. Clinical results indicate that AE significantly improves both metabolic and psychological parameters in patients with T2DM and MD, providing a substantial argument for integrating AE into comprehensive treatment plans. Future research should aim to establish detailed, personalized exercise prescriptions and explore the long-term benefits of AE in this population. This review underscores the potential of AE to complement existing therapeutic modalities and enhance the management of patients with T2DM and MD.
Collapse
Affiliation(s)
- Jiaxuan He
- Institute of Life Sciences and Biomedical Collaborative Innovation Center of Zhejiang Province, Wenzhou University, Wenzhou 325035, China
| | - Fan Liu
- Institute of Life Sciences and Biomedical Collaborative Innovation Center of Zhejiang Province, Wenzhou University, Wenzhou 325035, China
| | - Peiye Xu
- Institute of Life Sciences and Biomedical Collaborative Innovation Center of Zhejiang Province, Wenzhou University, Wenzhou 325035, China
| | - Ting Xu
- Institute of Life Sciences and Biomedical Collaborative Innovation Center of Zhejiang Province, Wenzhou University, Wenzhou 325035, China
| | - Haiyang Yu
- Institute of Life Sciences and Biomedical Collaborative Innovation Center of Zhejiang Province, Wenzhou University, Wenzhou 325035, China
| | - Baihui Wu
- Institute of Life Sciences and Biomedical Collaborative Innovation Center of Zhejiang Province, Wenzhou University, Wenzhou 325035, China
| | - Hanbing Wang
- Department of Biotechnology, The University of Hong Kong, Hong Kong SAR 999077, China
| | - Jia Chen
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 611100, China
| | - Kun Zhang
- Chongqing Municipality Clinical Research Center for Endocrinology and Metabolic Diseases, Chongqing University Three Gorges Hospital, Chongqing 404000, China
| | - Junbei Zhang
- Department of Endocrinology, Yiwu Central Hospital, The Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu 322000, China
| | - Kaikai Meng
- Department of Endocrinology, Yiwu Central Hospital, The Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu 322000, China
| | - Xiaoqing Yan
- The Chinese-American Research Institute for Diabetic Complications, School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, China
| | - Qinsi Yang
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou 325000, China
| | - Xingxing Zhang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Da Sun
- Institute of Life Sciences and Biomedical Collaborative Innovation Center of Zhejiang Province, Wenzhou University, Wenzhou 325035, China
- Department of Endocrinology, Yiwu Central Hospital, The Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu 322000, China
| | - Xia Chen
- Department of Endocrinology, Yiwu Central Hospital, The Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu 322000, China
| |
Collapse
|
2
|
Gostoli S, Raimondi G, Popa AP, Giovannini M, Benasi G, Rafanelli C. Behavioral Lifestyle Interventions for Weight Loss in Overweight or Obese Patients with Type 2 Diabetes: A Systematic Review of the Literature. Curr Obes Rep 2024; 13:224-241. [PMID: 38436787 PMCID: PMC11150315 DOI: 10.1007/s13679-024-00552-5] [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: 01/22/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE OF REVIEW Around 80-90% of patients with type 2 diabetes mellitus (T2DM) are overweight or obese, presenting a greater risk for serious health complications and mortality. Thus, weight loss represents a main goal for T2DM management. Although behavioral lifestyle interventions (BLIs) could help promoting weight loss in T2DM patients with overweight or obesity, their effectiveness is still controversial. This systematic review offers an updated and comprehensive picture of BLIs according to Michie's classification in T2DM patients with overweight or obesity and identifies possible factors (related to both patients and interventions) associated with weight loss. The PRISMA guidelines were followed. The literature search till March 2023 indicated 31 studies involving 42 different BLIs. RECENT FINDINGS Our findings suggest that structured BLIs, characterized by frequent feedback and support, can lead to a clinically meaningful 5% weight loss, regardless of specific behavioral, diet, and physical activity components. Further research should address methodological issues and heterogeneity of interventions, also considering the effect of pharmacological therapies on weight reduction. Lastly, more attention should be paid to the long-term effectiveness of behavioral lifestyle interventions and to the relationship between weight loss and diabetes.
Collapse
Affiliation(s)
- Sara Gostoli
- Department of Psychology "Renzo Canestrari", University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy
| | - Giulia Raimondi
- Department of Psychology "Renzo Canestrari", University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy
| | - Alexandra Paula Popa
- Department of Psychology "Renzo Canestrari", University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy
| | - Micaela Giovannini
- Department of Psychology "Renzo Canestrari", University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy
| | - Giada Benasi
- Department of Medicine, Division of General Medicine, Columbia University Irving Medical Center, 622 West 168th Street, 10032, New York, NY, United States
| | - Chiara Rafanelli
- Department of Psychology "Renzo Canestrari", University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy.
| |
Collapse
|
3
|
Zhu X, Ren B, Liu W, Lei S, Lin S, Liu Q, Yin L, Feng B. The short- and long-term effects of community-family-doctor-based type 2 diabetes self-management interventions. Public Health 2024; 230:96-104. [PMID: 38521030 DOI: 10.1016/j.puhe.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/27/2024] [Accepted: 02/16/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVES The popularity of contracted family doctor services in China has been growing in recent years, but community-family-doctor-based type 2 diabetes mellitus (T2DM) intervention programs have yet to be adequately studied. This study was to evaluate the short- and long-term effects of community-family-doctor-based self-management interventions for T2DM and to explore strategies for long-term glycemic control. STUDY DESIGN This was a randomized controlled trial. METHODS A total of 144 eligible participants were randomly assigned to intervention and control groups. The control group received only routine community diabetes care, and the intervention group received community-family-doctor-based interventions involving the same standard of care. The interventions lasted for 3 months, and the follow-up was continued for 15 months. Intention-to-treat analysis and generalized estimation equations were then used to determine the short- and long-term effects of the interventions on glycated hemoglobin (HbA1c), diabetes self-management, and medication adherence. RESULTS There were statistically significantly greater improvements in all aspects of the intervention group after 3 months of intervention. Compared with baseline, changes in the attitude (β = 0.384, 95% confidence interval [CI; 0.194, 0.574], P < 0.001), practice (β = 1.751, 95% CI [0.762, 2.739], P = 0.001), and knowledge, attitudes, practice total scores (β = 2.338, 95% CI [0.682, 3.995], P = 0.006) of patients in the intervention group were statistically significant after 15 months, and the HbA1c (8.19 ± 1.73%), knowledge (16.42 ± 3.21), and medication adherence (5.53 ± 1.76) scores were slightly better than those at baseline, although not statistically significant (P > 0.05). CONCLUSIONS T2DM self-management interventions based on community family doctors improved patients' HbA1c, diabetes self-management, and medication adherence, did not do so significantly in the long term.
Collapse
Affiliation(s)
- Xiaoying Zhu
- The Department of Pharmacy Administration, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Biqi Ren
- The Department of Pharmacy Administration, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China; Xi'an People's Hospital (Xi'an Fourth Hospital), Xi'an, Shaanxi, China
| | - Wei Liu
- The Department of Pharmacy Administration, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shuang Lei
- The Department of Pharmacy Administration, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shuzhi Lin
- The Department of Pharmacy Administration, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qian Liu
- The Department of Pharmacy Administration, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Lin Yin
- The Department of Pharmacy Administration, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Bianling Feng
- The Department of Pharmacy Administration, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| |
Collapse
|
4
|
Robinson DJ, Hanson K, Jain AB, Kichler JC, Mehta G, Melamed OC, Vallis M, Bajaj HS, Barnes T, Gilbert J, Honshorst K, Houlden R, Kim J, Lewis J, MacDonald B, MacKay D, Mansell K, Rabi D, Sherifali D, Senior P. Diabetes and Mental Health. Can J Diabetes 2023; 47:308-344. [PMID: 37321702 DOI: 10.1016/j.jcjd.2023.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
|
5
|
Barker K, Holland AE, Skinner EH, Lee AL. Clinical Outcomes Following Exercise Rehabilitation in People with Multimorbidity: A Systematic Review. J Rehabil Med 2023; 55:jrm00377. [PMID: 36876460 PMCID: PMC10015470 DOI: 10.2340/jrm.v55.2551] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 01/13/2023] [Indexed: 03/07/2023] Open
Abstract
OBJECTIVE To determine the effectiveness of exercise rehabilitation in people with multimorbidity. Exercise capacity was the primary outcome. Secondary outcomes were: health-related quality of life, activities of daily living, cardiometabolic outcomes, mental health outcomes, symptom scores, resource utilization, health behaviours, economic outcomes, and adverse events. DATA SOURCES A search was conducted in MEDLINE, CINHAL, EMBASE, and Cochrane Central Register of Controlled Trials databases. STUDY SELECTION AND EXTRACTION Randomized and non-randomized controlled trials and cohort studies of exercise rehabilitation vs any comparison in people with multimorbidity. DATA SYNTHESIS Forty-four reports (38 studies) were included. Rehabilitation ranged from 8 weeks to 4 years, with 1-7 sessions of rehabilitation weekly. Exercise included aerobic and resistance, limb training, aquatic exercises and tai chi. Compared with usual care, exercise rehabilitation improved 6-min walk distance (weighted mean difference (WMD) 64 m, 95% CI 45-82) and peak oxygen consumption (WMD 2.74 mL/kg/min, 95% CI -3.32 to 8.79). Effects on cardiometabolic outcomes and health-related quality of life also favoured rehabilitation; however; few data were available for other secondary outcomes. CONCLUSION In people with multimorbidity, exercise rehabilitation improved exercise capacity, health-related quality of life, and cardiometabolic outcomes.
Collapse
Affiliation(s)
- Kathryn Barker
- Department of Chronic and Complex Care, Western Health, St Albans; Discipline of Physiotherapy, La Trobe University, Bundoora
| | - Anne E Holland
- Discipline of Physiotherapy, La Trobe University, Bundoora; Central Clinical School, Monash University, Melbourne; Alfred Health, Melbourne; Institute for Breathing and Sleep, Austin Health, Heidelberg
| | - Elizabeth H Skinner
- Alfred Health, Melbourne; Department of Physiotherapy, Monash University, Frankston; Department of Physiotherapy, The University of Melbourne, Parkville, Australia
| | - Annemarie L Lee
- Institute for Breathing and Sleep, Austin Health, Heidelberg; Department of Physiotherapy, Monash University, Frankston.
| |
Collapse
|
6
|
Thangiah G, Johar H, Ismail R, Reininghaus U, Bärnighausen T, Thurairajasingam S, Reidpath D, Su TT. Diabetes Treatment and Mental Illness: A Call for an Integrated Health Care System in Underserved Semi-Rural Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10015. [PMID: 36011650 PMCID: PMC9408510 DOI: 10.3390/ijerph191610015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
Diabetes mellitus (DM) management imposes a tremendous psychological burden on patients. The study investigates the association between DM treatment with blood glucose (BG) control and common mental health conditions. A cross-sectional study was conducted among 1821 individuals with DM in a community-based survey conducted in 2013. Information on respondents’ sociodemographic, mental health, DM treatment, and BG levels was collected. Multinomial logistic regression was employed to examine the association of diabetes treatment with controlled BG levels (<11.1 mmol/L) (42.5%, n = 774) or uncontrolled BG levels (34.3%, n = 625) compared with those not undergoing treatment (23.2%, n = 422) on depression anxiety, and stress. Having DM treatment and controlled BG was associated with high depressive symptoms (Relative Risk Ratio, RRR: 2.42; 95% CI 1.33−4.41) and high anxiety symptoms (1.66; 1.08−2.56) but not with perceived stress. However, treated DM with uncontrolled BG was associated with anxiety (high: 1.64; 1.05−2.56; low: 2.59; 1.10−6.09) but not depression or perceived stress. Our results suggest that being treated for DM, regardless of glucose control status, was associated with anxiety symptoms, whereas being treated with controlled BG was associated with high depressive symptoms. This situation highlights the need for integrative, multidisciplinary care for DM patients with mental health comorbidities.
Collapse
Affiliation(s)
- Govindamal Thangiah
- South East Asia Community Observatory (SEACO) & Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya 47500, Malaysia
| | - Hamimatunnisa Johar
- South East Asia Community Observatory (SEACO) & Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya 47500, Malaysia
- Department of Psychosomatic Medicine and Psychotherapy, University of Giessen and Marburg, 35392 Giessen, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, 85764 Munich, Germany
| | - Roshidi Ismail
- South East Asia Community Observatory (SEACO) & Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya 47500, Malaysia
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, 68159 Mannheim, Germany
- ESRC Centre for Society and Mental Health, King’s College London, London WC2R 2LS, UK
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London WC2R 2LS, UK
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine, University of Heidelberg, 69117 Heidelberg, Germany
| | - Sivakumar Thurairajasingam
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Johor Bahru 80100, Malaysia
| | - Daniel Reidpath
- Institute for Global Health and Development, Queen Margaret University, Edinburgh EH21 6UU, UK
| | - Tin Tin Su
- South East Asia Community Observatory (SEACO) & Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya 47500, Malaysia
- Heidelberg Institute of Global Health, Faculty of Medicine, University of Heidelberg, 69117 Heidelberg, Germany
| |
Collapse
|
7
|
Al Harbi SS, Alajmi MM, Algabbas SM, Alharbi MS. The comparison of self-management group education and the standard care for patients with type 2 diabetes mellitus: An updated systematic review and meta-analysis. J Family Med Prim Care 2022; 11:4299-4309. [PMID: 36352914 PMCID: PMC9638609 DOI: 10.4103/jfmpc.jfmpc_2087_21] [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: 10/19/2021] [Revised: 01/27/2022] [Accepted: 02/07/2022] [Indexed: 11/15/2022] Open
Abstract
To investigate the efficacy of self-management group education versus the standard care for patients with type 2 diabetes mellitus (DM). An electronic search was performed in nine databases including PubMed for selecting eligible studies. Meta-analysis was used for pooling of the results. Of 3446 records screened, we included ten studies for this systematic review and meta-analysis. Regarding assessment of effectiveness, there was a significant superiority reported in the intervention group when compared to the usual/standard care (standardized mean difference [95% confidence interval] = 0.24 [0.15; 0.32]). The intervention group had a significant reduction in the levels of hemoglobin A1C (HbA1C), fasting blood glucose, low-density lipoprotein, total cholesterol, and body mass index compared to the usual/standard care (p < 0.05). Moreover, no significant difference was observed in the levels of high-density lipoprotein, systolic blood pressure (SBP), or diastolic blood pressure (DBP) between the two groups (p > 0.05). Self-management group education interventions are recommended in patients with type 2 DM for their effectiveness in different clinical aspects.
Collapse
Affiliation(s)
- Shatha Saleh Al Harbi
- Assistant Consultant at King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia
| | - Mubarak Mohammed Alajmi
- Fellow, Adult Endocrinology and Metabolic Disease, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | | | | |
Collapse
|
8
|
Rebello CJ, Axelrod CL, Reynolds CF, Greenway FL, Kirwan JP. Exercise as a Moderator of Persistent Neuroendocrine Symptoms of COVID-19. Exerc Sport Sci Rev 2022; 50:65-72. [PMID: 35019862 PMCID: PMC8900884 DOI: 10.1249/jes.0000000000000284] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Precipitated by chronic psychological stress, immune system dysregulation, and a hyperinflammatory state, the sequelae of postacute COVID-19 (long COVID) include depression and new-onset diabetes. We hypothesize that exercise counters the neuropsychiatric and endocrine sequelae of long COVID by inducing the release of circulating factors that mediate the anti-inflammatory response, support brain homeostasis, and increase insulin sensitivity.
Collapse
|
9
|
Li W, Yin H, Liu Q, Chen Y, Liang Y, Zhou H, Ma H, Geng Q. Associations Among Depression, Hemoglobin A1c Level, and Prognosis in Patients With Coronary Artery Disease: A Prospective Study. Front Psychiatry 2022; 13:815196. [PMID: 35782452 PMCID: PMC9243435 DOI: 10.3389/fpsyt.2022.815196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depression is ubiquitous in patients with coronary artery disease (CAD). The relationship between depression and hemoglobin A1c (HbA1c) is controversial. The combined effect of high HbA1c and depression on prognosis is unclear, especially in non-diabetic CAD patients. We sought to explore these associations. METHODS 558 CAD patients were included in this prospective study. Patients were grouped by HbA1c levels and the status of clinical depression. The average follow-up period was about 2.2 years, and Cox proportional hazards models were used to compare the differences of prognosis in all the groups. RESULTS Clinical depression had no associations with HbA1c in all CAD patients (P for Pearson correlation = 0.74). In the all four groups, compared to group 1 (patients without clinical depression and low HbA1c), group 3 (without clinical depression and high HbA1c) had a higher risk of MACE (adjusted hazard ratio [aHR], 1.97; 95% confidence interval [CI], 1.2-3.25) and composite events (aHR, 1.67; 95% CI, 1.09-2.053). Group 4 (patients with clinical depression and high HbA1c) had higher HRs for MACE (aHR, 2.9; 95%CI, 1.32-6.38) and composite events (aHR, 2.12; 95% CI, 1.06-4.25). In CAD patients without diabetes, patients with clinical depression and high HbA1c had a higher risk of MACE (HR, 2.71; 95% CI, 1.02-7.19), non-cardiac readmission (HR,3.48; 95% CI, 1.26-9.57) and composite events (HR,2.44; 95% CI, 1.08-5.53) than those with no clinical depression and low HbA1c. In patients with comorbidities of depression and diabetes, patients with depression and high HbA1c more likely to experienced non-cardiac readmissions (HR, 4.49; 95% CI, 1.31-15.38) than patients with no depression and low HbA1c only. In all the above analysis, p-values for interaction between clinical depression and HbA1c were not statistically significant. CONCLUSIONS The presence of both depression and high HbA1c lead to a worse prognosis in CAD patients than one risk factor alone, no matter with or without the comorbidity of diabetes in these CAD patients. For patients with CAD and depression, lower HbA1c may be required.
Collapse
Affiliation(s)
- Weiya Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Han Yin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Quanjun Liu
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Yilin Chen
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Yanting Liang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Haofeng Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Huan Ma
- Department of Cardiac Rehabilitation, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qingshan Geng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,School of Medicine, South China University of Technology, Guangzhou, China
| |
Collapse
|
10
|
Rodriguez K, Ryan D, Dickinson JK, Phan V. Improving Quality Outcomes: The Value of Diabetes Care and Education Specialists. Clin Diabetes 2022; 40:356-365. [PMID: 35979327 PMCID: PMC9331628 DOI: 10.2337/cd21-0089] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Given the growing prevalence and accelerating cost of diabetes, there is an urgent need to expand strategies in health care that improve access and outcomes and reduce the financial and human burden of the disease. Diabetes care and education specialists (DCESs) are well positioned to assist health care systems with delivery models that enhance diabetes care through evidence-based standards and quality improvement strategies. DCESs have increased opportunities to apply their competencies in primary, specialty, hospital, and acute care settings; accountable care organizations; community settings; research; and academia. Two national certification programs provide an evidence-based foundation for quality in the specialty, with updated competencies guiding practice. This article serves as a call to action for health care systems to integrate specialists in diabetes care and education into diabetes care delivery models and raise awareness of the positive impact these professionals have on the lives of people with diabetes.
Collapse
Affiliation(s)
| | - Donna Ryan
- Ascension Florida Gulf Coast Ministry, Pensacola, FL
| | | | - Victor Phan
- California Northstate University College of Pharmacy, Elk Grove, CA
| |
Collapse
|
11
|
Adams RN, Athinarayanan SJ, McKenzie AL, Hallberg SJ, McCarter JP, Phinney SD, Gonzalez JS. Depressive symptoms improve over 2 years of type 2 diabetes treatment via a digital continuous remote care intervention focused on carbohydrate restriction. J Behav Med 2022; 45:416-427. [PMID: 35084637 PMCID: PMC9160138 DOI: 10.1007/s10865-021-00272-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 12/13/2021] [Indexed: 01/02/2023]
Abstract
Depressive symptoms are prevalent among people with type 2 diabetes (T2D) and, even at low severity levels, are associated with worse diabetes outcomes. Carbohydrate restriction is an effective treatment for T2D but its long-term impacts on depressive symptoms are unclear. In the current study we explored changes in depressive symptoms over 2 years among 262 primarily non-depressed T2D patients participating in a continuous remote care intervention emphasizing carbohydrate restriction. Subclinical depressive symptoms decreased over the first 10 weeks and reductions were maintained out to 2 years. Increased frequency of blood ketone levels indicative of adherence to low carbohydrate eating predicted decreases in depressive symptoms. Concerns have been raised with recommending restrictive diets due to potential negative impacts on quality-of-life factors such as mood; however, results of the current study support positive rather than negative long-term impacts of closely monitored carbohydrate restriction on depressive symptoms.
Collapse
Affiliation(s)
- Rebecca N Adams
- Virta Health Corp, 501 Folsom Street, San Francisco, CA, 94105, USA.
| | | | - Amy L McKenzie
- Virta Health Corp, 501 Folsom Street, San Francisco, CA, 94105, USA
| | - Sarah J Hallberg
- Virta Health Corp, 501 Folsom Street, San Francisco, CA, 94105, USA
- Indiana University Health Arnett, Lafayette, IN, USA
| | - James P McCarter
- Abbott Diabetes Care, Alameda, CA, USA
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Jeffrey S Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
- Departments of Medicine (Endocrinology) and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
12
|
Vrany EA, Jennings A, Hossain MB, Hill-Briggs F. Mental Health History and DECIDE (Decision-Making Education for Choices in Diabetes Everyday) Diabetes Support Program Outcomes Among African Americans With Type 2 Diabetes. Sci Diabetes Self Manag Care 2021; 47:425-435. [PMID: 34617828 DOI: 10.1177/26350106211048782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to determine behavioral and clinical outcomes of the DECIDE (Decision-Making Education for Choices in Diabetes Everyday) diabetes support program trial participants with and without a mental health (MH) history by treatment arm. METHODS A secondary analysis was conducted of data from the DECIDE trial sample of urban African American adults with type 2 diabetes (T2DM; N = 137) who received the DECIDE diabetes support program in 1 of 3 delivery formats: self-study (n = 46), individual (n = 45), and group (n = 46). Positive screen on the Patient Health Questionnaire-2 and/or reported MH diagnosis were coded as MH history. Self-management, knowledge, problem-solving, and A1C data at baseline and 1 week and 6 months postintervention were analyzed for participants with and without MH history. RESULTS Prevalence of MH history was 37% in the sample. Among those with no MH history, knowledge and problem-solving improved at 6 months postintervention in all intervention arms. For those with MH history, knowledge and problem-solving improved in the self-study and individual arms but not in the group arm. Clinically but not statistically significant changes in A1C were observed at 6 months. CONCLUSIONS In an urban minority T2DM sample, those with an MH history benefited from the intervention, but delivery format mattered, with robust improvements when participants with an MH history received self-directed or one-on-one formats rather than group.
Collapse
Affiliation(s)
- Elizabeth A Vrany
- From Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Arianne Jennings
- Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, Maryland
| | - Mian B Hossain
- Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, Maryland
| | - Felicia Hill-Briggs
- From Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.,Welch Center for Prevention, Epidemiology & Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| |
Collapse
|
13
|
Damhudi D, Kertia N, Effendy C. The Effect of Modified Diabetes Self-management Education and Support on Self-care and Quality of Life among Patients with Diabetic Foot Ulcers in Rural Area of Indonesia. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND: Diabetes self-management education and support (DSMES) programs are patient-centered, holistic solution that enables it one of the best approaches for improving medication adherence enhanced coping, empowerment and self-efficacy, quality of life (QoL), and lower rates of depression, in people with type 2 diabetes mellitus (T2DM). In isolation, DSME strategies have not shown significant improvements to self-care and/or reduction of diabetic foot ulcer (DFU).
AIM: This study sought to determine the effect of modified DSMES on self-care, DFU severity, and QoL in rural Indonesian patients with DFUs.
METHODS: A quasi-experimental design with pre-test and post-test control group design, in Singkawang, West Kalimantan, Indonesia, with a total sample of 60 patients consisting of 30 patients in the intervention group and 30 patients in the control group. The DSMES has been adapted to cover 2 h of content for a period of 8 weeks and the eight-core components of DSMES. The curriculum was culturally adapted revised to incorporate culturally appropriate nature similarities, such as a prominent change to represent changes in glucose counts; to incorporate photos; to incorporate culturally relevant eating habits, such as fish and fruit; to communicate in detail the significance of medication adherence, with an emphasis on metformin’s organic, plant-based characteristics; and to emphasize engagement. Intention-to-treat analyses were conducted to determine the effect of modified DSMES on self-care, DFU severity, and QoL.
RESULTS: The DSMES program improved outcomes in three of the three outcome indicators when compared to the control group at T1: In this study, (1) the DFU degree increased by 3.3% points (95% confidence interval [CI]: 0.018–0.194), (2) the diabetes foot self-care behavior score increased by a modest 8.8% points (95% CI: 0.021–0.203), and (3) the QoL increased by 32.7% points (95% CI: 00.075–0.689). The degree of DFU (difference-in-difference [DID] coef. 0.350, 95% CI 0.084–0.572), diabetes foot self-care behavior (DID coef. 0.085, 95% CI 0.065–0.405), and QoL (DID coef. 0.343, 95% CI 0.078–0.436) are all still significantly improved compared to the control at T2.
CONCLUSION: The primary outcome analyses indicate that the adapted DSMES was more effective than standard care at improving self-care and QoL and decreasing DFU degree in this sample of Indonesians with DFU, both immediately after and 3 months after the intervention. As nurse educators, it is our responsibility to ensure that we evaluate all of the support options accessible to the patients in our care.
Collapse
|
14
|
Dugani SB, Mielke MM, Vella A. Burden and management of type 2 diabetes in rural United States. Diabetes Metab Res Rev 2021; 37:e3410. [PMID: 33021052 PMCID: PMC7990742 DOI: 10.1002/dmrr.3410] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/10/2020] [Accepted: 08/23/2020] [Indexed: 12/31/2022]
Abstract
In the United States, rural areas have a higher burden of type 2 diabetes (T2DM) compared to urban areas. However, there is limited information on risk factors and interventions that improve the primary prevention and management of T2DM in rural areas. To synthesize current knowledge on T2DM in rural areas and to guide healthcare providers and policy makers, we reviewed five scientific databases and the grey literature over the last decade (2010-2020). We described classification systems for rurality and the T2DM burden based on rurality and region (West, South, Midwest, and Northeast). We highlighted risk factors for T2DM in rural compared to urban areas, and summarized interventions to screen and manage T2DM based on opportunistic screening, T2DM self-management, community-based initiatives, as well as interventions targeting comorbidities and T2DM. Several studies identified the co-existence of T2DM and depression/psychological symptoms, which could reduce adherence to non-pharmacologic and pharmacologic management of T2DM. We highlighted the role of technology in education and counselling of patients with geographic and financial barriers to accessing care, which is exacerbated by the SARS-CoV-2 coronavirus disease-19 pandemic. We identified knowledge gaps and next steps in improving T2DM care in rural areas. There is an urgent need for interventions tailored to rural areas given that rural Americans currently experience a disproportionate burden of T2DM and are encumbered by its associated morbidity, mortality, and loss in economic productivity.
Collapse
Affiliation(s)
| | | | - Adrian Vella
- Division of Endocrinology, Mayo Clinic, Rochester, MN
| |
Collapse
|
15
|
Xie Y, Wu Z, Sun L, Zhou L, Wang G, Xiao L, Wang H. The Effects and Mechanisms of Exercise on the Treatment of Depression. Front Psychiatry 2021; 12:705559. [PMID: 34803752 PMCID: PMC8602192 DOI: 10.3389/fpsyt.2021.705559] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/05/2021] [Indexed: 12/12/2022] Open
Abstract
Background: It is necessary to seek alternative therapies for depression, because side effects of medications lead to poor adherence and some patients do not achieve a clinical treatment effect. Recently the role of exercise as a low-cost and easy-to-use treatment for depression has gained attention with a number of studies showing that exercise is effective at reducing depressive symptoms and improving body functions such as cardiorespiratory system and cognitive function. Because of the heterogeneity of exercise therapy programs, there is no standardized and unified program. Few studies have summarized the specific properties of exercise programs (type, intensity, duration, and frequency) and clinical prescriptions for exercise are not mentioned in most articles. Aims: This study aimed to investigate the feasibility and efficacy of exercise therapy for patients with depression, in order to appraise the evidence and outline accepted guidelines to direct individualized treatment plans for patients with depression based on their individual situations. Methods: A systematic review of English language literature including papers published from 2010 to present in PubMed was performed. Given the feasibility of prescribing exercise therapy for patients with depression, nearly 3 years of clinical studies on the treatments of depressive symptoms with exercise were first reviewed, comparing the exercise programs utilized. Conclusions: Exercise has therapeutic effects on depression in all age groups (mostly 18-65 years old), as a single therapy, an adjuvant therapy, or a combination therapy, and the benefits of exercise therapy are comparable to traditional treatments for depression. Moderate intensity exercise is enough to reduce depressive symptoms, but higher-dose exercise is better for overall functioning. Exercise therapy has become more widely used because of its benefits to the cardiovascular system, emotional state, and systemic functions. Recommendations: Aerobic exercise/mind-body exercise (3-5 sessions per week with moderate intensity lasting for 4-16 weeks) is recommended. Individualized protocols in the form of group exercise with supervision are effective at increasing adherence to treatment.
Collapse
Affiliation(s)
- Yumeng Xie
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zuotian Wu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Limin Sun
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lin Zhou
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Gaohua Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ling Xiao
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Huiling Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| |
Collapse
|
16
|
Lee CB, Baek SS. Impact of exercise on hippocampal neurogenesis in hyperglycemic diabetes. J Exerc Rehabil 2020; 16:115-117. [PMID: 32509694 PMCID: PMC7248443 DOI: 10.12965/jer.2040210.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/25/2020] [Indexed: 11/28/2022] Open
Abstract
Hyperglycemic diabetes is a chronic metabolic disorder characterized by high level of plasma glucose. Numerous studies have shown that hy-perglycemic diabetes leads to brain dysfunction including cognitive im-pairment and emotional disorders. This study evaluated the impact of exercise on brain dysfunction, hippocampal neurogenesis, and cogni-tive impairment in hyperglycemic diabetes. The present study suggests that exercise improves hyperglycemic control and prevents decline of cognition through increasing hippocampal neurogenesis. Understanding the mechanism of exercise for hippocampal neurogenesis can lead to the development of therapeutic strategies for metabolic disorders.
Collapse
Affiliation(s)
| | - Seung-Soo Baek
- Corresponding author: Seung-Soo Baek, https://orcid.org/0000-0002-1340-2098, Department of Sport & Health Care, College of Art & Culture, Sangmyung University, 20 Hongjimun 2-gil, Jongno-gu, Seoul 03016, Korea, E-mail:
| |
Collapse
|
17
|
Wagner JA, Feinn R, Lampert R, Bermúdez-Millán A, Pérez-Escamilla R. Changes in negative affect and changes in heart rate variability among low-income latinos with type 2 diabetes in a randomized, controlled stress management trial. J Psychosom Res 2019; 124:109774. [PMID: 31443815 DOI: 10.1016/j.jpsychores.2019.109774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/05/2019] [Accepted: 07/05/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Structural equation modeling examined the relationship between change in negative affect (NA) and change in heart rate variability (HRV) among 121 Latinos with type 2 diabetes. METHODS This study leveraged data from the Community Health Workers Assisting Latinos Manage Stress and Diabetes (CALMSD) study which compared diabetes education vs diabetes education plus stress management. Participants completed surveys of NA at baseline and again 8-10 weeks later. They also wore 7‑lead, 3-channel ambulatory ECG monitors for 24 h at both time points. The latent variable NA was modeled by observed scores on symptoms of depression, anxiety, diabetes distress, and wellbeing (reversed). The latent variable HRV was modeled by observed scores in the time domain (the standard deviation of the R-R interval [SDNN] and the root mean square of the successive differences [RMSSD]) and in the frequency domain, i.e., log-transformed ultra-low frequency, very-low frequency, low frequency, and high frequency. RESULTS At baseline, there were strong, negative cross-sectional associations between NA and HRV. Baseline NA predicted change in HRV, whereas baseline HRV did not predict change in NA. Controlling for fasting glucose and treatment assignment did not meaningfully alter the findings. Stress management improved NA but not HRV. At followup, a greater reduction (improvement) in NA was associated with a larger increase (improvement) in HRV, with a small-to-medium negative association that approached statistical significance. CONCLUSIONS Findings indicate a longitudinal relationship between NA and HRV, and suggest that improvement in one may be associated with improvement in the other.
Collapse
Affiliation(s)
- Julie A Wagner
- University of Connecticut Schools of Medicine and Dental Medicine, United States of America.
| | - Richard Feinn
- Quinnipiac University School of Medicine, United States of America
| | - Rachel Lampert
- Yale University School of Medicine, United States of America
| | | | | |
Collapse
|
18
|
Overcoming barriers to self-management: The person-centred diabetes foot behavioural agreement. Foot (Edinb) 2019; 38:65-69. [PMID: 30665197 DOI: 10.1016/j.foot.2019.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/04/2019] [Accepted: 01/09/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Behavioural agreements have been proposed as a clinical strategy for improving concordance with diabetes foot self-management practices, both for individuals 'At-risk' of, and with active, diabetes foot disease. This narrative review sought to explore the potential supportive role of person-centred diabetes foot behavioural agreements in promoting protective foot self-management behaviours among 'At-risk' individuals. CONCLUSIONS Healthcare professionals (HCPs) involved in diabetes foot risk stratification and management dedicate considerable time, effort and resources to the prevention of diabetic foot ulcers (DFU) and lower extremity amputation (LEA) and are uniquely placed to deliver person-centred diabetes self-management education and support (DSMES) interventions. Written, verbal and non-verbal agreements are consistent with a wider global move toward DSMES approaches, respectful of people's preferences, and supporting them to undertake protective self-care behaviours. PRACTICE IMPLICATIONS It is theorised that clear communication of the roles of the person with diabetes, their family or carers and HCPs may improve concordance with self-management behaviours. Rather than a punitive measure or means of facilitating discharge of 'non-concordant' individuals, person-centred behavioural agreements should be framed positively, as a means of delineating, prescribing and supporting individual diabetes foot-care responsibilities. This is an area worthy of further research.
Collapse
|
19
|
Shi J, Li Y. Disparities in Diabetes Education Program Use by Disability Status Among People with Diabetes: Findings from Behavioral Risk Factor Surveillance System 2015. AMERICAN JOURNAL OF HEALTH EDUCATION 2018. [DOI: 10.1080/19325037.2018.1546627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Yong Li
- California State University, Bakersfield
| |
Collapse
|
20
|
Robinson DJ, Coons M, Haensel H, Vallis M, Yale JF. Diabetes and Mental Health. Can J Diabetes 2018; 42 Suppl 1:S130-S141. [PMID: 29650085 DOI: 10.1016/j.jcjd.2017.10.031] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Indexed: 01/28/2023]
|
21
|
Kumar S, Moseson H, Uppal J, Juusola JL. A Diabetes Mobile App With In-App Coaching From a Certified Diabetes Educator Reduces A1C for Individuals With Type 2 Diabetes. DIABETES EDUCATOR 2018; 44:226-236. [PMID: 29575982 DOI: 10.1177/0145721718765650] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose There are currently many diabetes apps available, but there is limited evidence demonstrating clinical impact. The purpose of this study is to evaluate the impact of a diabetes mobile app with in-app coaching by a certified diabetes educator on glycemic control for individuals with type 2 diabetes. Methods A 12 week-long single-arm intent-to-treat trial evaluated the impact of a diabetes mobile app and coaching program (One Drop | Mobile With One Drop | Experts), which facilitated tracking of self-care and included an in-app diabetes education program, on A1C for individuals with type 2 diabetes and an A1C ≥7.5% (58 mmol/mol). An online study platform (Achievement Studies, Evidation Health Inc, San Mateo, CA) was used to screen, consent, and enroll participants; collect study data; and track participants' progress throughout the study. Baseline and study end A1C measurements as well as questionnaire data from participants were collected. Results Participants (n = 146) were 52 ± 9 years old, 71% female, 25% black or Hispanic, diagnosed with diabetes for 11 ± 7 years, and with a mean baseline A1C of 9.87% ± 2.0 (84 mmol/mol). In adjusted repeated measures models, mean A1C improved by -0.86% among study completers (n = 127), -0.96% among active users of the app and coaching program (n = 93), and -1.32% among active users with a baseline A1C ≥9.0% (75 mmol/mol) (n = 53). Conclusions This program was associated with a clinically meaningful and significant reduction in A1C and can potentially increase access to effective diabetes self-management education and support for individuals with diabetes.
Collapse
|
22
|
Chatterjee S, Davies MJ, Heller S, Speight J, Snoek FJ, Khunti K. Diabetes structured self-management education programmes: a narrative review and current innovations. Lancet Diabetes Endocrinol 2018; 6:130-142. [PMID: 28970034 DOI: 10.1016/s2213-8587(17)30239-5] [Citation(s) in RCA: 226] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/13/2017] [Accepted: 06/26/2017] [Indexed: 12/17/2022]
Abstract
Both type 1 and type 2 diabetes are associated with long-term complications that can be prevented or delayed by intensive glycaemic management. People who are empowered and skilled to self-manage their diabetes have improved health outcomes. Over the past 20 years, diabetes self-management education programmes have been shown to be efficacious and cost-effective in promotion and facilitation of self-management, with improvements in patients' knowledge, skills, and motivation leading to improved biomedical, behavioural, and psychosocial outcomes. Diabetes self-management education programmes, developed robustly with an evidence-based structured curriculum, vary in their method of delivery, content, and use of technology, person-centred philosophy, and specific aims. They are delivered by trained educators, and monitored for quality by independent assessors and routine audit. Self-management education should be tailored to specific populations, taking into consideration the type of diabetes, and ethnic, social, cognitive, literacy, and cultural factors. Ways to improve access to and uptake of diabetes self-management programmes are needed globally.
Collapse
Affiliation(s)
- Sudesna Chatterjee
- Diabetes Research Centre, University of Leicester, Leicester, UK; Department of Diabetes and Endocrinology, University Hospitals of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Simon Heller
- Academic Unit of Diabetes, Endocrinology, and Metabolism, University of Sheffield, Sheffield, UK
| | - Jane Speight
- School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia; Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia; AHP Research, Hornchurch, Essex, UK
| | - Frank J Snoek
- Department of Medical Psychology, Academic Medical Centre and VU University Medical Centre, Amsterdam, Netherlands
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK.
| |
Collapse
|
23
|
Salinas JJ, Gonzalez JMR, Al Snih S. Type 2 diabetes, depressive symptoms and disability over a 15-year follow-up period in older Mexican Americans living in the southwestern United States. J Diabetes Complications 2018; 32:75-82. [PMID: 29074123 PMCID: PMC5662478 DOI: 10.1016/j.jdiacomp.2016.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/18/2016] [Accepted: 06/26/2016] [Indexed: 10/21/2022]
Abstract
AIMS To evaluate how depression and diabetes severity impact disability progression among Mexican Americans over a 15-year period. METHODS We used seven waves of the Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE). Primary disability outcomes included the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales. Explanatory variables included time since diagnosis with diabetes (no type 2 diabetes, 1-10, 11-20, 21+), an indicator of disease severity, and depression. Longitudinal generalized estimating equation models were used to estimate the relationship between time since diabetes diagnosis, depressive symptoms and ADL and IADL disability progression over a 15-year time period. RESULTS Years since diabetes diagnosis was associated with more rapid ADL and IADL disability progression compared to those without type 2 diabetes. Depression accelerated the disabling process in participants who were diagnosed with diabetes 11years or more years ago. CONCLUSIONS Longer duration of diabetes and greater symptoms of depression increase vulnerability for disability among older Mexican American adults.
Collapse
Affiliation(s)
- Jennifer J Salinas
- Department of Epidemiology, Human Genetics, Environmental Sciences, University of Texas Health Science Center at Houston School of Public Health, United States, 1101 N. Campbell St., El Paso, TX 79902, USA.
| | - Jennifer M Reingle Gonzalez
- Department of Epidemiology, Human Genetics, Environmental Sciences, University of Texas Health Science Center at Houston School of Public Health, 6011 Harry Hines Blvd., Suite V8.112, Dallas, TX 75390, USA.
| | - Soham Al Snih
- Division of Rehabilitation Sciences, School of Health Professions, Internal Medicine, Division of Geriatrics, Sealy Center on Aging Rebecca Sealy Bldg 5.112A, 301 University Blvd. Rt. 0177, Galveston, TX, 77555, USA.
| |
Collapse
|
24
|
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an overview of shared dysregulation of the hypothalamic-pituitary-adrenal (HPA) and brain-gut-microbiome (BGM) axes associated with depression and type 2 diabetes (T2D). Clinical implications and future research are also discussed. RECENT FINDINGS Both depression and T2D are associated with dysregulation of the HPA and BGM axes. These pathways regulate immune function, glucose metabolism, and sleep, which are altered in both illnesses. Dysregulation of homeostatic brain-body pathways may be positively influenced through different therapeutic actions, including psychotherapy, healthy eating, physical activity, sleep promotion, and certain anti-inflammatory or antidepressant medications. While the causal nature of the relationship between depression and T2D remains unclear, these conditions share dysregulation of homeostatic brain-body pathways that are central to mental and physical health. Better understanding of this dysregulation may provide opportunities for interventions that could benefit both conditions. Future research should examine the additive burden of depression and T2D on HPA and BGM dysregulation and better differentiate depression from emotional distress.
Collapse
Affiliation(s)
- Claire J Hoogendoorn
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Avenue, Rousso Building, Bronx, NY, 10461, USA.
| | - Juan F Roy
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Avenue, Rousso Building, Bronx, NY, 10461, USA
| | - Jeffrey S Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Avenue, Rousso Building, Bronx, NY, 10461, USA
- Department of Medicine (Endocrinology), Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
25
|
de Groot M, Doyle T, Averyt J. Program ACTIVE: Cognitive Behavioral Therapy to Treat Depression in Adults With Type 2 Diabetes in Rural Appalachia. J Cogn Psychother 2017; 31:158-170. [PMID: 29242676 PMCID: PMC5726264 DOI: 10.1891/0889-8391.31.3.158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
High rates of type 2 diabetes (T2DM) and depression exist in rural Appalachia with limited access to psychotherapeutic treatment. No manualized cognitive behavioral therapy (CBT) treatment materials exist that are culturally tailored for individuals in this region with T2DM. We describe the development of the Program ACTIVE CBT intervention for use with adults with T2DM and depression by mental health providers in rural Appalachia. Qualitative and quantitative methods were used to test the feasibility and acceptability of Program ACTIVE. Intervention materials were rated at the 6th-7th grade reading level. Key informant interviews evaluated materials as culturally sensitive and accessible. Participants indicated high levels of satisfaction with therapy (94%), support from their therapist (86%), and usefulness of therapy and depression improvement (80.3%). Program ACTIVE was found to be a feasible and acceptable culturally tailored manualized CBT treatment for adults with T2DM and depression living in rural Appalachia. Implementation of these materials on a regional scale needs to be assessed.
Collapse
Affiliation(s)
- Mary de Groot
- Department of Medicine, Indiana University, Indianapolis, Indiana
| | - Todd Doyle
- Department of Psychiatry and Behavioral Neurosciences, Loyola University Medical Center, Maywood, Illinois
| | | |
Collapse
|
26
|
Turi KN, Grigsby-Toussaint DS. Spatial spillover and the socio-ecological determinants of diabetes-related mortality across US counties. APPLIED GEOGRAPHY (SEVENOAKS, ENGLAND) 2017; 85:62-72. [PMID: 36238660 PMCID: PMC9555791 DOI: 10.1016/j.apgeog.2017.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The spatial structure of diabetes-related mortality in US counties is evident from previous studies. However, it is not clear if spatial variation in diabetes-related mortality is associated with spatial variation in socioecological factors. We analyze the spatial spillover effect of changes in socioeconomic gradients (education, employment, household income), retail food environments, and access to health care, on diabetes-related mortality rates across the United States. Seven-year aggregates of multiple cause mortality data from the CDC WONDER compressed mortality database were merged with several sources of county-level data to examine mortality clusters, factors associated with the clusters, and spatial spillover effects in 3109 continuous US counties. The results suggest that high diabetes-related mortality cluster counties are located throughout the Southern Plains, Southeastern, and Appalachian regions. Lower socioeconomic status, a high density of fast food restaurants, a lack of access to grocery stores, a high proportion of Blacks, and low physical activity characterize high diabetes-related mortality rates clusters. The impacts from improvements in socioeconomic gradients and the retail food environment in neighboring counties spill over, and reduce the diabetes-related mortality rate in a particular county. This result implies that improvements in socioeconomic status and access to healthy food would significantly reduce diabetes-related mortality rates in contiguous US counties.
Collapse
Affiliation(s)
- Kedir N. Turi
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Diana S. Grigsby-Toussaint
- Department of Kinesiology and Community Health, Division of Nutritional Sciences, University of Illinois-Urbana Champaign, Champaign, IL, USA
| |
Collapse
|
27
|
Bai JW, Lovblom LE, Cardinez M, Weisman A, Farooqi MA, Halpern EM, Boulet G, Eldelekli D, Lovshin JA, Lytvyn Y, Keenan HA, Brent MH, Paul N, Bril V, Cherney DZI, Perkins BA. Neuropathy and presence of emotional distress and depression in longstanding diabetes: Results from the Canadian study of longevity in type 1 diabetes. J Diabetes Complications 2017; 31:1318-1324. [PMID: 28599823 DOI: 10.1016/j.jdiacomp.2017.05.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/29/2017] [Accepted: 05/05/2017] [Indexed: 11/20/2022]
Abstract
AIM To determine the association of neuropathy and other complications with emotional distress and depression among patients with longstanding type 1 diabetes (T1DM). METHODS Canadians with ≥50years of T1DM completed a questionnaire including assessment of distress and depression by the Problem Areas in Diabetes Scale (PAID) and Geriatric Depression Scale (GDS), respectively. Complications were determined using the Michigan Neuropathy Screening Instrument (Questionnaire Component), fundoscopy reports, renal function tests, and self-reported peripheral-(PVD) and cardiovascular (CVD) disease. Associations were analyzed by Poisson regression. RESULTS Among 323 participants, 137 (42.4%) had neuropathy, 113 (36.5%) nephropathy, 207 (69.5%) retinopathy, 95 (29.4%) CVD, and 31 (9.8%) PVD. The neuropathy subgroup had higher prevalence of distress (13 (9.5%) vs. 6 (3.3%), p=0.029) and depression (34 (24.9%) vs. 12 (6.5%), p<0.001). Adjusting for diabetes complications, neuropathy was associated with higher PAID (adjusted RR 1.44 (95% CI 1.14-1.82), p=0.003) and GDS scores (adjusted RR1.57 (1.18-2.11), p=0.002). Independent of potential confounders, neuropathy remained associated with higher PAID (adjusted RR 1.39 (1.10-1.76), p=0.006) and GDS scores (adjusted RR 1.37 (1.03-1.83), p=0.032). Associations with neuropathy were not fully explained by neuropathic pain. CONCLUSION Compared to other complications, neuropathy had the greatest association with distress and depression in longstanding T1DM, independent of pain. Strategies beyond pain management are needed to improve quality of life in diabetic neuropathy.
Collapse
Affiliation(s)
- Johnny-Wei Bai
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Leif E Lovblom
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Marina Cardinez
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Alanna Weisman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Mohammed A Farooqi
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Elise M Halpern
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Genevieve Boulet
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Devrim Eldelekli
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Julie A Lovshin
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Yuliya Lytvyn
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Michael H Brent
- Department of Ophthalmology and Vision Sciences, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Narinder Paul
- Joint Department of Medical Imaging, Division of Cardiothoracic Radiology, University Health Network, Toronto, Ontario, Canada
| | - Vera Bril
- The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Krembil Neuroscience Centre, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David Z I Cherney
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bruce A Perkins
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
28
|
Tang TS, Yusuf FLA, Polonsky WH, Fisher L. Assessing quality of life in diabetes: II - Deconstructing measures into a simple framework. Diabetes Res Clin Pract 2017; 126:286-302. [PMID: 28190527 DOI: 10.1016/j.diabres.2016.10.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/13/2016] [Indexed: 12/19/2022]
Abstract
A growing number of instruments measuring diabetes-specific health-related quality of life (HRQOL) have been identified in previous systematic reviews, the most recent being published in 2008. The purpose of this paper is report on an updated systematic review of diabetes-specific HRQOL measures highlighting the time period 2006-2016; to deconstruct existing diabetes-specific HRQOL measures into a simple framework for evaluating the goodness-of-fit between specific research needs and instrument characteristics; and to present core characteristics of measures not yet reported in other reviews to further facilitate scale selection. Using the databases Medline, Pubmed, CINAHL, OVID Embase, and PsycINFO, we identified 20 diabetes-specific HRQOL measures that met our inclusion criteria. For each measure, we extracted eight core characteristics for our measurement selection framework. These characteristics include target population (type 1 vs. type 2), number and type of HRQOL dimensions measured and scored, type of score and calculation algorithm, sensitivity to change data reported in subsequent studies, number of survey items, approximate time length to complete, number of studies using the instrument in the past 10years, and specific languages instruments is translated. This report provides a way to compare and contrast existing diabetes-specific HRQOL measures to aid in appropriate scale selection and utilization.
Collapse
Affiliation(s)
| | | | - William H Polonsky
- Behavioral Diabetes Institute, San Diego, CA, USA; University of California, San Diego, CA, USA
| | - Lawrence Fisher
- University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
29
|
Krall J, Durdock K, Johnson P, Kanter J, Koshinsky J, Thearle M, Siminerio L. Exploring Approaches to Facilitate Diabetes Therapy Intensification in Primary Care. Clin Diabetes 2017; 35:100-105. [PMID: 28442825 PMCID: PMC5391815 DOI: 10.2337/cd16-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Jodi Krall
- University of Pittsburgh Diabetes Institute, Pittsburgh, PA
| | - Kendra Durdock
- Penn State Hershey Medical Group Care Management, Penn State Hershey, Hershey, PA
| | | | - Justin Kanter
- University of Pittsburgh Diabetes Institute, Pittsburgh, PA
| | | | | | - Linda Siminerio
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
30
|
Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Fischl AH, Maryniuk MD, Siminerio L, Vivian E. Diabetes Self-management Education and Support in Type 2 Diabetes. DIABETES EDUCATOR 2017; 43:40-53. [DOI: 10.1177/0145721716689694] [Citation(s) in RCA: 204] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Margaret A. Powers
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Joan Bardsley
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Marjorie Cypress
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Paulina Duker
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Martha M. Funnell
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Amy Hess Fischl
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Melinda D. Maryniuk
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Linda Siminerio
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Eva Vivian
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| |
Collapse
|
31
|
Schoenberg NE, Ciciurkaite G, Greenwood MK. Community to clinic navigation to improve diabetes outcomes. Prev Med Rep 2016; 5:75-81. [PMID: 27957410 PMCID: PMC5149068 DOI: 10.1016/j.pmedr.2016.11.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 11/11/2016] [Accepted: 11/24/2016] [Indexed: 02/01/2023] Open
Abstract
Rural residents experience rates of Type 2 Diabetes Mellitus (T2DM) that are considerably higher than their urban or suburban counterparts. Two primary modifiable factors, self-management and formal clinical management, have potential to greatly improve diabetes outcomes. “Community to Clinic Navigation to Improve Diabetes Outcomes,” is the first known randomized clinical trial pilot study to test a hybrid model of diabetes self-management education plus clinical navigation among rural residents with T2DM. Forty-one adults with T2DM were recruited from two federally qualified health centers in rural Appalachia from November 2014–January 2015. Community health workers provided navigation, including helping participants understand and implement a diabetes self-management program through six group sessions and, if needed, providing assistance in obtaining clinic visits (contacting providers' offices for appointments, making reminder calls, and facilitating transportation and dependent care). Pre and post-test data were collected on T2DM self-management, physical measures, demographics, psychosocial factors, and feasibility (cost, retention, and satisfaction). Although lacking statistical significance, some outcomes indicate trends in positive directions, including diet, foot care, glucose monitoring, and physical health, including decreased HbA1c and triglyceride levels. Process evaluations revealed high levels of satisfaction and feasibility. Due to the limited intervention dose, modest program expenditures (~$29,950), and a severely affected population most of whom had never received diabetes education, outcomes were not as robust as anticipated. Given high rates of satisfaction and retention, this culturally appropriate small group intervention holds promise for hard to reach rural populations. Modifications should include expanded recruitment venues, sample size, intervention dosage and longer term assessment. Community to clinic navigation combined diabetes self-management and navigation. CCN showed some positive trends in diet, triglycerides, self-care, and diabetes. CCN was feasible (low cost and high retention) and satisfactory. Increasing dose, length, and recruitment venues may improve the CCN intervention.
Collapse
Affiliation(s)
- Nancy E Schoenberg
- 125 Medical Behavioral Science Office Building, University of Kentucky, Lexington, KY 40536-0086, USA
| | - Gabriele Ciciurkaite
- Department of Sociology, Social Work and Anthropology, Utah State University, 0730 Old Main Hill, Logan, UT 84322-0730, USA
| | - Mary Kate Greenwood
- University of Kentucky College of Medicine, UK Medical Center MN 150, Lexington, KY 40536-0298, USA
| |
Collapse
|
32
|
de Groot M, Crick KA, Long M, Saha C, Shubrook JH. Lifetime Duration of Depressive Disorders in Patients With Type 2 Diabetes. Diabetes Care 2016; 39:2174-2181. [PMID: 27729427 PMCID: PMC5127229 DOI: 10.2337/dc16-1145] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/25/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Depression in patients with type 2 diabetes (T2D) is associated with long-term complications, disability, and early mortality. No studies have systematically examined the length of episodes and remission in adults with major depressive disorder (MDD) and T2D. This study examined the course of depressive disorders in patients with T2D and MDD. RESEARCH DESIGN AND METHODS Participants (N = 50) enrolled in a behavioral intervention for adults with T2D and MDD were interviewed using the Structured Clinical Interview for DSM-IV-TR to assess history of depressive disorders at baseline (lifetime history), postintervention, and 3-month follow-up. Onset and remission dates were recorded for all Axis I depressive disorders from birth to final interview. RESULTS Average number of MDD episodes was 1.8 with a mean duration of 23.4 months (SD 31.9; range 0.5-231.3). Over the life course, mean exposure to MDD was 43.1 months (SD 46.5; range 0.5-231.3). Kaplan-Meier survival curve analysis indicated median episode duration decreased with subsequent episodes (14 months, first episode; 9 months, second episode; P < 0.002). In patients with multiple depressive episodes, recovery time was shorter with each subsequent episode (P = 0.002). No differences in length of episode or remission were observed based on chronology of T2D diagnosis. CONCLUSIONS The overall exposure to depression in this sample of adults with T2D represents a substantial period of time that can contribute to negative medical and psychiatric outcomes. Recurrent episodes decrease in duration as do recovery periods, resulting in a waxing and waning pattern. Findings from this study underscore the need to effectively diagnose and treat depression in patients with T2D to minimize risk of future depressive episodes.
Collapse
Affiliation(s)
- Mary de Groot
- Diabetes Translational Research Center, Indiana University School of Medicine, Indianapolis, IN
| | - Kent A Crick
- Diabetes Translational Research Center, Indiana University School of Medicine, Indianapolis, IN
| | - Molly Long
- Diabetes Translational Research Center, Indiana University School of Medicine, Indianapolis, IN
| | - Chandan Saha
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
| | - Jay H Shubrook
- Touro University California College of Osteopathic Medicine, Vallejo, CA
| |
Collapse
|
33
|
Zhang Y, Mei S, Yang R, Chen L, Gao H, Li L. Effects of lifestyle intervention using patient-centered cognitive behavioral therapy among patients with cardio-metabolic syndrome: a randomized, controlled trial. BMC Cardiovasc Disord 2016; 16:227. [PMID: 27863480 PMCID: PMC5116154 DOI: 10.1186/s12872-016-0398-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 11/07/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Cardio-metabolic syndrome (CMS) is a highly prevalent condition. There is an urgent need to identify effective and integrated multi-disciplinary approaches that can reduce risk factors for CMS. METHODS Sixty-two patients with a history of CMS were randomized 1:1 into two groups: a standard information -only group (control), or a self-regulated lifestyle waist circumference (patient-centered cognitive behavioral therapy) intervention group. A pretest and posttest, controlled, experimental design was used. Outcomes were measured at the baseline (week 0) and at the end of intervention (week 12). Comparisons were drawn between groups and over time. RESULTS The mean (standard deviation) age of the subjects was 48.6 (5.8) years ranging from 32 to 63, and 56.9% of the participants were female. Both groups showed no significant differences in Demographic variables and the metabolic syndrome indicators at baseline. While the control group only showed modest improvement after 12 weeks, compared to baseline, the intervention group demonstrated significant improvement from baseline. This study controlled for patients' demographics and baseline characteristics when assessing the effects of intervention. After adjusting for age, education and baseline level, the experimental group and the control group were statistically significant different in the following post-treatment outcomes: WC (F = 35.96, P < 0.001), TG (F = 18.93, P < 0.001), RSBP (F = 33.89, P < 0.001) and SF-36(F = 157.93, P < 0.001). The results showed patients' age and education were not strong predictors of patients' outcome (including WC, TG, RSBP and SF-36). CONCLUSIONS Lifestyle intervention on patient-centered cognitive behavioral therapy can improve the physical and mental health conditions among individuals reporting a history of cardio-metabolic syndrome, and possibly provided preliminary benefits for the treatment of CMS. TRIAL REGISTRATION Chinese Clinical Trial Register #, ChiCTR15006148 .
Collapse
Affiliation(s)
- Ying Zhang
- Department of Children and Adolescent Health Care, School of Public Health, Jilin University, #1163 Xinmin Street, Changchun, 130021 People’s Republic of China
- Department of Education, The First Affiliated Hospital, Jinzhou Medical University, Jinzhou, China
| | - Songli Mei
- Department of Children and Adolescent Health Care, School of Public Health, Jilin University, #1163 Xinmin Street, Changchun, 130021 People’s Republic of China
| | - Rui Yang
- Department of Internal Medicine, The First Affiliated Hospital, Jinzhou Medical University, Jinzhou, China
| | - Ling Chen
- Department of Internal Medicine, The First Affiliated Hospital, Jinzhou Medical University, Jinzhou, China
| | - Hang Gao
- Department of Internal Medicine, The First Affiliated Hospital, Jinzhou Medical University, Jinzhou, China
| | - Li Li
- Faculty of Humanity Management, Jinzhou Medical University, Jinzhou, China
| |
Collapse
|
34
|
|
35
|
Vahedi H, Khosravi A, Sadeghi Z, Aliyari R, Shabankhamseh A, Mahdavian M, Binesh E, Amiri M. Health-Promoting Lifestyle in Patients with and without Diabetes in Iran. HEALTH SCOPE 2016. [DOI: 10.17795/jhealthscope-39428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
36
|
Diabetes and brain health: implications for practice. Ir J Psychol Med 2016; 33:179-191. [PMID: 30115190 DOI: 10.1017/ipm.2015.55] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND It is widely accepted that people with mental illness have increased risk of cardiometabolic complications such as obesity and type 2 diabetes mellitus. What is less well known is that individuals with diabetes have an increased risk of brain health complications including depression, cognitive impairment and dementia. These conditions can adversely influence disease self-management and further increase risk of other diabetes complications. Aim The aim of this paper is to highlight the increased risk of brain health complications in populations with diabetes in order to promote awareness of such complications among healthcare professionals and encourage timely intervention. METHODS An overview of the prevalence and potential mechanisms linking depression and cognitive impairment with diabetes as well as implications for detection, management and brain health protection, based on a narrative review of the literature. CONCLUSIONS Early detection and effective management of depression and cognitive impairment among individuals with diabetes has the potential to minimise adverse health outcomes. In order to promote screening healthcare professionals caring for individuals with diabetes in all settings must be aware of the increased risk of brain health complications in this vulnerable population.
Collapse
|
37
|
Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Fischl AH, Maryniuk MD, Siminerio L, Vivian E. Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Clin Diabetes 2016; 34:70-80. [PMID: 27092016 PMCID: PMC4833481 DOI: 10.2337/diaclin.34.2.70] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Joan Bardsley
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, MD
| | | | - Paulina Duker
- Lifescan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates
| | | | | | | | - Linda Siminerio
- School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Eva Vivian
- University of Wisconsin–Madison, Madison, WI
| |
Collapse
|
38
|
Schneider KL, Panza E, Handschin B, Ma Y, Busch AM, Waring ME, Appelhans BM, Whited MC, Keeney J, Kern D, Blendea M, Ockene I, Pagoto SL. Feasibility of Pairing Behavioral Activation With Exercise for Women With Type 2 Diabetes and Depression: The Get It Study Pilot Randomized Controlled Trial. Behav Ther 2016; 47:198-212. [PMID: 26956652 PMCID: PMC4863641 DOI: 10.1016/j.beth.2015.10.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 10/16/2015] [Accepted: 10/21/2015] [Indexed: 12/20/2022]
Abstract
Major depressive disorder is often comorbid with diabetes and associated with worse glycemic control. Exercise improves glycemic control and depression, and thus could be a parsimonious intervention for patients with comorbid diabetes and major depression. Because patients with diabetes and comorbid depression are often sedentary and lack motivation to exercise, we developed a group exercise intervention that integrates strategies from behavioral activation therapy for depression to increase motivation for and enjoyment of exercise. We conducted a 6-month pilot randomized controlled trial to test the feasibility of the behavioral activation exercise intervention (EX) for women with diabetes and depression. Of the 715 individuals who contacted us about the study, 29 participants were randomized to the EX condition or an enhanced usual care condition (EUC), which represents 4.1% of participants who initially contacted us. Inclusion criteria made recruitment challenging and limits the feasibility of recruiting women with diabetes and depression for a larger trial of the intervention. Retention was 96.5% and 86.2% at 3 and 6months. Participants reported high treatment acceptability; use of behavioral activation strategies and exercise class attendance was acceptable. No condition differences were observed for glycemic control, depressive symptoms, and physical activity, though depressive symptoms and self-reported physical activity improved over time. Compared to participants in the EUC condition, participants in the EX condition reported greater exercise enjoyment and no increase in avoidance behavior over time. Using behavioral activation strategies to increase exercise is feasible in a group exercise setting. However, whether these strategies can be delivered in a less intensive manner to a broader population of sedentary adults, for greater initiation and maintenance of physical activity, deserves further study.
Collapse
Affiliation(s)
| | | | | | | | - Andrew M Busch
- The Miriam Hospital and Alpert Medical School of Brown University
| | | | | | | | - Jacey Keeney
- Rosalind Franklin University of Medicine & Science
| | - Daniel Kern
- Rosalind Franklin University of Medicine & Science
| | | | - Ira Ockene
- University of Massachusetts Medical School
| | | |
Collapse
|
39
|
|
40
|
Psychosocial interventions for people with diabetes and co-morbid depression. A systematic review. Int J Nurs Stud 2015; 52:1625-39. [DOI: 10.1016/j.ijnurstu.2015.05.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 04/07/2015] [Accepted: 05/29/2015] [Indexed: 12/14/2022]
|
41
|
de Groot M, Shubrook J, Schwartz F, Hornsby WG, Pillay Y, Saha C. Program ACTIVE II: Design and Methods for a Multi-Center Community-Based Depression Treatment for Rural and Urban Adults with Type 2 Diabetes. ACTA ACUST UNITED AC 2015; 1. [PMID: 27500279 PMCID: PMC4974010 DOI: 10.16966/2380-5544.108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective Depression affects one in four adults with type 2 diabetes (T2DM) and is associated with worsened diabetes complications, increased health care costs and early mortality. Rural and low-income urban areas, including the Appalachian region, represent an epicenter of the T2DM epidemic. Program ACTIVE II is a comparative effectiveness treatment trial designed to test whether a combination of cognitive behavioral therapy (CBT) and community-based exercise (EXER) will offer greater improvements in diabetes and depression outcomes compared to individual treatment approaches and usual care (UC). The secondary aims are to assess changes in cardiovascular risk factors across groups and to conduct a cost-effectiveness analysis of predicted incidence of cardiovascular complications across groups. Methods The study is a 2-by-2 factorial randomized controlled trial consisting of 4 treatment groups: CBT alone, EXER alone, combination of CBT and EXER, and UC. Adults with T2DM for > 1 year and who meet DSM-IVTR criteria for Major Depressive Disorder (MDD) are eligible to participate at two rural Appalachian sites (southeastern Ohio and West Virginia) and one urban site (Indianapolis). This type II behavioral translation study uses a community-engaged research (CEnR) approach by incorporating community fitness centers and mental health practices as interventionists. Conclusions This is the first study to evaluate the comparative effectiveness of combined CBT and exercise in the treatment of depression using community-based intervention delivery. This approach may serve as a national model for expanding depression treatment for patients with T2DM.
Collapse
Affiliation(s)
| | | | - Frank Schwartz
- Ohio University Heritage College of Osteopathic Medicine, USA
| | | | | | | |
Collapse
|
42
|
Pibernik-Okanović M, Hermanns N, Ajduković D, Kos J, Prašek M, Šekerija M, Lovrenčić MV. Does treatment of subsyndromal depression improve depression-related and diabetes-related outcomes? A randomised controlled comparison of psychoeducation, physical exercise and enhanced treatment as usual. Trials 2015; 16:305. [PMID: 26174334 PMCID: PMC4501064 DOI: 10.1186/s13063-015-0833-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 06/30/2015] [Indexed: 12/11/2022] Open
Abstract
Background Elevated depressive symptoms that do not reach criteria for a clinical diagnosis of depression are highly prevalent in persons with diabetes. This study was aimed at determining the efficacy of psychoeducation and physical exercise compared with enhanced treatment as usual on 1-year changes in depressive symptoms, diabetes distress and self-management, and quality of life and metabolic control in type 2 diabetes patients with subsyndromal depression. Methods Adult type 2 diabetes patients who screened positively for depression and expressed a need for professional help with mood-related issues were eligible. Exclusion criteria were clinical depression, current psychiatric treatment and advanced diabetes complications. Out of 365 eligible patients 209 consented to either 6 weekly sessions of psychoeducation (A) and physical exercise (B), or to enhanced treatment as usual (C). Computer-generated sequences for block randomisation stratified by gender were used. Depressive symptoms (primary outcome) and diabetes distress, diabetes self-care, metabolic control and health-related quality of life (secondary outcomes) were analysed at 6-month and 12-month follow-up using repeated-measures ANOVAs. Results Out of the 74 patients randomised into group A, 66 into B and 69 into group C, 203 completed the interventions, and 179 patients with all 3 assessments were analysed. Depressive symptoms in participants from the psychoeducational, physical exercise and the enhanced treatment as usual groups improved equally from baseline to 12-month follow-up (time versus time x group effect; F = 12.51, p < 0.001, η2 = 0.07 and F = 0.609, p = 0.656, η2 = 0.007 respectively), as did diabetes distress and quality of life (all p < 0.001), diabetes self-care (p < 0.001 to < 0.05), triglycerides, and total cholesterol and LDL-cholesterol (p < 0.001). Conclusions The employed interventions had comparable positive effects on 12-month psychological and diabetes-related outcomes suggesting that even minimal intervention addressing patients’ diabetes-related problems and concerns had favourable clinical implications and might be sufficient to treat subsyndromal depression. Further investigation is warranted to clarify possible mechanisms of improvement. Trial registration Current Controlled Trials ISRCTN05673017 The message on assigning the above mentioned ISRCTN was received on 11 August 2010 Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0833-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Mirjana Pibernik-Okanović
- Merkur University Hospital, Vuk Vrhovac University Clinic for Diabetes, Zajčeva 19, 10000, Zagreb, Croatia.
| | - Norbert Hermanns
- Forschungsinstitut Diabetes-Akademie Bad Mergentheim (FIDAM GmbH), Theodor Klotzbücher Strasse 12, 97980, Bad Mergentheim, Germany.
| | - Dea Ajduković
- Merkur University Hospital, Vuk Vrhovac University Clinic for Diabetes, Zajčeva 19, 10000, Zagreb, Croatia.
| | - Jadranka Kos
- Merkur University Hospital, Vuk Vrhovac University Clinic for Diabetes, Zajčeva 19, 10000, Zagreb, Croatia.
| | - Manja Prašek
- Merkur University Hospital, Vuk Vrhovac University Clinic for Diabetes, Zajčeva 19, 10000, Zagreb, Croatia.
| | - Mario Šekerija
- Croatian Institute of Public Health, Rockfellerova 7, 10000, Zagreb, Croatia.
| | - Marijana Vučić Lovrenčić
- Merkur University Hospital, Vuk Vrhovac University Clinic for Diabetes, Zajčeva 19, 10000, Zagreb, Croatia.
| |
Collapse
|
43
|
Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Hess Fischl A, Maryniuk MD, Siminerio L, Vivian E. Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Diabetes Care 2015; 38:1372-82. [PMID: 26048904 DOI: 10.2337/dc15-0730] [Citation(s) in RCA: 273] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - Joan Bardsley
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, MD
| | | | - Paulina Duker
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates
| | | | | | | | - Linda Siminerio
- School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Eva Vivian
- University of Wisconsin-Madison, Madison, WI
| |
Collapse
|
44
|
Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Fischl AH, Maryniuk MD, Siminerio L, Vivian E. Diabetes Self-management Education and Support in Type 2 Diabetes. DIABETES EDUCATOR 2015; 41:417-30. [DOI: 10.1177/0145721715588904] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Margaret A. Powers
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Joan Bardsley
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Marjorie Cypress
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Paulina Duker
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Martha M. Funnell
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Amy Hess Fischl
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Melinda D. Maryniuk
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Linda Siminerio
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| | - Eva Vivian
- International Diabetes Center at Park Nicollet, Minneapolis, Minnesota (Dr Powers)
- MedStar Health Research Institute and MedStar Nursing, Hyattsville, Maryland (Ms Bardsley)
- ABQ Health Partners, Albuquerque, New Mexico (Dr Cypress)
- LifeScan, a Johnson & Johnson Diabetes Solutions Company, Dubai, United Arab Emirates (Ms Duker)
- University of Michigan Medical School, Ann Arbor, Michigan (Ms Funnell)
| |
Collapse
|
45
|
Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Fischl AH, Maryniuk MD, Siminerio L, Vivian E. Diabetes Self-Management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. J Acad Nutr Diet 2015; 115:1323-34. [PMID: 26054423 DOI: 10.1016/j.jand.2015.05.012] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Indexed: 01/15/2023]
|
46
|
Holt RIG, de Groot M, Lucki I, Hunter CM, Sartorius N, Golden SH. NIDDK international conference report on diabetes and depression: current understanding and future directions. Diabetes Care 2014; 37:2067-77. [PMID: 25061135 PMCID: PMC4113168 DOI: 10.2337/dc13-2134] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Comorbid diabetes and depression are a major clinical challenge as the outcomes of each condition are worsened by the other. This article is based on the presentations and discussions during an international meeting on diabetes and depression convened by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) in collaboration with the National Institute of Mental Health and the Dialogue on Diabetes and Depression. While the psychological burden of diabetes may contribute to depression in some cases, this explanation does not sufficiently explain the relationship between these two conditions. Shared biological and behavioral mechanisms, such as hypothalamic-pituitary-adrenal axis activation, inflammation, autonomic dysfunction, sleep disturbance, inactive lifestyle, poor dietary habits, and environmental and cultural risk factors, are important to consider in understanding the link between depression and diabetes. Both individual psychological and pharmacological depression treatments are effective in people with diabetes, but the current range of treatment options is limited and has shown mixed effects on glycemic outcomes. More research is needed to understand what factors contribute to individual differences in vulnerability, treatment response, and resilience to depression and metabolic disorders across the life course and how best to provide care for people with comorbid diabetes and depression in different health care settings. Training programs are needed to create a cross-disciplinary workforce that can work in different models of care for comorbid conditions.
Collapse
Affiliation(s)
- Richard I G Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, U.K.
| | - Mary de Groot
- Diabetes Translational Research Center, Indiana University School of Medicine, Indianapolis, IN
| | - Irwin Lucki
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Christine M Hunter
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes and the Dialogue on Diabetes and Depression, Geneva, Switzerland
| | - Sherita H Golden
- Departments of Medicine and Epidemiology, Johns Hopkins University Schools of Medicine and Public Health, Baltimore, MD
| |
Collapse
|
47
|
Hatakeyama Y, Kataoka H, Nakajima N, Watabe T, Fujimoto S, Okuhara Y. Prediction model for glucose metabolism based on lipid metabolism. Methods Inf Med 2014; 53:357-63. [PMID: 24986162 DOI: 10.3414/me14-01-0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 04/18/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVES We developed a robust, long-term clinical prediction model to predict conditions leading to early diabetes using laboratory values other than blood glucose and insulin levels. Our model protects against missing data and noise that occur during long-term analysis. METHODS RESULTS of a 75-g oral glucose tolerance test (OGTT) were divided into three groups: diabetes, impaired glucose tolerance (IGT), and normal (n = 114, 235, and 325, respectively). For glucose metabolic and lipid metabolic parameters, near 30-day mean values and 10-year integrated values were compared. The relation between high-density lipoprotein cholesterol (HDL-C) and variations in HbA1c was analyzed in 158 patients. We also constructed a state space model consisting of an observation model (HDL-C and HbA1c) and an internal model (disorders of lipid metabolism and glucose metabolism) and applied this model to 116 cases. RESULTS The root mean square error between the observed HbA1c and predicted HbA1c was 0.25. CONCLUSIONS In the observation model, HDL-C levels were useful for prediction of increases in HbA1c. Even with numerous missing values over time, as occurs in clinical practice, clinically valid predictions can be made using this state space model.
Collapse
Affiliation(s)
- Y Hatakeyama
- Yutaka Hatakeyama, Center of Medical Information Science, Kochi University Medical School, Oko-cho Kohasu, Nankoku, Kochi, Kochi 783-8505, Japan, E-mail:
| | | | | | | | | | | |
Collapse
|
48
|
Penckofer S, Doyle T, Byrn M, Lustman PJ. State of the science: depression and type 2 diabetes. West J Nurs Res 2014; 36:1158-82. [PMID: 24577866 DOI: 10.1177/0193945914524491] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Depression is a significant comorbid condition in diabetes. Individuals with type 2 diabetes (T2DM) are 2 times more likely to experience depression or elevated depressive symptoms compared to those without T2DM. The aims of this state of the science review were to summarize the putative links between diabetes and depression and review empirically supported treatments of depression in diabetes. Findings suggest that a bidirectional association between depression and T2DM exists and that several biological and psychosocial mediators underlie these conditions. Available data indicate that conventional treatments (antidepressant medication, cognitive behavioral therapy, and collaborative care) reduce depression and symptoms of depression; however more controlled studies and development of novel therapies are needed. Glycemic outcomes have most frequently been examined, but findings have been mixed. Self-care and adherence outcomes have been less well studied. Emerging evidence suggests that these outcomes may be important targets for future depression research in T2DM.
Collapse
Affiliation(s)
| | - Todd Doyle
- Loyola University Chicago, Maywood, IL, USA
| | - Mary Byrn
- Saint Mary's College, Notre Dame, IN, USA
| | | |
Collapse
|
49
|
Kendzor DE, Chen M, Reininger BM, Businelle MS, Stewart DW, Fisher-Hoch SP, Rentfro AR, Wetter DW, McCormick JB. The association of depression and anxiety with glycemic control among Mexican Americans with diabetes living near the U.S.-Mexico border. BMC Public Health 2014; 14:176. [PMID: 24548487 PMCID: PMC3929559 DOI: 10.1186/1471-2458-14-176] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 02/12/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The prevalence of diabetes is alarmingly high among Mexican American adults residing near the U.S.-Mexico border. Depression is also common among Mexican Americans with diabetes, and may have a negative influence on diabetes management. Thus, the purpose of the current study was to evaluate the associations of depression and anxiety with the behavioral management of diabetes and glycemic control among Mexican American adults living near the border. METHODS The characteristics of Mexican Americans with diabetes living in Brownsville, TX (N = 492) were compared by depression/anxiety status. Linear regression models were conducted to evaluate the associations of depression and anxiety with BMI, waist circumference, physical activity, fasting glucose, and glycated hemoglobin (HbA1c). RESULTS Participants with clinically significant depression and/or anxiety were of greater age, predominantly female, less educated, more likely to have been diagnosed with diabetes, and more likely to be taking diabetes medications than those without depression or anxiety. In addition, anxious participants were more likely than those without anxiety to have been born in Mexico and to prefer study assessments in Spanish rather than English. Greater depression and anxiety were associated with poorer behavioral management of diabetes (i.e., greater BMI and waist circumference; engaging in less physical activity) and poorer glycemic control (i.e., higher fasting glucose, HbA1c). CONCLUSIONS Overall, depression and anxiety appear to be linked with poorer behavioral management of diabetes and glycemic control. Findings highlight the need for comprehensive interventions along the border which target depression and anxiety in conjunction with diabetes management.
Collapse
Affiliation(s)
- Darla E Kendzor
- School of Public Health, The University of Texas Health Science Center, Dallas, TX, USA
- Population Science and Cancer Control Program, UT Southwestern Harold C. Simmons Cancer Center, Dallas, TX, USA
| | - Minxing Chen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Belinda M Reininger
- School of Public Health, The University of Texas Health Science Center, Brownsville, TX, USA
| | - Michael S Businelle
- School of Public Health, The University of Texas Health Science Center, Dallas, TX, USA
- Population Science and Cancer Control Program, UT Southwestern Harold C. Simmons Cancer Center, Dallas, TX, USA
| | - Diana W Stewart
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan P Fisher-Hoch
- School of Public Health, The University of Texas Health Science Center, Brownsville, TX, USA
| | - Anne R Rentfro
- College of Nursing, The University of Texas at Brownsville, Brownsville, TX, USA
| | - David W Wetter
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph B McCormick
- School of Public Health, The University of Texas Health Science Center, Brownsville, TX, USA
| |
Collapse
|
50
|
Wang IK, Tsai MK, Liang CC, Yen TH, Huang CC, Wen SF, Wen CP. The role of physical activity in chronic kidney disease in the presence of diabetes mellitus: a prospective cohort study. Am J Nephrol 2013; 38:509-516. [PMID: 24356340 DOI: 10.1159/000357133] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 11/06/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND/AIMS Although the effect of exercise on health is well established, nephrologists seldom consider physical activity in the treatment of chronic kidney disease (CKD) or CKD in the presence of diabetes mellitus (DM/CKD). The aim of the present study was to analyze the benefits of leisure-time physical activity (LTPA) in DM/CKD. METHODS A total of 445,075 adult participants who underwent a medical screening program between 1996 and 2008 were prospectively recruited. Of these, 7,863 DM/CKD subjects were identified. Each participant was categorized according to LTPA level (a product of duration and intensity) as inactive, low-active or fully active. Hazard ratios (HRs) for mortality risk were calculated. RESULTS Fully active LTPA was associated with lower odds of DM/CKD development and lower risk of mortality among patients with DM/CKD in a dose-response relationship. The fully active and low-active DM/CKD groups had a 26% (HR 0.74, 95% CI 0.66-0.85) and 13% (HR 0.87, 95% CI 0.75-1.01) lower risk of all-cause mortality, respectively, in comparison to the inactive group. The association of exercise with mortality rate reduction was more pronounced among DM/CKD subjects (mortality rate reduction of 446.5 per 100,000 person-years) than among subjects with diabetes alone or CKD alone. CONCLUSION Exercise, at the recommended level or more, is associated not only with lower odds of DM/CKD but also with a 26% lower mortality risk among DM/CKD patients. Nephrologists should encourage all DM/CKD subjects to be physically active
Collapse
Affiliation(s)
- I-Kuan Wang
- Graduate Institute of Clinical Medical Sciences, China Medical University, Taichung, Taiwan, ROC
| | | | | | | | | | | | | |
Collapse
|