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Pecoli PFG, Rosa ADS, Gabbay MAL, Dib SA. Psycho-Behavioral Characteristics Perceived as Facilitators by Brazilian Adults with Type 1 Diabetes Mellitus in a Public Health Service. Healthcare (Basel) 2023; 11:2300. [PMID: 37628498 PMCID: PMC10454162 DOI: 10.3390/healthcare11162300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Type 1 diabetes imposes a complex and challenging routine on patients and caregivers. Therefore, considering individual experiences and personal facilitators to promote assertive interventions is crucial. However, no studies have addressed these perspectives in the Brazilian adult population. We aimed to identify psycho-behavioral characteristics perceived as facilitators for coping with the condition. We used a biographical method to conduct semi-structured, face-to-face, in-depth interviews for each participant. Transcripts were analyzed using inductive thematic analysis. Participants (n = 22) were aged 18-57 years (mean: 30.2; standard deviation (SD): 8.7), and the duration since diagnosis was approximately 20.6 years (SD: 4.6). A total of 12 (54.4%) were women, 13 (59.1%) used insulin pumps, 14 (63.6%) had at least a college degree, and 13 (59.1%) had HbA1C (glycated hemoglobin) levels above 58 mmol/mol (7.5%). Five major themes emerged: (1) peer learning, (2) ownership, (3) welcoming experiences, (4) equity, and (5) reframing the path (P.O.W.E.R.). All themes appeared in the lived experiences shared by participants with HbA1C levels below 58 mmol/mol (7.5%). Improved glycemic control can be achieved, and the challenges encountered in diabetes care within similar socioeconomic contexts can be addressed by an interdisciplinary care team that takes P.O.W.E.R. into consideration when providing person-centered care strategies.
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Affiliation(s)
| | | | - Mônica Andrade Lima Gabbay
- Diabetes and Endocrinology Center, Internal Medicine Department, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil
| | - Sérgio Atala Dib
- Diabetes and Endocrinology Center, Internal Medicine Department, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil
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Due-Christensen M, Bruun LD, Joensen LE, Norgaard O, Andersen TH. Psychosocial aspects and perspectives of adult-onset type 1 diabetes: A systematic scoping review. Diabet Med 2023; 40:e15073. [PMID: 36807612 DOI: 10.1111/dme.15073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/21/2022] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
AIM To map existing research on psychosocial aspects of adult-onset type 1 diabetes (T1D), including psychosocial health status, ways psychosocial aspects may affect management of T1D in everyday life, and interventions targeting management of adult-onset T1D. METHODS We conducted a systematic search in MEDLINE, EMBASE, CINAHL and PsycInfo. Search results were screened with predefined eligibility criteria, followed by data extraction of the included studies. Charted data were summarized in narrative and tabular form. RESULTS We included 10 reports describing nine studies from the 7302 identified in the search. All studies were conducted in Europe. Participant characteristics were missing in several studies. Five of the nine studies incorporated psychosocial aspects as the main aim of the study. Limited information on psychosocial aspects was available in the remaining studies. We identified three overarching themes related to psychosocial aspects: (1) the impact of the diagnosis on everyday life, (2) the influence of psychosocial health on metabolic levels and adaptation, and (3) provision of self-management support. CONCLUSIONS Research focussing on psychosocial aspects of the adult-onset population is scarce. Future research should involve participants across the adult life age span and from a wider geographical area. Sociodemographic information should be collected to explore different perspectives. Further exploration of suitable outcome measures considering adults' limited experience of living with the condition is needed. This would help to better understand how psychosocial aspects may affect management of T1D in everyday life and thus enable healthcare professionals to provide appropriate support to adults with new-onset T1D.
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Affiliation(s)
- Mette Due-Christensen
- Department of Health Promotion, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Herlev, Denmark
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - L D Bruun
- Danish Diabetes Knowledge Center, Department of Education, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - L E Joensen
- Department of Health Promotion, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - O Norgaard
- Danish Diabetes Knowledge Center, Department of Education, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - T H Andersen
- Danish Diabetes Knowledge Center, Department of Education, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
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Liew AYL, Holmes-Truscott E, Flatt AJS, Bennett D, Crookston R, Pimkova M, Birtles L, Casey J, Pernet A, Wood RC, Choudhary P, Forbes S, Rutter MK, Rosenthal M, Johnson P, Shaw JAM, Speight J. Characterization of pre-transplant psychosocial burden in an integrated national islet transplant program. Islets 2020; 12:21-31. [PMID: 32815765 PMCID: PMC7527016 DOI: 10.1080/19382014.2020.1736740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The psychological burden experienced by people with diabetes prior to islet transplantation is recognized but has not been studied comprehensively, especially in relation to glycemia. Therefore, we conducted a rigorous pre-operative psychosocial profile of UK islet transplant recipients, and compared groups with higher/lower HbA1 c to test the null hypothesis that pre-transplant hypoglycemia awareness and psychosocial burden would not be related to baseline HbA1 c in this high-risk cohort. Pre-transplant, recipients (n = 44) completed validated hypoglycemia awareness questionnaires and generic/diabetes-specific measures of psychological traits and states. Scores were compared in groups, dichotomized by HbA1 c (≤8% versus >8%). Participants were aged (mean±SD) 53 ± 10 years; 64% were women; with HbA1 c 8.3 ± 1.7%. Median rate of severe hypoglycemia over the preceding 12 months was 13 events/person-year and 90% had impaired awareness of hypoglycemia (Gold/Clarke score ≥4). Participants had elevated fear of hypoglycemia (HFS-II Worry), impaired diabetes-specific quality of life (DQoL) and low generic health status (SF-36; EQ-5D). One quarter reported scores indicating likely anxiety/depression (HAD). Dispositional optimism (LOT-R) and generalized self-efficacy (GSE) were within published 'norms.' Despite negative perceptions of diabetes (including low personal control), participants were confident that islet transplantation would help (BIPQ). Hypoglycemia awareness and psychosocial profile were comparable in lower (n = 24) and higher (n = 20) HbA1 c groups. Islet transplant candidates report sub-optimal generic psychological states (anxiety/depressive symptoms), health status and diabetes-specific psychological states (fear of hypoglycemia, diabetes-specific quality of life). While their generic psychological traits (optimism, self-efficacy) are comparable with the general population, they are highly optimistic about forthcoming transplant. HbA1 c is not a proxy measure of psychosocial burden, which requires the use of validated questionnaires to systematically identify those who may benefit most from psychological assessment and support.
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Affiliation(s)
- Aaron YL Liew
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Elizabeth Holmes-Truscott
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Anneliese JS Flatt
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Denise Bennett
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Robert Crookston
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Mirka Pimkova
- Institute of Immunity and Transplantation, Royal Free Hospital, London, UK
| | - Linda Birtles
- Manchester Academic Health Science Centre (MAHSC), Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - John Casey
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Andrew Pernet
- Department of Diabetes, School of Life Course Sciences, King’s College London, London, UK
| | - Ruth C Wood
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Pratik Choudhary
- Department of Diabetes, School of Life Course Sciences, King’s College London, London, UK
| | - Shareen Forbes
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
- BHF Centre for Cardiovascular Sciences, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Martin K Rutter
- Manchester Academic Health Science Centre (MAHSC), Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK
| | - Miranda Rosenthal
- Institute of Immunity and Transplantation, Royal Free Hospital, London, UK
| | - Paul Johnson
- Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - James AM Shaw
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- CONTACT James Am Shaw Translational and Clinical Research Institute, Newcastle University, the Medical School, Framlington Place, Newcastle upon TyneNE2 4HH, UK
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
- AHP Research, Hornchurch, UK
- Jane Speight The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne, VIC3000, Australia
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Wisting L, Rø A, Skrivarhaug T, Dahl-Jørgensen K, Rø Ø. Disturbed eating, illness perceptions, and coping among adults with type 1 diabetes on intensified insulin treatment, and their associations with metabolic control. J Health Psychol 2019; 26:688-700. [DOI: 10.1177/1359105319840688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This study investigated associations between psychological aspects and metabolic control among adults with type 1 diabetes ( n = 282). Linear regression analyses demonstrated that the illness perception personal control and the coping strategy seeking emotional social support explained 23.2 percent of the variance in hemoglobin A1c among females ( β = 0.40, p < 0.001 and β = −0.22, p < 0.01, respectively). Among males, only personal control remained significant, explaining 13.9 percent of the variance in hemoglobin A1c ( β = 0.37, p < 0.001). The associations between psychological correlates and hemoglobin A1c indicate that addressing such aspects clinically may facilitate metabolic control, thereby potentially contributing to reduce the risk of complications.
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Affiliation(s)
- Line Wisting
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway
- Oslo Diabetes Research Centre, Norway
| | - Astrid Rø
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Torild Skrivarhaug
- Oslo Diabetes Research Centre, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
- The Norwegian Diabetic Centre, Oslo, Norway
- Department of Paediatric and Adolescent Medicine, Oslo University Hospital, Norway
| | - Knut Dahl-Jørgensen
- Oslo Diabetes Research Centre, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
- The Norwegian Diabetic Centre, Oslo, Norway
- Department of Paediatric and Adolescent Medicine, Oslo University Hospital, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway
- Institute of Clinical Medicine, Mental Health and Addiction, University of Oslo, Norway
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Sionti V, Papageorgiou G, Peschos D, Charalambous G, Kotrotsiou E, Christodoulides P, Zakopoulou V, Gouva M. Quality of life in patients with type 2 diabetes mellitus: a cross-sectional study. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2019. [DOI: 10.1108/ijphm-02-2018-0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to investigate certain social and psychological parameters and to compare them with basic demographic information, such as the gender and the education, of patients suffering from Type 2 diabetes mellitus (T2DM).
Design/methodology/approach
A cross-sectional study of Type 2 diabetic patients was conducted. In total, 200 patients with T2DM were enrolled in the study. Psychological factors were assessed with questionnaires, including the Symptom Checklist 90-R (SCL-90-R), the Short-Form Health Survey (SF-36), the Life Orientation Test-Revised (LOT-R) and the Cardiac Anxiety Questionnaire (CAQ). The associations of psychological with socio-demographic factors were assessed through logistic regression analyses.
Findings
Women patients had higher levels of heart-focused anxiety psychopathology than men, and therefore, women tend to avoid activities that burden the heart. Men patients had a significantly higher index of physical functionality than women. No differences were recorded by the SCL-90R questionnaire between men and women. For the patients with elementary education, lower levels of mental health (SF-36-MCS) were observed.
Originality/value
The chronicity of the disease aggravates the psychopathology of the patients thereby creating adverse impact not only on health but also on efforts for compliance. A personalized approach by the health professionals could contribute in addressing the psychological factors that accompany T2DM.
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Personality Functioning in Adolescents and Emerging Adults With Type 1 Diabetes. J Adolesc Health 2018; 63:792-798. [PMID: 30266568 DOI: 10.1016/j.jadohealth.2018.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 06/27/2018] [Accepted: 06/27/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE Although prior research has stressed the role of personality in adjusting to type 1 diabetes, longitudinal research is lacking. The objectives of the present study were twofold: (1) to chart the development of patients' personality over a 2-year period; and (2) to examine prospective associations among personality, treatment adherence, glycemic control, and diabetes-specific distress. METHODS Adolescents and emerging adults with type 1 diabetes, aged 14-25 years (Mage = 18.86 years, 54% female), participated in a three-wave longitudinal study spanning 2 years (n = 560 at Time 1). Patients filled out questionnaires on Big Five personality traits, treatment adherence, and diabetes-specific distress. HbA1c values were obtained from treating physicians. We used latent growth curve modeling to examine the development of patients' personality. Cross-lagged path analysis was performed to examine prospective associations among the study variables. RESULTS First, we observed mean-level increases in extraversion, agreeableness, and conscientiousness over the course of the study. Second, we uncovered bidirectional associations between personality and several important indicators of adjustment. Lower conscientiousness and higher extraversion predicted a relative decrease in treatment adherence 1 year later. Poorer treatment adherence, in turn, predicted relative decreases in conscientiousness and agreeableness over time. Furthermore, lower emotional stability predicted a relative increase in distress 1 year later. Higher distress, in turn, predicted a relative decrease in agreeableness over time. Finally, lower conscientiousness predicted poorer glycemic control 1 year later. CONCLUSIONS This study found young patients to move toward a more mature personality and stressed the importance of personality in adjusting to type 1 diabetes.
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Novak JR, Anderson JR, Johnson MD, Hardy NR, Walker A, Wilcox A, Lewis VL, Robbins DC. Does Personality Matter in Diabetes Adherence? Exploring the Pathways between Neuroticism and Patient Adherence in Couples with Type 2 Diabetes. Appl Psychol Health Well Being 2017; 9:207-227. [PMID: 28401663 DOI: 10.1111/aphw.12087] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Personality has received some attention in the Type 2 diabetes literature; however, research has not linked personality and diabetes adherence behaviors (diet and exercise), identified pathways through which they are associated, nor taken into consideration important contextual factors that influence behavior (the patient's partner). METHODS Dyadic data from 117 married, heterosexual couples in which one member is diagnosed with Type 2 diabetes was used to explore associations between each partner's neuroticism and patient dietary and exercise adherence through the pathways of negative affect, depression symptoms, and couple-level diabetes efficacy (both patient and spouse report of confidence in the patient's ability to adhere to diabetes management regimens). RESULTS Results revealed that higher levels of neuroticism were associated with lower patient dietary and exercise adherence through (1) higher levels of depression symptoms (for patients' neuroticism) and negative affect (for spouses' neuroticism), and (2) lower levels of couple-level diabetes efficacy. CONCLUSIONS The results from this study provide evidence that both patient and spouse personality traits are associated with patient dietary and exercise adherence through increased emotional distress-albeit different emotional pathways for patients and spouses-and lower couple confidence in the patients' ability to manage their diabetes.
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Affiliation(s)
| | | | | | | | - Ann Walker
- University of Kansas Medical Center, USA
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Gonzalez JS, Tanenbaum ML, Commissariat PV. Psychosocial factors in medication adherence and diabetes self-management: Implications for research and practice. ACTA ACUST UNITED AC 2017; 71:539-551. [PMID: 27690483 DOI: 10.1037/a0040388] [Citation(s) in RCA: 164] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Diabetes is a chronic illness that places a significant self-management burden on affected individuals and families. Given the importance of health behaviors-such as medication adherence, diet, physical activity, blood glucose self-monitoring-in achieving optimal glycemic control in diabetes, interventions designed and delivered by psychologists hold promise in assisting children, adolescents, and adults with diabetes in improving their health status and lowering their risk of serious complications. This article first provides an overview of diabetes self-management and associated challenges and burdens. Socioeconomic status factors that may influence diabetes management and outcomes are briefly highlighted. We then review the evidence base for select psychosocial factors that may be implicated in diabetes self-management. Modifiable targets of psychological intervention are presented across 3 overarching domains: (a) knowledge, beliefs, and related cognitive constructs; (b) emotional distress and well-being; and (c) behavioral skills and coping. Important methodological issues facing future research are discussed, along with opportunities for psychologists in improving the care and treatment outcomes of individuals and families living with diabetes. In conclusion, we advocate for continued research emphasis on improving psychosocial aspects of living with diabetes, with greater attention to the situational context in which the self-regulatory processes underlying self-management occur. Psychologists have important roles to play in reducing emotional distress, improving patient knowledge, and providing training in behavioral skills to promote successful self-management and to support patient-centered diabetes care. (PsycINFO Database Record
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Gottfredson LS, Deary IJ. Intelligence Predicts Health and Longevity, but Why? CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2016. [DOI: 10.1111/j.0963-7214.2004.01301001.x] [Citation(s) in RCA: 383] [Impact Index Per Article: 47.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Large epidemiological studies of almost an entire population in Scotland have found that intelligence (as measured by an IQ-type test) in childhood predicts substantial differences in adult morbidity and mortality, including deaths from cancers and cardiovascular diseases. These relations remain significant after controlling for socioeconomic variables. One possible, partial explanation of these results is that intelligence enhances individuals' care of their own health because it represents learning, reasoning, and problem-solving skills useful in preventing chronic disease and accidental injury and in adhering to complex treatment regimens.
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Affiliation(s)
| | - Ian J. Deary
- Department of Psychology, University of Edinburgh, Edinburgh, Scotland, United Kingdom
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Suchy Y, Turner SL, Queen TL, Durracio K, Wiebe DJ, Butner J, Franchow EI, White PC, Murray MA, Swinyard M, Berg CA. The Relation of Questionnaire and Performance-Based Measures of Executive Functioning With Type 1 Diabetes Outcomes Among Late Adolescents. Health Psychol 2016; 35:2016-23418-001. [PMID: 27175580 PMCID: PMC5107170 DOI: 10.1037/hea0000326] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Successfully managing Type 1 diabetes involves adherence to a complex daily medical regimen, requiring self-regulatory skills that rely on neurocognitive processes known as executive functioning (EF). Adolescents with poorer rated EF abilities display poorer diabetes outcomes. The purpose of this study was to examine the relationship of EF questionnaire and performance measures with adherence and glycemic control, after controlling for IQ and general questionnaire response style. METHOD Adolescents with Type 1 diabetes (M age = 17.74, SD = .38 years) and their mothers (N = 196) completed a self/mother-report questionnaire assessing adolescents' ratings of EF abilities (Behavior Rating Inventory of Executive Functioning-Self-Report). Adolescents also completed performance-based tests of EF (Delis-Kaplan Executive Function System) and intellectual functioning (Wechsler Adult Intelligence Scale, 4th ed., Vocabulary). Adherence was indexed via 2 self-report inventories and the number of daily blood glucose checks, and glycemic control via HbA1c obtained from assay kits. RESULTS Self/mother-reports of EF ability were associated with self/mother-reported adherence. Both questionnaire and performance-based measures of EF were associated with glycemic control. However, once IQ was taken into consideration, performance-based EF was no longer associated with glycemic control; IQ independently shared variance with glycemic control. CONCLUSION Our findings suggest that self-reports of EF may be useful in identifying late adolescents who need assistance in managing diabetes in daily life. The finding that performance-based EF measures were not related to glycemic control independent of underlying intellectual capacity raises questions about the specific role of EF in diabetes outcomes. (PsycINFO Database Record
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Affiliation(s)
- Yana Suchy
- Department of Psychology, University of Utah
| | | | | | | | | | | | | | - Perrin C. White
- Department of Pediatrics, University of Texas Southwestern Medical Center
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Modeling predictors of changes in glycemic control and diabetes-specific quality of life amongst adults with type 1 diabetes 1 year after structured education in flexible, intensive insulin therapy. J Behav Med 2015; 38:817-29. [PMID: 26072044 DOI: 10.1007/s10865-015-9649-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/02/2015] [Indexed: 12/15/2022]
Abstract
Few studies have identified determinants of glycemic control (HbA1c) and diabetes-specific quality of life (DSQoL) in adults with type 1 diabetes. To identify factors predicting outcomes following structured diabetes education. 262 participants completed biomedical and questionnaire assessments before, and throughout 1 year of follow-up. The proportion of variance explained ranged from 28 to 62 % (DSQoLS) and 14-20 % (HbA1c). When change in psychosocial variables were examined, reduced hypoglycemia fear, lower 'perceived diabetes seriousness', greater self-efficacy and well-being predicted QoL improvements from baseline to 3-months. Increased frequency of blood glucose testing predicted improvements in HbA1c from baseline to 6-months. Greater benefits may be achieved if programs focus explicitly on psychosocial factors. Self-care behaviours did not predict HbA1c suggesting existing assessment tools need refinement. Evaluation of treatment mechanisms in self-management programs is recommended.
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Associations Between Diabetes and Cognitive Function in Socioeconomically Diverse African American and White Men and Women. Psychosom Med 2015; 77:643-52. [PMID: 26163817 PMCID: PMC4563816 DOI: 10.1097/psy.0000000000000196] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To examine whether race and poverty (income <125% of the federal poverty limit), modifies associations between diabetes and cognition in a biracial, urban-dwelling sample. METHODS Cross-sectional data for 2066 participants (mean age = 47.6 years, 56.8% women, 56.2% African American, 38.6% below poverty) from the first wave of the Healthy Aging in Neighborhoods of Diversity across the Life Span study were used for analyses. Eleven tests measured cognitive function. Interactions among diabetes, race, and poverty status with cognition were assessed in multiple regression analyses. RESULTS Significant interactions among diabetes, race, and poverty status were observed. Among African Americans below poverty, diabetic individuals performed lower than nondiabetic individuals on California Verbal Learning Test Free Recall Short Delay (z = -0.444 [0.123] versus z = -0.137 [0.045]) and Long Delay (z = -0.299 [0.123] versus z = -0.130 [0.045]), Digit Span Backward (z = -0.347 [0.109] versus z = -0.072 [0.041]), and the Brief Test of Attention (z = -0.452 [-0.099] versus z = -0.099 [0.047]), and higher on Category Fluency (z = 0.114 [0.117] versus z = -0.118 [0.044]). No consistent differences between diabetic and nondiabetic individuals were found for African American and white participants above poverty. CONCLUSIONS Diabetes was associated with poorer verbal memory, working memory, and attention among African Americans living in poverty. Diabetic African Americans below poverty may have increased risk of cognitive deficit at a younger age. Improving health literacy, doctor-patient communication, and multidisciplinary medical care for impoverished individuals may reduce differences. Additional research is needed to clarify mechanisms underlying these associations.
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Heller S, Lawton J, Amiel S, Cooke D, Mansell P, Brennan A, Elliott J, Boote J, Emery C, Baird W, Basarir H, Beveridge S, Bond R, Campbell M, Chater T, Choudhary P, Clark M, de Zoysa N, Dixon S, Gianfrancesco C, Hopkins D, Jacques R, Kruger J, Moore S, Oliver L, Peasgood T, Rankin D, Roberts S, Rogers H, Taylor C, Thokala P, Thompson G, Ward C. Improving management of type 1 diabetes in the UK: the Dose Adjustment For Normal Eating (DAFNE) programme as a research test-bed. A mixed-method analysis of the barriers to and facilitators of successful diabetes self-management, a health economic analysis, a cluster randomised controlled trial of different models of delivery of an educational intervention and the potential of insulin pumps and additional educator input to improve outcomes. PROGRAMME GRANTS FOR APPLIED RESEARCH 2014. [DOI: 10.3310/pgfar02050] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BackgroundMany adults with type 1 diabetes cannot self-manage their diabetes effectively and die prematurely with diabetic complications as a result of poor glucose control. Following the positive results obtained from a randomised controlled trial (RCT) by the Dose Adjustment For Normal Eating (DAFNE) group, published in 2002, structured training is recommended for all adults with type 1 diabetes in the UK.AimWith evidence that blood glucose control is not always improved or sustained, we sought to determine factors explaining why some patients benefit from training more than other patients, identifying barriers to successful self-management, while developing other models to make skills training more accessible and effective.FindingsWe confirmed that glycaemic outcomes are not always improved or sustained when the DAFNE programme is delivered routinely, although improvements in psychosocial outcomes are maintained. DAFNE courses and follow-up support is needed to help participants instil and habituate key self-management practices such as regular diary/record keeping. DAFNE graduates need structured professional support following training. This is currently either unavailable or provided ad hoc without a supporting evidence base. Demographic and psychosocial characteristics had minimal explanatory power in predicting glycaemic control but good explanatory power in predicting diabetes-specific quality of life over the following year. We developed a DAFNE course delivered for 1 day per week over 5 weeks. There were no major differences in outcomes between this and a standard 1-week DAFNE course; in both arms of a RCT, glycaemic control improved by less than in the original DAFNE trial. We piloted a course delivering both the DAFNE programme and pump training. The pilot demonstrated the feasibility of a full multicentre RCT and resulted in us obtaining subsequent Health Technology Assessment programme funding. In collaboration with the National Institute for Health Research (NIHR) Diabetes Research Programme at King’s College Hospital (RG-PG-0606-1142), London, an intervention for patients with hypoglycaemic problems, DAFNE HART (Dose Adjustment for Normal Eating Hypoglycaemia Awareness Restoration Training), improved impaired hypoglycaemia awareness and is worthy of a formal trial. The health economic work developed a new type 1 diabetes model and confirmed that the DAFNE programme is cost-effective compared with no structured education; indeed, it is cost-saving in the majority of our analyses despite limited glycated haemoglobin benefit. Users made important contributions but this could have been maximised by involving them with grant writing, delaying training until the group was established and funding users’ time off work to maximise attendance. Collecting routine clinical data to conduct continuing evaluated roll-out is possible but to do this effectively requires additional administrator support and/or routine electronic data capture.ConclusionsWe propose that, in future work, we should modify the current DAFNE curricula to incorporate emerging understanding of behaviour change principles to instil and habituate key self-management behaviours that include key DAFNE competencies. An assessment of numeracy, critical for insulin dose adjustment, may help to determine whether or not additional input/support is required both before and after training. Models of structured support involving professionals should be developed and evaluated, incorporating technological interventions to help overcome the barriers identified above and enable participants to build effective self-management behaviours into their everyday lives.Trial registrationClinicalTrials.gov NCT01069393.FundingThe NIHR Programme Grants for Applied Research programme.
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Affiliation(s)
- Simon Heller
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Julia Lawton
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Debbie Cooke
- Division of Psychology, University College London, London, UK
| | - Peter Mansell
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Alan Brennan
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jackie Elliott
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jonathan Boote
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
- Centre for Research into Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Celia Emery
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Wendy Baird
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Hasan Basarir
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Susan Beveridge
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rod Bond
- School of Psychology, University of Sussex, Brighton, UK
| | - Mike Campbell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Timothy Chater
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Marie Clark
- Division of Psychology, University College London, London, UK
| | | | - Simon Dixon
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | | | - Richard Jacques
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jen Kruger
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Susan Moore
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Lindsay Oliver
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Tessa Peasgood
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - David Rankin
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Sue Roberts
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | | | - Carolin Taylor
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Praveen Thokala
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Gill Thompson
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Candice Ward
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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14
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Rassart J, Luyckx K, Klimstra TA, Moons P, Groven C, Weets I. Personality and Illness Adaptation in Adults with Type 1 Diabetes: The Intervening Role of Illness Coping and Perceptions. J Clin Psychol Med Settings 2014; 21:41-55. [DOI: 10.1007/s10880-014-9387-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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15
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Rassart J, Luyckx K, Moons P, Weets I. Personality and self-esteem in emerging adults with Type 1 diabetes. J Psychosom Res 2014; 76:139-45. [PMID: 24439690 DOI: 10.1016/j.jpsychores.2013.11.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 11/21/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The present study examined (1) mean-level differences in self-esteem and Big Five personality traits between individuals with and without diabetes; and (2) demographic, clinical, and psychological correlates of patients' self-esteem and Big Five. RESEARCH DESIGN AND METHODS A total of 478 emerging adults with Type 1 diabetes (18-35 years old) were selected from the Belgian Diabetes Registry and completed questionnaires on personality, self-esteem, and diabetes-related distress. The control group consisted of 341 healthy participants who were matched (1:1) on sex and age with the patient group. RESULTS First, mean-level differences between patients and controls differed according to patients' sex and illness duration. Women with diabetes reported lower self-esteem and were less extraverted and emotionally stable as compared to female controls. In contrast, men with diabetes reported higher self-esteem and were more agreeable but less emotionally stable as compared to male controls. Furthermore, whereas both patients with shorter and longer illness duration were less extraverted and emotionally stable as compared to controls, only patients with longer illness duration reported heightened agreeableness. Second, self-esteem and Big Five were found to relate to patients' sex and (to a lesser extent) age and illness duration. Finally, patients reporting elevated diabetes-related distress reported lower self-esteem, and were less agreeable and emotionally stable as compared to patients not reporting such distress. CONCLUSIONS Patients' personality and self-esteem might be important targets for future prevention and intervention efforts. The present findings can assist healthcare professionals in identifying those patients who might benefit the most from such programs.
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Affiliation(s)
| | | | - Philip Moons
- KU Leuven, Leuven, Belgium; University Hospitals of Leuven, Leuven, Belgium; The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ilse Weets
- Free University Brussels, Brussels, Belgium
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16
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Fickley CE, Lloyd CE, Costacou T, Miller RG, Orchard TJ. Type A behavior and risk of all-cause mortality, CAD, and CAD-related mortality in a type 1 diabetic population: 22 years of follow-up in the Pittsburgh Epidemiology of Diabetes Complications Study. Diabetes Care 2013; 36:2974-80. [PMID: 23835685 PMCID: PMC3781516 DOI: 10.2337/dc13-0266] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether type A behavior predicts all-cause mortality and incident coronary artery disease (CAD) in a type 1 diabetic population. RESEARCH DESIGN AND METHODS Follow-up data (22 years) from the Pittsburgh Epidemiology of Diabetes Complications (EDC) study of childhood-onset type 1 diabetes were analyzed for the 506 participants who completed the Bortner Rating Scale (measuring type A behavior) and Beck Depression Inventory (BDI) at baseline (1986-1988). CAD comprised myocardial infarction as determined by hospital records/Q waves on electrocardiogram (ECG), CAD death (determined by a mortality classification committee), angiographic stenosis, ischemic ECG, and angina. RESULTS There were 128 deaths (25.3%) during follow-up. Univariate analysis showed an inverse relationship between Bortner scores and all-cause mortality (P=0.01), which remained significant after allowing for age, sex, duration, HbA1c, education, smoking, BMI, and physical activity (P=0.03). However, the addition of BDI scores attenuated the relationship (P=0.11) with a significant interaction (P=0.03) such that any protective effect against mortality was limited among individuals with lower BDI scores (bottom three quintiles) (P=0.07), whereas no effect was seen in those with higher BDI scores (P=0.97). Bortner scores showed only a borderline association with incident CAD (P=0.09). CONCLUSIONS Those with higher type A behavior have lower all-cause mortality in our type 1 diabetic population, an effect that interacts with depressive symptomatology such that it is only operative in those with low BDI scores. Further research should focus on understanding this interaction.
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17
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Rotella F, Cresci B, Monami M, Aletti V, Andreoli V, Ambrosio ML, Ricca V, Dicembrini I, Mannucci E. Are psychopathological features relevant predictors of glucose control in patients with type 2 diabetes? A prospective study. Acta Diabetol 2012; 49 Suppl 1:S179-84. [PMID: 22644473 DOI: 10.1007/s00592-012-0403-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 05/08/2012] [Indexed: 12/22/2022]
Abstract
Type 2 diabetes has been associated with an increased prevalence of psychopathology, in comparison with matched non-diabetic controls. However, the cross-sectional design of most studies does not allow causal inferences. The aim of the present study is the exploration of this possible association in patients with type 2 diabetes, in a longitudinal fashion. This prospective observational study was conducted on a consecutive series of 250 type 2 diabetic outpatients and a 1-year follow-up period was performed. At enrollment, a complete medical history was collected and hemoglobin A1c was measured. General psychopathology was assessed using the Symptom Checklist 90-revised and the Eating Disorder Examination Questionnaire. Among the 187 patients available at follow-up, factors associated with unsatisfactory glycemic control at follow-up were baseline hemoglobin A1c, insulin therapy, a longer duration of diabetes, higher scores on the Eating behavior, and Somatization scales. At multivariate analysis, the attainment of hemoglobin A1c ≤ 7 % was associated with baseline hemoglobin A1c (p = 0.01), insulin therapy (p = 0.016), and Eating behavior (p = 0.02), whereas duration of diabetes and Somatization were no longer significant after adjusting for confounders. The results of the present study suggest that clinical features have a much greater impact on attainment of therapeutic goals than psychopathology. However, there are several aspects, such as temperament, motivation, self-efficacy, and well-being, not assessed in the present study, which could be crucial. These areas should be adequately explored for obtaining an overall picture of the psychological determinants of appropriate metabolic control in diabetes.
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Affiliation(s)
- Francesco Rotella
- Diabetes Agency, Careggi Teaching Hospital and University of Florence, Largo Brambilla 3, 50134 Florence, Italy.
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18
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Yang J. Systematical Analysis of the Application of Chinese Traditional Medicine Informatics to Diabetes Proved Recipesw. ACTA ACUST UNITED AC 2012. [DOI: 10.7243/2050-0866-1-11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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19
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Gillani SW, Sulaiman SAS, Sundram S, Victor SC, Abdullah AH. Clinical critics in the management of diabetes mellitus. Health (London) 2012. [DOI: 10.4236/health.2012.48085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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20
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Imayama I, Plotnikoff RC, Courneya KS, Johnson JA. Determinants of quality of life in adults with type 1 and type 2 diabetes. Health Qual Life Outcomes 2011; 9:115. [PMID: 22182307 PMCID: PMC3258220 DOI: 10.1186/1477-7525-9-115] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 12/19/2011] [Indexed: 12/17/2022] Open
Abstract
Background Limited evidence exists on the determinants of quality of life (QoL) specific to adults with type 1 diabetes (T1D). Further, it appears no study has compared the determinants of QoL between T1D and type 2 diabetes (T2D) groups. The objectives of this study were to examine: (1) determinants of QoL in adults with T1D; and, (2) differences in QoL determinants between T1D and T2D groups. Methods The Alberta Longitudinal Exercise and Diabetes Research Advancement (ALEXANDRA) study, a longitudinal study of adults with diabetes in Alberta, Canada. Adults (18 years and older) with T1D (N = 490) and T2D (N = 1,147) provided information on demographics (gender, marital status, education, and annual income), personality (activity trait), medical factors (diabetes duration, insulin use, number of comorbidities, and body mass index), lifestyle behaviors (smoking habits, physical activity, and diet), health-related quality of life (HRQL) and life satisfaction. Multiple regression models identified determinants of HRQL and life satisfaction in adults with T1D. These determinants were compared with determinants for T2D adults reported in a previous study from this population data set. Factors significantly associated with HRQL and life satisfaction in either T1D or T2D groups were further tested for interaction with diabetes type. Results In adults with T1D, higher activity trait (personality) score (β = 0.28, p < 0.01), fewer comorbidities (β = -0.27, p < 0.01), lower body mass index (BMI)(β = -0.12, p < 0.01), being a non-smoker (β = -0.14, p < 0.01), and higher physical activity levels (β = 0.16, p < 0.01) were associated with higher HRQL. Having a partner (β = 0.11, p < 0.05), high annual income (β = 0.16, p < 0.01), and high activity trait (personality) score (β = 0.27, p < 0.01) were significantly associated with higher life satisfaction. There was a significant age × diabetes type interaction for HRQL. The T2D group had a stronger positive relationship between advancing age and HRQL compared to the T1D group. No interaction was significant for life satisfaction. Conclusions Health services should target medical and lifestyle factors and provide support for T1D adults to increase their QoL. Additional social support for socioeconomically disadvantaged individuals living with this disease may be warranted. Health practitioners should also be aware that age has different effects on QoL between T1D and T2D adults.
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Affiliation(s)
- Ikuyo Imayama
- Centre for Health Promotion Studies, School of Public Health, University of Alberta, Edmonton, (T6G 2B3), Canada
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21
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Rasmussen B, Ward G, Jenkins A, King SJ, Dunning T. Young adults' management of Type 1 diabetes during life transitions. J Clin Nurs 2011; 20:1981-92. [PMID: 21545569 DOI: 10.1111/j.1365-2702.2010.03657.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To identify life transitions likely to impact diabetes self-care among young adults with Type 1 diabetes and their coping strategies during transition events. BACKGROUND Relationships among psychosocial stress, adjustment, coping and metabolic control affect clinical outcomes and mental health. Life transitions represent major change and are associated with stress that temporarily affects individuals' problem-solving, coping abilities and blood glucose levels. DESIGN A qualitative interpretive inquiry. METHOD Semi-structured interviews were conducted with 20 young adults with Type 1 diabetes and a constant comparative analysis method. Data and analysis was managed using QSR NVivo 7 software. RESULTS Participants identified two significant transition groups: life development associated with adolescence, going through the education system, entering new relationships, motherhood and the workforce and relocating. Diabetes-related transitions included being diagnosed, developing diabetes complications, commencing insulin pump treatment and going on diabetes camps. Participants managed transitions using 'strategic thinking and planning' with strategies of 'self-negotiation to minimise risks'; 'managing diabetes using previous experiences'; 'connecting with others with diabetes'; 'actively seeing information to 'patch' knowledge gaps'; and 'putting diabetes into perspective'. CONCLUSIONS Several strategies are used to manage diabetes during transitions. Thinking and planning strategically was integral to glycaemic control and managing transitions. The impact of transitions on diabetes needs to be explored in larger and longitudinal studies to identify concrete strategies that assist diabetes care during life transitions. RELEVANCE TO CLINICAL PRACTICE It is important for health professionals to understand the emotional, social and cognitive factors operating during transitions to assist young adults with Type 1 diabetes to achieve good health outcomes by prioritising goals and plan flexible, timely, individualised and collaborative treatment.
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Affiliation(s)
- Bodil Rasmussen
- School of Nursing, Faculty of Health, Medicine, Nursing and Behavioural Sciences, Deakin University, Burwood, Vic., Australia.
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22
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Lawson VL, Bundy C, Belcher J, Harvey JN. Mediation by illness perceptions of the effect of personality and health threat communication on coping with the diagnosis of diabetes. Br J Health Psychol 2010; 15:623-42. [DOI: 10.1348/135910709x478664] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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23
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Brod M, Valensi P, Shaban JA, Bushnell DM, Christensen TL. Patient treatment satisfaction after switching to NovoMix® 30 (BIAsp 30) in the IMPROVE™ study: an analysis of the influence of prior and current treatment factors. Qual Life Res 2010; 19:1285-93. [PMID: 20602172 PMCID: PMC2963740 DOI: 10.1007/s11136-010-9699-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2010] [Indexed: 11/30/2022]
Abstract
Purpose Understanding treatment satisfaction (TS) for diabetes is increasingly important as treatment options increase. This study examines treatment satisfaction with NovoMix® 30 in an observational study in patients with type 2 diabetes. Methods The DiabMedSat assesses Overall, Treatment Burden, Symptom and Efficacy Treatment Satisfaction. The impact of type of pretreatment variables on TS was examined by ANOVA at baseline and week 26. Satisfaction at week 26 was examined by t-test and effect size. Linear regression models examined impact of prior treatment factors (age, gender, duration of diabetes, type of prior treatment and diabetes-related comorbidities) and current treatment factors (weight gain, hypoglycemic events, reaching therapeutic goal) on TS. Results The data set comprised 17,488 persons. Prior treatment with insulin had a more positive impact on baseline satisfaction. At week 26, there were no differences between type of prior treatment groups in Overall, Symptoms and Burden TS. Current treatment with NovoMix 30 significantly improved TS. Regression analyses examining the combined effect of pretreatment factors and current treatment factors found that all factors except for age-impacted TS although the domains impacted varied. Conclusions Patients treated with NovoMix 30 reported improved treatment satisfaction, and the improvement is considered clinically meaningful to patients.
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Affiliation(s)
- Meryl Brod
- The Brod Group, 219 Julia Avenue, Mill Valley, CA 94941, USA.
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24
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Hall PA, Rodin GM, Vallis TM, Perkins BA. The consequences of anxious temperament for disease detection, self-management behavior, and quality of life in Type 2 diabetes mellitus. J Psychosom Res 2009; 67:297-305. [PMID: 19773022 DOI: 10.1016/j.jpsychores.2009.05.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 02/28/2009] [Accepted: 05/27/2009] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study is to examine the consequences of anxious temperament for disease detection, self-management behavior, and quality of life in Type 2 diabetes mellitus (T2DM). METHOD A sample of 204 individuals newly diagnosed with T2DM completed measures of anxious temperament, self-management behavior, and quality of life; participants also supplied a blood sample for glycated hemoglobin (A1C) analysis at initial diagnosis (baseline) and at 6-month follow-up (as indicators of disease progression at diagnosis and achieved glycemic control, respectively). RESULTS Anxious temperament was inversely associated with A1C at both baseline and at 6-month follow-up. However, the association between anxious temperament and A1C at follow-up was mostly accounted for by the association between anxious temperament and baseline A1C and not by the uptake of self-management behaviors after diagnosis. Higher levels of anxious temperament were also associated with an increased likelihood of having been diagnosed with a prediabetic condition but were associated with poorer quality of life at both time points. CONCLUSION Anxious temperament appears to be a double-edged sword that may facilitate early detection but not subsequent behavioral or emotional adjustment to T2DM.
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25
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Expanding the g-nexus: Further evidence regarding the relations among national IQ, religiosity and national health outcomes. INTELLIGENCE 2009. [DOI: 10.1016/j.intell.2009.06.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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26
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Gurková E, Čáp J, Žiaková K. Quality of life and treatment satisfaction in the context of diabetes self-management education. Int J Nurs Pract 2009; 15:91-8. [DOI: 10.1111/j.1440-172x.2009.01733.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Misra R, Lager J. Ethnic and gender differences in psychosocial factors, glycemic control, and quality of life among adult type 2 diabetic patients. J Diabetes Complications 2009; 23:54-64. [PMID: 18413181 DOI: 10.1016/j.jdiacomp.2007.11.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Revised: 07/18/2007] [Accepted: 11/09/2007] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To examine ethnic and gender differences in psychosocial factors, e.g., social support and acceptance of the disease, knowledge levels, perceived difficulty in adherence behaviors, and diabetes outcome (glycemic control and quality of life) in Type 2 diabetic patients. METHODS Data were collected via telephone interviews from 180 diabetic subjects (34% Hispanics, 27% Non-Hispanic whites, 18% African-Americans, and 20% Asian-Indians; 52% females) from 2 clinics. Hemoglobin A1c levels were obtained from patient charts. RESULTS Significant ethnic and gender differences existed in acceptance of the disease, in receiving social support, disease knowledge, perceived difficulty in self-management behaviors, glycemic control, and quality of life among Type 2 diabetic patients; differences were more pronounced by gender than by ethnicity. In general, social support and acceptance of the disease were high. However, perceived difficulty in self-management behaviors varied by racial/ethnic groups with self-monitoring of blood glucose perceived as most difficult by Hispanic respondents, dietary management was most difficult for non-Hispanic whites, while physical activity was the most difficult for African-Americans. Hispanic respondents had greatest severity of the disease (poorest metabolic control). CONCLUSIONS Ethnic and gender variations exist in social support, acceptance of diabetes, quality of life, and adherence behaviors. The outcomes of diabetes care can be improved if practitioners factor these differences in tailoring diabetes education and supportive care for individuals with Type 2 diabetes.
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Affiliation(s)
- Ranjita Misra
- Health and Kinesiology Department, 4243 TAMU, 158V Read Building, Texas A&M University, College Station, TX 77843-4243, USA.
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28
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Chida Y, Hamer M. An association of adverse psychosocial factors with diabetes mellitus: a meta-analytic review of longitudinal cohort studies. Diabetologia 2008; 51:2168-78. [PMID: 18806995 DOI: 10.1007/s00125-008-1154-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Accepted: 08/11/2008] [Indexed: 12/15/2022]
Abstract
AIMS/HYPOTHESIS There has been substantial interest in the association between psychosocial stress and risk of diabetes mellitus, but no data on the systematic quantification of the causal relationship have been published. This analysis aims to evaluate the association between adverse psychosocial factors and diabetes mellitus. METHODS We performed a search of Medline, PsycINFO, Web of Science and PubMed up to July 2008. The studies included were prospective cohort studies investigating the association between adverse psychosocial factors and risk of diabetes mellitus. RESULTS There were 22 relationships between psychosocial factors and disease-related factors (in 14 papers), of which 16 evaluated the associations of adverse psychosocial factors with diabetes control in diabetic populations and six evaluated the associations of adverse psychosocial factors with the incidence of diabetes in populations without any diagnosed diabetes. The overall meta-analysis demonstrated that adverse psychosocial factors were significantly associated with poor diabetes control (combined correlation coefficient, r = 0.096, p = 0.006), whereas adverse psychosocial factors were not associated with incident diabetes mellitus. More notably, sensitivity analyses showed that low social support was more robustly associated with poor diabetes control than stressful events per se or stress-prone personality or coping style, and that adverse psychosocial factors were associated with poor control of type 1 and type 2 diabetes. CONCLUSIONS/INTERPRETATION The current review revealed a detrimental association of psychosocial factors with the prognosis of both type 1 and type 2 diabetes. However, any aetiological effect of adverse psychosocial factors remains elusive as a result of the small number of individuals enrolled in the cohorts studied.
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Affiliation(s)
- Y Chida
- Psychobiology Group, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
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29
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Abstract
OBJECTIVE To examine the association between anxious temperament and disease progression at diagnosis for individuals with Type 2 diabetes mellitus (T2DM). METHODS A sample of 204 individuals, newly diagnosed with T2DM, completed the Behavioral Inhibition and Activation Scales (BIS/BAS) and provided an A1C reading. Regression analyses were used to predict A1C levels from individual differences in BIS and BAS. RESULTS Individual differences in BIS were inversely related to A1C at diagnosis in the sample as a whole, and this association remained strong after controlling for demographic variables and body mass index. Most importantly, temperamentally anxious individuals had low A1C levels at diagnosis in all age groups, in contrast to their nonanxious counterparts who showed increasing A1C at diagnosis as a function of decreasing age. BAS scores were unrelated to A1C. CONCLUSIONS Although older age is generally associated with lower disease progression at diagnosis, high BIS individuals show uniformly lower disease progression across all age groups. High levels of temperamental anxiety may facilitate early diagnosis of T2DM, particularly among younger individuals who are not subject to routine screening.
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30
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Molton IR, Siegel SD, Penedo FJ, Dahn JR, Kinsinger D, Traeger LN, Carver CS, Shen BJ, Kumar M, Schneiderman N, Antoni MH. Promoting recovery of sexual functioning after radical prostatectomy with group-based stress management: the role of interpersonal sensitivity. J Psychosom Res 2008; 64:527-36. [PMID: 18440406 PMCID: PMC2429960 DOI: 10.1016/j.jpsychores.2008.01.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Revised: 06/25/2007] [Accepted: 01/10/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Treatment for localized prostate carcinoma (PCa) is frequently associated with decrements in sexual functioning and satisfaction. Given the highly interpersonal nature of these decrements, interpersonal problems (such as interpersonal sensitivity) may affect recovery of sexual functioning after PCa treatment through interference with physician and partner communication and through distorted cognitions surrounding sexual dysfunction. The objective of the present study was to determine the effect of interpersonal sensitivity on several treatment indicators, including response to a group-based psychosocial intervention. METHODS Participants were 101 older men recovering from radical prostatectomy who were enrolled in a randomized controlled trial of a 10-week group-based cognitive-behavioral stress management (CBSM) intervention. Measures included the Inventory of Interpersonal Problems and the sexual functioning subscale of the University of California-Los Angeles quality-of-life measure. RESULTS At baseline, interpersonal sensitivity was related to a belief linking sexual dysfunction to core male identity (r=.29, P<.05). Using hierarchical regression, we found that (a) the CBSM intervention was effective in promoting sexual recovery in all participants, and (b) this effect was moderated by interpersonal sensitivity, such that individuals with higher levels of interpersonal sensitivity made larger improvements in sexual functioning in response to CBSM. CONCLUSIONS CBSM was effective in improving sexual function after radical prostatectomy. Individuals with higher levels of interpersonal sensitivity were more likely to perceive sexual dysfunction as a threat to masculine identity and made larger gains in the CBSM intervention. Results and relevance to the older male cancer patients are discussed from the perspective of interpersonal theory.
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Affiliation(s)
- Ivan R Molton
- Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA, USA
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31
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Lawson VL, Bundy C, Harvey JN. The development of personal models of diabetes in the first 2 years after diagnosis: a prospective longitudinal study. Diabet Med 2008; 25:482-90. [PMID: 18341594 DOI: 10.1111/j.1464-5491.2008.02394.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS Personal models of diabetes comprise beliefs about symptoms, treatment effectiveness, consequences and emotional responses to possible future complications. They are associated with, and influence, self-care behaviour. Little work has examined potential influences on the development and maintenance of personal models. The aims of this study were: (i) to assess changes in personal models over 2 years from diagnosis of diabetes; and (ii) to examine the relative contributions of health threat communication (at diagnosis, since diagnosis, during follow-up care) and personality to personal models of diabetes 2 years post-diagnosis. METHODS Newly diagnosed patients were interviewed at diagnosis (< 3 months; time 1) and 6 months (time 2), 1 year (time 3) and 2 years (time 4) after diagnosis. Data were available for 158 patients at time 1 (32 Type 1 patients and 126 Type 2 patients), 147 at time 2, 142 at time 3 and 138 at time 4. RESULTS Perceptions of symptoms, consequences, course and control of diabetes remained stable over time. Emotional responses decreased and illness coherence (perceived understanding) increased over time. Health threat communication was a stronger predictor of personal models than personality. Emotional responses to diabetes 2 years after diagnosis were predicted by perceptions of a threatening health message (at diagnosis 18%, at follow-up 5%). Health threat communication predicted perceptions of serious consequences (at diagnosis 5%, at follow-up 9%). Perceptions of a reassuring message during follow-up were related to beliefs of treatment effectiveness (26%). CONCLUSIONS The communication of information and the way it is perceived is an important determinant of the patient's view of their diabetes. The initial effects of the education process at diagnosis persisted 2 years after diagnosis.
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Affiliation(s)
- V L Lawson
- Wales College of Medicine, Wrexham Academic Unit, Wrexham, UK
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Abstract
AIMS To determine the factors responsible for poor glycaemic control in diabetes and whether any such factors are associated with likely improvement in glycaemic control. METHODS A prospective cohort study of 130 diabetic patients with poor glycaemic control (HbA(1c )> or = 10.0%) with 1-year follow-up in a teaching hospital Diabetes Clinic. Changes in HbA(1c) were measured after 1 year. RESULTS Poor glycaemic control was attributed to one of 15 possible causes. Those cases due to recent diagnosis of diabetes, inadequate treatment with diet, oral glucose-lowering agents or insulin, exacerbation of co-existent medical problems, recent stressful life-events and missed clinic appointments were all associated with significant improvement in HbA(1c) at 12 months. Patients with low mood or alcohol excess, inadequate blood glucose monitoring, poor exercise/sedentary lifestyle, refusal to take tablets or underdosing and refusal to take insulin at all or to increase the dose were all associated with continuing poor glycaemic control at 12 months. The patients were divided almost equally between the two groups. CONCLUSIONS In patients with poor glycaemic control, it is possible by simple features identified at clinic to predict which individuals are likely to show improvement in control and which will not. These findings have not been reported previously and suggest that about half of individuals with poor control will improve within our current diabetes clinic practice. Additional strategies will be required to address those individuals who are not likely to respond.
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Affiliation(s)
- R Singh
- Department of Diabetes, The Royal Free Hospital, London, UK.
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Lawson VL, Bundy C, Harvey JN. The influence of health threat communication and personality traits on personal models of diabetes in newly diagnosed diabetic patients. Diabet Med 2007; 24:883-91. [PMID: 17459093 DOI: 10.1111/j.1464-5491.2007.02155.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Personal models of diabetes, i.e. patients' beliefs about symptoms, treatment effectiveness, consequences (impact on life, seriousness) and emotional response to possible short- and long-term complications, have been associated with diabetes self-care behaviours. Little work has examined potential determinants of personal models. AIMS To examine the influence of health threat communication and personality traits on personal models in newly diagnosed patients. METHODS Newly diagnosed patients (n = 158; 32 Type 1 and 126 Type 2) completed the Big Five Personality Inventory, Diabetes Health Threat Communication Questionnaire (DHTCQ), Personal Models of Diabetes Interview-Adapted (PMDI) and Illness Perception Questionnaire-Revised (IPQ-R). RESULTS Emotional responses to diabetes (PMDI) were associated with perceptions of a more threatening health message (22% explained variance), less emotional stability (5%) and the presence of dependent children (3%). Emotional representations (IPQ-R) were associated with a threatening health message (6%) and less emotional stability (15%). An adverse view of consequences (PMDI) was predicted by a more threatening/less reassuring health message (15%), less emotional stability (6%) and Type 1 diabetes (4%). Consequences (IPQ-R) were predicted by perceptions of a more threatening health message (20%), being less agreeable/cooperative (7%) and having dependent children (4%). Treatment effectiveness beliefs (PMDI) were associated with perceptions of a more reassuring health message (31%), younger age (3%) and more openness/intellect (2%). CONCLUSIONS Personal models of diabetes are influenced by health threat communication, demographic and personality factors. These findings support the concept of tailoring health messages to the needs of individual patients and provide information on factors to be taken into account in the education process.
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Affiliation(s)
- V L Lawson
- Wales College of Medicine, Wrexham Academic Unit, Wrexham, UK.
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Lawson VL, Bundy C, Harvey JN. Development of the Diabetes Health Threat Communication Questionnaire (DHTCQ). PATIENT EDUCATION AND COUNSELING 2007; 67:117-26. [PMID: 17532596 DOI: 10.1016/j.pec.2007.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2006] [Revised: 02/19/2007] [Accepted: 02/28/2007] [Indexed: 05/15/2023]
Abstract
OBJECTIVES (1) To develop a brief instrument, the Diabetes Health Threat Communication Questionnaire (DHTCQ) to measure diabetes patients' (type1 and type 2) perceptions of the health threat communication process (i) at time of diagnosis and (ii) since diagnosis; (2) to assess the measure' psychometric properties. METHODS Data from a pilot study (n=110) and a prospective longitudinal study (n=158, within 3 months of diagnosis and n=147, 6 months after baseline) were examined in order to demonstrate reliability and validity of the DHTCQ. RESULTS Principal components factor analysis revealed 2 meaningful factors (Reassurance and Threat) with satisfactory internal consistency (Cronbach' alpha) and adequate test-retest reliability. Correlational analyses supported the measure' construct validity. CONCLUSION Initial support for the psychometric properties of the DHTCQ was shown. Perceptions of health threat communication were associated with patients' illness representations of diabetes (beliefs and feelings about diabetes and its treatment). PRACTICE IMPLICATIONS The DHTCQ may be used to assess patient perceptions of health communication and shape subsequent communication. The findings may help to improve practitioner/patient interaction leading to more adaptive representations of diabetes.
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Affiliation(s)
- Valerie L Lawson
- Wales College of Medicine, Wrexham Academic Unit, Wrexham, United Kingdom.
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Brod M, Christensen T, Bushnell D. Maximizing the value of validation findings to better understand treatment satisfaction issues for diabetes. Qual Life Res 2007; 16:1053-63. [PMID: 17516149 DOI: 10.1007/s11136-007-9209-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2006] [Accepted: 03/11/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Variables associated with treatment satisfaction (TS) can be broadly categorized as precursors, ongoing treatment issues, and treatment outcomes. This study continues the validation process for the Insulin Treatment Satisfaction Questionnaire (ITSQ) while examining relationships between TS and these broader influences. METHODS Data (N = 299) were collected in a RCT comparing safety and efficacy of inhaled vs. injectable insulin. Validation examined item and factor characteristics, reliability and validity. Regression analyses examined relationships between overall and domain specific TS and the broader influences. RESULTS Patients with less previous or current treatment burden had greater TS (p < 0.001). Gender, injection fear, functioning, age, compliance and glycemic control were differentially related to TS at the beginning and end of study. Baseline satisfaction was predictive of future TS (p < 0.001). When all significant factors were examined together, lower burden with the current treatment and higher satisfaction with previous treatment continued to be key (p < 0.001) while other factors were no longer significant. Validation findings confirmed the ITSQ was psychometrically sound. CONCLUSION Over the course of treatment, some factors are associated with TS at treatment start while others are key drivers at treatment end. This suggests that TS is not a static concept.
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Affiliation(s)
- Meryl Brod
- The BROD GROUP, 219 Julia Avenue, Mill Valley, CA 94941, USA.
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Brod M, Cobden D, Lammert M, Bushnell D, Raskin P. Examining correlates of treatment satisfaction for injectable insulin in type 2 diabetes: lessons learned from a clinical trial comparing biphasic and basal analogues. Health Qual Life Outcomes 2007; 5:8. [PMID: 17286868 PMCID: PMC1802740 DOI: 10.1186/1477-7525-5-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2006] [Accepted: 02/07/2007] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Successfully managing diabetes is a complex process that includes addressing issues of drug efficacy, safety and treatment satisfaction. Additionally, the combined impact of patient/disease characteristics and treatment outcomes on treatment satisfaction is not well understood. The purpose of this study was to examine the impact of age, weight, gender, co-morbid conditions, diabetes history, treatment burden, efficacy (HbA1c) and side effects (weight gain, hypoglycemic events) on patients' appraisal of treatment satisfaction using linear regression models. METHODS Data from a multi-center, randomized clinical trial comparing the efficacy/safety of biphasic insulin aspart 70/30 (BIAsp 70/30) vs. glargine (Glar) among insulin naïve type 2 patients were analyzed. Subjects were between ages 18-75, with baseline HbA1c > 8% and BMI < or = 40 kg/m2 (N = 233). Treatment satisfaction was assessed by the Insulin Treatment Satisfaction Questionnaire (ITSQ). RESULTS When factors were examined independently, multiple significant relationships (age, co-morbidity, hypoglycemic events, and weight gain) with overall and/or domains of treatment satisfaction were found. However, when all significant relationships were examined together, only neuropathy, treatment efficacy, and number of hypoglycemic events maintained their previous significance. CONCLUSION By examining predictors independently, significant relationships were identified. However, not all findings remained significant when examined in combination with each other. Thus, to more accurately characterize the impact of factors on treatment satisfaction, a more comprehensive approach may be necessary. By improving patient treatment satisfaction, the efficacy of treatments, as well as critical treatment outcomes such as compliance and cost of care should be improved.
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Affiliation(s)
- Meryl Brod
- The BROD GROUP, 219 Julia Ave., Mill Valley, CA 94941, USA
| | - David Cobden
- Novo Nordisk Inc., 100 College Rd. West, Princeton, NJ, 08540, USA
| | - Morten Lammert
- Novo Nordisk A/S, Global Development, Novo Allé, 2880 Bagsværd, Denmark
| | - Donald Bushnell
- Health Research Associates, Inc. 6505 216th St. SW, Suite 105, Mountlake Terrace, WA. 98043, USA
| | - Philip Raskin
- University of Texas, Southwestern Medical School at Dallas, 5323 Harry Hines Blvd., Dallas, TX 25390, USA
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Hahl J, Hämäläinen H, Simell T, Simell O. The effects of type 1 diabetes and its long-term complications on physical and mental health status. PHARMACOECONOMICS 2006; 24:559-69. [PMID: 16761904 DOI: 10.2165/00019053-200624060-00004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To analyse how type 1 diabetes mellitus (DM) and the symptoms of its chronic long-term complications correlate with health status domains in the adult population in Finland. METHODS A representative sample of patients with type 1 DM was selected randomly from the Finnish drug reimbursement registry. Participants reported symptoms, diagnoses and treatments indicating the presence and time of appearance of long-term complications, and completed the RAND 36 questionnaire. A principal component analysis was performed to compress the eight RAND 36 dimensions into composite domains of health status. The results were validated with split-sample analysis. Regression analyses were used to estimate the effects of age, sex, symptoms of long-term complications and comorbidities on the component T-scores. RESULTS Of the 752 (70.8%) responders, 592 fulfilled the criteria of type 1 DM. Of these, 82.6% fully completed the RAND 36 questionnaire. Principal component analysis of our data supports the theory of the 2-factor model of health, as physical and mental health domains were reflected unambiguously by different RAND 36 dimensions. The regression results show that the symptoms of long-term complications correlate more strongly with the physical than the mental domain of health status. CONCLUSION Type 1 DM, and especially the symptoms of its long-term complications, correlate mainly with the physical domain of health, although the mental domain is also affected. The prevalence of long-term complications with type 1 DM is sufficiently high within the Finnish population to substantially influence the health status of people with type 1 DM.
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Affiliation(s)
- Jarmo Hahl
- Department of Economics, Turku School of Economics and Business Administration, Turku, Finland.
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Ng TP, Goh LG, Tan Y, Tan E, Leong H, Tay EG, Thai AC. Ethnic differences in glycaemic control in adult Type 2 diabetic patients in primary care: a 3-year follow-up study. Diabet Med 2005; 22:1598-604. [PMID: 16241927 DOI: 10.1111/j.1464-5491.2005.01759.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate ethnic differences and characteristics related to glycaemic control in patients with Type 2 diabetes in primary care. RESEARCH DESIGN AND METHODS Prospective cohort study; 500 adult patients with Type 2 diabetes, who were not on insulin therapy, were followed up annually for 3 years. HbA(1c) at baseline and 3-year changes and subsequent insulin therapy were related to baseline characteristics. RESULTS Malay patients had significantly higher HbA(1c) (mean 8.7% +/- sd 1.66) compared with Chinese (8.2 +/- sd 1.67) and Indian (8.2 +/- sd 1.55) (P = 0.032) at baseline, and consistently for all years of HbA(1c) assessment (P = 0.017). At baseline, Malay patients were significantly more obese than Chinese or Indians (P < 0.001); fewer of them received structured shared-care intervention (P = 0.001), but they had a significantly higher glucose control educational score (P < 0.05). Multivariable analyses showed that HbA(1c) at baseline was significantly related to age (P = 0.001), BMI (P = 0.031) and ethnicity (P = 0.002). HbA(1c) declined significantly over 3 years in the whole population and in all ethnic groups. Significantly greater HbA(1c) declines were associated with higher baseline HbA(1c), structured shared-care intervention and non-insulin therapy. Correcting for differences on these factors, the decline in HbA(1c) in Malays was significantly less than in the Chinese. Insulin therapy was associated with higher baseline HbA(1c) and higher BMI. CONCLUSIONS Malay ethnicity was associated with persistently poor glycaemic control. Sociocultural and behavioural factors should be addressed in improving care for patients with poorly controlled diabetes.
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Affiliation(s)
- T-P Ng
- Department of Psychological Medicine, Occupational and Family Medicine, National University of Singapore, 5 Lower Kent Ridge Road, Singapore 119074.
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van der Ven NCW, Lubach CHC, Hogenelst MHE, van Iperen A, Tromp-Wever AME, Vriend A, van der Ploeg HM, Heine RJ, Snoek FJ. Cognitive behavioural group training (CBGT) for patients with type 1 diabetes in persistent poor glycaemic control: who do we reach? PATIENT EDUCATION AND COUNSELING 2005; 56:313-322. [PMID: 15721974 DOI: 10.1016/j.pec.2004.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2003] [Revised: 03/12/2004] [Accepted: 03/14/2004] [Indexed: 05/24/2023]
Abstract
Approximately a quarter of adults with type 1 diabetes do not succeed in achieving satisfactory glycaemic control, partly due to problems with the demanding self-management regimen. To improve glycaemic control, interventions with a cognitive behavioural approach, aimed at modifying dysfunctional beliefs, reducing negative emotions and enhancing self-care practices are a potentially successful tool. Little is known about the reach of such an approach. This article describes characteristics of participants in a randomized, controlled trial of cognitive behavioural group training for patients with type 1 diabetes in poor glycaemic control. Results show that outpatients from seven hospitals in the area of Amsterdam, selected on long-standing high HbA1c and volunteering to participate, report high levels of psychological distress and depressive symptoms. Furthermore, self-care behaviours were perceived as important, but burdensome. Diabetes-specific self-efficacy was relatively low. It is concluded that this selected group of adults with type 1 diabetes would potentially benefit from a cognitive-behavioural intervention in order to reduce negative emotions, enhance diabetes self-efficacy, self-care behaviour and glycaemic outcomes.
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MESH Headings
- Adaptation, Psychological
- Adolescent
- Adult
- Cognitive Behavioral Therapy/organization & administration
- Cost of Illness
- Depression/diagnosis
- Depression/etiology
- Depression/prevention & control
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 1/prevention & control
- Diabetes Mellitus, Type 1/psychology
- Female
- Follow-Up Studies
- Health Knowledge, Attitudes, Practice
- Humans
- Male
- Middle Aged
- Motivation
- Negativism
- Netherlands
- Outpatient Clinics, Hospital
- Patient Compliance/psychology
- Psychotherapy, Group/organization & administration
- Quality of Life
- Self Care/psychology
- Self Care/standards
- Stress, Psychological/diagnosis
- Stress, Psychological/etiology
- Stress, Psychological/prevention & control
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Affiliation(s)
- Nicole C W van der Ven
- Diabetes Research Group, Department of Medical Psychology, VU University Medical Centre, vd Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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Abstract
Around 25% of the adult Type 1 diabetes population is in persistent poor glycaemic control and thus at increased risk of developing microvascular complications. We here discuss correlates of long-standing poor glycaemic control and review the efficacy of clinical strategies designed to overcome persistent poor control. Only a few studies have identified determinants and correlates of long-standing poor glycaemic control in Type 1 diabetes. There is some evidence implicating genetic factors, as well as lower economic status, and psychological factors, including lack of motivation, emotional distress, depression and eating disorders. Ways of improving glycaemic control include strategies to enable self-management, e.g. motivational strategies, coping-orientated education, psychosocial therapies, and/or intensifying insulin injection therapy plus continuous subcutaneous insulin infusion. Long-standing poor glycaemic control appears to be a heterogeneous and complex phenomenon, for which there is no simple, single solution. Comprehensive psycho-medical assessment in diabetes care may prove useful in tailoring interventions. Further research is warranted, to increase our understanding how psychosocial and biomedical factors, separately and in interaction, determine poor outcomes in Type 1 diabetes.
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Affiliation(s)
- J H Devries
- Department of Endocrinology, Diabetes Centre, VU University Medical Centre, Amsterdam, The Netherlands.
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Jonnalagadda SS. Effectiveness of medical nutrition therapy: Importance of documenting and monitoring nutrition outcomes. ACTA ACUST UNITED AC 2004; 104:1788-92. [PMID: 15565070 DOI: 10.1016/j.jada.2004.10.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Current literature in diabetes. Diabetes Metab Res Rev 2003; 19:248-55. [PMID: 12789659 DOI: 10.1002/dmrr.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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