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Whipple MO, Pinto AJ, Abushamat LA, Bergouignan A, Chapman K, Huebschmann AG, Masters KS, Nadeau KJ, Scalzo RL, Schauer IE, Rafferty D, Reusch JE, Regensteiner JG. Sex Differences in Physical Activity Among Individuals With Type 2 Diabetes Across the Life Span: A Systematic Review and Meta-analysis. Diabetes Care 2022; 45:2163-2177. [PMID: 36044665 PMCID: PMC9472508 DOI: 10.2337/dc22-0576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/06/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Physical activity (PA) is a cornerstone of type 2 diabetes mellitus (T2DM) treatment. Sex differences in PA behavior or barriers/facilitators to PA among individuals with T2DM are unclear. PURPOSE To summarize the evidence related to sex differences in participation in PA and barriers/facilitators to PA among individuals with T2DM across the life span. DATA SOURCES Systematic searches (CRD42021254246) were conducted with Ovid MEDLINE, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), APA PsychInfo, and SPORTDiscus. STUDY SELECTION We included studies with assessment of PA, sedentary behaviors (SB), or barriers/facilitators to PA among individuals with T2DM by sex or gender. DATA EXTRACTION Participant characteristics, meeting PA guidelines, participation in PA and SB, and barriers/facilitators to PA were extracted by two independent reviewers. DATA SYNTHESIS A total of 53 articles (65,344 participants) were included in the systematic review and 21 articles in the meta-analysis. Sex differences were not observed in meeting of PA guidelines among adolescents (odds ratio 0.70 [95% CI 0.31, 1.59]), but males were more likely than females to meet PA guidelines among adults (1.65 [1.36, 2.01]) and older adults (1.63 [1.27, 2.09]). Males performed more moderate-to-vigorous PA (MVPA) than females across all age-groups. Common barriers to PA were lack of time (men) and lack of social support and motivation (women). LIMITATIONS Limitations include heterogeneity of measures used to assess PA and lack of stratification of data by sex. CONCLUSIONS Sex differences in meeting PA guidelines were not observed among adolescents but were apparent among adults and older adults with T2DM. Females consistently engaged in less MVPA than males across the life span.
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Affiliation(s)
- Mary O. Whipple
- School of Nursing, University of Minnesota, Minneapolis, MN
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Ana J. Pinto
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Layla A. Abushamat
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX
| | - Audrey Bergouignan
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO
- Hubert Curien Pluridisciplinary Institute UMR7178, CNRS and Université de Strasbourg, Strasbourg, France
| | - Kristina Chapman
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Amy G. Huebschmann
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kevin S. Masters
- Anschutz Health and Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, CO
- Clinical Health Psychology, Department of Psychology, University of Colorado Denver, Denver, CO
| | - Kristen J. Nadeau
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, CO
- Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Rebecca L. Scalzo
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Rocky Mountain Regional VA Medical Center, Aurora, CO
| | - Irene E. Schauer
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Rocky Mountain Regional VA Medical Center, Aurora, CO
| | - Deirdre Rafferty
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jane E.B. Reusch
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Rocky Mountain Regional VA Medical Center, Aurora, CO
| | - Judith G. Regensteiner
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
- Ludeman Family Center for Women’s Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO
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Ling J, Koye D, Buizen L, Khunti K, Montvida O, Paul SK. Temporal trends in co-morbidities and cardiometabolic risk factors at the time of type 2 diabetes diagnosis in the UK. Diabetes Obes Metab 2021; 23:1150-1161. [PMID: 33496366 DOI: 10.1111/dom.14323] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/24/2020] [Accepted: 01/14/2021] [Indexed: 12/17/2022]
Abstract
AIM To evaluate temporal patterns in co-morbidities, cardiometabolic risk factors and a high atherosclerotic cardiovascular disease (ASCVD) risk population at type 2 diabetes (T2D) diagnosis by age groups and sex. MATERIALS AND METHODS From the UK primary care database, 248,619 people with a new diagnosis of T2D during 2005-2016 were identified. Among people without ASCVD, high ASCVD risk was defined as two or more of current smoker, grade 2+ obesity, hypertension, dyslipidaemia or microvascular disease. Cardiometabolic multimorbidity (CMM) was defined as two or more of cardiovascular disease, microvascular disease, hypertension, dyslipidaemia, grade 2+ obesity or cancer. Temporal patterns in the distribution of cardiometabolic risk factors were evaluated. RESULTS While the prevalence of ASCVD was stable over time (approximately 18%), 50% were identified to have a high ASCVD risk (26% and 38% in the 18-39 and 40-49 years age groups, respectively), with an increasing trend across all age groups. Overall, 51% had CMM at diagnosis, increasing during 2005-2016 for the 18-39 years age group by 14%-17%, for the 40-49 years age group by 27%-33%, for the 50-59 years age group by 41%-50%, for the 60-69 years age group by 56%-65%, and for the 70-79 years age group by 65%-80%. People with young-onset T2D had significantly higher HbA1c, body mass index and lipids at diagnosis (all p < .01). The proportions with an HbA1c of 7.5% or higher in the 18-39 and 40-49 years age groups were 58% and 54%, respectively, significantly and consistently higher over the last decade compared with those aged 50 years or older, with males having higher proportions of 15-26 and 10-18 percentage points, respectively, compared with females. CONCLUSIONS CMM and high ASCVD risk have been increasing consistently across all age groups and in both sex, in particular CMM in those aged younger than 50 years. Our findings indicate that the European Society of Cardiology-European Association for the Study of Diabetes recommendations need to change to consider people with young-onset T2D as a high-risk group, as recommended in the Primary Care Diabetes Europe position statement.
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Affiliation(s)
- Joanna Ling
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
- School of Health and Biomedical Sciences, RMIT, Melbourne, Victoria, Australia
| | - Digsu Koye
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Luke Buizen
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Olga Montvida
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - Sanjoy K Paul
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
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Zawadzka E, Domańska Ł. Cognitive illness representation and anxiety in older men and women with type 2 diabetes. Psychogeriatrics 2020; 20:288-295. [PMID: 31896162 DOI: 10.1111/psyg.12497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/10/2019] [Accepted: 12/05/2019] [Indexed: 12/14/2022]
Abstract
AIM In the elderly, type 2 diabetes is a frequent chronic condition that requires the attention of health care. As patient involvement is a prerequisite for treatment, it seems crucial to assess psychosocial aspects, including patient's cognitive component of attitude towards the condition, as early as upon diagnosis. The aim of this study was to examine whether the cognitive illness representation in older female and male patients with type 2 diabetes is differentiated. Considering disease duration, we determined the effect of cognitive illness representation on older diabetes emotional wellbeing. METHODS The study in 99 older adults with type 2 diabetes used Disease-Related Appraisals Scale (Skala Oceny Własnej Choroby; SOWCh) to assess cognitive illness representation and State-Trait Anxiety Inventory (STAI) to assess the severity of state anxiety. RESULTS In a subgroup with short-standing diagnosis, women scored significantly higher than men on subscales of Threat, Obstacle/Loss and Profit. In a subgroup with long-standing diagnosis, women scored significantly higher than men on the subscale of Threat and significantly lower than men on the subscale of Value. The associations between the individual dimensions of cognitive illness representation and anxiety were also determined. These correlations differed between sexes and stages of the disease. CONCLUSION Both at early and late stages of type 2 diabetes, women perceive their illness as a threat significantly more than men do. This appraisal persists throughout the entire duration of the illness. Men with long-standing diagnosis, attribute higher value to diabetes than women do, perceiving it as an opportunity to appreciate values they did not pay attention to before. Anxiety reported by older women and men can be explained to a significant extent by certain dimensions of their respective cognitive illness representation.
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Affiliation(s)
- Ewa Zawadzka
- Department of Clinical Psychology and Neuropsychology, Institute of Psychology, Maria Curie-Skłodowska University, Lublin, Poland
| | - Łucja Domańska
- Department of Clinical Psychology and Neuropsychology, Institute of Psychology, Maria Curie-Skłodowska University, Lublin, Poland
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Chai S, Yao B, Xu L, Wang D, Sun J, Yuan N, Zhang X, Ji L. The effect of diabetes self-management education on psychological status and blood glucose in newly diagnosed patients with diabetes type 2. PATIENT EDUCATION AND COUNSELING 2018; 101:1427-1432. [PMID: 29622281 DOI: 10.1016/j.pec.2018.03.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 03/13/2018] [Accepted: 03/24/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the efficacy of self-management education on psychological outcomes and glycemic control in type 2 diabetes mellitus. METHODS Patients were randomly assigned to education group and control group. Education group received professional education and control group received routine outpatient education. RESULTS A total of 118 patients were randomly assigned to two groups (education group, n = 63; control group, n = 55). Compared with control group, the anxiety score (36.00 vs. 42.50, P < 0.05) and depression score (35.50 vs. 44.00, P < 0.05) significantly decreased at the sixth month in education group, respectively. Compared with control group, fasting blood glucose (6.78 mmol/L vs. 7.70 mmol/L, P < 0.00), postprandial blood glucose (7.90 mmol/L vs. 10.58 mmol/L, P < 0.00) and glycosylated haemoglobin A1C level [6.20 (5.80, 6.60)% vs. 6.70 (6.40, 7.30)%, P < 0.01] significantly decreased after the sixth month in education group. CONCLUSION The psychological status and blood glucose of patients with diabetes receiving self-management education were significantly improved. PRACTICE IMPLICATIONS Type 2 diabetes mellitus has been usually linked to increased prevalence and risk of depression and anxiety, which can affect blood glucose levels. Through education, the mood of newly diagnosed patients with diabetes improved, resulting in better blood glucose control.
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Affiliation(s)
- Sanbao Chai
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing, 102206, China
| | - Baoting Yao
- Department of Endocrinology and Metabolism, First Hospital of Dandong, Dandong, 118000, China
| | - Lin Xu
- Department of Endocrinology and Metabolism, First Hospital of Dandong, Dandong, 118000, China
| | - Danyang Wang
- Department of Endocrinology and Metabolism, First Hospital of Dandong, Dandong, 118000, China
| | - Jianbin Sun
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing, 102206, China
| | - Ning Yuan
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing, 102206, China
| | - Xiaomei Zhang
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing, 102206, China.
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing, 102206, China; Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, 100044, China
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Taggart L, Truesdale M, Carey ME, Martin-Stacey L, Scott J, Bunting B, Coates V, Brown M, Karatzias T, Northway R, Clarke JM. Pilot feasibility study examining a structured self-management diabetes education programme, DESMOND-ID, targeting HbA 1c in adults with intellectual disabilities. Diabet Med 2018; 35:137-146. [PMID: 29083501 DOI: 10.1111/dme.13539] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2017] [Indexed: 11/26/2022]
Abstract
AIM To report on the outcomes of a pilot feasibility study of a structured self-management diabetes education programme targeting HbA1c . METHODS We conducted a two-arm, individually randomized, pilot superiority trial for adults with intellectual disability and Type 2 diabetes mellitus. A total of 66 adults with disabilities across the UK met the eligibility criteria. Of these, 39 agreed to participate and were randomly assigned to either the DESMOND-ID programme (n = 19) or a control group (n = 20). The programme consisted of seven weekly educational sessions. The primary outcome was HbA1c level, and secondary outcomes included BMI, diabetes illness perceptions, severity of diabetes, quality of life, and attendance rates. RESULTS This study found that the DESMOND-ID programme was feasible to deliver. With reasonable adjustments, the participants could be recruited successfully, and could provide consent, complete the outcome measures, be randomized to the groups and attend most of the sessions, with minimal loss to follow-up. The fixed-effects model, the interaction between occasion (time) and condition, showed statistically significant results (0.05 level) for HbA1c ; however, the CI was large. CONCLUSION This is the first published study to adapt and pilot a national structured self-management diabetes education programme for adults with intellectual disability. This study shows it is possible to identify, recruit, consent and randomize adults with intellectual disabilities to an intervention or control group. Internationally, the results of this pilot are promising, demonstrating that a multi-session education programme is acceptable and feasible to deliver. Its effectiveness should be further tested in an adequately powered trial.
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Affiliation(s)
- L Taggart
- Institute of Nursing and Health Research, Ulster University, Belfast, UK
| | | | - M E Carey
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - L Martin-Stacey
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - J Scott
- Northern Health and Social Care Trust, Coleraine, UK
| | - B Bunting
- Institute of Psychology, Ulster University, Derry, UK
| | - V Coates
- Institute of Nursing and Health Research, Ulster University, Belfast, UK
| | - M Brown
- Edinburgh Napier University, Edinburgh, UK
| | | | | | - J M Clarke
- MRC Hub for Trials Methodology Research, Queen's University Belfast, Belfast, UK
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Cleal B, Panton UH, Willaing I, Holt RIG. Relative changes in earned income five years after diagnosis with diabetes: A register based study 1996-2012. J Diabetes Complications 2017; 31:1506-1514. [PMID: 28811132 DOI: 10.1016/j.jdiacomp.2017.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/02/2017] [Accepted: 07/05/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE With previous studies indicating that diabetes affects employment status and lifetime earnings, the aim of this study was to determine the impact on earnings in the immediate period after diagnosis. Recognising that earnings and employment status are dynamic over the life course, we matched people with diabetes to counterparts in the general population and compared nominal growth in earned income five calendar years after diagnosis. RESEARCH DESIGN AND METHODS The study draws upon Danish population registers. Residents aged 25-62years between 1996 and 2007 were included in the study. We identified an individually matched control group from approximately 2,800,000 'diabetes-free' Danish adults using propensity score matching. Matching was based on age, gender, residence, earned income, growth in earned income, and unemployment in the calendar year before diagnosis. RESULTS 91,090 people with diabetes were included in the study and matched to 91,090 controls in the general population. The analysis revealed highly significant loss of earnings for people with diabetes when compared with people without diabetes, with an overall relative loss of US $ 3694 (8.01%) among men and US $ 924 (3.03%) among women. The effect was generally largest in the youngest age-group, in lower earners and among men. CONCLUSIONS The results clearly indicate that a diagnosis of diabetes has a significant impact on earnings. Age and earnings at the time of diagnosis appear to play a moderating role.
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Affiliation(s)
- Bryan Cleal
- Health Promotion Research, Steno Diabetes Center, Copenhagen, Niels Steensens Vej 6, Gentofte, DK-2820, Denmark.
| | | | - Ingrid Willaing
- Health Promotion Research, Steno Diabetes Center, Copenhagen, Niels Steensens Vej 6, Gentofte, DK-2820, Denmark.
| | - Richard I G Holt
- Human Development and Health Academic Unit, Faculty of Medicine, The Institute of Developmental Sciences (IDS Building), MP887, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.
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Pilkington K, Loef M, Polley M. Searching for Real-World Effectiveness of Health Care Innovations: Scoping Study of Social Prescribing for Diabetes. J Med Internet Res 2017; 19:e20. [PMID: 28153817 PMCID: PMC5314100 DOI: 10.2196/jmir.6431] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/07/2016] [Accepted: 11/23/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Social prescribing is a process whereby primary care patients are linked or referred to nonmedical sources of support in the community and voluntary sector. It is a concept that has arisen in practice and implemented widely in the United Kingdom and has been evaluated by various organizations. OBJECTIVE The aim of our study was to characterize, collate, and analyze the evidence from evaluation of social prescribing for type 2 diabetes in the United Kingdom and Ireland, comparing information available on publicly available websites with the published literature. METHODS We used a broad, pragmatic definition of social prescribing and conducted Web-based searches for websites of organizations providing potentially relevant services. We also explored linked information. In parallel, we searched Medline, PubMed, Cochrane Library, Google Scholar, and reference lists for relevant studies published in peer-reviewed journals. We extracted the data systematically on the characteristics, any reported evaluation, outcomes measured and results, and terminology used to describe each service. RESULTS We identified 40 UK- or Ireland-based projects that referred people with type 2 diabetes and prediabetes to nonmedical interventions or services provided in the community. We located evaluations of 24 projects; 11 as published papers, 12 as Web-based reports, and 1 as both a paper and a Web-based report. The interventions and services identified included structured group educational programs, exercise referral schemes, and individualized advice and support with signposting of health-related activities in the community. Although specific interventions such as community-based group educational programs and exercise referral have been evaluated in randomized controlled trials, evaluation of individualized social prescribing services involving people with type 2 diabetes has, in most cases, used pre-post and mixed methods approaches. These evaluations report generic improvement in a broad range of outcomes and provide an insight into the criteria for the success of social prescribing services. CONCLUSIONS Our study revealed the varied models of social prescribing and nonmedical, community-based services available to people with type 2 diabetes and the extent of evaluation of these, which would not have been achieved by searching databases alone. The findings of this scoping study do not prove that social prescribing is an effective measure for people with type 2 diabetes in the United Kingdom, but can be used to inform future evaluation and contribute to the development of the evidence base for social prescribing. Accessing Web-based information provides a potential method for investigating how specific innovative health concepts, such as social prescribing, have been translated, implemented, and evaluated in practice. Several challenges were encountered including defining the concept, focusing on process plus intervention, and searching diverse, evolving Web-based sources. Further exploration of this approach will inform future research on the application of innovative health care concepts into practice.
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Affiliation(s)
- Karen Pilkington
- School of Life Sciences, Faculty of Science and Technology, University of Westminster, London, United Kingdom.,School of Health Sciences and Social Work, Faculty of Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Martin Loef
- Institute of Transcultural Health Studies, European University Viadrina, Frankfurt, Germany
| | - Marie Polley
- School of Life Sciences, Faculty of Science and Technology, University of Westminster, London, United Kingdom
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Khunti K, Chatterjee S, Carey M, Daly H, Batista-Ferrer H, Davies MJ. New drug treatments versus structured education programmes for type 2 diabetes: comparing cost-effectiveness. Lancet Diabetes Endocrinol 2016; 4:557-9. [PMID: 27235133 DOI: 10.1016/s2213-8587(16)30048-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 03/24/2016] [Accepted: 04/15/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK; Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Sudesna Chatterjee
- Diabetes Research Centre, University of Leicester, Leicester, UK; Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester LE5 4PW, UK.
| | - Marian Carey
- Diabetes Research Centre, University of Leicester, Leicester, UK; Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Heather Daly
- Diabetes Research Centre, University of Leicester, Leicester, UK; Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester LE5 4PW, UK
| | | | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK; Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester LE5 4PW, UK
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Yang YS, Wu YC, Lu YL, Kornelius E, Lin YT, Chen YJ, Li CL, Hsiao HW, Peng CH, Huang CN. Adherence to self-care behavior and glycemic effects using structured education. J Diabetes Investig 2015; 6:662-9. [PMID: 26543540 PMCID: PMC4627543 DOI: 10.1111/jdi.12343] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 02/06/2015] [Accepted: 02/18/2015] [Indexed: 11/30/2022] Open
Abstract
AIMS/INTRODUCTION The purpose of the present study was to examine glycemic control in suboptimally controlled type 2 diabetes provided by a structured education group using the Diabetes Conversation Map™ (CM™) vs usual care in a university-based hospital primary care clinic. MATERIALS AND METHODS This was a randomized, pragmatic clinical trial. Patients with type 2 diabetes were randomly assigned to structured education or usual care groups. The primary outcome was the difference in the mean change of glycated hemoglobin (HbA1c) from baseline to 12 months. Secondary outcomes included the percentage achieving therapeutic HbA1c goal and self-behavioral changes. RESULTS A total of 245 patients were randomly assigned to two groups (CM™ group n = 121; usual care group, n = 116). The absolute reduction of HbA1c was significantly greater in the CM™ group at 3 and 6 months (Δ = -0.59% and Δ = -1.13%, P < 0.01), but the difference was no longer statistically significant at 9 and 12 months (Δ = -0.43% and Δ = -0.49%), based on an intention-to-treat analysis. A per-protocol analysis showed the significant change was maintained at 12 months (Δ = -0.67%). In the intervention group, greater percentages of patients achieved their American Association of Diabetes Educators Self-Care Behaviours™ framework (AADE7) behavioral goals at 3 months, in particular being active, problem-solving, reducing risk and health coping. CONCLUSIONS In type 2 diabetic patients with suboptimally controlled glucose, there were greater improvements in glucose control and self-care behavioral goals in those who underwent the CM™ education program compared with outcomes achieved in patients receiving usual care.
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Affiliation(s)
- Yi-Sun Yang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung Shan Medical University HospitalShalu County, Taichung, Taiwan
- Institute of Medicine, School of Medicine, Chung Shan Medical UniversityShalu County, Taichung, Taiwan
| | - Yueh-Chu Wu
- Department of Nursing, Chung Shan Medical University HospitalShalu County, Taichung, Taiwan
| | - Ying-Li Lu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung Shan Medical University HospitalShalu County, Taichung, Taiwan
| | - Edy Kornelius
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung Shan Medical University HospitalShalu County, Taichung, Taiwan
| | - Yu-Tze Lin
- Department of Nursing, Chung Shan Medical University HospitalShalu County, Taichung, Taiwan
| | - Yu-Ju Chen
- Department of Nursing, Chung Shan Medical University HospitalShalu County, Taichung, Taiwan
| | - Ching-Lu Li
- Department of Nursing, Chung Shan Medical University HospitalShalu County, Taichung, Taiwan
| | - Hui-Wen Hsiao
- Department of Nursing, Chung Shan Medical University HospitalShalu County, Taichung, Taiwan
| | - Chiung-Huei Peng
- Division of Basic Medical Science, HungKuang UniversityShalu County, Taichung, Taiwan
| | - Chien-Ning Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung Shan Medical University HospitalShalu County, Taichung, Taiwan
- Institute of Medicine, School of Medicine, Chung Shan Medical UniversityShalu County, Taichung, Taiwan
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Taggart L, Coates V, Clarke M, Bunting B, Davies M, Carey M, Northway R, Brown M, Truesdale-Kennedy M, Martin-Stacey L, Scott G, Karatzias T. A study protocol for a pilot randomised trial of a structured education programme for the self-management of type 2 diabetes for adults with intellectual disabilities. Trials 2015; 16:148. [PMID: 25872928 PMCID: PMC4404014 DOI: 10.1186/s13063-015-0644-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 03/11/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The need for structured education programmes for type 2 diabetes is a high priority for many governments around the world. One such national education programme in the United Kingdom is the DESMOND Programme, which has been shown to be robust and effective for patients in general. However, these programmes are not generally targeted to people with intellectual disabilities (ID), and robust evidence on their effects for this population is lacking. We have adapted the DESMOND Programme for people with ID and type 2 diabetes to produce an amended programme known as DESMOND-ID. This protocol is for a pilot trial to determine whether a large-scale randomised trial is feasible, to test if DESMOND-ID is more effective than usual care in adults with ID for self-management of their type 2 diabetes, in particular as a means to reduce glycated haemoglobin (Hb1Ac), improve psychological wellbeing and quality of life and promote a healthier lifestyle. This protocol describes the rationale, methods, proposed analysis plan and organisational and administrative details. METHODS/DESIGN This trial is a two arm, individually randomised, pilot trial for adults with ID and type 2 diabetes, and their family and/or paid carers. It compares the DESMOND-ID programme with usual care. Approximately 36 adults with mild to moderate ID will be recruited from three countries in the United Kingdom. Family and/or paid carers may also participate in the study. Participants will be randomly assigned to one of two conditions using a secure computerised system with robust allocation concealment. A range of data will be collected from the adults with ID (biomedical, psychosocial and self-management strategies) and from their carers. Focus groups with all the participants will assess the acceptability of the intervention and the trial. DISCUSSION The lack of appropriate structured education programmes and educational materials for this population leads to secondary health conditions and may lead to premature deaths. There are significant benefits to be gained globally, if structured education programmes are adapted and shown to be successful for people with ID and other cognitive impairments. TRIAL REGISTRATION Registered with International Standard Randomised Controlled Trial (identifier: ISRCTN93185560 ) on 10 November 2014.
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Affiliation(s)
- Laurence Taggart
- Institute of Nursing and Health Research, Ulster University, Shore Road, Newtownabbey, Co Antrim BT37 0QB, Northern Ireland.
| | - Vivien Coates
- Institute of Nursing and Health Research, Ulster University, Shore Road, Newtownabbey, Co Antrim BT37 0QB, Northern Ireland.
| | - Mike Clarke
- MRC Hub for Trials Methodology Research, Queen's University Belfast, Malone Road, Belfast, BT7 1NN, Northern Ireland.
| | - Brendan Bunting
- Institute of Psychology, Ulster University, Northland Road, Derry, BT48 7JL, Northern Ireland.
| | - Melanie Davies
- Leicester Diabetes Centre, University of Leicester, Gwendolen Road, Leicester LE5, England.
| | - Marian Carey
- Leicester Diabetes Centre, University of Leicester, Gwendolen Road, Leicester LE5, England.
| | - Ruth Northway
- University of South Wales, Glyntaff Campus, Cardiff, CF37 4BD, Wales.
| | - Michael Brown
- Edinburgh Napier University, Sighthill Campus, Bankhead Avenue, Edinburgh, EH11 4DE, Scotland.
| | - Maria Truesdale-Kennedy
- Institute of Nursing and Health Research, Ulster University, Shore Road, Newtownabbey, Co Antrim BT37 0QB, Northern Ireland.
| | - Lorraine Martin-Stacey
- Leicester Diabetes Centre, University of Leicester, Gwendolen Road, Leicester LE5, England.
| | - Gillian Scott
- Northern Health and Social Care Trust, Ulster, Rathlea House, Mountfern Complex, 8A Rugby Ave, Coleraine, BT52 1JL, Northern Ireland.
| | - Thanos Karatzias
- Edinburgh Napier University, Sighthill Campus, Bankhead Avenue, Edinburgh, EH11 4DE, Scotland.
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11
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Hudson JL, Bundy C, Coventry PA, Dickens C. Exploring the relationship between cognitive illness representations and poor emotional health and their combined association with diabetes self-care. A systematic review with meta-analysis. J Psychosom Res 2014; 76:265-74. [PMID: 24630175 DOI: 10.1016/j.jpsychores.2014.02.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 02/10/2014] [Accepted: 02/11/2014] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Depression and anxiety are common in diabetes and are associated with lower diabetes self-care adherence. How this occurs is unclear. Our systematic review explored the relationship between cognitive illness representations and poor emotional health and their combined association with diabetes self-care. METHODS Medline, Psycinfo, EMBASE, and CINAHL were searched from inception to June 2013. Data on associations between cognitive illness representations, poor emotional health, and diabetes self-care were extracted. Random effects meta-analysis was used to test the relationship between cognitive illness representations and poor emotional health. Their combined effect on diabetes self-care was narratively evaluated. RESULTS Nine cross-sectional studies were included. Increased timeline cyclical, consequences, and seriousness beliefs were associated with poorer emotional health symptoms. Lower perceived personal control was associated with increased depression and anxiety, but not mixed anxiety and depressive symptoms. Remaining cognitive illness representation domains had mixed statistically significant and non-significant relationships across emotional states or were measured only once. Effect sizes ranged from small to large (r=±0.20 to 0.51). Two studies explored the combined effects of cognitions and emotions on diabetes self-care. Both showed that cognitive illness representations have an independent effect on diabetes self-care, but only one study found that depression has an independent effect also. CONCLUSIONS Associations between cognitive illness representations and poor emotional health were in the expected direction - negative diabetes perceptions were associated with poorer emotional health. Few studies examined the relative effects of cognitions and emotions on diabetes self-care. Longitudinal studies are needed to clarify directional pathways.
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Affiliation(s)
- Joanna L Hudson
- Health Psychology Section, Psychology Department, Institute of Psychiatry, King's College London, UK; NIHR Collaboration for Leadership in Applied Health Research and Care for Greater Manchester and Manchester Academic Health Science Centre, University of Manchester, UK.
| | - Chris Bundy
- NIHR Collaboration for Leadership in Applied Health Research and Care for Greater Manchester and Manchester Academic Health Science Centre, University of Manchester, UK.
| | - Peter A Coventry
- NIHR Collaboration for Leadership in Applied Health Research and Care for Greater Manchester and Manchester Academic Health Science Centre, University of Manchester, UK.
| | - Chris Dickens
- Mental Health Research Group, Institute of Health Research, University of Exeter Medical School, UK; The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula (PenCLAHRC), UK.
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12
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Khunti K, Gray LJ, Skinner T, Carey ME, Realf K, Dallosso H, Fisher H, Campbell M, Heller S, Davies MJ. Effectiveness of a diabetes education and self management programme (DESMOND) for people with newly diagnosed type 2 diabetes mellitus: three year follow-up of a cluster randomised controlled trial in primary care. BMJ 2012; 344:e2333. [PMID: 22539172 PMCID: PMC3339877 DOI: 10.1136/bmj.e2333] [Citation(s) in RCA: 224] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2012] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To measure whether the benefits of a single education and self management structured programme for people with newly diagnosed type 2 diabetes mellitus are sustained at three years. DESIGN Three year follow-up of a multicentre cluster randomised controlled trial in primary care, with randomisation at practice level. SETTING 207 general practices in 13 primary care sites in the United Kingdom. PARTICIPANTS 731 of the 824 participants included in the original trial were eligible for follow-up. Biomedical data were collected on 604 (82.6%) and questionnaire data on 513 (70.1%) participants. INTERVENTION A structured group education programme for six hours delivered in the community by two trained healthcare professional educators compared with usual care. MAIN OUTCOME MEASURES The primary outcome was glycated haemoglobin (HbA(1c)) levels. The secondary outcomes were blood pressure, weight, blood lipid levels, smoking status, physical activity, quality of life, beliefs about illness, depression, emotional impact of diabetes, and drug use at three years. RESULTS HbA(1c) levels at three years had decreased in both groups. After adjusting for baseline and cluster the difference was not significant (difference -0.02, 95% confidence interval -0.22 to 0.17). The groups did not differ for the other biomedical and lifestyle outcomes and drug use. The significant benefits in the intervention group across four out of five health beliefs seen at 12 months were sustained at three years (P<0.01). Depression scores and quality of life did not differ at three years. CONCLUSION A single programme for people with newly diagnosed type 2 diabetes mellitus showed no difference in biomedical or lifestyle outcomes at three years although there were sustained improvements in some illness beliefs. TRIAL REGISTRATION Current Controlled Trials ISRCTN17844016.
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Affiliation(s)
- Kamlesh Khunti
- Department of Health Sciences, University of Leicester, Leicester LE1 6TP, UK.
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13
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Crasto W, Jarvis J, Khunti K, Skinner TC, Gray LJ, Brela J, Troughton J, Daly H, Lawrence IG, McNally PG, Carey ME, Davies MJ. Multifactorial intervention in individuals with type 2 diabetes and microalbuminuria: the Microalbuminuria Education and Medication Optimisation (MEMO) study. Diabetes Res Clin Pract 2011; 93:328-36. [PMID: 21640424 DOI: 10.1016/j.diabres.2011.05.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 04/25/2011] [Accepted: 05/05/2011] [Indexed: 11/23/2022]
Abstract
AIMS To determine whether tighter cardiovascular risk factor control with structured education in individuals with type 2 diabetes (T2DM) and microalbuminuria benefits cardiovascular risk factors. METHODS Participants from a multiethnic population, recruited from primary care and specialist clinics were randomised to intensive intervention with structured patient (DESMOND model) education (n=94) or usual care by own health professional (n=95). PRIMARY OUTCOME change in HbA1c at 18months. SECONDARY OUTCOMES changes in blood pressure (BP), cholesterol, albuminuria, proportion reaching risk factor targets, modelled cardiovascular risk scores. RESULTS Mean (SD) age and diabetes duration of participants were 61.5 (10.5) and 11.5 (9.3) years, respectively. At 18months, intensive intervention showed significant improvements in HbA1c (7.1(1.0) vs. 7.8(1.4)%, p<0.0001), systolic BP (129(16) vs. 139(17) mmHg, p<0.0001), diastolic BP (70(11) vs. 76(12) mmHg, p<0.001), total cholesterol (3.7(0.8) vs. 4.1(0.9) mmol/l, p=0.001). Moderate and severe hypoglycaemia was 11.2 vs. 29.0%; p=0.001 and 0 vs. 6.3%; p=0.07, respectively. More intensive participants achieved ≥3 risk factor targets with greater reductions in cardiovascular risk scores. CONCLUSIONS Intensive intervention showed greater improvements in metabolic control and cardiovascular risk profile with lower rates of moderate and severe hypoglycaemia. Intensive glycaemic interventions should be underpinned by structured education promoting self-management in T2DM.
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Affiliation(s)
- W Crasto
- University Hospitals of Leicester, UK.
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14
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Rane K, Wajngot A, Wändell PE, Gåfvels C. Psychosocial problems in patients with newly diagnosed diabetes: number and characteristics. Diabetes Res Clin Pract 2011; 93:371-8. [PMID: 21636163 DOI: 10.1016/j.diabres.2011.05.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 02/28/2011] [Accepted: 05/05/2011] [Indexed: 02/08/2023]
Abstract
Early in the course of diabetes, it is important to identify and support patients whose psychosocial situations and reactions to the diagnosis may affect their ability to adjust or take adequate responsibility for self-care. We aimed to identify (a) the number and characteristics of patients, 18-65 years, newly diagnosed with diabetes, who needed psychosocial interventions and (b) the type of psychosocial problems they had. A total of 106 patients (72 men) were included in the study. Interviews showed that 41.5% had psychosocial problems. Fifteen dropped out early in the study; 38% of those remaining had psychosocial problems (PSP). More than half had problems with their life situation; most commonly in relationships. About a third had problems related to diabetes, most commonly, work-related. Compared to other participants, PSP patients lived in more strained social situations, especially regarding personal finances and social support. More of the PSP patients were anxious and depressed. They used negative coping strategies more often and more frequently expected that diabetes would negatively affect their future. In conclusion, early in the course of diabetes, screening instruments should be used to identify PSP patients. Treatment by medical social workers skilled in diabetes care should be offered.
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Affiliation(s)
- K Rane
- Departments of Diabetes and Endocrinology and Social Work, Karolinska University Hospital, Stockholm, Sweden
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15
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Webb DR, Gray LJ, Khunti K, Campbell S, Dallosso H, Davies MJ. Contrasting cardiovascular risk profiles and prescribed cardio-protective therapies in newly-diagnosed type 2 diabetes identified through screening and standard practice. Diabetes Res Clin Pract 2011; 91:280-5. [PMID: 21194777 DOI: 10.1016/j.diabres.2010.11.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 11/16/2010] [Indexed: 10/18/2022]
Abstract
AIMS Screening for Type 2 diabetes mellitus (T2DM) may improve long-term outcomes by managing cardiovascular risk at an earlier stage of the disease. The cardiovascular risk profile of screen-detected (SD) T2DM is ill defined and has not been compared to conventional newly diagnosed (CD) cases. METHODS Baseline data from SD (n=337) and CD (n=824) cohorts were compared. SD adopted mixed approaches to screening, population based (n=214) and cardiovascular-risk factor targeted (n=123). CD reflected UK primary care practice with cases referred within four weeks of diagnosis. RESULTS People with SD T2DM were leaner, had a lower HbA1c(%) and lower triglyceride but were more hypertensive compared to people with CD T2DM. Fewer SD were on blood pressure lowering (46% vs. 60%, p<0.0001), statin (30% vs. 41%, p<0.0001) or anti-platelet (15% vs. 27%, p<0.0001) therapies. Modelled 10 year cardiovascular disease (CVD) risk was actually greater in the SD group compared to CD (CVD: 20.8 vs. 17.2, p=0.0001). CONCLUSION Individuals with SD T2DM are at high risk of CVD as a result of untreated hyperglycaemia, hypertension and dyslipidaemia. Those prescribed antihypertensive or lipid-lowering therapies frequently still had inadequate control. Identifying vascular risk by screening for latent glucose disease provides therapeutic opportunities for earlier intervention.
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Affiliation(s)
- D R Webb
- Department of Cardiovascular Sciences, University of Leicester, UK.
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16
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Fornaro M, Iovieno N, Clementi N, Boscaro M, Paggi F, Balercia G, Fava M, Papakostas GI. Diagnosis of co-morbid axis-I psychiatric disorders among women with newly diagnosed, untreated endocrine disorders. World J Biol Psychiatry 2010; 11:991-6. [PMID: 20569197 DOI: 10.3109/15622975.2010.491126] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To determine the prevalence of major depressive disorder (MDD) and other selected axis-I disorders among women with newly diagnosed, untreated endocrine disorders. METHODS Two hundred and eighteen consecutive women, aged 18-65, with newly diagnosed, untreated endocrine disorders were referred for potential diagnosis of co-morbid axis-I disorders with the use of the Structured Clinical Interview for Axis I-Patient Edition (SCID-P). The SCID-P was re-administered after 12 weeks. RESULTS At baseline, 64 (29.3%) women met criteria for at least one axis-I disorder. Women who were diagnosed with hyperthyroidism were more likely to meet criteria for generalized anxiety disorder and panic disorder than women without hyperthyroidism. Nine of 154 (5.8 %) women who did not meet criteria for an axis-I disorder at baseline met criteria for at least one axis-I disorder during follow-up. Among them, the presence of diabetes mellitus was statistically correlated with a higher probability of developing major depressive disorder at follow-up. CONCLUSIONS Although preliminary, our findings are consistent with previous studies and suggest an increased prevalence of MDD and other axis-I disorders among women with newly diagnosed endocrine disorders, providing further evidence suggesting that women with endocrine abnormalities may be at increased risk of depression and/or anxiety disorders.
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Affiliation(s)
- Michele Fornaro
- Department of Neuroscience, Section of Psychiatry, University of Genova, Genoa, Italy.
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17
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Gillett M, Dallosso HM, Dixon S, Brennan A, Carey ME, Campbell MJ, Heller S, Khunti K, Skinner TC, Davies MJ. Delivering the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cost effectiveness analysis. BMJ 2010; 341:c4093. [PMID: 20729270 PMCID: PMC2924963 DOI: 10.1136/bmj.c4093] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To assess the long term clinical and cost effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) intervention compared with usual care in people with newly diagnosed type 2 diabetes. DESIGN We undertook a cost-utility analysis that used data from a 12 month, multicentre, cluster randomised controlled trial and, using the Sheffield type 2 diabetes model, modelled long term outcomes in terms of use of therapies, incidence of complications, mortality, and associated effect on costs and health related quality of life. A further cost-utility analysis was also conducted using current "real world" costs of delivering the intervention estimated for a hypothetical primary care trust. SETTING Primary care trusts in the United Kingdom. PARTICIPANTS Patients with newly diagnosed type 2 diabetes. INTERVENTION A six hour structured group education programme delivered in the community by two professional healthcare educators. MAIN OUTCOME MEASURES Incremental costs and quality adjusted life years (QALYs) gained. RESULTS On the basis of the data in the trial, the estimated mean incremental lifetime cost per person receiving the DESMOND intervention is pound209 (95% confidence interval - pound704 to pound1137; euro251, -euro844 to euro1363; $326, -$1098 to $1773), the incremental gain in QALYs per person is 0.0392 (-0.0813 to 0.1786), and the mean incremental cost per QALY is pound5387. Using "real world" intervention costs, the lifetime incremental cost of the DESMOND intervention is pound82 (- pound831 to pound1010) and the mean incremental cost per QALY gained is pound2092. A probabilistic sensitivity analysis indicated that the likelihood that the DESMOND programme is cost effective at a threshold of pound20 000 per QALY is 66% using trial based intervention costs and 70% using "real world" costs. Results from a one way sensitivity analysis suggest that the DESMOND intervention is cost effective even under more modest assumptions that include the effects of the intervention being lost after one year. CONCLUSION Our results suggest that the DESMOND intervention is likely to be cost effective compared with usual care, especially with respect to the real world cost of the intervention to primary care trusts, with reductions in weight and smoking being the main benefits delivered.
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Affiliation(s)
- M Gillett
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield.
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18
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Skinner TC, Carey ME, Cradock S, Dallosso HM, Daly H, Davies MJ, Doherty Y, Heller S, Khunti K, Oliver L. Depressive symptoms in the first year from diagnosis of Type 2 diabetes: results from the DESMOND trial. Diabet Med 2010; 27:965-7. [PMID: 20653757 DOI: 10.1111/j.1464-5491.2010.03028.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIMS To describe the course of depressive symptoms during the first year after diagnosis of Type 2 diabetes. METHODS Post hoc analysis of data from a randomized controlled trial of self-management education for 824 individuals newly diagnosed with Type 2 diabetes. Participants completed the Depression scale of the Hospital Anxiety and Depression Scale after diagnosis and at 4, 8 and 12 months follow-up. Participants also completed the Problem Areas in Diabetes scale at 8 and 12 months follow-up. We present descriptive statistics on prevalence and persistence of depressive symptoms. Logistic regression is used to predict possible depression cases, and multiple regression to predict depressive symptomatology. RESULTS The prevalence of depressive symptoms in individuals recently diagnosed with diabetes (18-22% over the year) was not significantly different from normative data for the general population (12%) in the UK. Over 20% of participants indicated some degrees of depressive symptoms over the first year of living with Type 2 diabetes; these were mostly transient episodes, with 5% (1% severe) reporting having depressive symptoms throughout the year. At 12 months post diagnosis, after controlling for baseline depressive symptoms, diabetes-specific emotional distress was predictive of depressive symptomatology. CONCLUSIONS The increased prevalence of depressive symptoms in diabetes is not manifest until at least 1 year post diagnosis in this cohort. However, there are a significant number of people with persistent depressive symptoms in the early stages of diabetes, and diabetes-specific distress may be contributing to subsequent development of depressive symptoms in people with Type 2 diabetes.
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Affiliation(s)
- T C Skinner
- Combined Universities Centre for Rural Health, University of Western Australia, Geraldton, Western Australia, Australia.
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19
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Göbl CS, Dobes B, Luger A, Bischof MG, Krebs M. Long-term impact of a structured group-based inpatient-education program for intensive insulin therapy in patients with diabetes mellitus. Wien Klin Wochenschr 2010; 122:341-5. [PMID: 20577823 DOI: 10.1007/s00508-010-1398-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Accepted: 04/26/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE Structured patient education aiming to improve self-management strategies might be beneficial for insulin-treated diabetic patients. However, in previous studies the extent of the benefit has been inconsistent in different subgroups of patients. The aim of the present study was to assess the potential benefit of a structured inpatient-education program for intensive insulin therapy according to the basal-bolus concept with particular emphasis on self-management strategies. METHODS We included 81 diabetic patients (59 with type 1, 14 with type 2, eight with other forms) in this retrospective longitudinal study; all had completed the training program on eight consecutive days at a university clinic between 2003 and 2005. Data assessment included HbA1c, LDL-cholesterol, HDL-cholesterol and BMI at baseline (0-15 months before the training) and after 0-5, 5-10 and 10-20 months. RESULTS A transient decrease of HbA1c (0.2%, 95% CI: 0.04-0.37, P = 0.017) and LDL-cholesterol levels (9.95 mg/dl, 95% CI: 2.24-17.76, P = 0.013) between baseline and the first follow-up examination was observed in the group overall. Thereafter, HbA1c and LDL-cholesterol were similar to baseline, whereas a persistent increase in HDL-cholesterol (P = 0.025) was evident in the multivariable analysis. No changes in BMI were observed. A significant type-by-time interaction (P = 0.008) in HbA1c suggests a long-term benefit in glycemic control in patients with type 2 diabetes. CONCLUSION A diabetes training program for intensive insulin therapy with particular emphasis on self-management skills was followed by a moderate and transient improvement of glycemic control and LDL-cholesterol and by a persistent increase in HDL-cholesterol. Long-term improvement in glycemic control was observed only in patients with type 2 diabetes.
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Affiliation(s)
- Christian S Göbl
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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20
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Khunti K, Davies M. Glycaemic goals in patients with type 2 diabetes: current status, challenges and recent advances. Diabetes Obes Metab 2010; 12:474-84. [PMID: 20518803 DOI: 10.1111/j.1463-1326.2009.01186.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Recommendations for the management of type 2 diabetes include rigorous control of blood glucose levels and other risk factors, such as hypertension and dyslipidaemia. In clinical practice, many patients do not reach goals for glycaemic control. Causes of failure to control blood glucose include progression of underlying pancreatic beta-cell dysfunction, incomplete adherence to treatment (often because of adverse effects of weight gain and hypoglycaemia) and reluctance of clinicians to intensify therapy. There is increasing focus on strategies that offer potential to improve glycaemic control. Structured patient education has been shown to improve glycaemic control and other cardiovascular risk factors in people with type 2 diabetes. Payment of general practitioners by results has been shown to improve glycaemic control. New classes of glucose-lowering agents have expanded the treatment options available to clinicians and patients and include the dipeptidyl peptidase 4 (DPP-4) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists. These new classes of therapy and other strategies outlined above could help clinicians to individualize treatment and help a greater proportion of patients to achieve long-term control of blood glucose.
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Affiliation(s)
- K Khunti
- Department of Health Sciences, University of Leicester, Leicester, UK.
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21
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Jarvis J, Skinner TC, Carey ME, Davies MJ. How can structured self-management patient education improve outcomes in people with type 2 diabetes? Diabetes Obes Metab 2010; 12:12-9. [PMID: 19788430 DOI: 10.1111/j.1463-1326.2009.01098.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Type 2 diabetes (T2DM) is a long-term chronic condition that is complex to manage, with the majority of management being done by the person with diabetes outside of the clinical setting. Because of its complexities, effective self-management requires skills, confidence and the ability to make decisions and choices about treatments and lifestyle on a day-to-day basis. Equipping a person with these self-management skills is in itself challenging and it is now widely accepted that structured education is an integral part of the management of T2DM. This paper explores whether structured self-management education can improve outcomes in people with diabetes. The authors explore what self-management education is, why it is needed and then go on to examine the recent evidence from clinical trials from 2006 onwards.
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Affiliation(s)
- J Jarvis
- Diabetes Research Group, University Hospitals of Leicester NHS Trust, Leicester, UK.
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22
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Aujla N, Abrams KR, Davies MJ, Taub N, Skinner TC, Khunti K. The prevalence of depression in white-European and South-Asian people with impaired glucose regulation and screen-detected type 2 diabetes mellitus. PLoS One 2009; 4:e7755. [PMID: 19898618 PMCID: PMC2768906 DOI: 10.1371/journal.pone.0007755] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 10/14/2009] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is a clear relationship between depression and diabetes. However, the directionality of the relationship remains unclear and very little research has considered a multi-ethnic population. The aim of this study was to determine the prevalence of depression in a White-European (WE) and South-Asian (SA) population attending a community diabetes screening programme, and to explore the association of depression with screen-detected Type 2 diabetes mellitus (T2DM) and impaired glucose regulation (IGR). METHODOLOGY/PRINCIPAL FINDINGS Participants were recruited from general practices in Leicestershire (United Kingdom) between August 2004 and December 2007. 4682 WE (40-75 years) and 1327 SA participants (25-75 years) underwent an Oral Glucose Tolerance Test, detailed history, anthropometric measurements and completed the World Health Organisation-Five (WHO-5) Wellbeing Index. Depression was defined by a WHO-5 wellbeing score < or =13. Unadjusted prevalence of depression for people in the total sample with T2DM and IGR was 21.3% (21.6% in WE, 20.6% in SA, p = 0.75) and 26.0% (25.3% in WE, 28.9% in SA, p = 0.65) respectively. For people with normal glucose tolerance, the prevalence was 25.1% (24.9% in WE, 26.4% in SA, p = 0.86). Age-adjusted prevalences were higher for females than males. Odds ratios adjusted for age, gender, and ethnicity, showed no significant increase in prevalent depression for people with T2DM (OR = 0.95, 95%CI 0.62 to 1.45) or IGR (OR = 1.17, 95%CI 0.96 to 1.42). CONCLUSIONS Prior to the knowledge of diagnosis, depression was not significantly more prevalent in people with screen detected T2DM or IGR. Differences in prevalent depression between WE and SA people were also not identified. In this multi-ethnic population, female gender was significantly associated with depression.
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Affiliation(s)
- Navneet Aujla
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom.
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Current literature in diabetes. Diabetes Metab Res Rev 2009; 25:i-xii. [PMID: 19405078 DOI: 10.1002/dmrr.973] [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: 11/06/2022]
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