Psychosocial Care for People With Diabetes: A Position Statement of the American Diabetes Association

Psychometric validation and reliability of the Japanese version of the type 1 diabetes stigma assessment scale (DSAS-1 JP)

AIMS

We aimed to develop and validate a Japanese version of the type 1 diabetes (T1D) stigma assessment scale (DSAS-1 JP) to measure the stigma perceived and experienced by adults with T1D.

METHODS

The DSAS-1 JP was created through forward and backward translations, cognitive debriefing with 10 participants, and extensive proofreading. Its reliability and validity were evaluated in 384 adults with T1D using confirmatory factor analysis, Cronbach's α for internal reliability, and Spearman's rank correlation for construct validity.

RESULTS

The DSAS-1 JP was found to be acceptable by the experts and the target population. Confirmatory factor analysis verified the three-factor structure representing 'treated differently', 'blame and judgement', and 'identity concern', with Cronbach's α values of 0.86, 0.85, and 0.89, respectively. Overall, Cronbach's α for the DSAS-1 JP was 0.92. The model fit indices were robust (goodness-of-fit index=0.94, comparative fit index=0.94, root mean square error of approximation=0.068). Correlations of the DSAS-1 JP score with diabetes distress (r = 0.60, p < 0.001), self-esteem (r = -0.28, p < 0.001), and depressive symptoms (r = 0.34, p < 0.001) confirmed its constant validity. The test-retest reliability was strong at 0.77 (p < 0.0001).

CONCLUSION

The DSAS-1 JP is a reliable and valid tool for assessing the extent of perceived and experienced stigma in Japanese adults with T1D.

Preferences, Expectations and Attitudes on Basal Insulin from Patient-Physician-Payer Perspective: A Multi-stakeholder Survey by the Italian Diabetes Society (ITA4P Study)

INTRODUCTION

Diabetes management often involves complex insulin regimens, posing significant challenges for patients and healthcare systems. Weekly basal insulin formulations aim to simplify treatment, reduce injection frequency, and improve adherence and quality of life. This study explored the beliefs, preferences and attitudes of patients, physicians and payers regarding current basal insulin therapy and weekly insulin formulations.

METHODS

An online survey with structured questionnaires was developed for multiple stakeholders: patients with type 1 or type 2 diabetes, physicians and payers. Participants provided self-reported insights into basal insulin therapy and perceptions of weekly formulations. Results are presented in a descriptive non-analytical way.

RESULTS

A total of 1094 patients, 468 physicians and 100 payers participated. Patients reported moderate satisfaction with current insulin therapy, with lower satisfaction in type 2 diabetes (T2D). The major burdens identified were daily injections and fear of hypoglycaemia, with weekly insulin seen as a promising alternative. Physicians prioritized glycaemic control goals, while patients emphasized independence and quality of life. Payers valued adherence and hypoglycaemia avoidance but raised concerns about costs and education needs.

CONCLUSIONS

According to this multi-stakeholder survey, weekly basal insulin offers a promising approach to reduce treatment burden and improve adherence and quality of life. Addressing concerns about safety, efficacy and cost will be critical to its successful adoption in clinical practice.

Insulin resistance: The role in comorbid type 2 diabetes mellitus and depression

Insulin resistance (IR) plays a significant role in the pathophysiology of comorbid type 2 diabetes mellitus (T2DM) and depression (CDD) through multifaceted mechanisms, including dysregulation of insulin signaling (both central and peripheral), neuroendocrine disturbances (hypothalamic-pituitary-adrenal axis dysfunction and monoaminergic neurotransmission impairment), chronic inflammation, oxidative stress, disruption of the microbiota-gut-brain axis, reduced brain-derived neurotrophic factor levels, and altered synaptic plasticity. These IR-related pathways may predispose individuals to depressive symptoms or exacerbate existing mood disorders. A comprehensive understanding of these mechanisms is critical for developing integrated therapeutic strategies that concurrently target metabolic and psychiatric dysfunction. Antidepressant medications exhibit divergent effects on glucose metabolism. Tricyclic antidepressants, particularly amitriptyline and nortriptyline, worsen metabolic profiles by exacerbating IR, promoting weight gain, and inducing hyperglycemia, thereby increasing diabetes risk with prolonged use. Consequently, tricyclic antidepressants should be avoided in metabolically vulnerable populations unless alternatives are unavailable. Mirtazapine presents a paradoxical profile-while its appetite-stimulating effects often lead to weight gain (a known IR risk factor), some evidence suggests potential β-cell function preservation, necessitating cautious use of mirtazapine in individuals with metabolic syndrome. Among selective serotonin reuptake inhibitors, fluoxetine and escitalopram demonstrate favorable metabolic effects, including improved insulin sensitivity and glycemic control, though hypoglycemia risk (particularly with concomitant sulfonylureas) warrants monitoring. Bupropion, a norepinephrine-dopamine reuptake inhibitor, uniquely promotes weight loss and enhances glycemic control, making it a preferred option for depression comorbid with obesity or T2DM. Agomelatine, with its neutral metabolic profile and circadian rhythm-modulating properties, represents a safer alternative for patients with metabolic concerns. Concurrently, certain antidiabetic agents show promise in managing depression. Metformin and sodium-glucose cotransporter-2 inhibitors may be prioritized for diabetic patients at risk for depression, while glucagon-like peptide-1 receptor agonists appear particularly beneficial for obesity-related mood disturbances. Thiazolidinediones offer value in treatment-resistant cases, whereas insulin secretagogues should be used cautiously in psychiatrically vulnerable individuals. Future research should prioritize three key directions: (1) Mechanistic investigations using advanced neuroimaging to elucidate the contribution of IR to depressive phenotypes and evaluate novel interventions (such as intranasal insulin); (2) Precision medicine approaches incorporating biomarkers, including genetic polymorphisms, inflammatory markers, and gut microbiome signatures, to optimize antidepressant selection and develop personalized treatment algorithms; and (3) Therapeutic innovation, including dual GLP-1/GIP agonists and anti-inflammatory-antidepressant combinations, as well as integrating digital health technologies (e.g., continuous glucose monitoring coupled with mood tracking), will enable real-time, data-driven management. These advances will be instrumental in establishing integrated care paradigms for this comorbidity, which intertwines metabolic and psychiatric conditions.

New-onset mental disorders increase among patients with metabolic diseases after the COVID-19 pandemic

There is limited information on new-onset mental disorders in adults with metabolic diseases following the COVID-19 pandemic. Here, we aimed to examine the changes in mental health following the COVID-19 pandemic and identify factors associated with the development of new-onset mental disorders. Among 90,580 UK Biobank participants diagnosed with COVID-19 between Jan 31, 2020 and Oct 31, 2022, those who completed both baseline and follow-up mental health questionnaires in 2016-2017 and 2022-2023 were included in the analysis. New-onset depression, anxiety, and alcohol use disorder following the COVID-19 pandemic, as well as changes in mental health scores, were assessed. Furthermore, their association with sociodemographic, clinical, and self-perceived emotional state-related exposures was examined. Prevalent metabolic diseases were significantly associated with a higher risk of new-onset depression (hypertension: odds ratio [OR], 1.22; 95% CI 1.01-1.47; diabetes: OR 1.8; 95% CI 1.25-2.6; obesity: OR 1.66; 95% CI 1.43-1.95) and anxiety (hypertension: OR 1.32; 95% CI 1.06-1.63; diabetes: OR 1.66; 95% CI 1.06-2.62; obesity: OR 1.2; 95% CI 0.99-1.44) following COVID-19 pandemic. There was a significant increase of Patient Health Questionnaire-9 (PHQ-9; beta, 0.32; 95% CI 0.29-0.35) and Generalized Anxiety Disorder-7 (GAD-7; beta, 0.10; 95% CI 0.06-0.13) scores throughout the COVID-19 pandemic, while Alcohol Use Disorder Identification Test (AUDIT) score decreased over time (beta, - 0.24; 95% CI - 0.30 to - 0.18). Preexisting metabolic diseases were associated with the accelerated increase in the PHQ-9 and GAD-7 scores following the pandemic. Adults with metabolic diseases are associated with an increased risk of new-onset depression, anxiety, and alcohol use disorders following the COVID-19 pandemic.

Development, validation, and item bias assessment of the Self-Care Inventory-Short-Form among racially and income-diverse adolescents living with type 1 diabetes and their caregivers

OBJECTIVE

Youth with type 1 diabetes and their families engage in complex health behaviors to help manage blood glucose levels and to reduce the risk of serious health complications. Given well-documented health disparities in pediatric diabetes, rapid and equitable assessment of diabetes self-care can help identify potential areas where support is needed. This purpose of this study was to (a) develop a short-form of the Self-Care Inventory-Revised (SCI-R) and (b) evaluate validity, reliability, and differential item functioning (DIF) across several socio-illness-demographic variables of the full and short-form SCI-R.

METHODS

Participants were 181 adolescent-caregiver dyads from the Predicting Resiliency in Youth with Type 1 Diabetes (PRYDE) study who completed a 15-item version of the SCI-R. Adolescents (age: M = 14.64, SD =1.70, range 12-18 years), identifying as female (n = 92), male (n = 92), Black/AA (57%), and/or White (43%), also completed diabetes-specific measures of stress and Health-related Quality of Life (T1D-HRQoL). Youths' most recent hemoglobin A1c (HbA1c) values were extracted from their medical records.

RESULTS

Initial items selected based on the six highest factor loadings of 15 were evaluated using DIF analyses. The final 6-item youth and caregiver SCI-SF6 totals correlated with HbA1c, stress, and T1D-HRQoL. They were invariant across participant dyads at the scalar level (root mean squared error of approximation =.077, 90% CI: .056-.098; comparative fit index =.971, standardized root mean square residual = .0490). DIF analyses failed to reject the null hypothesis for item bias factor loadings or item thresholds across age, family income, HbA1c, racial category, gender, and illness duration.

CONCLUSIONS

The results support initial evidence of equitable assessment, measurement invariance, validity, and reliability for SCI-SF6 across important socio-illness-demographic variables.

Disordered eating attitudes and behaviours among older adults with type 1 diabetes: An exploratory study

AIMS

We explored the prevalence of disordered eating behaviours (DEBs) and attitudes among older adults with type 1 diabetes (T1D) and associations with demographic and clinical variables.

METHODS

Adults aged ≥65 years with T1D from a university-affiliated hospital system completed an electronic survey (September to November 2023) including the Diabetes Eating Problem Survey-Revised (DEPS-R). Clinical data were extracted from medical records.

RESULTS

Seventy-seven older adults (mean [SD] age: 71.8 [4.1]; mean [SD] HbA1c [mmol/mol]: 51 [12]; BMI [kg/m2]: 27.3 [4.7]) with T1D completed the DEPS-R. Mean DEPS-R score was 11.5 (6.0), with 5.2% (n = 4) having clinically significant DEBs (score ≥ 20). We found a positive linear association between DEPS-R score and BMI (adjusted p = 0.002). There was no significant association with HbA1c.

CONCLUSIONS

Older adults with T1D endorsed variable degrees of DEBs. Greater DEBs were associated with higher BMI; more research is needed to characterise this relationship.

Validation of the Filipino Version of the Diabetes Distress Scale for Adult Patients with Diabetes seen at the Outpatient Department of a Tertiary Government Hospital in Quezon City, Philippines

Introduction

Caring for persons with diabetes involves a holistic approach. Addressing diabetes distress is crucial to achieve optimal health outcomes for persons with diabetes. This study aims to validate a Filipino version of the diabetes distress scale (DDS).

Methodology

We conducted forward and backward translations to construct a Filipino version from the validated English questionnaire. We performed statistical analysis to check internal consistency and validation and to correlate diabetes distress with glycemic control based on the subjects' HbA1c levels.

Results

We included one hundred and seventy patients (170) seen at the Outpatient Diabetes Clinic in the analysis. Of the participants, 13 (7.6%) have Type 1 Diabetes Mellitus (T1DM), while the rest have Type 2 (T2DM). We found physician distress (PD) to be significantly associated with having T1DM. All domains in the Filipino DDS showed good internal consistency, ranging from 0.81 to 0.85. We used factor analysis to extract four factors similar to the original diabetes distress scale. We did not find any significant correlation between diabetes distress and HbA1c level.

Conclusion

The Filipino DDS showed good internal reliability and had consistent results similar to the original diabetes distress scale. However, we did not find a significant correlation between diabetes-related distress and the HbA1c level.

Experience with a team-based gamification health app for behavior change adapted to people with diabetes: A pilot study

BackgroundHealth apps offer promising support for people with diabetes; however, the retention rates are low. Team-based apps and gamification can increase engagement and contribute to sustained use.ObjectiveThis pilot study explored how a team-based gamification app can support diabetes self-care.MethodsIndividuals with diabetes were introduced to a team-based gamification app that encourages the development of new habits. After 6 weeks of use, participants completed a questionnaire on system satisfaction, ease of use, enjoyment, usefulness for self-care, and burden, using a five-point scale. Qualitative data were also collected.ResultsOf the 32 participants, 65% were satisfied, 81% found it useful for lifestyle management, and 71% found it useful for exercise. The team system and challenge-tracking features were the most useful. Participants stated that the app provided emotional support and motivated healthy habits through social comparison; however, they also reported confusion in aligning team and individual needs.ConclusionsThe team-based gamification health app provided emotional support by team members who shared the same goals and motivated healthy lifestyle habits through social comparison.

Bridging illness uncertainty and self-care: The role of cognitive emotion regulation in type 2 diabetes management

AIMS

This study assessed the mediating role of cognitive emotion regulation strategies in the relationship between illness uncertainty and diabetes health-promoting self-care behaviours.

METHODS

A cross-sectional study was conducted with 433 T2DM outpatients using the Mishel Uncertainty in Illness Scale, the Diabetes Health Promotion Self-Care Scale, and the Cognitive Emotion Regulation Questionnaire (CERQ). Data were analysed using SPSS (v.29) for descriptive and Pearson correlation tests, and Process Macro for SPSS (Model 4, v.4.2) for mediation analysis.

RESULTS

There is a statistically significant, weak negative relationship between illness uncertainty and diabetes health promotion self-care scores (r = -0.105, p = 0.029). CERQ showed a weak negative correlation with illness uncertainty scores, whereas the questionnaire demonstrated a statistically significant, moderate positive correlation with diabetes health-promoting self-care (p < 0.05). The relationship between illness uncertainty and diabetes health- promoting self-care was mediated by CERQ such as self-blame (β= 0.083, 95 % CI= 0.019 - 0.155), acceptance (β= -0.031, 95 % CI= -0.061 - -0.007), rumination (β= -0.107, 95 % CI= -0.179 - -0.048), and positive reappraisal (β= -0.043, 95 % CI= -0.091 - -0.001).

CONCLUSIONS

Illness uncertainty negatively impacts self-care behaviours in T2DM patients. CERQ, including self-blame, acceptance, rumination, and positive reappraisal, play a mediating role, highlighting their potential in interventions to improve self-care.

Cardiometabolic Risk in Chronic Spinal Cord Injury: A Systematic Review with Meta-Analysis and Temporal and Geographical Trends

Objectives: This systematic review with meta-analysis compared cardiometabolic syndrome (CMS) in adults with chronic (≥1 year) spinal cord injury (SCI) to non-SCI individuals (controls) and athletes, analyzing the effect of specific injury characteristics and exploring temporal and geographical trends. Methods: Ovid Medline, Embase, Cochrane, CINAHL, Scopus, and Web of Science were searched from inception to September 2024. Adults with chronic SCI were included based on observational and baseline data derived from experimental studies. Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields assessed quality. Weighted means with 95% bootstrapped confidence intervals (CI) were computed for risk stratification. Group differences were assessed using random effects meta-analysis, calculating weighted mean differences with 95% bootstrapped CI. Temporal and geographical trends were evaluated with linear regression based on sample-size-weighted distributions and relevant covariates. Results: Of 31,163 identified records, 471 studies were included (n ≤ 31,782 SCI participants). CMS was present in men with SCI, paraplegia, tetraplegia, and injuries above T6; men with complete SCI (AIS A); and men and women with motor-complete SCI (AIS A-B). Compared to controls, adults with SCI had a lower body mass index (BMI), higher total and visceral fat, and worse lipid and carbohydrate profiles, including increased insulin resistance (IR). Tetraplegia was associated with greater visceral fat, poorer glycemic control, and lower BMI, insulin sensitivity, high-density lipoprotein-cholesterol (HDL-C), and triglycerides than paraplegia. Motor-complete SCI had lower BMI, HDL-C, and fasting glucose than motor-incomplete injuries. Injuries above T6 had lower blood pressure and higher fasting insulin levels than those below T6. Athletes with SCI had a lower BMI, fat mass, and fasting glucose, and higher systolic blood pressure than non-athletes with SCI, but frequently presented with obesity and carbohydrate dysfunction. Temporal analysis revealed increasing obesity trends and improved systolic blood pressure, while other CMS risk factors remained unchanged. We also identified global variations in obesity, lipids, blood pressure, and carbohydrate patterns. Conclusions: With a large sample, we revealed a widespread cardiometabolic burden in chronic SCI, even among athletes. Specifically, obesity, IR, and hypoalphalipoproteinemia worsened with increasing injury severity, alongside rising obesity trends and geographic disparities in risk profiles. These patterns highlight the evolution of what was deemed an epidemic into a global cardiometabolic pandemic.

Exploring Psychosocial Burdens of Diabetes in Pregnancy and the Feasibility of Technology-Based Support: Qualitative Study

BACKGROUND

Gestational diabetes mellitus and type 2 diabetes mellitus impose psychosocial burdens on pregnant individuals. As there is less evidence about the experience and management of psychosocial burdens of diabetes mellitus during pregnancy, we sought to identify these psychosocial burdens and understand how a novel smartphone app may alleviate them. The app was designed to provide supportive, educational, motivational, and logistical support content, delivered through interactive messages.

OBJECTIVE

The study aimed to analyze the qualitative data generated in a feasibility randomized controlled trial of a novel mobile app designed to promote self-management skills, motivate healthy behaviors, and inform low-income pregnant individuals with diabetes.

METHODS

Individuals receiving routine clinical care at a single, large academic medical center in Chicago, Illinois were randomized to use of the SweetMama app (n=30) or usual care (n=10) from diagnosis of diabetes until 6 weeks post partum. All individuals completed exit interviews at delivery about their experience of having diabetes during pregnancy. Interviews were guided by a semistructured interview guide and were conducted by a single interviewer extensively trained in empathic, culturally sensitive qualitative interviewing of pregnant and postpartum people. SweetMama users were also queried about their perspectives on the app. Interview data were audio-recorded and professionally transcribed. Data were analyzed by 2 researchers independently using grounded theory constant comparative techniques.

RESULTS

Of the 40 participants, the majority had gestational diabetes mellitus (n=25, 63%), publicly funded prenatal care (n=33, 83%), and identified as non-Hispanic Black (n=25, 63%) or Hispanic (n=14, 35%). Participants identified multiple psychosocial burdens, including challenges taking action, negative affectivity regarding diagnosis, diet guilt, difficulties managing other responsibilities, and reluctance to use insulin. External factors, such as taking care of children or navigating the COVID-19 pandemic, affected participant self-perception and motivation to adhere to clinical recommendations. SweetMama participants largely agreed that the use of the app helped mitigate these burdens by enhancing self-efficacy, capitalizing on external motivation, validating efforts, maintaining medical nutrition therapy, extending clinical care, and building a sense of community. Participants expressed that SweetMama supported the goals they established with their clinical team and helped them harness motivating factors for self-care.

CONCLUSIONS

Psychosocial burdens of diabetes during pregnancy present challenges with diabetes self-management. Mobile health support may be an effective tool to provide motivation, behavioral cues, and access to educational and social network resources to alleviate psychosocial burdens during pregnancy. Future incorporation of machine learning and language processing models in the app may provide further personalization of recommendations and education for individuals with DM during pregnancy.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03240874; https://clinicaltrials.gov/study/NCT03240874.

Design and methods of a multicenter randomized clinical trial of effects of diabetes-educated psychologist on glucose management and diabetes distress

Introduction

Many people with type 1 diabetes struggle to manage their glucose levels and experience stress related to the behavioral demands of the disease. The aim of this study is to investigate whether treatment with a diabetes-educated psychologist can improve glucose levels and decrease diabetes distress.

Materials and methods

Individuals with HbA1c >62 mmol/mol (7.8%) were randomized to either psychological treatment or control group. The study duration for each participant was 52 weeks. Patients who received treatment met with a diabetes-educated psychologist a minimum of seven times. In total 6 outpatient diabetes units and 10 psychologists participated. Cognitive behavioral therapy was primarily the treatment of choice. Both groups met with a diabetes nurse and/or physician at the start of the study and at 3, 6, and 12 months. HbA1c, blood pressure, and weight were measured at scheduled visits. Diabetes distress, quality of life, hypoglycemia confidence, and treatment satisfaction were evaluated using questionnaires. The primary endpoint is the difference in HbA1c from baseline to week 52. Secondary endpoints are changes in diabetes distress and quality of life from baseline to week 52, as well as treatment satisfaction at 52 weeks.

Discussion

This study seeks to improve knowledge about how to support patients who struggle to manage their diabetes. If the results of this study show that psychological treatment has an effect on HbA1c or on diabetes distress, it could indicate that psychologists should become more involved in diabetes care teams. Clinical trial registration: ClinicalTrials.gov ID NCT03753997.

Effect of mindfulness-based intervention in patients with diabetes: a meta-analytic review

BACKGROUND/OBJECTIVE

Traditional management strategies for diabetes primarily focus on behavioural risk factors and pharmacological therapies. Furthermore, mindfulness-based interventions (MBIs) aim to assist patients in recognising and accepting sensations, emotions and cognitions without automatic reactivity. This approach can potentially enhance glycaemic control and mental health in diabetic patients. This systematic review and meta-analysis aim to assess the effects of MBIs among individuals diagnosed with diabetes.

METHODS

A systematic literature search and meta-analysis were conducted following international quality standards utilised by the Cochrane Collaboration. Randomised controlled trials were included. The population of interest was defined as any patient diagnosed with diabetes; MBIs were defined as the intervention. Pubmed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials and Lilacs were accessed. A grey literature search was performed using OpenGrey and ClinicalTrials tools. Outcomes included changes in glycosylated haemoglobin percentage (%HbA1c), depression, and stress scores. The risk of bias was assessed using the RoB 2 tool, and publication bias was evaluated through Egger's test. The results were presented with forest plots. The mean difference (MD) for the %HbA1c and the standardised MD for the measurement scale scores were used as effect measures.

RESULTS

The initial search retrieved 442 scientific articles, 11 randomised clinical trials were finally selected for the systematic review, which included 987 participants (487 in the intervention groups), and seven articles were included in the meta-analysis. The meta-analysis showed that MBIs had effects at follow-up (between 12 and 20 weeks) in reducing %HbA1c levels (MD = -0.5, CI 95% [-0.67, -0.34]) and depression SMD = -0.84, CI 95% [-1.11, -0.56]).

CONCLUSIONS

It is proposed that mindfulness significantly enhances mental health and glycaemic control in patients with diabetes. Further research is warranted to confirm these effects and gain a deeper understanding of the contribution of MBIs in comprehensive diabetes treatment.

Protocol for the diabetes, distress and disparities (3D) study: an explanatory sequential mixed-methods design

INTRODUCTION

Psychosocial factors impact diabetes outcomes, yet healthcare systems remain inadequately equipped to address these needs. Research centring on the experiences of people with diabetes (PWD) can inform programme implementation, policies and partnerships to address psychosocial care needs. The goals of the diabetes, distress and disparities (3D) study are to quantify the psychosocial care needs of PWD in a large academic medical centre, generate insights regarding how psychosocial factors shape diabetes outcomes and identify modifiable determinants of psychosocial care.

METHODS AND ANALYSIS

The 3D study is recruiting adults with type 1 (T1D), type 2 (T2D), latent autoimmune diabetes in adults (LADA) and gestational diabetes (GD) from the Caswell Diabetes Registry at Michigan Medicine. The 3D study uses an explanatory sequential mixed-methods design with two phases. Phase I (P1: target n=500, began July 2023) consists of an online survey to quantify prevalence and examine correlates of a wide range of psychosocial factors (eg, diabetes-related distress, depression, stigma). This survey was refined through consultation with PWD. Phase II (P2) involves semi-structured telephone interviews with n=40 P1 respondents, recruited using maximum variation sampling informed by demographic characteristics and responses to psychosocial survey measures. P2 will explore a subset of factors (eg, patient-provider communication, social support, barriers/promoters to care). To date, n=573 (5% response rate) have completed P1. In March 2024, we identified a target sample of P1 respondents (n=65) for recruitment into P2. All data collection was completed by September 2024. Analysis will involve quantitative linear and logistic regression to understand correlates of psychosocial outcomes from P1, and qualitative content analysis to clarify potential points of intervention from P2.

ETHICS AND DISSEMINATION

This study is approved by the University of Michigan Institutional Review Board (HUM00223735). Protocol materials are available at https://osf.io/yfz6b/. Findings from this study will be disseminated through peer-reviewed publications, presentations at conferences and outreach to key stakeholders, including creating educational materials for patient advocacy groups and interprofessional practice.

The Role of Neuroinflammation in the Comorbidity of Psychiatric Disorders and Internal Diseases

Psychiatric disorders and internal diseases frequently co-occur, posing significant challenges due to overlapping symptoms, shared pathophysiological mechanisms, and increased healthcare burdens. Neuroinflammation has emerged as a central mechanism linking these conditions, driven by systemic inflammation, hypothalamic-pituitary-adrenal (HPA) axis dysregulation, and autonomic nervous system (ANS) imbalance. This review synthesizes current evidence on the role of neuroinflammation in comorbid conditions such as depression, anxiety, cardiovascular disease, and diabetes mellitus, emphasizing bidirectional relationships and shared inflammatory pathways. This analysis identifies gaps in longitudinal studies, biomarker validation, and the integration of multidisciplinary care models. Emerging therapeutic approaches, including IL-6 inhibitors, vagus nerve stimulation, and behavioral interventions, show promise but remain underexplored in combined applications. Furthermore, disparities in research representation limit the generalizability of findings and highlight the need for inclusive clinical trials. Addressing these gaps through precision medicine, advanced biomarker monitoring technologies, and equitable healthcare strategies could transform the management of these complex comorbidities. By advancing our understanding of neuroinflammatory mechanisms and promoting integrated interventions, this review underscores the need for a collaborative, patient-centered approach to improve outcomes and reduce the global burden of psychiatric and internal disease comorbidities.

Psychological distress in Aotearoa New Zealand adults with type 1 diabetes

The psychological burden of type 1 diabetes (T1D) can negatively impact health outcomes. This study evaluates the prevalence of low mood (WHO-5), disordered eating (DEPS-R), diabetes distress (PAID) and fear of hypoglycaemia (HFS-II), in a sample of 250 New Zealand adults (8.4% Māori/91.6% non-Māori; 43.6% female/56.4% male) with T1D using validated tools. Māori and female patients indicated low mood, with lower median WHO-5 scores than non-Māori (p = 0.027) and males (p = 0.002). Māori were more likely to score in the clinical range on the WHO-5, DEPS-R, PAID and HFS-II (all p < 0.05). HbA1c was correlated with emotional well-being (rs = -0.189), diabetes distress (rs = 0.223) and disordered eating (rs = 0.389; all p < 0.001) whilst DEPS-R correlated with age (rs = -0.232) and BMI (rs = 0.343; both p ≤ 0.001). Thus, diabetes-related psychological distress is common in New Zealand adults with T1D, particularly for Māori, females and those with elevated HbA1c levels.

Assessment and Intervention for Diabetes Distress in Primary Care Using Clinical and Technological Interventions: Protocol for a Single-Arm Pilot Trial

BACKGROUND

Diabetes distress (DD) is a common emotional response to living with diabetes. If not addressed, DD can have negative impacts on diabetes management, including the progression to mental health conditions such as depression and anxiety. Routine screening and treatment for DD is recommended, with primary care being an ideal setting given that the majority of people with diabetes receive their diabetes care from primary care providers. However, consistent screening of DD does not routinely occur in primary care settings. Research is needed to understand how to effectively and feasibly integrate DD screening and treatment into routine diabetes care.

OBJECTIVE

This study aims to (1) design and implement individualized technology-supported DD workflows, (2) evaluate the primary outcome of determining the acceptability and feasibility of integrating technology-based workflows to provide treatment for DD, and (3) evaluate the secondary outcomes of changes in DD, depression, and anxiety (baseline, 3 months, and 6 months) in patients receiving screening and personalized treatment.

METHODS

In total, 30 English and Spanish-speaking primary care patients with either type 1 or type 2 diabetes will receive screening for DD during clinical visits and subsequent support from an artificial intelligence (AI)-based health care chatbot with interactive tailored messaging. In addition, the use of electronic consultation with a specialist or referral to a behavioral health provider could occur depending on the severity and source of DD. The use of electronic consultations allows providers convenient and timely asynchronous access to a range of specialty care providers. Health outcomes will be measured through changes in validated screening measures for DD, depression, and anxiety. Digital outcomes will be measured through surveys assessing user experience with technology and system usability, and by system performance data. Qualitative data on acceptability and satisfaction with the clinical workflows and technological interventions will be collected through interviews with patients and clinical providers. Descriptive statistics will summarize quantitative outcome measures and responses to closed-ended survey items, and rapid thematic and content analysis will be conducted on open-ended survey and interview data.

RESULTS

Workflows for screening and treating DD have been approved and clinical staff have received training on the process. Electronic surveys for screening measure collection have been created. Data from visit screeners will be entered into the electronic medical record during the medical appointment. Recruitment will begin late June-July 2024.

CONCLUSIONS

This study is expected to demonstrate the feasibility and acceptability of integrating individualized workflows for DD into primary care. Improving clinical and digital interventions for addressing DD in primary care can provide alternative care options for busy clinical providers. This study is intended to deliver whole-person diabetes care to people with diabetes within a primary care setting.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/62916.

Prevalence and Risk Factors of Obesity Among Type 2 Diabetic Participants in Abha, Saudi Arabia: A Cross-Sectional Study

Background: The prevalence of obesity among type 2 diabetic participants is a growing concern globally, including in Abha, Saudi Arabia. This study aimed to investigate the prevalence and its associated risk factors of obesity among type 2 diabetic participants in Abha. Methods: A cross-sectional study targeted 400 type 2 diabetic participants in Abha, Saudi Arabia. A hybrid method (snowball sampling + purposive) techniques were used to obtain an adequate sample size. Data were collected after obtaining telephonic or digital consent; the questionnaire was shared with participants who were able and willing to complete it independently those with type 2 diabetes who wished to participate but were unable to complete the questionnaire on their own. The researcher conducted a telephonic interview and recorded their responses. The questionnaire captured demographic details, Anthropometric history, medical history, lifestyle habits, and type 2 Diabetes (T2DM) specific factors. Data were analyzed using IBM SPSS Statistics for Windows, Version 27.0. Results: The overall prevalence of obesity among the type 2 DM study participants was 46.0%, 115 participants (28.8%) fell into the Obesity Grade I category, 43 (10.8%) as Obesity Grade II, while 26 (6.5%) were classified as Obesity Grade III, the overall median BMI of participants was 29.3 ± 5.88. Significant bio-demographic factors associated with obesity included age, gender, educational level, marital status, and co-morbidities (p < 0.05). Notably, females and older adults exhibited higher obesity rates. Significant lifestyle factors included the frequency and type of physical activity, soft drink consumption, and attempts to control weight. Participants who exercised regularly and avoided soft drinks had lower obesity rates. Multiple logistic regression analysis identified age, gender, co-morbidities, family history of obesity, regular dinner consumption, soft drink consumption, and exercise frequency as significant predictors of obesity (p < 0.05). Conclusions: The study determined a high prevalence of obesity among type 2 diabetic participants in Abha, Saudi Arabia, with significant associations with bio-demographic and lifestyle factors. Interventions targeting weight management, physical activity, dietary habits, and health education are urgently needed to address obesity in this population. Further research is recommended to explore these associations longitudinally and to develop tailored intervention strategies.

Cost of hospitalization and length of stay of hypoglycemic events in hospitalized patients with diabetes mellitus: A cross-sectional study

This study aims to assess the length of stay and cost per hypoglycemia episode, as well as to determine the factors that influence the length of stay, intensive care unit (ICU) admission, and hospitalization costs among patients with diabetes mellitus. This is a retrospective cross-sectional study conducted on a cohort of diabetic individuals who experienced confirmed hypoglycemia episodes. The data pertaining to these patients were obtained from their respective hospital medical records, covering the period from January 2021 to December 2022. King Fahd Medical City was selected as the site of data collection for this study. A total of 396 patients were involved in this study. The median duration of stay for the patients was 7.0 (2.0-16.0) days. Only 3.0% of the patients had a previous hypoglycemia admission history. Around 53.3% of the patients were admitted to the ICU. The median duration of ICU admission stay was 1.0 (0.0-1.0) days. The highest cost driver for patients with hypoglycemia was ICU stay with a median cost of 9000.0 (1125.0-15750.0) Saudi Arabia riyal (SAR) (2399.6 (300.0-4199.2) United States dollar (USD)). The total median cost associated with hypoglycemia hospitalization was 4696.0 (886.5-12789.5) SAR (1252.0 (236.4-3410.0) USD). Ex-smokers were more likely to have higher hospitalization costs for hypoglycemia (4.4-folds) (P < .001). Being admitted to the ICU increased the likelihood of having a longer length of hospitalization by 2.6-folds (P < .001). Patients with longer diabetes duration (above 9 years) were more likely to be admitted to the ICU by 2.9-folds (P = .008). Understanding the factors that affect hypoglycemia hospitalization cost and length is essential for improving diabetes care and resource usage. Identifying high-risk patients and implementing efficient preventative strategies can lower the economic burden of DM and accompanying hypoglycemic episodes and enhance DM management.

Impact of family environment on mental disorders and quality of life in children with type 1 diabetes mellitus: a cross-sectional study and intervention policy analysis

Background

Type 1 diabetes mellitus (T1DM) is common in adolescents and negatively affects their quality of life and mental health. This study examines the impact of family environment on mental disorders and quality of life in adolescents with T1DM and analyzes related intervention policies.

Methods

A retrospective analysis was conducted on 75 adolescents with T1DM admitted between October 2020 and December 2023, with 75 healthy adolescents as a control group. Assessments included SCARED, DSRSC, FES, SCL-90, and PedsQL 4.0. Correlation analysis explored the relationships between family environment, anxiety, depression, quality of life and glycosylated haemoglobin (HbA1C).

Results

Significant differences (P < 0.05) were found between the T1DM and control groups in family conflict, independence, harmony, and emotional expression. The T1DM group had higher anxiety, depression, and poorer quality of life. Family cohesion was negatively correlated with mental state, anxiety, depression, and HbA1C, while emotional expression was positively correlated with role functioning.

Conclusion

The family environment significantly impacts the mental health and quality of life of adolescents with T1DM. Enhancing emotional expression and family cohesion can improve outcomes, highlighting the need for targeted interventions.

Psychosocial well-being and diabetes distress in the transition to motherhood among women with type 1 or type 2 diabetes

OBJECTIVE

To investigate the associations between psychological well-being, measured with the Postnatal Well-being in Transition (PostTrans) Questionnaire, and diabetes distress among mothers with type 1 or type 2 diabetes.

METHOD

Eighty-two postnatal women completed a cross-sectional survey. The survey included the Diabetes Distress Scale, and the PostTrans Questionnaire to assess the psychosocial well-being of women transitioning to motherhood. Linear and logistic regressions were used to assess associations.

RESULTS

Using the Diabetes Distress Scale (cut-off score ≥ 2), the overall prevalence of diabetes distress was 64 %. Psychosocial well-being was negatively associated with diabetes distress (B=─1.65; 95 % CI, ─2.02, ─1.29; P < 0.001), and more strongly with regimen-related distress (B= ─1.90; 95 % CI, ─2.44, ─1.35; P < 0.001). Four sub-scales of the PostTrans Questionnaire (coping with diabetes and managing an infant, anxiety and guilt about diabetes, sensitivity to opinions, healthcare professional support and information) were negatively associated with diabetes distress score (B between ─0.42 and ─0.68), while receiving family support and prioritising self-care did not show a statistically significant association with diabetes distress.

CONCLUSION

Psychological factors unique to postnatal women and a lack of healthcare professional support are significantly associated with diabetes distress. However, it is unclear whether lack of family support and self-care behaviours could contribute to increased diabetes distress. Interventions that target psychological factors and that involve healthcare professionals, may optimise diabetes self-management and infant care.

Psychosocial and behavioral risk patterns and risk of cardiovascular complications in people with type 2 diabetes

INTRODUCTION

Psychosocial and behavioral risk factors often co-occur in patients with type 2 diabetes (T2D). The clustering of these risk factors and their role in predisposing patients to cardiovascular complications is not well understood. This study aims to identify patient subgroups with distinct psychological and behavioral risk patterns and evaluate the long-term risk of cardiovascular complications associated with these risk patterns.

METHODS

A total of 24,467 patients with T2D were identified from the UK Biobank (mean age 59 years, 86.7 %white), used Latent Class Analysis (LCA) to distinguish risk patterns among observed psychosocial (social isolation, loneliness, high neuroticism, anxiety, and depression) and behavioral (smoking, alcohol consumption, sleep duration, diet quality, and physical inactivity) risk factors. the Cox proportional hazards model was applied to assess the association of the identified risk patterns and risk of coronary heart disease (CHD), stroke, and a composite CVD (CHD or stroke) accounting for age, age at T2D diagnosis, race, gender, Townsend Deprivation Index, anti-diabetes medications, lipid-lowering medications, and anti-hypertensive medications.

RESULTS

Three distinct latent classes were identified: a low-risk group (n = 8,227, 33.62 %), a high psychosocial risk group (n = 15,965, 65.25 %), and a high behavioral risk group (n = 275, 1.12 %). Over a median follow-up of 12 years, the fully adjusted model showed that the high psychosocial risk group had a significantly increased risk of CHD (HR = 1.16; 95 % CI 1.08, 1.24) and composite CVD (HR = 1.13; 95 % CI 1.06, 1.20).

CONCLUSION

The psychosocial risk pattern is significantly associated with the risk of CHD and CVD among patients with T2D. These findings emphasize the importance of integrating psychosocial support into tailored care strategies to mitigate cardiovascular risks in T2D patients.

Telehealth occupational therapy improves psychosocial well-being but not glycemia among young adults with type 1 diabetes: The Resilient, Empowered, Active Living-Telehealth (REAL-T) randomized controlled trial

BACKGROUND

Young adults with type 1 diabetes mellitus often face challenges managing their condition, leading to elevated glucose and heightened psychosocial distress. Diabetes care traditionally focuses on biomedical outcomes, with less emphasis on well-being. Occupational therapy offers a holistic approach to managing diabetes by integrating changes to daily habits and routines and psychosocial support.

METHODS

This randomized controlled trial involved participants aged 18-30 with HbA1c ≥ 7.5 % (≥58 mmol/mol). Participants received either telehealth occupational therapy or usual care. The intervention addressed diabetes management, daily habits and routines, and emotional well-being. Data collected at baseline, 3 months, and 6 months included HbA1c, continuous glucose monitoring metrics, and psychosocial outcomes. Analyses employed intent-to-treat principles, using ANCOVA to evaluate between-group differences.

RESULTS

Participants (n = 209) were 24.3 (±3.7) years old, 59.8 % female, 44.5 % non-Hispanic White, and 47.4 % publicly insured. No significant differences were found in glycemic outcomes. Intervention participants had improved diabetes-related quality of life (DQoL; least-squares [LS] mean 0.67, 95 % CI 0.02 to 1.32, p = 0.045) and reduced diabetes distress (LS-mean -0.36, CI -0.65 to -0.07, p = 0.01).

CONCLUSION

Generalizability may be impacted by external factors related to COVID-19. The findings suggest occupational therapy may be beneficial for young adults experiencing diabetes-related distress and poor DQoL.

Evaluating a mental health support mobile app for adults with type 1 diabetes living in rural and remote communities: The REACHOUT pilot study

AIMS

To evaluate a mobile app that delivers mental health support to adults with type 1 diabetes (T1D) living in rural and remote communities using the Reach, Effectiveness, Adoption, Intervention fidelity, Maintenance (RE-AIM) framework.

METHODS

This study recruited 46 adults to participate in a 6-month intervention using REACHOUT, a mobile app that delivers peer-led mental health support (one-on-one, group-based texting and face-to-face virtual). Baseline and 6-month assessments measured diabetes distress (DD), depressive symptoms and perceived support (from family/friends, health care team and peers) along with other RE-AIM metrics.

RESULTS

Calculations for reach and adoption found that 3% of eligible adults enrolled in REACHOUT and 55% of diabetes education centres participated in recruitment efforts. Maintenance metrics revealed 56% and 24% of peer supporters and participants, respectively, became peer supporters for a subsequent randomized controlled trial of REACHOUT. Post-intervention reductions were observed for overall distress (p = 0.007), powerlessness (p = 0.009), management distress (p = 0.001), social perception distress (p = 0.023), eating distress (p = 0.032) and depressive symptoms (p = 0.009); and elevations in support from family/friends and peers. After adjusting for sex and age, only support-related improvements persisted. When analysing women and men groups separately, women reported lower levels of overall distress, three distress subscales, and higher levels of family/friends and peer support whereas men did not.

CONCLUSIONS

While reach was relatively low, metrics for adoption and maintenance are promising. Improvements in distress were observed for the total sample, but these changes were reduced when controlling for sex and age, with significance maintained only for women. Digital health-enabled peer support may be instrumental in the delivery of mental health support to geographically isolated communities.

Evaluation of the Psychosocial Status of Patients With Type 2 Diabetes Mellitus and Their Treating Physicians Using the Glycemic Happiness Scale: A Multicentric, Cross-sectional Study

BACKGROUND

The purpose of this study was to evaluate the psychosocial status of patients with type 2 diabetes (T2D) and treating physicians using a novel Glycemic Happiness (GH) scale.

METHODS

This was a real-world, prospective, multicentric, cross-sectional observational study. Male and female participants aged ≥ 18 years with a clinical diagnosis of T2D were eligible to take part. Additionally, the physicians with extensive T2D patient experience were enrolled in the study.

RESULTS

The study included a total of 400 participants of T2D and 27 physicians. The patient population consisted of 213 (53.3%) men and 187 (46.7%) women, with a mean age of 54.29 ± 12.05 years. The proportions of patients and physicians who were found to be happy were 50.5% and 90.8%, respectively. A statistically significant difference was found in the mean value of the GH score of insulin and oral antidiabetic drugs (OAD) for the physician component (P=0.0160). Although no significant difference in GH score was observed between insulin and OAD usage among the patients (P=0.9564), a significant difference was observed for dosage frequency of OAD (Once daily (OD) vs. three times daily (TID) (P=0.0034) and twice daily (BID) vs. TID (P=0.0324)). In the multiple regression analysis, GH in patients was found to be associated with glycated hemoglobin (HbA1c) and postprandial glucose (PPG) values.

CONCLUSIONS

High glucose levels and OAD dosage frequency have been negatively associated with GH in patients with T2D. To achieve long-term happiness and well-being in diabetes management, there is a need to focus on various aspects of GH among patients and physicians.

Mind Matters: Mental Health and Diabetes Management

CONTEXT

Managing diabetes is an intensive, lifelong responsibility that significantly impacts a person's mental health and diabetes outcomes such as glycemic stability and complications. This mini-review examines the research leading to this conclusion as well as the implications for screening and treatment of mental health issues in people with diabetes within an interdisciplinary care model.

EVIDENCE ACQUISITION

We searched the literature for the past 10 years, including original articles, reviews, and meta-analyses from PubMed and OVID using the search terms diabetes and mental health.

EVIDENCE SYNTHESIS

Diabetes is a lifelong burden, and people with the disease grapple with intensive management, financial burden, fear of hypoglycemia, chronic hyperglycemia complications, and diabetes stigma. These stressors have a debilitating emotional impact, making it difficult to carry out diabetes care tasks, which in turn is associated with poorer short-term glycemic stability and greater mental health symptoms. Psychological syndromes related to a diabetes diagnosis, management, or coping with the disease include major depressive disorder, diabetes distress, anxiety, and eating disorders. Providers managing people with diabetes can leverage 4 validated screening instruments to assess for these syndromes. The main psychological interventions studied to treat these mental health conditions include cognitive behavioral therapy, cognitive conceptualization, dialectical behavioral therapy, relational therapy, and psychoeducation.

CONCLUSION

It is pertinent to address the mental health of people with diabetes as rates of psychological syndromes are significantly higher than among those without diabetes. Interdisciplinary care involving endocrinologists, mental health providers, diabetes educators, and medical nutritionists could improve diabetes self-care and glycemic control.

The influence of cyclothymic and hyperthymic affective temperaments on glycemic control in patients with type 2 diabetes

Affective temperaments are inherited parts of personality determining mood and activity, affecting the management of somatic conditions. We aimed to investigate the association between affective temperaments, depressive symptoms, and self-care (physical activity, smoking, alcohol consumption), and their effect on glycemic control, among patients with type 2 diabetes (T2DM) in general practice, in a cross-sectional study enrolling 338 consecutive patients from six primary care practices in Hungary. A self-administered questionnaire (history, anthropometric, socioeconomic, laboratory parameters), the Beck Depression Inventory (BDI), the Hamilton Anxiety Scale, and the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire were used. Cyclothymic affective temperament determined HbA1c levels in regression analysis (p = 0.002), and the BDI score (p = 0.048). In causal mediation analyses, cyclothymic affective temperament was directly associated with higher HbA1c (p = 0.008). Hyperthymic affective temperament was indirectly associated with lower HbA1c, mediated by BDI (p = 0.034). Depressive, anxious, and irritable affective temperaments, and lifestyle factors were not associated with HbA1c neither in regression nor in mediation analysis as direct or mediating factors. Among primary care patients with T2DM, cyclothymic temperament correlates with worse glycemic control, independently of depressive symptoms. Hyperthymic temperament reduces depressive symptoms, thereby improving glycemic control. Identifying affective temperaments may improve diabetes care.

Differential associations of somatic and cognitive-affective symptoms of depression with inflammation and insulin resistance: cross-sectional and longitudinal results from the Emotional Distress Sub-Study of the GRADE study

AIMS/HYPOTHESIS

Insulin resistance and inflammation are components of a biological framework that is hypothesised to be shared by type 2 diabetes and depression. However, depressive symptoms include a large heterogeneity of somatic and cognitive-affective symptoms, and this may obscure the associations within this biological framework. Cross-sectional and longitudinal data were used to disentangle the contributions of insulin resistance and inflammation to somatic and cognitive-affective symptoms of depression.

METHODS

This secondary analysis used data from the Emotional Distress Sub-Study of the GRADE trial. Insulin resistance and inflammation were assessed using the HOMA-IR estimation and high-sensitivity C-reactive protein (hsCRP) levels, respectively, at baseline and at the study visits at year 1 and year 3 (HOMA-IR) and every 6 months (hsCRP) for up to 3 years of follow-up. Depressive symptoms were assessed at baseline using the Patient Health Questionnaire (PHQ-8), and a total score as well as symptom cluster scores for cognitive-affective and somatic symptoms were calculated. For the cross-sectional analyses, linear regression analyses were performed, with inflammation and insulin resistance at baseline as dependent variables. For the longitudinal analyses, linear mixed-effect regression analyses were performed, with inflammation and insulin resistance at the various time points as dependent variables. In all analyses, depressive symptoms (total score and symptom cluster scores) were the independent variables, controlled for important demographic, anthropometric and metabolic confounders. For the analysis of insulin resistance (HOMA-IR), data from 1321 participants were analysed. For the analysis of inflammation (hsCRP), data from 1739 participants were analysed.

RESULTS

In cross-sectional analysis and after adjustment for potential confounders, a one-unit increase in PHQ-8 total score was significantly associated with a 0.8% increase in HOMA-IR (p=0.007), but not with hsCRP (0.6% increase, p=0.283). The somatic symptom score was associated with a 5.8% increase in HOMA-IR (p=0.004). Single-item analyses of depressive symptoms showed that fatigue (3.6% increase, p=0.002) and increased/decreased appetite (3.5% increase, p=0.009) were significantly associated with HOMA-IR cross-sectionally. The cognitive-affective symptom score was not significantly associated with HOMA-IR at baseline. In longitudinal analyses, a one-unit increase in PHQ-8 total score was significantly associated with a 0.8% increase in hsCRP over time (p=0.014), but not with HOMA-IR over time (0.1% decrease, p=0.564). Again, only the somatic symptom cluster was significantly associated with hsCRP over time (5.2% increase, p=0.017), while the cognitive-affective symptom score was not.

CONCLUSION/INTERPRETATION

The results highlight the associations of depressive symptoms with markers of inflammation and insulin resistance, both cross-sectionally and longitudinally, in individuals with type 2 diabetes. In particular, somatic symptoms of depression appear to be the driver of these associations, even after controlling for concomitant conditions, with a potential role for fatigue and issues with appetite.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01794143.

The Interconnected Complexity of Diabetes and Depression

Diabetes and depression have a bidirectional relationship, with negative impacts on glycemia, self-care, long-term complications, quality of life, and mortality. This review highlights key aspects of the interconnected and complex relationship between diabetes and depression, including how it affects health outcomes, depression duration and recurrence, age-specific manifestations, and recommendations for screening and nonpharmacological treatment.

Defining patient-reported outcomes in diabetes, obesity, cardiovascular disease, and chronic kidney disease for clinical practice guidelines - perspectives of the taskforce of the Guideline Workshop

Recent clinical practice guidelines for diabetes, obesity, cardiovascular disease (CVD) and chronic kidney disease (CKD) emphasise a holistic, person-centred approach to care. However, they do not include recommendations for the assessment of patient-reported outcomes (PROs), which would - dependent on the topic of guideline - be important for improving shared decision-making, patients' concordance with guideline recommendations, clinical outcomes and health-related quality of life (HRQoL). The Taskforce of the Guideline Workshop discussed PROs in diabetes, obesity, CVD and CKD as well as the relevance of their inclusion in clinical practice guidelines for the management of these conditions.

Identification and study of mood-related biomarkers and potential molecular mechanisms in type 2 diabetes mellitus

A significant correlation between type 2 diabetes mellitus (T2DM) and mood has been reported. However, the specific mechanism of mood's role in T2DM is unclear. This study aims to discover mood-related biomarkers in T2DM and further elucidate their underlying molecular mechanisms. The GSE81965 and GSE55650 datasets were sourced from public databases, and mood-related genes (MRGs) were retrieved from previous literature. Initially, differentially expressed MRGs (DE-MRGs) were obtained by combining differential expression analysis and weighted gene co-expression network analysis (WGCNA). Subsequently, the DE-MRGs were incorporated into the LASSO and SVM to identify diagnostic biomarkers for T2DM. Four machine learning methods were utilized to construct the diagnostic models in T2DM, and the model with the optimal algorithm was screened. Further, based on biomarkers, functional enrichment, immune infiltration, and regulatory network analyses were conducted to excavate deeper into the pathogenesis of T2DM. In vivo experiments were used to validate the expression of the biomarkers. A total of 23 DE-MRGs were identified by overlapping 723 DEGs and 64 key modules, and there were strong positive correlations between these DE-MRGs. Afterward, KCTD16, SLC8A1, RAB11FIP1, and RASGEF1B were identified as biomarkers associated with mood in T2DM, and they had favorable diagnostic performance. Meanwhile, the RF diagnostic model constructed based on biomarkers was performed optimally and had high diagnostic accuracy for T2DM patients. Animal experiments indicated that expression levels of SLC8A1, RAB11FIP1, and RASGEF1B in T2DM were consistent with the microarray results. In conclusion, KCTD16, SLC8A1, RAB11FIP1, and RASGEF1B were identified as biomarkers related to mood in T2DM.

Socio-cognitive determinants affecting insulin adherence/non-adherence in late adolescents and young adults with type 1 diabetes: a systematic review

Non-adherence to insulin treatment is common in adolescents and young adults (AYAs) with type 1 diabetes (T1D) and is associated with increased morbidity and mortality. However, the socio-cognitive determinants (SCDs) of adherence in AYAs with T1D are less frequently represented in systematic reviews. This systematic review aimed to investigate the key SCDs associated with adherence/non-adherence to insulin treatment in AYAs in the age range of 17-24 years with T1D. A systematic review in PubMed, Embase, Web of Science, and PsycINFO was conducted. The search took place from 2021, to January 1st, 2022, and was repeated on June 5-7, 2022 and from July 18 to July 24, 2023. The methodological quality of studies was assessed by the National Heart, Lung, and Blood Institute quality assessment tool for observational cohort and cross-sectional studies. Six articles representing 973 AYAs with T1D were included for data extraction. The identified SCDs included risk perceptions, attitude, family and friends' social support, self-efficacy, and information factors. However, there was inconsistency in correlational findings among studies. The identified SCDs influencing insulin adherence in AYAs with T1D could serve as targets for patients' consultations and tailored interventions to improve adherence and overall health outcomes, as well as for policymakers to integrate these interventions into diabetes care planning. However, further research in the area of factors affecting insulin adherence in quality-designed studies that use detailed and comprehensive measures for assessing adherence is needed.

International Society for Pediatric and Adolescent Diabetes Clinical Practice Consensus Guidelines 2024 Diabetes Technologies: Glucose Monitoring

The International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines represent a rich repository that serves as the only comprehensive set of clinical recommendations for children, adolescents, and young adults living with diabetes worldwide. This chapter builds on the 2022 ISPAD guidelines, and summarizes recent advances in the technology behind glucose monitoring, and its role in glucose-responsive integrated technology that is feasible with the use of automated insulin delivery (AID) systems in children and adolescents. The International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines represent a rich repository that serves as the only comprehensive set of clinical recommendations for children, adolescents, and young adults living with diabetes worldwide. This chapter builds on the 2022 ISPAD guidelines, and summarizes recent advances in the technology behind glucose monitoring, and its role in glucose-responsive integrated technology that is feasible with the use of automated insulin delivery (AID) systems in children and adolescents.

The interface of depression and diabetes: treatment considerations

This state-of-the-art review explores the relationship between depression and diabetes, highlighting the two-way influences that make treatment challenging and worsen the outcomes of both conditions. Depression and diabetes often co-occur and share genetic, lifestyle, and psychosocial risk factors. Lifestyle elements such as diet, physical activity, and sleep patterns play a role on the development and management of both conditions, highlighting the need for integrated treatment strategies. The evidence suggests that traditional management strategies focusing on either condition in isolation fall short of addressing the intertwined nature of diabetes and depression. Instead, integrated care models encompassing psychological support and medical management are recommended to improve treatment efficacy and patient adherence. Such models require collaboration across multiple healthcare disciplines, including endocrinology, psychiatry, and primary care, to offer a holistic approach to patient care. This review also identifies significant patient-related barriers to effective management, such as stigma, psychological resistance, and health literacy, which need to be addressed through patient-centered education and support systems. Future directions for research include longitudinal studies in diverse populations to further elucidate causal relationships and the exploration of novel therapeutic targets, as well as the effectiveness of healthcare models aimed at preventing the onset of one condition in individuals diagnosed with the other.

Type 2 diabetes mellitus: A cross-sectional analysis of glycemic controls and brain health outcomes

In this cross-sectional analysis, we explored how fluctuations in glycemic levels impact executive functions and psychosocial outcomes in patients with type 2 diabetes mellitus (T2DM). The goal was to understand the relationship between glycemic control and both neuropsychological and psychosocial health. We stratified participants into well-controlled and poorly controlled groups based on glycated hemoglobin (HbA1c) levels and variability, including a healthy control group for comparison. The study consisted of neuropsychological tests and psychosocial assessments. Results indicated that the poorly controlled T2DM group experienced significant executive dysfunction and scored lower on the Tower of London, Wisconsin Card Sorting, and Digit Span Tests, reflecting a broader impact on quality of life and resilience. These findings support the importance of maintaining stable glycemic levels for better executive and psychosocial outcomes and highlight the need for regular neuropsychological and psychosocial assessments in diabetes care.

Exploring the Needs and Preferences of Users and Parents to Design a Mobile App to Deliver Mental Health Peer Support to Adolescents With Type 1 Diabetes: Qualitative Study

BACKGROUND

Beyond physical health, managing type 1 diabetes (T1D) also encompasses a psychological component, including diabetes distress, that is, the worries, fears, and frustrations associated with meeting self-care demands over the lifetime. While digital health solutions have been increasingly used to address emotional health in diabetes, these technologies may not uniformly meet the unique concerns and technological savvy across all age groups.

OBJECTIVE

This study aimed to explore the mental health needs of adolescents with T1D, determine their preferred modalities for app-based mental health support, and identify desirable design features for peer-delivered mental health support modeled on an app designed for adults with T1D.

METHODS

A semistructured qualitative focus group study was conducted with adolescents with T1D and parents of adolescents with T1D. Data were collected through pre-focus group surveys, including sociodemographic background, diabetes status, health care experiences, and focus group sessions, including their opinions on peer support and technology. A thematic analysis following an inductive and iterative process was performed to develop themes and subthemes from the collected information.

RESULTS

Focus group participants included 10 adolescents (mean 16, SD 1 years; 8/10, 80% female; who had been living with diabetes for an average of 9, SD 5 years) and 10 parents (mean age 51, SD 7 years; 9/10, 90% female). Four core themes emerged: (1) experience: navigating adolescence with T1D, (2) empowerment: support systems that enabled better management of their T1D, (3) obstacles: societal barriers that affect adolescents' T1D management, and (4) innovation: adolescent-driven preferences for digital peer support platforms.

CONCLUSIONS

App-based peer support offers a promising avenue for addressing the mental health needs of adolescents with T1D. Understanding the unique support needs of these adolescents and using this information to suggest design considerations for a mental health peer support app is an important step toward addressing their complex emotional and social challenges.

The relationship between self-care preparedness and quality of life in a 3-year-follow-up: a study in primary health care

BACKGROUND

Measuring self-care preparedness may enable better support for patients in general practice.

OBJECTIVE

This study assessed the relationship between the self-care preparedness index (SCPI) and health-related quality of life (HRQoL) in a longitudinal analysis over 36 months.

METHODS

This was a secondary analysis of an intervention group of a randomized controlled trial. Participants were adults (n = 256) with hypertension, diabetes, or coronary artery disease in primary health care. The intervention group was included in the present study since they had answered SCPI as a part of the intervention. The relationship between SCPI and HRQoL (15D) and other outcomes were studied at baseline. The mean changes in SCPI and 15D were calculated from baseline up to 36 months. Regression-based analysis was used to study to what extent the baseline SCPI was associated with the change in SCPI and 15D and to what extent the change in SCPI was associated with the change in 15D.

RESULTS

At baseline, 15D, physical activity, self-rated health, life satisfaction, and patient activation measures had a positive linear relationship with SCPI. Body mass index and depressive symptoms had a negative linear relationship with SCPI. The longitudinal association between changes in SCPI and 15D was statistically significant and positive. The adjusted β was + 0.19 (95% confidence interval: 0.07 to 0.30, P = .002).

CONCLUSION

Those patients who managed to increase their SCPI over the study period experienced an improvement in HRQoL.

Diabetes Distress and Unmet Support Needs Hinder Optimal Care for Adolescents With Type 2 Diabetes: A Mixed Methods Study

Objectives: Adolescents with type 2 diabetes (T2D) are more likely than those with type 1 diabetes (T1D) to develop complications soon after diagnosis. However, limited data exist about diabetes-specific distress (DD) and how diabetes teams can better support adolescents with T2D. We aimed to assess DD and other aspects of emotional/mental health among adolescents with T2D and qualitatively explore their lived experience and support needs. Methods: This study used a cross-sectional mixed methods survey of adolescents with T2D, recruited via two tertiary diabetes clinics. Study outcomes included the Diabetes Distress Scale (DDS), World Health Organization-Five Well-being Index (WHO-5), Patient Health Questionnaire-2 (PHQ-2) and two free-text questions concerning what they wished their health professionals understood about living with T2D and diabetes support. Descriptive statistics and inductive thematic analysis were applied. Results: Forty adolescents with T2D (22 females, predominantly from non-Indigenous background) completed all questionnaires. Nineteen were taking metformin, 18 were taking metformin plus injectables, and 3 were on lifestyle management. They had mean ± standard deviation (SD) age of 15.7 ± 2.1 years, median (interquartile range [IQR]) diabetes duration of 1.8 (0.8-2.6) years and median (IQR) glycated haemoglobin (HbA1c) of 6.9 (6.0-9.5)% (52 [42-80] mmol/mol). Twenty-one (53%) adolescents had moderate-to-severe DD, 16 (40%) had suboptimal emotional well-being, and 23 (58%) had depressive symptoms; 15 (38%) had both DD and depressive symptoms, while 11 (28%) had neither. Four themes described what adolescents wished their health professionals understood about living with diabetes: diabetes stigma, diabetes management burden, diabetes is challenging for young people and impact on mental health. Five themes described the support adolescents desired from their diabetes teams: show empathy and assist with motivation; mental health support; more frequent and convenient appointments; access to, and choice of, medications and management tools; and discussions about the future. Conclusions: Most adolescents with T2D experience significant DD, impaired general emotional well-being and/or depressive symptoms. They also have considerable unmet support needs relevant to optimising their well-being and diabetes self-management.

Spanish Validation of the Problem Area in Diabetes-Pediatric Version Survey and Its Weak Association with Metabolic Control Parameters in Pediatric Diabetes: A Cross-Sectional Multicenter Study

Background: Type 1 diabetes mellitus (T1DM) in pediatric patients often leads to emotional distress, impacting self-management. The PAID-Peds survey measures diabetes-related emotional burden but lacks a validated Spanish version. This study aimed to validate the Spanish PAID-Peds survey in children and adolescents with T1DM and correlate it with diabetic metabolic control parameters. Methods: A cross-sectional study was conducted from October 2022 to December 2023, recruiting 636 patients aged 8-17 years from three Spanish hospitals. Psychometric properties were assessed using Cronbach's alpha for reliability and confirmatory factor analysis for construct validity. Associations between PAID-Peds scores and clinical measures, such as HbA1c, were examined. Results: The final sample consisted of 538 participants (84.59% response rate). The PAID-Peds survey showed high internal consistency (Cronbach's alpha = 0.90). The confirmatory factor analysis indicated a satisfactory model fit (χ2 = 812.28, p < 0.001; RMSEA = 0.08). Weak correlations were found between PAID-Peds scores and HbA1c (r = 0.14, p < 0.001). Conclusions: The Spanish PAID-Peds survey is a reliable tool for assessing emotional burden in pediatric T1DM patients. Integrating it into clinical practice may improve early identification of emotional distress, aiding in better diabetes management. Further research should explore its application over time and in intervention studies.

Psychosocial factors influencing dietary management in patients with type 2 diabetes and healthy adults: an ecological momentary assessment approach

Background

Dietary management in diabetic patients is affected by psychosocial factors and the social-environmental context. Ecological momentary assessment (EMA) allows patients to consistently report their experiences in real-time over a certain period and across different contexts. Despite the importance of dietary management, only a few EMA studies have been conducted on dietary management and psychosocial factors in patients with type 2 diabetes; further evidence must be gathered. Therefore, this study examined dietary management and psychosocial factors using EMA, comparing type 2 diabetes patients with healthy adults.

Methods

A total of 20 patients with type 2 diabetes and 16 healthy adults underwent EMA. Relying on event-contingent recordings, this study evaluated the participants' mood (e.g., anxiety, anger, vigor), appetite (hunger, craving), meal types (e.g., breakfast), location (e.g., eating out), companions (e.g., family), and dietary lapses (e.g., I ate a larger portion of a meal or snack than I intended) before and after meals. Dietary lapse recording after meals was paired with psychosocial data before meals. Only the type 2 diabetes patients used a sensor-based glucose monitoring system (Freestyle Libre Pro, Abbot) and wearable activity monitors (GT3X-BT, ActiGraph).

Results

The EMA produced a total of 4,254 responses. Dietary lapse predicted two-hour postprandial glucose through a sensor-based glucose monitoring system. Multilevel logistic regression analyses were performed. For diabetes patients, dietary lapse was affected by vigor, fatigue, and cravings before eating. Meanwhile, for healthy adults, only fatigue before meals affected dietary lapse, and increased vigor from dietary intake was associated with dietary lapse. In both type 2 diabetes patients and healthy adults, eating-out situations were linked to dietary lapse.

Conclusion

The results suggest differences in psychosocial factors influencing dietary lapse between patients with type 2 diabetes and healthy adults. EMA is well suited to assess psychosocial factors that drive dietary management in diabetic patients. This study further discussed the possibility of individual approaches using EMA data.

American Diabetes Association Professional Practice Committee, ElSayed NA, McCoy RG, Aleppo G, Balapattabi K, Beverly EA, Briggs Early K, Bruemmer D, Ebekozien O, Echouffo-Tcheugui JB, Ekhlaspour L, Garg R, Khunti K, Lal R, Lingvay I, Matfin G, Pandya N, Pekas EJ, Pilla SJ, Polsky S, Segal AR, Seley JJ, Stanton RC, Bannuru RR. 1. Improving Care and Promoting Health in Populations: Standards of Care in Diabetes-2025

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

American Diabetes Association Professional Practice Committee, ElSayed NA, McCoy RG, Aleppo G, Balapattabi K, Beverly EA, Briggs Early K, Bruemmer D, Echouffo-Tcheugui JB, Ekhlaspour L, Garg R, Khunti K, Lal R, Lingvay I, Matfin G, Napoli N, Pandya N, Pekas EJ, Pilla SJ, Polsky S, Segal AR, Seley JJ, Stanton RC, Bannuru RR. 13. Older Adults: Standards of Care in Diabetes-2025

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

American Diabetes Association Professional Practice Committee, ElSayed NA, McCoy RG, Aleppo G, Balapattabi K, Beverly EA, Briggs Early K, Bruemmer D, Echouffo-Tcheugui JB, Eichorst B, Ekhlaspour L, Garg R, Hassanein M, Khunti K, Lal R, Lingvay I, Matfin G, Middelbeek RJ, Pandya N, Pekas EJ, Pilla SJ, Polsky S, Segal AR, Seley JJ, Stanton RC, Tanenbaum ML, Urbanski P, Bannuru RR. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2025

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

American Diabetes Association Professional Practice Committee, ElSayed NA, McCoy RG, Aleppo G, Balapattabi K, Beverly EA, Briggs Early K, Bruemmer D, Echouffo-Tcheugui JB, Ekhlaspour L, Garg R, Khunti K, Lal R, Lingvay I, Matfin G, Pandya N, Pekas EJ, Pilla SJ, Polsky S, Segal AR, Seley JJ, Srinivasan S, Stanton RC, Bannuru RR. 14. Children and Adolescents: Standards of Care in Diabetes-2025

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Depression prevalence, screening, and treatment in adult outpatients with type 1 and type 2 diabetes: A nationally representative cross-sectional study (National Ambulatory Medical Care Survey 2014-2019)

BACKGROUND

Studies have shown that the presence of diabetes or depression may increase the risk for developing the other. The primary objective of this study is to describe the current prevalence of comorbid depression and the rate of screening and treatment for comorbid depression in US adult outpatients with diabetes compared to those without diabetes.

METHODS

We analyzed data from the 2014-2019 National Ambulatory Medical Care Survey. Descriptive statistics, univariate analyses, and multivariable regression models were developed with weighting factors applied.

RESULTS

Depression prevalence is higher in those with diabetes than without diabetes. Females with diabetes have higher rates of depression (15.4%) compared to females without diabetes (13.7%) or males with diabetes (9.1%). Screening rates for depression are extremely low (<6%) in patients with diabetes and without diabetes. Patients with diabetes and depression are less likely to be screened than those with depression alone.

LIMITATIONS

The cross-sectional design of the study cannot establish causality and has inherent limitations in capturing temporal relationships. The reliance on ICD codes limits the scope of diagnosis and underestimates rates of comorbidity if depression is not formally diagnosed. The NAMCS cohort only includes ambulatory visits to office-based physicians, so depression diagnoses and screening rates among patients who visit other health care settings or are not seeing physicians would be underestimated.

CONCLUSIONS

Depression is prevalent in people with diabetes. Screening rates are unacceptably low, indicating a gap in recommended care and underreporting of depression. More routine screening and treatment are necessary to align with guideline-recommended care.

Exploring perceptions of diabetes distress and its care in Japan: a qualitative study of patients and physicians

OBJECTIVES

This study aimed to identify the obstacles preventing care of diabetes distress from being integrated into diabetes management, as perceived by both patients and healthcare professionals. By conducting interviews with people with type 2 diabetes (PWD) and physicians, this study aimed to gain insight into the current state of care for diabetes distress in diabetes management and propose targeted interventions to improve patients' overall well-being and treatment outcomes.

DESIGN

This qualitative study used semistructured interviews with patients and physicians. The interviews followed a guide with open-ended questions to gather detailed, reflective responses about participant experiences, perceptions and attitudes towards the research topic.

SETTING

This study targeted stakeholders in type 2 diabetes care in Japan.

PARTICIPANTS

Nine PWD and nine physicians participated in the interviews. The patients had been receiving treatment for more than 5 years, and the physicians had at least 1 year of clinical experience in diabetes treatment and had treated a minimum of five PWD per month. The physicians were recruited through snowball sampling.

RESULTS

This study uncovered four primary themes. Patients and physicians had differing perceptions of diabetes distress, with patients experiencing psychological challenges, such as anxiety over self-management and fluctuating blood glucose levels, while physicians focused on poor adherence and financial constraints. PWD often felt responsible for managing their condition, leading to self-blame and reluctance to seek emotional support from healthcare providers (HCPs). Physicians faced constraints in providing psychosocial support owing to limited resources and insufficient training. HCPs support affected patient motivation and clinic visits, with positive reinforcement and understanding fostering self-management, whereas one-sided guidance had negative effects. Patients frequently used self-tracking data to enhance their self-management and effectively communicate with HCPs. These data provided valuable insights for treatment planning and helped bridge gaps in the monthly laboratory results.

CONCLUSION

This study highlights significant discrepancies between patients' and physicians' perceptions of diabetes distress. Effective communication and trust building are essential for addressing the psychological needs of patients. The integration of self-tracking data can enhance patient-HCP interactions and support better diabetes management. Addressing these gaps can improve care of diabetes distress in clinical practice, leading to better quality of life and treatment outcomes for PWD.

Diabetes distress and associated factors among adults with diabetes mellitus residing in a metropolitan city of India: a community-based study

BACKGROUND

Diabetes distress "refers to the negative emotional or affective experiences resulting from the challenge of living with the demands of diabetes." Despite recommendations to screen for distress at regular intervals, it usually remains undiagnosed. This study aimed to determine the prevalence of diabetes distress among adults living with diabetes, determine the factors associated with distress, the association between selfcare and distress, glycemic control and distress and compare the health-related quality of life among those with and without distress.

METHODS

This cross-sectional, community-based study was conducted in an urban colony in Delhi, India. The participants were selected using simple random sampling and included adults diagnosed with diabetes mellitus. The sample size calculated was 390. The questionnaire included the Diabetes Distress Scale 17, Diabetes Self-Management Questionnaire and Healthy Days measure. Factors associated with distress were tested using bivariate followed by multivariable logistic regression. Multivariable logistic regression was used to find the association between selfcare and distress and glycemic control and distress. Mean number of unhealthy days and health rating were compared between distressed and non-distressed diabetics using Wilcoxon rank sum test and chi square test respectively.

RESULTS

A total of 412 adults were included in the study, of which 35.4% had clinically significant distress. Female sex, low socio-economic status, 1 or more comorbidities, diagnosis of diabetes 10 or more years prior, being on treatment and an unmet need for social support were the factors found to be associated with distress. There was a positive association between physicians contact and distress. Those with poor glycemic control had higher odds of distress. There was a significant difference in the health reported by those with and without distress (p < 0.001). Those with distress also suffered from significantly more physically unhealthy days and mentally unhealthy days than those without distress (p < 0.001).

CONCLUSION

In this study, more than one in three diabetics were found to be distressed. Healthcare providers should increase their focus on the psychological aspects of diabetes and improve their communication with patients. Diabetes distress needs to be screened for in routine clinical settings and addressed appropriately.

A short tool to screen self-care preparedness: cross-sectional study in general practice

BACKGROUND

Self-care is crucial in the prevention and treatment of chronic diseases. It is important to identify patients who need support with self-care.

OBJECTIVES

This study introduces a self-care preparedness index (SCPI) and examines its associations with health-related quality of life (HRQoL) and other outcomes.

METHODS

A cross-sectional study of adults (n = 301) with hypertension, coronary artery disease, or diabetes in primary health care. Based on the self-care questionnaire, SCPI was formed. A higher SCPI value indicated better self-care preparedness. We examined correlations and a hypothesis of linearity between SCPI and HRQoL (15D), depressive symptoms (BDI), patient activation (PAM), and health-related outcomes (self-rated health, life satisfaction, physical activity, body mass index [BMI], waist, low-density lipoprotein). Exploratory factor analysis was used to test the construct validity of SCPI.

RESULTS

A total of 293 patients with a mean age of 68 (54.3% women) were included in the analysis. BDI, BMI, and waist had a negative linear trend with SCPI. Self-rated health, physical activity, patient activity, and life satisfaction had a positive linear trend with SCPI. SCPI correlated with HRQoL (r = 0.31 [95% CI: 0.20 to 0.41]). Exploratory factor analysis of the SCPI scores revealed 3 factors explaining 82% of the total variance.

CONCLUSIONS

SCPI seems to identify individuals with different levels of preparedness in self-care. This provides means for health care providers to individualize the levels of support and counselling. SCPI seems to be a promising tool in primary health care but needs further validation before use in large scale trials or clinical practice.

The impact of socioeconomic deprivation on the prevalence of gestational diabetes: An observational study

Background

Approximately 3.5% of pregnancies in the United Kingdom are complicated by gestational diabetes mellitus (GDM). Risk factors for this mirror those contributing to type 2 diabetes (T2DM). Though socioeconomic status (SES) is presumed to contribute to GDM, evidence in the United Kingdom is limited. In this unique study, we explored the impact of SES on GDM prevalence in a London suburb population.

Materials and Methods

Four thousand one hundred and sixty-three pregnant women who booked between July 2018 and March 2020 at Princess Royal University Hospital were retrospectively analyzed. Associations between GDM prevalence and SES trends (using multiple deprivation deciles (MDD)), and body mass index (BMI), age, ethnicity, screening uptake, birth-weights and birth outcomes, were analyzed.

Results

Patients with BMI >30 kg/m2, older than 35 years, and non-Caucasian ethnicity have an increased risk of developing GDM (p < 0.0001, p < 0.0001, p < 0.0001, respectively). No association existed between MDD and GDM prevalence (p-values over 0.05). Patients with risk factors for GDM were highest in the deprived areas p < 0.0001. MDD 1-4 (most deprived) had the highest percentage of missed screening (15% of patients with risk factors missed screening), compared to 8% in the least deprived group (p < 0.0001).

Discussion

Our data surprisingly suggest that low SES did not increase the incidence of GDM, despite a higher proportion of women with risk factors for GDM living in the most deprived postcodes. However this unclear finding may be due to low screening uptake of deprived populations, and therefore lack of GDM diagnosis, or indicate that GDM is a result of a different aetiology to T2DM. Further research is needed to explore if access to screening services, lack of health education or other health inequalities were responsible for the high proportion of missed screening opportunities in deprived areas.

Pathophysiology and Treatment of Prediabetes and Type 2 Diabetes in Youth

Youth-onset type 2 diabetes is a heterogeneous disease with increasing prevalence in relation to increased rates of obesity in children. It has genetic, epigenetic, social, and environmental determinants. Youth-onset type 2 diabetes is alarming given a rapidly progressive course compared with the course of adult-onset disease, early-onset vascular complications, and long-term exposure to hyperglycemia and associated complications. It is often preceded by prediabetes, a disease phase where defects in β-cell function relative to insulin sensitivity emerge. Herein, we review the current understanding of the pathophysiology of prediabetes and type 2 diabetes in youth. We describe the mechanisms underlying insulin resistance, the precipitous decline of β-cell function, and the role of other hormonal abnormalities in the pathogenesis of the disease. We discuss the critical importance of social determinants of health in the predisposition and progression of these conditions and present current management strategies and the advances in therapeutic approaches. These must adapt to meet the unique needs of the individual patient and family. Significant knowledge gaps remain that need to be addressed in future research.