Translation, Revision, and Validation of the Diabetes Distress Scale for Indonesian Type 2 Diabetic Outpatients with Various Types of Complications

Ascertainment of Minimal Clinically Important Differences in the Diabetes Distress Scale-17: A Secondary Analysis of a Randomized Clinical Trial

Importance

The Diabetes Distress Scale-17 (DDS-17) is a common measure of diabetes distress. Despite its popularity, there are no agreed-on minimal clinically important difference (MCID) values for the DDS-17.

Objective

To establish a distribution-based metric for MCID in the DDS-17 and its 4 subscale scores (interpersonal distress, physician distress, regimen distress, and emotional distress).

Design, Setting, and Participants

This secondary analysis of a randomized clinical trial used baseline and postintervention data from a hybrid (implementation-effectiveness) trial evaluating Empowering Patients in Chronic Care (EPICC) vs an enhanced form of usual care (EUC). Participants included adults with uncontrolled type 2 diabetes (glycated hemoglobin A1c [HbA1c] level >8.0%) who received primary care during the prior year in participating Department of Veterans Affairs clinics across Illinois, Indiana, and Texas. Data collection was completed in November 2018, and data analysis was completed in June 2023.

Interventions

Participants in EPICC attended 6 group sessions led by health care professionals based on collaborative goal-setting theory. EUC included diabetes education.

Main Outcomes and Measures

The main outcome was distribution-based MCID values for the total DDS-17 and 4 DDS-17 subscales, calculated using the standard error of measurement. Baseline to postintervention changes in DDS-17 and its 4 subscale scores were grouped into 3 categories: improved, no change, and worsened. Multilevel logistic and linear regression models examined associations between treatment group and MCID change categories and whether improvement in HbA1c varied in association with MCID category.

Results

A total of 248 individuals with complete DDS-17 data were included (mean [SD] age, 67.4 [8.3] years; 235 [94.76%] men), with 123 participants in the EPICC group and 125 participants in the EUC group. The MCID value for DDS-17 was 0.25 and MCID values for the 4 distress subscales were 0.38 for emotional and interpersonal distress and 0.39 for physician and regimen distress. Compared with EUC, more EPICC participants were in the MCID improvement category on DDS-17 (63 participants [51.22%] vs 40 participants [32.00%]; P = .003) and fewer EPICC participants were in the worsened category (20 participants [16.26%] vs 39 participants [31.20%]; P = .008). There was no direct association of DDS-17 MCID improvement (β = -0.25; 95% CI, -0.59 to 0.10; P = .17) or worsening (β = 0.18; 95% CI, -0.22 to 0.59; P = .38) with HbA1c levels among all participants.

Conclusions and Relevance

In this secondary analysis of data from a randomized clinical trial, an MCID improvement or worsening of more than 0.25 on the DDS-17 was quantitatively significant and patients in the EPICC group were more likely to experience improvement than those in the EUC group.

Trial Registration

ClinicalTrials.gov Identifier: NCT01876485.

Development of the information quality scale for health information supply chain type 2 diabetes mellitus management using exploratory factor analysis

Background

Research on the quality scale of the healthcare supply chain is still limited. This study aimed to assess the information quality of the supply chain model with a focus on construct validity. Studies related to information quality measurement generally focus on measuring the dimensions of the completeness of medical records and consumer perspectives. We intended to assess the scale based on doctors needed as care coordinators on type 2 diabetes mellitus or the Non-Insulin-Dependent-Diabetes-Mellitus (NIDDM) program in primary healthcare.

Methods

Sixty-four primary healthcare doctors with an age range of 24-51 years were involved in this research. The scale obtained was formed from the assessment of the point of view of a panel of experts through the content validity index (CVI). The exploratory factor analysis (EFA) method was used to explore the scale of information quality in the information supply chain model for the NIDDM chronic disease management program.

Result

The data analysis results indicated three main factors that affected the quality of the information supply chain model of NIDDM, namely accessibility, safety, and efficiency of information related to NIDDM. The results of the validity and reliability of the data showed that the scale used in this research was valid and reliable with a Cronbach alpha coefficient of 0.861.

Conclusion

The scale developed in this research could be used to explore the quality of the information supply chain of NIDDM management in primary healthcare. Each item on the scale could explain the variables according to their respective groups.

Patient-reported outcome measures for assessing health-related quality of life in people with type 2 diabetes: A systematic review

Patient-Reported Outcome Measures (PROMs) are important tools to assess outcomes relevant to patients, with Health-Related Quality Of Life (HRQOL) as an important construct to be measured. Many different HRQOL PROMs are used in the type 2 diabetes field, however a complete overview of these PROMs is currently lacking. We therefore aimed to systematically describe and classify the content of all PROMs that have specifically been developed or validated to measure (aspects of) HRQOL in people with type 2 diabetes. A literature search was performed in PubMed and EMBASE until 31 December 2021. Studies on the development or validation of a PROM measuring HRQOL, or aspects of HRQOL, in people with type 2 diabetes were included. Title and abstract and full-text screening were conducted by two independent researchers and data extraction was performed independently by one of the researchers. Data were extracted on language in which the PROM was developed, target population, construct(s) being measured, names of (sub)scales and number of items per (sub)scale. In addition, all PROMs and subscales were classified according to specific aspects of HRQOL based on the Wilson & Cleary model (symptom status, functional status, general health perceptions) to aid researchers in PROM selection. In total 220 studies were identified that developed or validated PROMs that measure (aspects of) HRQOL in people with type 2 diabetes. Of the 116 unique HRQOL PROMs, 91 (of the subscales) measured symptom status, 60 measured functional status and 26 measured general health perceptions. In addition, 16 of the PROMs (subscales) measured global quality of life. 61 of the 116 PROMs (subscales) also include characteristics of the individual (e.g. aspects of personality, coping) or environment (e.g. social or financial support) and patient-reported experience measures (PREMs, e.g. measure of a patient's perception of their personal experience of the healthcare they have received, e.g. treatment satisfaction), which are not part of the HRQOL construct. Only 9 of the 116 PROMs measure all aspects of HRQOL based on the Wilson & Cleary model. Finally, 8 of the 116 PROMs stating to measure HRQOL, measured no HRQOL construct. In conclusion, a large number of PROMs are available for people with type 2 diabetes, which intend to measure (aspects of) HRQOL. These PROMs measure a large variety of (sub)constructs, which are not all HRQOL constructs, with a small amount of PROMs not measuring HRQOL at all. There is a need for consensus on which aspects of HRQOL should be measured in people with type 2 diabetes and which PROMs to use in research and daily practice. PROSPERO: CRD42017071012. COMET database: http://www.comet-initiative.org/studies/details/956 .

Content Validity of Patient-Reported Outcome Measures Developed for Assessing Health-Related Quality of Life in People with Type 2 Diabetes Mellitus: a Systematic Review

PURPOSE OF REVIEW

We aimed to systematically evaluate the content validity of patient-reported outcome measures (PROMs) specifically developed to measure (aspects of) health-related quality of life (HRQOL) in people with type 2 diabetes. A systematic review was performed in PubMed and Embase of PROMs measuring perceived symptoms, physical function, mental function, social function/participation, and general health perceptions, and that were validated to at least some extent. Content validity (relevance, comprehensiveness, and comprehensibility) was evaluated using COSMIN methodology.

RECENT FINDINGS

We identified 54 (different versions of) PROMs, containing 150 subscales. We found evidence for sufficient content validity for only 41/150 (27%) (subscales of) PROMs. The quality of evidence was generally very low. We found 66 out of 150 (44%) (subscales of) PROMs with evidence for either insufficient relevance, insufficient comprehensiveness, or insufficient comprehensibility. For measuring diabetes-specific symptoms, physical function, mental function, social function/participation, and general health perceptions, we identified one to 11 (subscales of) PROMs with sufficient content validity, although quality of the evidence was generally low. For measuring depressive symptoms, no PROM with sufficient content validity was identified. For each aspect of HRQL, we found at least one PROM with sufficient content validity, except for depressive symptoms. The quality of the evidence was mostly very low.

Translation and performance of the Finnish Diabetes Risk Score for detecting undiagnosed diabetes and dysglycaemia in the Indonesian population

A diabetes risk score cannot directly be translated and applied in different populations, and its performance should be evaluated in the target population. This study aimed to translate the Finnish Diabetes Risk Score (FINDRISC) instrument and compare its performance with the modified version for detecting undiagnosed type 2 diabetes mellitus (T2DM) and dysglycaemia among the Indonesian adult population. Forward and backward translations were performed and followed by cultural adaptation. In total, 1,403 participants were recruited. The FINDRISC-Bahasa Indonesia (FINDRISC-BI) was scored according to the original FINDRISC instrument, while a Modified FINDRISC-BI was analyzed using a specific body mass index and waist circumference classification for Indonesians. The area under the receiver operating characteristic curve, sensitivity, specificity, and the optimal cut-offs of both instruments were estimated. The area under the receiver operating characteristic curve for detecting undiagnosed T2DM was 0.73 (0.67–0.78) for the FINDRISC-BI with an optimal cut-off score of ≥9 (sensitivity = 63.0%; specificity = 67.3%) and 0.72 (0.67–0.78) for the Modified FINDRISC-BI with an optimal cut-off score of ≥11 (sensitivity = 59.8%; specificity = 74.9%). The area under the receiver operating characteristic curve for detecting dysglycaemia was 0.72 (0.69–0.75) for the FINDRISC-BI instrument with an optimal cut-off score of ≥8 (sensitivity = 66.4%; specificity = 67.0%), and 0.72 (0.69–0.75) for the Modified FINDRISC-BI instrument with an optimal cut-off score ≥9 (sensitivity = 63.8%; specificity = 67.6%). The Indonesian version of the FINDRISC instrument has acceptable diagnostic accuracy for screening people with undiagnosed T2DM or dysglycaemia in Indonesia. Modifying the body mass index and waist circumference classifications in the Modified FINDRISC-BI results in a similar diagnostic accuracy; however, the Modified FINDRISC-BI has a higher optimal cut-off point than the FINDRISC-BI. People with an above optimal cut-off score are suggested to take a further blood glucose test.

Adaptation and validation of the HIV Knowledge Questionnaire-18 for the general population of Indonesia

Background

Despite a global decline in new HIV/AIDS cases in low-middle countries, cases are increasing in Indonesia. Low knowledge about the disease among the general population is one of the major factors responsible for this trend. Indonesia does not have a validated instrument to assess HIV/AIDS knowledge. The HIV Knowledge Questionnaire-18 (HIV-KQ-18) has been translated into several languages and is one of the most extensively used instruments for assessing HIV/AIDS knowledge. This paper describes the process of adapting and validating the HIV-KQ-18, an instrument to assess the level of HIV/AIDS knowledge in the general population of Indonesia.

Methods

In the adaptation phase, feedback for the initial Bahasa Indonesia version was gathered from two HIV activists, an obstetrician, two general practitioners, and 60 pilot participants. At the validation stage, we distributed the instrument link via Google Form to 6 major regions in Indonesia. Validity was measured using known-group validity and construct validity. The construct validity was assessed using an exploratory factor analysis (EFA) with a polychoric correlation matrix. Cronbach’s alpha was used to analyze the internal consistency.

Results

Based on the findings in the adaptation phase, additional descriptions (namely synonyms or examples) were added to 6 items to make them more understandable. In the validation phase, 1,249 participants were recruited. The a priori hypothesis in known-group validity was supported. We also found three items that did not meet the construct validity. Based on the acceleration factor approach to interpret the scree tree in the factor analysis, using only two factors was preferable. Cronbach's alpha values were 0.75 and 0.71 representing good internal reliability.

Conclusion

The HIV-KQ-18 Bahasa Indonesia is considered a valid and reliable instrument to assess the level of HIV/AIDS knowledge in Indonesia.

The Chinese version of the revised Diabetes Distress Scale for adults with type 2 diabetes: Translation and validation study

Objectives

This study aimed to translate the revised 17-item Diabetes Distress Scale (DDS17, 2017) into mandarin (simplified) Chinese and validate the Chinese version of DDS17 (C-DDS17, 2021) among adult patients with type 2 diabetes in China.

Methods

A scale translation and cross-sectional validation study was conducted. The DDS17 was translated into mandarin (simplified) Chinese through a five-step process: authorization, forward translation, synthesis, back translation, and amendment. During this session, 59 patients assessed the understandability and readability of the translated scale. From June 7 to September 4, 2021, a cross-sectional study that adhered to the COSMIN checklist was conducted with 400 individuals with type 2 diabetes from three Class A tertiary comprehensive hospitals in Beijing, China. The content, construct, convergent, discriminant validity, and reliability (Cronbach’s α coefficient and item-total correlation coefficients) of the C-DDS17 were evaluated. This study was a part of a project registered in the Chinese Clinical Trial Registry (no. ChiCTR2100047071).

Results

Among the participants, 33.3% (133/400) of them experienced moderate to high diabetes distress. The content validity indices of the C-DDS17 equaled 1.00. The scale yielded a four-factor structure. The average variances extracted were 0.42–0.57, which was lower than squared correlations. Cronbach’s α coefficient was 0.88 for the overall scale and ranged from 0.76 to 0.81 for sub-scales. Corrected item-total correlation coefficients ranged from 0.42 to 0.61. The eighth item (“Feeling that I am often failing with my diabetes routine”) was better fit to physician distress than regimen distress but had little influence on the validation results.

Conclusions

The C-DDS17 is a reliable and valid instrument for assessing diabetes distress in patients with type 2 diabetes. It is a promising instrument for early identification and management of diabetes distress in clinical practice and trials.

Psychometric validation of diabetes distress scale in Bangladeshi population

Diabetes Distress (DD)-an emotional or affective state arise from challenge of living with diabetes and the burden of self-care-negatively impact diabetes management and quality of life of T2DM patients. Early detection and management of DD is key to efficient T2DM management. The study aimed at developing a valid and reliable instrument for Bangladeshi patients as unavailability such a tool posing challenge in diabetes care. Linguistically adapted, widely used, 17-item Diabetes Distress Scale (DDS), developed through forward-backward translation from English to Bengali, was administered on 1184 T2DM patients, from four diabetes hospitals in Bangladesh. Psychometric assessment of the instrument included, construct validity using principal component factor analysis, internal consistency using Cronbach's α and discriminative validity through independent t-test and test-retest reliability using intraclass-correlation coefficient (ICC) and Kappa statistics. Factor analysis extracted 4 components similar to original DDS domains, confirms the construct validity. The scale demonstrated satisfactory internal consistency (α = 0.838), stability (test-retest ICC = 0.941) and good agreement across repeated measurements (Kappa = 0.584). Discriminative validity revealed that patients with complication (p < 0.001) and those are on insulin (p < 0.001) had significantly higher distress scores in all domains. Bengali version of DDS is a valid and reliable tool for assessing distress among Bangladeshi T2DM patients.

Factors Associated with Diabetes-Related Distress in Type 2 Diabetes Mellitus Patients

BACKGROUND

Diabetes-related distress is a unique emotional problem that is directly related to the burden and anxieties felt by type 2 diabetes mellitus (T2DM) patients. Diabetes-related distress may lead to pessimism and lower self-efficacy which resulted in a deficiency of self-treatment compliance and can cause further bad glycemic control. Knowing the associated factors of diabetic-related distress and solving them may help T2DM patients improve their glycemic control.

METHODS

This study is an analytical study with cross-sectional design conducted at Sanglah General Hospital from January to April 2021. The data were taken using the consecutive sampling method; 124 samples were collected according to inclusion and exclusion criteria. The participants filled Diabetes Distress Scale questionnaire (DDS17 Bahasa Indonesia). The data analysis was done using univariate (descriptive), bivariate (chi-square) and multivariate (logistic regression) analysis.

RESULTS

Seventy-five subjects out of 124 (60.5%) had diabetes-related distress. The associated factors of diabetes-related distress one among others are the insulin usage as diabetic therapy (OR= 8.30, 95% CI 2.24-30.72; p = 0.002), had a hypoglycaemia in last 3 months (OR=44.59, 95% CI 4.36-455.51; p = 0.001), had diabetes-related retinopathy (OR=10.28, CI 95% 1.54-68.70; p=0.016), and lack of family support (OR=44.791, 95% CI 10.02-200.22; p < 0.001).

CONCLUSION

Our present study revealed that diabetes distress prevalence is predominantly and associated among in type 2 diabetes mellitus. We suggest diabetes-related distress screening and regular health promotion which focus on relationship between diabetes and psychological may be a great potential action to improve public health and patient outcomes.

Emotional Distress is Associated with Lower Health-Related Quality of Life Among Patients with Diabetes Using Antihypertensive and/or Antihyperlipidemic Medications: A Multicenter Study in Indonesia

Objective

To evaluate the associations between different types of diabetes distress and health-related quality of life (HRQOL) among patients with type 2 diabetes (T2DM) using antihypertensive and/or antihyperlipidemic medications in Indonesia and to explore the differences between those using only antihypertensive, only antihyperlipidemic, or both medications.

Methods

A multicenter cross-sectional study was conducted in Community Health Centers in three cities in Indonesia among patients with T2DM aged at least 18 years who were using antihypertensive and/or antihyperlipidemic medications. Diabetes distress subscales (emotional, regimen-related, interpersonal, and physician-related distress) and HRQOL were assessed using a validated diabetes distress scale-17 and EQ-5D-5L scale, respectively. Multiple linear regression models were used to evaluate the associations between different types of diabetes distress and HRQOL adjusting for confounders.

Results

Most of the 503 participants were females (67.6%) and aged 60–69 years (40.8%). Emotional distress was negatively associated with HRQOL among the whole group of patients (β: −0.08; 95% confidence interval (CI): −0.10, −0.05; p < 0.001). This association was similar across all therapeutic subgroups. Regimen-related distress (β: −0.06; 95% CI: −0.09, −0.03; p < 0.001) and interpersonal distress (β: −0.02; 95% CI: −0.05, −0.01; p = 0.022) were negatively associated, whereas physician-related distress (β: 0.04; 95% CI: 0.01, 0.07; p = 0.037) was positively associated with HRQOL among the whole group. These associations were also observed among those using only antihypertensive medication.

Conclusion

Emotional distress affects HRQOL in T2DM patients treated for cardiovascular comorbidities, independent of antihypertensive and/or antihyperlipidemic medication use.

Measurement Properties of Patient-Reported Outcome Measures for Diabetes: Systematic Review

BACKGROUND

The management of diabetes is complex. There is growing recognition of the use of patient-reported outcome measures (PROMs) as a standardized method of obtaining an outlook on patients' functional status and well-being. However, no systematic reviews have summarized the studies that investigate the measurement properties of diabetes PROMs.

OBJECTIVE

Our aims were to conduct a systematic review of studies investigating the measurement properties of diabetes PROMs by evaluating the methodological quality and overall level of evidence of these PROMs and to categorize them based on the outcome measures assessed.

METHODS

This study was guided by the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Relevant articles were retrieved from the Embase, PubMed, and PsychINFO databases. The PROMs were evaluated with the COSMIN (COnsensus-based Standards for the selection of health Measurement Instruments) guidelines.

RESULTS

A total of 363 articles evaluating the measurement properties of PROMs for diabetes in the adult population were identified, of which 238 unique PROMs from 248 studies reported in 209 articles were validated in the type 2 diabetes population. PROMs with at least a moderate level of evidence for ≥5 of 9 measurement properties include the Chinese version of the Personal Diabetes Questionnaire (C-PDQ), Diabetes Self-Management Instrument Short Form (DSMI-20), and Insulin Treatment Appraisal Scale in Hong Kong primary care patients (C-ITAS-HK), of which the C-PDQ has a "sufficient (+)" rating for >4 measurement properties. A total of 43 PROMs meet the COSMIN guidelines for recommendation for use.

CONCLUSIONS

This study identified and synthesized evidence for the measurement properties of 238 unique PROMs for patients with type 2 diabetes and categorized the PROMs according to their outcome measures. These findings may assist clinicians and researchers in selecting appropriate high-quality PROMs for clinical practice and research.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42020180978; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020180978.

Psychometric Properties of the Polish Version of the Diabetes Distress Scale (DDS)

Background

Type 2 diabetes is a disease that affects the functioning and life of both the patient and their family. It involves the constant treatment, self-care, monitoring of blood glucose levels and adherence to physical activity recommendations. As a result, it causes discomfort, distress and reduces the quality of life.

Aim

Due to the lack of a scale that would precisely evaluate the level of distress in patients with diabetes in Poland, we decided to linguistically adapt the DDS scale to the Polish population and investigate its psychometric properties in relation to Polish patients.

Material

The study group consisted of 336 individuals in total, including 156 females (46.43%) and 180 males (53.57%), aged 59.13±8.4 on average. The patients were under the care of a specialist diabetes clinic. The research tool was the Diabetic Stress Scale (DDS).

Results and Conclusion

Our analysis showed that the reliability of both the scale and its components was at a good level. Only the RD-related part was characterised by a lower Cronbach’s alpha coefficient of 0.614. The DDS scale can be successfully used for the assessment of distress in the Polish population of patients with type 2 diabetes.

Predictors of diabetes distress among older persons with type 2 diabetes mellitus in Indonesia

Background

Older persons living with diabetes have an obligation to change their daily lifestyle, which may contribute to diabetes distress. Furthermore, predictive factors of diabetes distress in older persons might be different from other age groups due to age-related factors.

Aims

The purpose of the study was to examine the predictive factors of diabetes distress in older persons diagnosed with type 2 diabetes mellitus (T2DM) in Indonesia.

Methods

A cross-sectional design was used in this study. Participants were recruited from an outpatient department of a tertiary hospital in Klaten City, Central Java, Indonesia. Data were analysed using multiple linear regression with a stepwise method.

Results

A total 198 older persons were included in the study. The study demonstrated self-efficacy (β = −0.298, P < 0.01), spirituality (β = −0.139, P < 0.05), blood glucose (β = 0.134, P < 0.05), and non-supportive family behaviour (β = 0.135, P < 0.05) as the variables that could statistically predict diabetes distress in older persons with T2DM.

Conclusions

Self-efficacy is the strongest predictor of diabetes distress. Moreover, the findings can be used as evidence to guide identification and future management of diabetes distress among older persons with T2DM.

The differences in health-related quality of life between younger and older adults and its associated factors in patients with type 2 diabetes mellitus in Indonesia

Background

It is well known that diabetes mellitus (DM) affects health-related quality of life (HRQOL) in both younger (aged 18–64 years) and older adults (aged ≥ 65 years). However, to date, no study has compared HRQOL and its predictors between younger and older adults with DM in Indonesia. Such a comparison is important because the results can guide nurses and clinicians to establish evidence-based educational programs that are specific and suitable for patients. Therefore, the aim of this study was to investigate the difference in HRQOL and its predictors in younger and older adults with DM in Indonesia.

Methods

A cross-sectional study was conducted on 641 patients with type 2 diabetes mellitus (T2DM) who were recruited via simple random sampling from 16 primary health centers in Banyumas Regency, Indonesia. A self-administered questionnaire containing the Summary of Diabetes Self-Care Activities, the DDS17 Bahasa Indonesia, the Beck Depression Inventory II, the Self-Efficacy for Diabetes Scale, the Family APGAR, and the 36-item Short-Form Health Survey was used to measure diabetes self-management (DSM), diabetes distress (DD), depression, self-efficacy, family support, and HRQOL, respectively. Independent t-tests were used to compare the physical component summary (PCS) and mental component summary (MCS) scores between younger and older adults with T2DM. Hierarchical multiple regression analyses were used to examine the factors associated with HRQOL in both groups.

Results

PCS scores were significantly different between the two groups. Older adults reported lower PCS scores than younger adults. No differences between the two groups were observed in the MCS scores. The hierarchical multiple regression analysis showed that level of education, employment status, number of diabetes-related complications, DSM, DD, depression, and self-efficacy were significant predictors of HRQOL in younger adults, while income, depression, DD, and self-efficacy were significant predictors of HRQOL in older adults. DD was the strongest predictor of HRQOL in younger adults, and depression was the strongest predictor in older adults.

Conclusion

Older adult patients had lower PCS scores than younger adult patients. This study is the first to show that the predictors of HRQOL differ between younger and older adults with T2DM. It provides insights for nurses and clinicians in Indonesia to establish evidence-based, age-specific educational programs.

Diabetes-Related Distress and Its Associated Factors Among Patients with Diabetes in Vietnam

Background

Psychometric properties are regarded as one of the significant contributors related to diabetes treatment efficacy. Diabetes-related distress (DD) is one of the emotional burdens. The aims of this study were to investigate the prevalence of DD and to determine its associated factors among Vietnamese diabetic patients.

Methods

A cross-sectional study was conducted at a single medical center in the central of Vietnam. A total of 138 eligible DM outpatients were invited and a total of 112 patients who completed the questionnaire were utilized in this analysis using convenience sampling. DD was assessed using the diabetes distress scale (DDS). The participant’s sociodemographic and clinical information was obtained through face-to-face interviews and medical records. Multivariate logistic regression was used to determine independent factors associated with the presence of DD.

Results

Approximately, 12.5% of the patients experienced DD based on DDS self-administered questionnaire. The rates of mild/moderate and high distress were 8.0% and 4.5%, respectively. DD was found to be significantly higher in type 1 DM (p=0.04), insulin only in treatment regime (p=0.04), physical inactivities (p=0.02), times of mild hypoglycemia (time/month) (p=0.01), and fasting plasma glucose (mmol/l) (p=0.04). The occurrence of distress among DM patients was negatively correlated with their age and amount of physical exercise. Meanwhile, poor HbA1c control (HbA1c≥7%) was associated with an increased occurrence of diabetes distress.

Conclusion

The findings of single medical center in Vietnam highlights that DD is prevalent among DM patients. It should be of marked concerns, particularly the type 1 diabetic patients, younger age, and poor glycemic control patients.

Foot self-care behavior and its predictors in diabetic patients in Indonesia

OBJECTIVES

Previous studies have shown that diabetic foot ulcers are principally associated with improper foot self-care. Since appropriate foot self-care is essential to prevent diabetic foot-ulcers, any factors which can predict foot self-care behavior should be identified. However, until now, foot self-care behavior data and predictors of foot-care behavior in Indonesia remain unclear since such studies on Indonesian diabetic patients is very limited. Therefore, the purpose of this study was to investigate foot self-care behavior and to identify its predictors in Indonesia. The design of this study was cross-sectional. Cluster sampling was used, involving 546 type 2 diabetes mellitus patients registered in 22 primary healthcare centers. The questionnaires used in this study included the Diabetes Distress Scale, Beck Depression Inventory II, Family APGAR, Foot-Care Knowledge and Modified Diabetic Foot Care Behaviors.

RESULTS

Foot self-care behavior and knowledge about foot care were poor. The predictors of foot self-care behavior were age, educational level, diabetes distress, family support, and knowledge. It needs the program to improve foot self-care knowledge and the program to reduce the diabetes distress in Indonesian diabetic patients. In performing of these programs, families should be involved to improve the support toward foot self-care behavior in patients.

Diabetes distress in Indonesian patients with type 2 diabetes: a comparison between primary and tertiary care

BACKGROUND

The number of people living with diabetes mellitus (DM) in Indonesia has continued to increase over the last 6 years. Four previous studies in U.S have found that higher DD scores were associated with worse psychological outcomes, lower health-related quality of life (HRQoL) and increased risk of T2DM complications. In this study, we aimed to firstly compare DD scores in Indonesian T2DM outpatients treated in primary care versus those in tertiary care. Subsequently, we investigated whether socio-demographic characteristics and clinical conditions explain potential differences in DD score across healthcare settings.

METHODS

A cross-sectional study was conducted on Java island in three primary care (n = 108) and four tertiary care (n = 524) facilities. The participants completed the Bahasa Indonesia version of the Diabetes Distress Scale questionnaire (DDS17 Bahasa Indonesia). Ordinal regression analysis was conducted with the quartile of the summation of the DD score as the dependent variable to investigate how the association between the level of healthcare facilities and DD altered when adding different variables in the model.

RESULTS

The final adjusted model showed that the level of healthcare facilities was strongly associated with DD (p < .001), with participants in primary care having a 3.68 times (95% CI 2.46-5.55) higher likelihood of being more distressed than the participants in tertiary care. This association was detected after including the socio-demographic characteristics and clinical conditions as model confounders.

CONCLUSIONS

This is the first study in Indonesia to compare DD scores within different healthcare facilities. We recommend a regular DD assessment, possibly closely aligned with health-literacy partner programs, especially for T2DM patients in primary care settings.

'Diabetes is a gift from god' a qualitative study coping with diabetes distress by Indonesian outpatients

Background

More than two-thirds of patients diagnosed with type 2 diabetes mellitus (T2DM) in Indonesia encounter medical-related problems connected to routine self-management of medication and the social stigma related to T2DM. The current study aims to explore distress and coping strategies in Indonesian T2DM outpatients in a Primary Healthcare Centre (PHC) in Surabaya, East Java, Indonesia.

Methods

We conducted a qualitative study using two different data collection methods: focus group discussions and in-depth interviews. The guideline of interviews and discussions were developed based on seventeen questions derived from the DDS17 Bahasa Indonesia (a Bahasa Indonesia version of the Diabetes Distress Scale questionnaire), which covered physician distress domain, emotional burden domain, regimen distress domain and interpersonal distress domain.

Results

The majority of the 43 participants were females and aged 50 or older. Our study discovered two main themes: internal and external diabetes distress and coping strategies. Internal diabetes distress consists of disease burden, fatigue due to T2DM, fatigue not due to T2DM, emotional burden (fear, anxiety, etc.) and lack of knowledge. Internal coping strategies comprised spirituality, positive attitude, acceptance and getting more information about T2DM. External diabetes distress was evoked by distress concerning healthcare services, diet, routine medication, monthly blood sugar checks, interpersonal distress (family) and financial concern. External coping strategies included healthcare support, traditional medicine, vigilance, self-management, social and family support and obtaining information about health insurance.

Conclusion

Our study shows that for Indonesian T2DM-patients, spirituality and acceptance are the most common coping mechanisms for reducing DD. Furthermore, our study revealed an overall positive attitude towards dealing with T2DM as well as a need for more information about T2DM and potential coping strategies. Finally, an important finding of ours relates to differences in DD between males and females, potential DD associated with health services provision and the specific challenges faced by housewives with T2DM.

Health-related quality of life in Indonesian type 2 diabetes mellitus outpatients measured with the Bahasa version of EQ-5D

Objectives

To present EuroQol-5D (EQ-5D) index scores in Indonesian type 2 diabetes mellitus (T2DM) outpatients and to investigate the associations between EQ-5D and socio-demographic characteristics and clinical condition.

Methods

Socio-demographic data were collected by interviewing participants, clinical data were obtained from treating physicians and self-reporting. Participants originated from primary and secondary care facilities in the Java and Sulawesi regions. Ordinal regression analysis was conducted with the quintiles of the EQ-5D index scores as the dependent variable to investigate the multivariate association with the participants’ socio-demographic characteristics and clinical condition.

Results

907 participants completed the five-level Indonesian version of the EQ-5D. The mean age of the participants was 59.3 (SD 9.7), and 57% were female. The overall EQ-5D index score was 0.77 (0.75–0.79). Male participants had a higher EQ-5D index score compared to females, and the highest percentage of self-reported health problems was in the pain/discomfort dimension (61%). Factors identified as being significantly associated with lower EQ-5D index scores were: (i) treatment in secondary care, (ii) lower educational level, (iii) dependency on caregivers, (iv) not undergoing T2DM therapy, and (v) being a housewife.

Conclusion

This study provides estimates of EQ-5D index scores that can be used in health economic evaluations. As housewives were found to experience more T2DM-related pain/discomfort and anxiety/depression, targeted approaches to reduce these problems should be aimed specifically at this group of patients. Potential approaches could involve disease-specific-counselors (health literacy partners) who provide routine monitoring of T2DM therapy as well as improved health promotion among T2DM communities.

Depression and diabetes distress in adults with type 2 diabetes: results from the Australian National Diabetes Audit (ANDA) 2016

This study explores the prevalence of, and factors associated with, likely depression and diabetes distress in adults with type 2 diabetes in a large, national sample. Australian National Diabetes Audit data were analysed from adults with type 2 diabetes attending 50 diabetes centres. The Brief Case find for Depression and Diabetes Distress Score 17 were administered to screen for likely depression and diabetes-related distress, respectively. A total of 2,552 adults with type 2 diabetes participated: (mean ± SD) age was 63 ± 13 years, diabetes duration was 12 ± 10 years, and HbA1c was 8 ± 2%. Twenty-nine percent of patients had likely depression, 7% had high diabetes distress, and 5% had both. Difficulty following dietary recommendations, smoking, forgetting medications, and diabetes distress were all associated with greater odds of depression whereas higher own health rating was associated with lower odds (all p < 0.02). Female gender, increasing HbA1c, insulin use, difficulty following dietary recommendations and depression were all associated with greater odds of diabetes distress & older age, higher own health rating and monitoring blood glucose levels as recommended were associated with lower odds (all p < 0.04). Depression was associated with sub-optimal self-care, while diabetes distress was associated with higher HbA1c and sub-optimal self-care.