ORCID Profile
0000-0003-3845-2814
Current Organisation
Deakin University
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Publisher: Wiley
Date: 15-12-2021
DOI: 10.1111/DME.14759
Abstract: Acceptable and accessible interventions are needed to address ‘psychological insulin resistance’, which is a common barrier to insulin uptake among adults with type 2 diabetes (T2D). Our aim was to test the feasibility of a randomised controlled trial (RCT) study design and acceptability of a theoretically grounded, psycho‐educational, web‐based resource to reduce negative insulin appraisals among adults with T2D. A double‐blinded, parallel group, two‐arm pilot RCT (1:1), comparing intervention with active control (existing online information about insulin). Eligible participants were Australian adults with T2D, taking oral diabetes medications. Exclusion criteria: prior use of injectable medicines being ‘very willing’ to commence insulin. Primary outcomes: study feasibility (recruitment ease, protocol fulfilment, attrition, data completeness) secondary outcomes: intervention acceptability (intervention engagement, user feedback) and likely efficacy (negative Insulin Treatment Appraisal Scale [ITAS] scores at follow‐up). Online surveys completed at baseline and 2 weeks. During 4‐week recruitment, 76 people expressed interest: 51 eligible and 35 enrolled (intervention = 17, control = 18 median[interquartile range] age = 62[53, 69] years 17 women). Protocol fulfilment achieved by 26 (74%) participants ( n = 13 per arm), with low participant attrition ( n = 6, 17%). Intervention acceptability was high ( % endorsement, except format preference = 60%). ITAS negative scores differed between‐groups at follow‐up ( M diff = −6.5, 95% confidence interval: −10.7 to −2.4), favouring the intervention. This novel web‐based resource (“Is insulin right for me?”) is acceptable and associated with a likely reduction in negative insulin appraisals, relative to existing resources. This pilot shows the study design is feasible and supports conduct of a fully powered RCT.
Publisher: Wiley
Date: 25-04-2023
DOI: 10.1111/DME.15117
Abstract: To test ‘Is Insulin Right for Me?’, a theory‐informed, self‐directed, web‐based intervention designed to reduce psychological barriers to insulin therapy among adults with type 2 diabetes. Further, to examine resource engagement and associations between minimum engagement and outcomes. Double‐blind, two‐arm randomised controlled trial (1:1), comparing the intervention with freely available online information (control). Eligible participants were Australian adults with type 2 diabetes, taking oral diabetes medications, recruited primarily via national diabetes registry. Exclusion criteria: prior use of injectable medicines being ‘very willing’ to commence insulin. Data collections were completed online at baseline, 2‐week and 6‐month follow‐up. Primary outcome: negative insulin treatment appraisal scale (ITAS) scores secondary outcomes: positive ITAS scores and hypothetical willingness to start insulin. Analyses: intention‐to‐treat (ITT) per‐protocol (PP) examination of outcomes by engagement. Trial registration: ACTRN12621000191897. No significant ITT between‐arm (intervention: n = 233 control: n = 243) differences were observed in primary (2 weeks: Mdiff [95% CI]: −1.0 [−2.9 to 0.9] 6 months: −0.01 [−1.9 to 1.9]), or secondary outcomes at either follow‐up. There was evidence of lower Negative ITAS scores at 2‐week, but not 6‐month, follow‐up among those with minimum intervention engagement (achieved by 44%) compared to no engagement (−2.7 [−5.1 to −0.3]). Compared to existing information, ‘Is insulin right for me?’ did not improve outcomes at either timepoint. Small intervention engagement effects suggest it has potential. Further research is warranted to examine whether effectiveness would be greater in a clinical setting, following timely referral among those for whom insulin is clinically indicated.
Publisher: BMJ
Date: 02-2022
DOI: 10.1136/BMJOPEN-2021-051524
Abstract: Psychological barriers to insulin therapy are associated with the delay of clinically indicated treatment intensification for people with type 2 diabetes (T2D), yet few evidence-based interventions exist to address these barriers. We describe the protocol for a randomised controlled trial (RCT) examining the efficacy of a novel, theoretically grounded, psychoeducational, web-based resource designed to reduce psychological barriers to insulin among adults with non-insulin treated T2D: ‘ Is insulin right for me?’ . Double-blind, parallel group RCT. A target s le of N=392 participants (n=196/arm) will be randomised (1:1) to ‘ Is insulin right for me?’ (intervention) or widely available online resources (control). Eligible participants include adults (18–75 years), residing in Australia, currently taking oral hypoglycaemic agents to manage T2D. They will be primarily recruited via invitations and reminders from the national diabetes registry (from a purposefully selected s le of N≥12 000). Exclusion criteria: experience of self-administered injectable previously enrolled in pilot RCT ‘very willing’ to start insulin as baseline. Outcomes will be assessed via online survey at 2 weeks and 6 months. Primary outcome between-group: difference in mean negative Insulin Treatment Appraisal Scores (ITAS negative) at 2-week and 6-month follow-up. Secondary outcomes: between-group differences in mean positive insulin appraisals (ITAS positive) and percentage difference in intention to commence insulin at follow-up time points. All data analyses will be conducted according to the intention-to-treat principle. Deakin University Human Research Ethics Committee (2020–073). Dissemination via peer-reviewed journals, conferences and a plain-language summary. ACTRN12621000191897 Australian and New Zealand Clinical Trials Registry.
Publisher: Wiley
Date: 06-09-2023
DOI: 10.1111/DME.14943
Abstract: Commencing university presents particular challenges for young adults with diabetes. This integrative literature review aimed to synthesise the research exploring the experiences and support needs of university students with diabetes. Medline, CINAHL, PsychInfo and EMBASE databases were searched for quantitative and qualitative studies, among undergraduate and postgraduate students with type 1 or type 2 diabetes conducted in the university setting. Two reviewers independently screened titles, abstracts and full‐text articles. Data were analysed thematically and synthesised narratively utilising the ecological model as a framework for interpreting findings and making recommendations. We identified 25 eligible papers (20 studies) utilising various methods: in idual interview, focus group, survey, online forum. Four themes were identified: barriers to self‐care (e.g. lack of structure and routine) living with diabetes as a student identity, stigma and disclosure and strategies for managing diabetes at university. Students in the early years at university, recently diagnosed or moved away from home, reported more self‐care difficulties, yet few accessed university support services. Risky alcohol‐related behaviours, perceived stigma and reluctance to disclose diabetes inhibited optimal diabetes management. Despite the heterogeneity of studies, consistent themes related to diabetes self‐care difficulties and risky behaviours were reported by young adults with diabetes transitioning to university life. No effective interventions to support students with diabetes were identified in this setting. Multilevel approaches to support students to balance the competing demands of study and diabetes self‐care are needed, particularly in the early years of university life.
Publisher: Springer Science and Business Media LLC
Date: 12-08-2016
Publisher: CSIRO Publishing
Date: 19-07-2022
DOI: 10.1071/AH22040
Abstract: Diabetes prevalence is increasing the technologies and medicines used to manage diabetes have become more complex, and the specialist health workforce with qualifications in diabetes is insufficient. Generalist health professionals have limited diabetes knowledge, despite engaging with people with diabetes in healthcare daily. An innovative framework is needed to align with the Australian National Diabetes Strategy to build a competent, flexible and adaptive workforce to promote excellence in diabetes care. A three-staged modified Delphi technique was used to identify a consensus Capability Framework for Diabetes Care (the ‘Framework’). An implementation phase followed, involving representation from people with diabetes and key health professional organisations to co-design and implement the ‘Framework’. The ‘Framework’ can guide curricula at universities and TAFE institutes, and the professional development and practice of Australian nurses, allied health professionals, First Nations Australians health workers and practitioners, pharmacists, midwives and health assistants when delivering care to people living with diabetes. The ‘Framework’ defines nine core capabilities that healthcare providers require to deliver diabetes care effectively, underpinned by three sets of attributes for seven practice levels to enable the workforce. Information within the practice levels provides a nationally consistent approach to learning and training different healthcare providers in the essential elements of diabetes care. A ‘living’ evidence-based national ‘Framework’ for the whole health workforce and associated online resources will help promote a more responsive health workforce delivering better and more equitable diabetes care.
Publisher: Hindawi Limited
Date: 31-01-2018
DOI: 10.1111/PEDI.12641
Abstract: Glycated hemoglobin (HbA1c) is higher during adolescence than at any other life stage. Some research among adolescents indicates that depressive symptoms are associated with suboptimal HbA1c. However, research among adults suggests diabetes distress is a stronger predictor of HbA1c than depressive symptoms. To determine the relative contributions of depressive symptoms and diabetes distress to explain the variance in HbA1c among adolescents with type 1 diabetes. Diabetes MILES Youth Study respondents aged 13 to 19 years completed questionnaires assessing depressive symptoms (Patient Health Questionnaire for Adolescents: PHQA-8), diabetes distress (Problem Areas in Diabetes-Teen version: PAID-T), and self-reported socio-demographic and clinical variables, including their most recent HbA1c. Stepwise hierarchical multiple regression was conducted to examine the contributions of depressive symptoms and diabetes distress to HbA1c. Participants (N = 450) had a (mean ± SD) age of 15.7 ± 1.9 years diabetes duration of 6.9 ± 4.3 years and 38% (n = 169) were male. Twenty-one percent (n = 96) experienced moderate-to-severe depressive symptoms (PHQA-8 ≥ 11) and 36% (n = 162) experienced high diabetes distress (PAID-T > 90). In the final regression model, HbA1c was explained by: diabetes duration (β = .14, P = .001), self-monitoring of blood glucose (β = -.20, P < .001), and diabetes distress (β = .30, P < .001). Following the addition of diabetes distress, depressive symptoms were no longer significantly associated with HbA1c (P = .551). The final model explained 18% of the variance in HbA1c. Consistent with evidence from studies among adults, diabetes distress mediated the relationship between depressive symptoms and HbA1c among adolescents with type 1 diabetes. These findings suggest that clinicians need to be aware of diabetes distress.
Publisher: American Diabetes Association
Date: 07-09-2017
DOI: 10.2337/DC17-0441
Abstract: To establish cut point(s) for the Problem Areas in Diabetes–teen version (PAID-T) scale to identify adolescents with clinically meaningful, elevated diabetes distress. Data were available from the Diabetes Management and Impact for Long-term Empowerment and Success (MILES) Youth–Australia Study, a national survey assessing various psychosocial indicators among self-selected National Diabetes Services Scheme registrants. Participants in the current study (n = 537) were (mean ± SD) 16 ± 2 years old, had type 1 diabetes for 6 ± 4 years, and 62% (n = 334) were girls. They completed measures of diabetes distress (PAID-T) and depressive symptoms (Patient Health Questionnaire for Adolescents) and self-reported their most recent HbA1c and frequency of self-monitoring of blood glucose (SMBG). Relationships between the PAID-T and the psychological and clinical variables were examined to identify a clinically meaningful threshold for elevated diabetes distress. ANOVA was used to test whether these variables differed by levels of distress. Two cut points distinguished none-to-mild (& ), moderate (70–90), and high (& ) diabetes distress. Moderate distress was experienced by 18% of adolescents and high distress by 36%. Mean depressive symptoms, self-reported HbA1c, and SMBG differed significantly across the three levels of diabetes distress (all P & 0.001), with moderate-to-large effect sizes. Using the PAID-T, this study defined two clinically meaningful cut points to distinguish none-to-mild, moderate, and high diabetes distress in adolescents (aged 13–19). Based on these cut points, most respondents experienced at least moderate diabetes distress, which was clinically significant. Establishing thresholds for elevated diabetes distress will aid clinicians and researchers to interpret PAID-T scores, prompt discussion and intervention for those with unmet needs, and enable the effectiveness of interventions to be evaluated.
Publisher: Wiley
Date: 04-09-2022
DOI: 10.1111/DME.14681
Abstract: This qualitative study aims to explore beliefs, attitudes and experiences of injectable glucagon‐like‐peptide‐1 receptor agonists (GLP‐1RAs) use and discontinuation, as well as attitudes to further injectable treatment intensification, among adults with type 2 diabetes (T2D). Nineteen in‐depth semi‐structured interviews lasting (mean ± standard deviation) 45 ± 18 min were conducted, face‐to‐face ( n = 14) or via telephone ( n = 5). Transcripts were analysed using inductive template analyses. Eligible participants were English‐speaking adults with T2D who had recently initiated (≤3 years) GLP‐1RA treatment. Participants were aged 28–72 years, who predominantly lived in metropolitan areas ( n = 15), and had an experience of daily ( n = 11) and/or once‐weekly ( n = 13) GLP‐1RA formulations. Six participants had discontinued treatment and seven had trialled two or more formulations. Expectations and experiences of GLP‐1RA were related to the perceived: (1) symbolism and stigma of injectable diabetes treatment (2) ease of injectable administration and device preferences (3) treatment convenience and social impact (4) treatment efficacy and benefits, and (5) negative treatment side effects. Some participants reported increased receptiveness to insulin therapy following their GLP‐1RA experience, others emphasised unique concerns about insulin beyond injectable administration. This study provides a novel understanding of expectations and experience of non‐insulin injectables among Australian adults with T2D. Our data suggest expectations may be informed by attitudes to insulin therapy, while perceived treatment benefits (e.g. weight‐related benefits, administration frequency) may motivate uptake and ongoing use despite concerns. Experience of GLP‐1RA injections may impact receptiveness to future insulin use.
No related grants have been discovered for Virginia Hagger.