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0000-0002-1204-6896
Current Organisations
Diabetes Victoria
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Deakin University
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Publisher: Elsevier BV
Date: 02-2010
DOI: 10.1016/J.DIABRES.2009.12.003
Abstract: As part of our evaluation of the Diabetes UK Careline workshop "Overcoming barriers to diabetes care", we received feedback from 18 healthcare professionals. Generally, they felt competent in identifying patients' psychosocial issues but less knowledgeable/skilled in handling them. Lack of time, privacy and support were barriers to addressing patients' psychosocial concerns.
Publisher: BMJ
Date: 2021
DOI: 10.1136/BMJOPEN-2020-040438
Abstract: The successful treatment of type 1 diabetes (T1D) requires those affected to employ insulin therapy to maintain their blood glucose levels as close to normal to avoid complications in the long-term. The Dose Adjustment For Normal Eating (DAFNE) intervention is a group education course designed to help adults with T1D develop and sustain the complex self-management skills needed to adjust insulin in everyday life. It leads to improved glucose levels in the short term (manifest by falls in glycated haemoglobin, HbA1c), reduced rates of hypoglycaemia and sustained improvements in quality of life but overall glucose levels remain well above national targets. The DAFNE plus intervention is a development of DAFNE designed to incorporate behavioural change techniques, technology and longer-term structured support from healthcare professionals (HCPs). A pragmatic cluster randomised controlled trial in adults with T1D, delivered in diabetes centres in National Health Service secondary care hospitals in the UK. Centres will be randomised on a 1:1 basis to standard DAFNE or DAFNE plus . Primary clinical outcome is the change in HbA1c and the primary endpoint is HbA1c at 12 months, in those entering the trial with HbA1c .5% (58 mmol/mol), and HbA1c at 6 months is the secondary endpoint. S le size is 662 participants (approximately 47 per centre) 92% power to detect a 0.5% difference in the primary outcome of HbA1c between treatment groups. The trial also measures rates of hypoglycaemia, psychological outcomes, an economic evaluation and process evaluation. Ethics approval was granted by South West-Exeter Research Ethics Committee (REC ref: 18/SW/0100) on 14 May 2018. The results of the trial will be published in a National Institute for Health Research monograph and relevant high-impact journals. ISRCTN42908016 .
Publisher: Wiley
Date: 19-04-2013
DOI: 10.1111/DME.12192
Abstract: To conduct a pilot study to explore the potential impact of visual feedback of personal retinal images on diabetes outcomes. Twenty-five participants with non-proliferative diabetic retinopathy and suboptimal HbA(1c) (> 53 mmol/mol > 7%) were randomized to receive visual feedback of their own retinal images or to a control group. At baseline and 3-month follow-up, HbA(1c), standard measures of beliefs, diabetes-related distress and self-care activities were assessed. In unadjusted models, relative to controls, the intervention group showed significantly greater improvement in HbA(1c) at 3-month follow-up (-0.6% vs. +0.3%, P < 0.01), as well as enhanced motivation to improve blood glucose management (P < 0.05). This small pilot study provides preliminary evidence that visual feedback of personal retinal images may offer a practical educational strategy for clinicians in eye care services to improve diabetes outcomes in non-target compliant patients. A fully powered randomized controlled trial is required to confirm these findings and determine the optimal use of feedback to produce sustained effects.
Publisher: Mary Ann Liebert Inc
Date: 12-2017
Abstract: While the number of diabetes-specific mobile applications (apps) continues to grow, there is a lack of knowledge about their actual use. The second MILES (Management and Impact for Long-term Empowerment and Success)-Australia study was a national cross-sectional survey of the psychological, behavioral, and social aspects of diabetes for adults with type 1 diabetes (T1D) and type 2 diabetes (T2D). Associations between diabetes-specific app usage and demographic, clinical, and psychosocial variables were examined. Of the 1589 respondents responding to the diabetes-specific app questions, 795 had T1D (mean ± standard deviation age 43 ± 14 years 61% women diabetes duration 19 ± 14 years) and 794 had T2D (age 60 ± 9 years 40% women diabetes duration 11 ± 7 years). Among adults with T1D, 24% (n = 188) reported using apps, with carbohydrate counting (74% n = 139) as the most common cited purpose. App usage was significantly associated with shorter diabetes duration, more frequent glucose monitoring, and lower self-reported HbA1c. Among adults with T2D, 8% (n = 64) reported using apps, with glucose monitoring (62% n = 39) as the most common purpose. For all respondents, the most commonly reported reason for not using apps was a belief that they could not help with diabetes self-management. A minority of adults with T1D and T2D use apps to support their self-management. App use among adults with T1D is associated with a more recent T1D diagnosis, more frequent glucose monitoring, and lower self-reported HbA1c. Future efforts should focus on this association and determine the mechanisms by which app use is related to better clinical outcomes.
Publisher: Wiley
Date: 14-02-2020
DOI: 10.1111/DME.14254
Publisher: American Diabetes Association
Date: 08-11-2014
DOI: 10.2337/DC14-1947
Publisher: Springer Science and Business Media LLC
Date: 12-2012
Abstract: Severe hypoglycaemia (SH) is one of the most feared complications of type 1 diabetes (T1DM) with a reported prevalence of nearly 40%. In randomized trials of Multiple Daily Injections (MDI) and Continuous Subcutaneous Insulin Infusion (CSII) therapy there is a possible benefit of CSII in reducing SH. However few trials have used basal insulin analogues as the basal insulin in the MDI group and in iduals with established SH have often been excluded from prospective studies. In published studies investigating the effect of Real Time Continuous Glucose Monitoring (RT-CGM) benefit in terms of reduced SH has not yet been demonstrated. The primary objective of this study is to elucidate whether in people with T1DM complicated by impaired awareness of hypoglycaemia (IAH), rigorous prevention of biochemical hypoglycaemia using optimized existing self-management technology and educational support will restore awareness and reduce risk of recurrent SH. This is a multicentre prospective RCT comparing hypoglycaemia avoidance with optimized MDI and CSII with or without RT-CGM in a 2×2 factorial design in people with type 1 diabetes who have IAH. The primary outcome measure for this study is the difference in IAH (Gold score) at 24 weeks. Secondary outcomes include biomedical measures such as HbA1c, SH incidence, blinded CGM analysis, self monitored blood glucose (SMBG) and response to hypoglycaemia in gold standard cl studies. Psychosocial measures including well-being and quality of life will also be assessed using several validated and novel measures. Analysis will be on an intention-to-treat basis. Most existing RCTs using this study’s interventions have been powered for change in HbA1c rather than IAH or SH. This trial will demonstrate whether IAH can be reversed and SH prevented in people with T1DM in even those at highest risk by using optimized conventional management and existing technology. ISRCTN52164803 Eudract No: 2009-015396-27
Publisher: Public Library of Science (PLoS)
Date: 17-03-2023
DOI: 10.1371/JOURNAL.PONE.0283148
Abstract: The aim of this study was to determine the acceptability and psychometric properties of the Hypo-METRICS (Hypoglycemia MEasurement, ThResholds and ImpaCtS) application (app): a novel tool designed to assess the direct impact of symptomatic and asymptomatic hypoglycemia on daily functioning in people with insulin-treated diabetes. 100 adults with type 1 diabetes mellitus (T1DM, n = 64) or insulin-treated type 2 diabetes mellitus (T2DM, n = 36) completed three daily ‘check-ins’ (morning, afternoon and evening) via the Hypo-METRICs app across 10 weeks, to respond to 29 unique questions about their subjective daily functioning. Questions addressed sleep quality, energy level, mood, affect, cognitive functioning, fear of hypoglycemia and hyperglycemia, social functioning, and work roductivity. Completion rates, structural validity, internal consistency, and test-retest reliability were explored. App responses were correlated with validated person-reported outcome measures to investigate convergent (r s ±0.3) and ergent (r s ±0.3) validity. Participants’ mean±SD age was 54±16 years, diabetes duration was 23±13 years, and most recent HbA1c was 56.6±9.8 mmol/mol. Participants submitted mean±SD 191±16 out of 210 possible ‘check-ins’ (91%). Structural validity was confirmed with multi-level confirmatory factor analysis showing good model fit on the adjusted model (Comparative Fit Index .95, Root-Mean-Square Error of Approximation .06, Standardized Root-Mean-square Residual .08). Scales had satisfactory internal consistency (all ω≥0.5), and high test-retest reliability (r s ≥0.7). Convergent and ergent validity were demonstrated for most scales. High completion rates and satisfactory psychometric properties demonstrated that the Hypo-METRICS app is acceptable to adults with T1DM and T2DM, and a reliable and valid tool to explore the daily impact of hypoglycemia.
Publisher: JMIR Publications Inc.
Date: 22-07-2020
DOI: 10.2196/17038
Abstract: Embodied conversational agents (ECAs) are increasingly used in health care apps however, their acceptability in type 2 diabetes (T2D) self-management apps has not yet been investigated. This study aimed to evaluate the acceptability of the ECA (Laura) used to deliver diabetes self-management education and support in the My Diabetes Coach (MDC) app. A sequential mixed methods design was applied. Adults with T2D allocated to the intervention arm of the MDC trial used the MDC app over a period of 12 months. At 6 months, they completed questions assessing their interaction with, and attitudes toward, the ECA. In-depth qualitative interviews were conducted with a subs le of the participants from the intervention arm to explore their experiences of using the ECA. The interview questions included the participants’ perceptions of Laura, including their initial impression of her (and how this changed over time), her personality, and human character. The quantitative and qualitative data were interpreted using integrated synthesis. Of the 93 intervention participants, 44 (47%) were women the mean (SD) age of the participants was 55 (SD 10) years and the baseline glycated hemoglobin A1c level was 7.3% (SD 1.5%). Overall, 66 of the 93 participants (71%) provided survey responses. Of these, most described Laura as being helpful (57/66, 86%), friendly (57/66, 86%), competent (56/66, 85%), trustworthy (48/66, 73%), and likable (40/66, 61%). Some described Laura as not real (18/66, 27%), boring (26/66, 39%), and annoying (20/66, 30%). Participants reported that interacting with Laura made them feel more motivated (29/66, 44%), comfortable (24/66, 36%), confident (14/66, 21%), happy (11/66, 17%), and hopeful (8/66, 12%). Furthermore, 20% (13/66) of the participants were frustrated by their interaction with Laura, and 17% (11/66) of the participants reported that interacting with Laura made them feel guilty. A total of 4 themes emerged from the qualitative data (N=19): (1) perceived role: a friendly coach rather than a health professional (2) perceived support: emotional and motivational support (3) embodiment preference acceptability of a human-like character and (4) room for improvement: need for greater congruence between Laura’s words and actions. These findings suggest that an ECA is an acceptable means to deliver T2D self-management education and support. A human-like character providing ongoing, friendly, nonjudgmental, emotional, and motivational support is well received. Nevertheless, the ECA can be improved by increasing congruence between its verbal and nonverbal communication and accommodating user preferences. Australian New Zealand Clinical Trials Registry CTRN12614001229662 xshn6pd
Publisher: American Diabetes Association
Date: 06-2022
DOI: 10.2337/DB22-373-P
Abstract: Acute hypoglycemia impacts negatively on cognitive function. However, it remains unclear which specific domains of cognitive function are affected, and the extent to which level of hypoglycemia modifies this relationship. We conducted a systematic review and meta-analysis to investigate the impact of controlled hyperinsulinaemic hypoglycemia on cognitive function in adults with type 1 diabetes, following PRISMA guidelines. Experimental studies comparing cognitive function task performance during euglycemia and hypoglycemia were eligible for inclusion. Preliminary analyses were conducted on 38 studies, involving 54 cognitive task outcomes across three domains of cognitive function of varying complexity: attention/information processing speed (simplest) , working memory, and complex reasoning (most complex) . Three-level meta-analyses of the standardized mean differences (SMD) in performance during euglycemia and hypoglycemia, moderated by hypoglycemia level (Mdn=2.51 range=1.98-3.5 mmol/l) were conducted for each domain, with study and task as random effects to allow inclusion of multiple effect sizes per study. Hypoglycemia significantly impaired performance on all domains, with large effect sizes for attention/information processing speed (SMD=-1.17, 95% CI:-1.60 to -0.74) and working memory (SMD=-0.84, CI:-1.to -0.63) , and a medium effect size for complex reasoning (SMD=-0.61, CI:-0.99 to -0.23) . The degree of hypoglycemia significantly moderated this relationship for working memory only, such that for every 1mmol/l decrease in glucose level, performance was reduced by SMD=0.84 (CI:0.2 to 1.49) . These findings suggest that the impact of hypoglycemia on cognitive function is related to the cognitive domain complexity, with more impaired performance on simpler relative to more complex tasks. Further, degree of hypoglycemia may be differentially related to performance depending on the domain of cognitive function. M.M.Broadley: None. C.Hendrieckx: None. R.J.Mccrimmon: Advisory Panel Novo Nordisk, Sanofi, Research Support Diabetes UK, European Union, MedImmune. G.Nefs: None. U.Pedersen-bjergaard: Advisory Panel Novo Nordisk A/S, Sanofi. C.E.Verhulst: None. J.Speight: Advisory Panel Insulet Corporation, Research Support Novo Nordisk, Sanofi. F.Pouwer: Research Support Eli Lilly and Company, Novo Nordisk, Sanofi. The hypo-resolve consortium: n/a. H.Chatwin: None. U.Soeholm: Research Support Novo Nordisk A/S. J.Axelsen: None. S.A.Amiel: Advisory Panel Medtronic, Novo Nordisk, Other Relationship Sanofi. P.Choudhary: Advisory Panel Abbott Diabetes, Lilly Diabetes, Medtronic, Research Support Novo Nordisk, Speaker's Bureau Dexcom, Inc., Glooko, Inc., Insulet Corporation, Sanofi. B.E.De galan: Research Support Novo Nordisk. T.W.Fabricius: None. S.R.Heller: Advisory Panel Eli Lilly and Company, Medtronic, Mylan N.V., Zealand Pharma A/S, Zucara Therapeutics, Other Relationship Eli Lilly and Company, Research Support Dexcom, Inc., Speaker's Bureau Novo Nordisk A/S. Innovative Medicines Initiative 2 Joint Undertaking (777460)
Publisher: Wiley
Date: 28-02-2013
DOI: 10.1111/DME.12078
Abstract: The mean age of onset of Type 2 diabetes mellitus is decreasing in Australia and internationally. We conducted an internet-based survey to improve our understanding of the emotional well-being and unmet needs of younger adults with Type 2 diabetes, and to inform service provision for this group. A random s le of National Diabetes Services Scheme registrants (n = 1,417) with Type 2 diabetes, aged 18-39 years, living in the Australian state of Victoria received an invitation to complete the online survey. The study was also advertised state-wide. The survey included validated scales (PAID-5: diabetes-related distress WHO-5: general emotional well-being) and study-specific items. A total of 149 eligible respondents participated. Almost two-thirds (63%) of respondents reported severe-diabetes related distress more than a quarter (27%) had impaired general emotional well-being. Most (82%) were overweight or obese (BMI ≥ 25) most (77%) had at least one other co-morbidity. Lack of motivation, feeling burned out, and being time-poor were identified as top barriers to self-management. More than half (59%) of respondents had not participated in structured diabetes education. Respondents perceived that younger adults with Type 2 diabetes had different health-care needs than their older counterparts (68%), and that most Type 2 diabetes information/services were aimed at older adults (62%). Of a range of potential new services, respondents indicated greatest interest in an online forum specifically for younger adults with Type 2 diabetes. Younger adults with Type 2 diabetes have impaired emotional well-being and physical health. Population-based research is needed to confirm the current findings, to further inform service delivery and optimise outcomes for this group.
Publisher: Springer Science and Business Media LLC
Date: 23-03-2022
Publisher: Elsevier BV
Date: 06-2017
Publisher: BMJ
Date: 08-2021
DOI: 10.1136/BMJDRC-2021-002322
Abstract: Achieving glycemic targets and optimizing quality of life (QoL) are important goals of type 1 diabetes care. Hypoglycemia is a common barrier to achieving targets and can be associated with significant distress. However, the impact of hypoglycemia on QoL is not fully understood. The aim of this study was to explore how adults with type 1 diabetes are impacted by hypoglycemia in areas of life that are important to their overall QoL. Participants responded to a web-based qualitative survey involving a novel ‘Wheel of Life’ activity. Responses were analyzed using reflexive thematic analysis. The final s le included 219 adults with type 1 diabetes from Denmark, Germany, the Netherlands, and the UK. They had a mean±SD age of 39±13 years and diabetes duration of 20±14 years. Participants identified eight areas of life important to their overall QoL, including relationships and social life, work and studies, leisure and physical activity, everyday life, sleep, sex life, physical health, and mental health. Participants reported emotional, behavioral, cognitive, and social impacts of hypoglycemia within domains. Across domains, participants described interruptions, limited participation in activities, exhaustion, fear of hypoglycemia, compensatory strategies to prevent hypoglycemia, and reduced spontaneity. The findings emphasize the profound impact of hypoglycemia on QoL and diabetes self-care behaviors. Diabetes services should be aware of and address the burden of hypoglycemia to provide person-centered care. Clinicians could ask in iduals how hypoglycemia affects important areas of their lives to better understand the personal impact and develop tailored management plans.
Publisher: BMJ
Date: 05-10-2002
Abstract: Objectives: To evaluate whether a course teaching flexible intensive insulin treatment combining dietary freedom and insulin adjustment can improve both glycaemic control and quality of life in type 1 diabetes. Design: Randomised design with participants either attending training immediately (immediate DAFNE) or acting as waiting list controls and attending “delayed DAFNE” training 6 months later. Setting: Secondary care diabetes clinics in three English health districts. Participants: 169 adults with type 1 diabetes and moderate or poor glycaemic control. Main outcome measures: Glycated haemoglobin (HbA 1c ), severe hypoglycaemia, impact of diabetes on quality of life (ADDQoL). Results: At 6 months, HbA 1c was significantly better in immediate DAFNE patients (mean 8.4%) than in delayed DAFNE patients (9.4%) ( t =6.1, P .0001). The impact of diabetes on dietary freedom was significantly improved in immediate DAFNE patients compared with delayed DAFNE patients ( t =−5.4, P .0001), as was the impact of diabetes on overall quality of life ( t =2.9, P .01). General wellbeing and treatment satisfaction were also significantly improved, but severe hypoglycaemia, weight, and lipids remained unchanged. Improvements in “present quality of life” did not reach significance at 6 months but were significant by 1 year. Conclusion: Skills training promoting dietary freedom improved quality of life and glycaemic control in people with type 1 diabetes without worsening severe hypoglycaemia or cardiovascular risk. This approach has the potential to enable more people to adopt intensive insulin treatment and is worthy of further investigation.
Publisher: American Diabetes Association
Date: 07-08-2019
DOI: 10.2337/DC19-0002
Abstract: Impaired awareness of hypoglycemia (IAH) and recurrent severe hypoglycemia (RSH) remain problematic for people with type 1 diabetes (T1D), despite major therapeutic advances. We explored beliefs around hypo- and hyperglycemia in adults with T1D with, and without, IAH and RSH. A cross-sectional U.S. multicenter survey included Attitudes to Awareness of Hypoglycemia (A2A a 19-item questionnaire concerning beliefs about hypoglycemia), the Gold score (single item: awareness of hypoglycemia), and a question about severe hypoglycemia over the preceding year. The survey was emailed to 6,200 adult participants of the annual T1D Exchange clinic registry data collection. A2A data were subjected to principal component analysis with varimax rotation. Among 1,978 respondents (response rate 32%), 61.7% were women, mean ± SD age was 39.6 ± 16.3 years, and T1D duration was 23.1 ± 13.8 years. Thirty-seven percent reported IAH, 16% RSH, and 9% both. A2A items segregated into three factors, differently distributed by hypoglycemia experience. Respondents with IAH or RSH expressed appropriate concern about hypoglycemia, but those with IAH were more likely to prioritize hyperglycemia concerns than those with intact awareness (P = 0.002). Those with RSH showed greater normalization of asymptomatic hypoglycemia than those without (P = 0.019) and trended toward prioritizing hyperglycemia concerns (P = 0.097), driven by those with both IAH and RSH. Adults with T1D with IAH and RSH report specific cognitions about hypoglycemia and hyperglycemia, which may act as barriers to hypoglycemia avoidance and recovery of awareness. These may be modifiable and present a target for enhancing engagement of vulnerable people with strategies to avoid future hypoglycemia.
Publisher: Informa UK Limited
Date: 03-07-2018
Publisher: JMIR Publications Inc.
Date: 05-11-2020
DOI: 10.2196/20322
Abstract: Delivering self-management support to people with type 2 diabetes mellitus is essential to reduce the health system burden and to empower people with the skills, knowledge, and confidence needed to take an active role in managing their own health. This study aims to evaluate the adoption, use, and effectiveness of the My Diabetes Coach (MDC) program, an app-based interactive embodied conversational agent, Laura, designed to support diabetes self-management in the home setting over 12 months. This randomized controlled trial evaluated both the implementation and effectiveness of the MDC program. Adults with type 2 diabetes in Australia were recruited and randomized to the intervention arm (MDC) or the control arm (usual care). Program use was tracked over 12 months. Coprimary outcomes included changes in glycated hemoglobin (HbA1c) and health-related quality of life (HRQoL). Data were assessed at baseline and at 6 and 12 months, and analyzed using linear mixed-effects regression models. A total of 187 adults with type 2 diabetes (mean 57 years, SD 10 years 41.7% women) were recruited and randomly allocated to the intervention (n=93) and control (n=94) arms. MDC program users (92/93 participants) completed 1942 chats with Laura, averaging 243 min (SD 212) per person over 12 months. Compared with baseline, the mean estimated HbA1c decreased in both arms at 12 months (intervention: 0.33% and control: 0.20%), but the net differences between the two arms in change of HbA1c (−0.04%, 95% CI −0.45 to 0.36 P=.83) was not statistically significant. At 12 months, HRQoL utility scores improved in the intervention arm, compared with the control arm (between-arm difference: 0.04, 95% CI 0.00 to 0.07 P=.04). The MDC program was successfully adopted and used by in iduals with type 2 diabetes and significantly improved the users’ HRQoL. These findings suggest the potential for wider implementation of technology-enabled conversation-based programs for supporting diabetes self-management. Future studies should focus on strategies to maintain program usage and HbA1c improvement. Australia New Zealand Clinical Trials Registry (ACTRN) 12614001229662 anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614001229662
Publisher: Hindawi Limited
Date: 2014
DOI: 10.1155/2014/850731
Abstract: Background . Tracheal intubation is a potentially life-saving procedure. This skill is taught to many anesthetic healthcare professionals, including nurse anesthetists. Our goal was to evaluate the learning ability of nurse anesthetist trainees in their performance of orotracheal intubation with the Macintosh laryngoscope. Methods . Eleven nurse anesthetist trainees were enrolled in the study during the first three months of their training. All trainees attended formal lectures and practice sessions with manikins at least one time on performing successful tracheal intubation under supervision of anesthesiology staff. Learning curves for each nurse anesthetist trainee were constructed with the standard cumulative summation (cusum) methods. Results . Tracheal intubation was attempted on 388 patients. Three hundred and six patients (78.9%) were successfully intubated on the trainees’ first attempt and 17 patients (4.4%) on the second attempt. The mean ± SD number of orotracheal intubations per trainee was 35.5 ± 5.1 (range 30–47). Ten (90.9%) of 11 trainees crossed the 20% acceptable failure rate line. A median of 22 procedures was required to achieve an 80% orotracheal intubations success rate. Conclusion . At least 22 procedures were required to reach an 80% success rate for orotracheal intubation using Macintosh laryngoscope in nonexperienced nurse anesthetist trainees.
Publisher: Mary Ann Liebert Inc
Date: 07-2017
Abstract: This qualitative study explored trial participants' experiences of four nights of in-home closed loop. Sixteen adults with type 1 diabetes, who completed a randomized crossover trial, were interviewed after four consecutive nights of closed-loop. Interviews were audio recorded, transcribed, and analyzed with a coding framework developed to identify the main themes. Participants had a mean age of 42 ± 10 years, nine were women mean diabetes duration was 27 ± 7 years, and all were using insulin pumps. Overall, first impressions were positive. Participants found closed-loop easy to use and understand. Most experienced more stable overnight glucose levels, although for some these were similar to usual care or higher than they expected. Compared with their usual treatment, they noticed the proactive nature of the closed-loop, being able to predict trends and deliver micro amounts of insulin. Most reported technical glitches or inconveniences during one or more nights, such as transmission problems, problematic connectivity between devices, ongoing alarms despite addressing low glucose levels, and sensor inaccuracy. Remote monitoring by the trial team and their own hypoglycemic awareness contributed to feelings of trust and safety. Although rare, safety concerns were raised, related to feeling unsure whether the system would respond in time to falling glucose levels. This study provides relevant insights for implementation of closed-loop in the real world. For people with diabetes who are less familiar with technology, remote monitoring for the first few days may provide reassurance, strengthen their trust/skills, and make closed-loop an acceptable option for more people with type 1 diabetes.
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/PY15020
Abstract: Integrated care models have the potential to reduce fragmentation in the health system and improve outcomes for people with type 2 diabetes. A pilot evaluation of an integrated care model for people with type 2 diabetes in Melbourne, Australia, is reported on. Two studies were conducted: (1) a 6-month pilot randomised controlled trial (n=56) evaluating the impact of the integrated care model relative to hospital outpatient clinics and (2) a cross-sectional study (n=92) of patients attending the two services. The primary outcome was diabetes-specific distress secondary outcomes were perceived quality of diabetes care, diabetes-specific self-efficacy and glycated haemoglobin (HbA1c). There was no effect of service setting on diabetes-specific distress. Participants from the integrated care setting perceived the quality of diabetes care to be higher than did participants from the hospital clinics. Significant HbA1c improvements were observed over time, but with no effect of service setting. The model holds promise for people with type 2 diabetes who need more specialist/multidisciplinary care than can be provided in primary care. Patients’ evaluations of the quality of diabetes care received at the integrated care service are very positive, which is likely to be one of the key strengths of the integrated model.
Publisher: Wiley
Date: 09-10-2023
DOI: 10.1111/DME.15231
Publisher: Springer Science and Business Media LLC
Date: 30-01-2019
Publisher: Springer Science and Business Media LLC
Date: 18-05-2018
DOI: 10.1038/S41598-018-26138-5
Abstract: 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 s le. 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.
Publisher: Wiley
Date: 21-04-2023
DOI: 10.1111/DME.15109
Abstract: There is increasing evidence that diabetes stigma has negative impacts on behavioural and psychological outcomes among people with type 2 diabetes (T2D). However, research has focused largely on Caucasian and certain Asian groups. The aim of this study was to examine associations of diabetes stigma with diabetes distress and self‐care, and investigate the moderating effects of self‐esteem and social support, in Arabic‐speaking communities. A cross‐sectional study was conducted at 21 outpatient clinics and diabetes‐specialist centres in the United Arab Emirates. Besides the Arabic Type‐2 Diabetes Stigma Assessment Scale, participants completed other validated questionnaires assessing distress, self‐care, social support, and self‐esteem. General linear models were used to estimate the mean difference in diabetes‐specific distress and self‐care for every 1‐point increase in diabetes stigma total score. Among 327 adults with T2D, the mean total score of diabetes stigma was 43.55 ± 13.95. Every 1‐point increase in diabetes stigma was associated with significantly increased diabetes distress ( β = 0.113, 95% CI: 0.078 to 0.147 p = 0.003) and decreased self‐care behaviours: diet ( β = −0.029, 95% CI: −0.048 to −0.009 p = 0.008), physical activity ( β = −0.022, 95% CI: −0.038 to −0.006 p = 0.013) and foot care ( β = −0.043, 95% CI: −0.059 to −0.026 p 0.001). Self‐esteem mitigated the effect of diabetes stigma on diabetes distress. Perceived and experienced diabetes stigma was independently associated with increased diabetes distress and decreased engagement in diabetes self‐care among Arabic‐speaking adults with T2D. These findings are crucial to help clinicians provide more effective assessment and counselling and guide public health interventions to decrease diabetes stigma in these communities.
Publisher: Springer Science and Business Media LLC
Date: 04-12-2018
Publisher: American Chemical Society (ACS)
Date: 29-03-2019
Publisher: Springer Science and Business Media LLC
Date: 16-04-2015
Publisher: Wiley
Date: 07-2016
DOI: 10.1002/PDI.2036
Publisher: Mary Ann Liebert Inc
Date: 02-2020
Publisher: Informa UK Limited
Date: 11-01-2016
Publisher: Wiley
Date: 30-08-2017
DOI: 10.1002/EAT.22746
Abstract: To examine gender differences in disordered eating behaviors (DEB) and body dissatisfaction in adolescents with type 1 diabetes. While evidence shows that female youth with type 1 diabetes are more prone to DEB compared to their peers without diabetes, little is known about male adolescents. In a national online survey, adolescents (13-19 years) with type 1 diabetes for ≥1 year completed the Diabetes Eating Problem Survey-Revised (DEPS-R), and the Body Mass Index Silhouette Matching Test (BMI-SMT) and items on binge eating and insulin omission. About 477 adolescents (mean age 16 years 62% females) completed the DEPS-R and 431 the BMI-SMT. The DEPS-R total score was higher for females than males, with scores for females increasing with age. BMI, HbA A large proportion of adolescents with type 1 diabetes, particularly females reported engaging in DEB. Similarly, high rates of body dissatisfaction were reported, though ideal body shape preferences differed by gender. Given the high levels of self-reported DEB and gender-based patterns of body dissatisfaction, future research needs to examine the effectiveness of routine screening of DEB and consider implementation of stepped care approaches.
Publisher: Elsevier BV
Date: 12-2018
Publisher: Oxford University Press (OUP)
Date: 02-03-2021
DOI: 10.1093/TBM/IBAA144
Abstract: Diabetes distress is a common negative emotional response to the ongoing burden of living with diabetes. Elevated diabetes distress is associated with impaired diabetes self-management and quality of life yet rarely identified and addressed in clinical practice. Health professionals report numerous barriers to the provision of care for diabetes distress, including lack of skills and confidence, but few diabetes distress training opportunities exist. The purpose of this paper is to describe how we utilized Intervention Mapping to plan the development, implementation, and evaluation of a novel diabetes distress e-learning program for diabetes educators, to meet a well-documented need and significant gap in diabetes care. A multidisciplinary team (combining expertise in research, health and clinical psychology, diabetes education, nursing, tertiary education, and website architecture) developed a diabetes distress e-learning program. We followed a six-step process (logic model of the problem, program outcomes and objectives, program design, program production, program implementation plan, and evaluation plan) known as Intervention Mapping. The program is underpinned by educational and psychological theory, including Bloom’s Taxonomy of Educational Objectives and social cognitive theory. We developed a short (estimated 4 h) e-learning program for diabetes educators, which draws on the content of the Diabetes and Emotional Health handbook and toolkit. It integrates a 7As model, which provides a stepwise approach to identifying and addressing diabetes distress. Our diabetes distress e-learning program has been developed systematically, guided by an Intervention Mapping approach. In the next phase of the project, we will trial the e-learning.
Publisher: Informa UK Limited
Date: 12-04-2019
Publisher: Elsevier BV
Date: 02-2018
Publisher: American Diabetes Association
Date: 04-09-2020
DOI: 10.2337/DC19-2447
Abstract: To examine the association of diabetes stigma with psychological, behavioral, and HbA1c outcomes and to investigate moderation effects of self-esteem, self-efficacy, and/or social support. The national Second Diabetes MILES – Australia (MILES-2) survey included adults with type 1 diabetes (n = 959, 41% of whom were male, with mean ± SD age 44 ± 15 years), insulin-treated type 2 diabetes (n = 487, 60% male, age 61 ± 9 years), and non–insulin-treated type 2 diabetes (n = 642, 55% male, age 61 ± 10 years). (Un)adjusted linear regression analyses tested the association between diabetes stigma (Diabetes Stigma Assessment Scale [DSAS]) and psychological outcomes (depressive symptoms [eight-item version of the Patient Health Questionnaire (PHQ-8)], anxiety symptoms [Generalized Anxiety Disorder 7-item (GAD-7) questionnaire], and diabetes-specific distress [20-item Problem Areas In Diabetes (PAID) scale]), behavioral outcomes (healthy diet and physical activity [Summary of Diabetes Self-Care Activities (SDSCA)]), and self-reported HbA1c. Interaction effects tested whether associations varied by self-esteem (Rosenberg Self-Esteem Scale [RSES]), self-efficacy (Confidence in Diabetes Self-Care [CIDS] scale), or diabetes-specific social support (Diabetes Support Scale [DSS]). Significant positive associations were observed between DSAS and PHQ-8, GAD-7, and PAID across diabetes type/treatment groups (all P & 0.001), whereby each SD increase in DSAS scores was associated with approximately one-half SD deterioration in emotional well-being. Associations between DSAS and SDSCA and HbA1c were nonmeaningful. Self-esteem moderated psychological outcomes among participants with type 1 and non–insulin-treated type 2 diabetes and diabetes distress among those with insulin-treated type 2 diabetes. Interaction effects were partially observed for social support but not for self-efficacy. This study provides evidence of the association between diabetes stigma and depressive/anxiety symptoms and diabetes distress and for the moderating effects of self-esteem and social support among adults with type 1 and type 2 diabetes. Further research is needed to examine associations with objectively measured behavioral and clinical outcomes.
Publisher: Wiley
Date: 08-12-2016
DOI: 10.1111/DME.13022
Publisher: Springer Science and Business Media LLC
Date: 16-05-2017
DOI: 10.1007/S11892-017-0873-4
Abstract: This study aims to examine the operationalisation of 'psychological insulin resistance' (PIR) among people with type 2 diabetes and to identify and critique relevant measures. PIR has been operationalised as (1) the assessment of attitudes or beliefs about insulin therapy and (2) hypothetical or actual resistance, or unwillingness, to use to insulin. Five validated PIR questionnaires were identified. None was fully comprehensive of all aspects of PIR, and the rigour and reporting of questionnaire development and psychometric validation varied considerably between measures. Assessment of PIR should focus on the identification of negative and positive attitudes towards insulin use. Actual or hypothetical insulin refusal may be better conceptualised as a potential consequence of PIR, as its assessment overlooks the attitudes that may prevent insulin use. This paper provides guidance on the selection of questionnaires for clinical or research purpose and the development of new, or improvement of existing, questionnaires.
Publisher: Wiley
Date: 03-04-2019
DOI: 10.1111/DME.13934
Publisher: Elsevier BV
Date: 05-2019
Publisher: Wiley
Date: 02-04-2015
DOI: 10.1111/DME.12729
Abstract: To identify insulin therapy appraisals among adults with Type 2 diabetes using insulin and how negative appraisals relate to clinical, self-care and psychosocial outcomes. Diabetes MILES - Australia 2011 was a national survey of adults with diabetes, focused on behavioural and psychosocial issues. Subgroup analyses were conducted on the responses of 273 adults with Type 2 diabetes using insulin (46% women mean ± sd age: 59 ± 9 years diabetes duration: 12 ± 7 years years using insulin: 4 ± 4). They completed validated measures of insulin therapy appraisals (ITAS), depression (PHQ-9), anxiety (GAD-7), diabetes distress (PAID) and diabetes-specific self-efficacy (DES-SF). Insulin was perceived to be very important, and its benefits (e.g. improves health) were endorsed by most (82%). Fifty-one per cent believed that taking insulin means their diabetes has become worse 51% that insulin causes weight gain 39% that they have 'failed to manage' their diabetes. Those with the greatest and least 'ITAS negative' scores did not differ by diabetes duration or years using insulin, or by average number of insulin injections or blood glucose checks per day. Those with more negative insulin appraisals were significantly younger (Mean Diff. = 5 years, P < 0.001), less satisfied with recent blood glucose levels (P < 0.001, d = 0.63), had reduced diabetes-specific self-efficacy (P < 0.001, d = 0.7), and were more likely to report depressive symptoms, anxiety or diabetes distress (all P < 0.001, d = 0.65-1.1). Negative insulin therapy appraisals are common among adults with Type 2 diabetes using insulin, and are associated with lower general and diabetes-specific emotional well-being, reduced diabetes-specific self-efficacy and satisfaction with blood glucose.
Publisher: Wiley
Date: 13-08-2012
DOI: 10.1111/J.1464-5491.2012.03702.X
Abstract: To undertake further psychometric validation of the W-BQ28 to determine its suitability for use in adults with Type 2 diabetes in the UK using data from the AT.LANTUS follow-on study. A total of 353 people with Type 2 diabetes participated in the AT.LANTUS Follow-on study, completing measures of well-being (W-BQ28), treatment satisfaction (DTSQ) and self-care (SCI-R). Confirmatory factor analyses was used to confirm the W-BQ28 structure and internal consistency reliability was assessed. Additional statistical tests were conducted to explore convergent, ergent and known-groups validity. Minimal important differences were calculated using distribution and anchor-based techniques. Structure of the W-BQ28 (seven four-item subscales plus 16-item generic and 12-item diabetes-specific scales) was confirmed (comparative fit index = 0.917, root mean square error of approximation (RMSEA) = 0.057). Internal consistency reliability was satisfactory (four-item subscales: alpha = 0.73-0.90 12/16-item scales: α = 0.84-0.90). Convergent validity was supported by expected moderate to high correlations (r(s) = 0.35-0.67) between all W-BQ28 subscales (except Energy) ergent validity was supported by expected low to moderate correlations with treatment satisfaction (r(s) = -0.03-0.52) and self-care (r(s) = 0.02-0.22). Known-groups validity was supported with statistically significant differences by sex, age and HbA(1c) for expected subscales. Minimal important differences were established (range 0.14-2.90). The W-BQ28 is a valid and reliable measure of generic and diabetes-specific well-being in Type 2 diabetes in the UK. Confirmation of the utility of W-BQ28 (including establishment of minimal important differences) means that its use is indicated in research and clinical practice.
Publisher: JMIR Publications Inc.
Date: 29-09-2023
DOI: 10.2196/42100
Publisher: BMJ
Date: 07-2018
DOI: 10.1136/BMJOPEN-2017-021435
Abstract: Optimal glycaemia can reduce type 2 diabetes (T2D) complications. Observing retrospective continuous glucose monitoring (r-CGM) patterns may prompt therapeutic changes but evidence for r-CGM use in T2D is limited. We describe the protocol for a randomised controlled trial (RCT) examining intermittent r-CGM use (up to 14 days every three months) in T2D in general practice (GP). General Practice Optimising Structured MOnitoring To achieve Improved Clinical Outcomes is a two-arm RCT asking ‘does intermittent r-CGM in adults with T2D in primary care improve HbA1c?’ Absolute difference in mean HbA1c at 12 months follow-up between intervention and control arms. Secondary outcomes: (a) r-CGM per cent time in target (4–10 mmol/L) range, at baseline and 12 months (b) diabetes-specific distress (Problem Areas in Diabetes). Aged 18–80 years, T2D for ≥1 year, a (past month) HbA1c .5 mmol/mol (0.5%) above their in idualised target while prescribed at least two non-insulin hypoglycaemic therapies and/or insulin (therapy stable for the last four months). Our general glycaemic target is 53 mmol/mol (7%) (patients with a history of severe hypoglycaemia or a recorded diagnosis of hypoglycaemia unawareness will have a target of 64 mmol/mol (8%)). Our trial compares r-CGM use and usual care. The r-CGM report summarising daily glucose patterns will be reviewed by GP and patient and inform treatment decisions. Participants in both arms are provided with 1 hour education by a specialist diabetes nurse. The s le (n=150/arm) has 80% power to detect a mean HbA1c difference of 5.5 mmol/mol (0.5%) with an SD of 14.2 (1.3%) and alpha of 0.05 (allowing for 10% clinic and 20% patient attrition). University of Melbourne Human Ethics Sub-Committee (ID 1647151.1). Dissemination will be in peer-reviewed journals, conferences and a plain-language summary for participants. ACTRN12616001372471 Pre-results.
Publisher: Mary Ann Liebert Inc
Date: 06-2021
Publisher: Wiley
Date: 13-12-2013
DOI: 10.1111/J.1464-5491.2012.03748.X
Abstract: Around a quarter of UK care-home residents have diabetes. Diabetes is known to impact quality of life but existing diabetes-specific quality of life measures are unsuitable for elderly care-home residents. We aimed to develop and evaluate a new measure for use with older adults, to be particularly suitable for use with care-home residents: the Audit of Diabetes-Dependent Quality of Life (ADDQoL) Senior*. Content and format changes were made to the 19-domain ADDQoL, informed by related measures for people with visual impairments (12 domain-specific items were retained, four items were revised/added and three items were removed). This revision was modified further following cognitive debriefing interviews with three older adults living in a care home. Psychometric evaluation of the newly developed 17-domain ADDQoL Senior was conducted using data from 90 care-home residents with diabetes who took part in a broader intervention study. The life domains most impacted by diabetes were 'independence' and 'freedom to eat as I wish'. The ADDQoL Senior demonstrated good factor structure and internal consistency (Cronbach's alpha = 0.924). Domain scores were, as expected, significantly intercorrelated. The ADDQoL Senior measures the perceived impact of diabetes on quality of life in older adults, and has been found to be suitable for those living in care homes if administered by interview. The scale has demonstrated acceptability and excellent psychometric properties. It is anticipated that the number of items may be reduced in the future if our current findings can be replicated.
Publisher: Elsevier BV
Date: 05-2017
Publisher: Elsevier BV
Date: 08-2013
DOI: 10.1016/J.DIABRES.2013.05.017
Abstract: To examine the emotional well-being of severely obese Australians with type 2 diabetes, along with markers of social and economic disadvantage, using the Diabetes MILES - Australia dataset. Diabetes MILES - Australia was a national survey of 3338 adults with diabetes that focused on psychosocial issues 1795 had type 2 diabetes and reported BMI. We extracted data regarding depression (PHQ-9), anxiety (GAD-7), obesity- and diabetes-related comorbidities, and demographics. The severely obese group (SOG) (BMI ≥ 35 median BMI=41.6) constituted 530 (30%) of the type 2 diabetes respondents and was matched with 530 controls (CG) (BMI<35 median BMI=28.2). Within- and between-group trends were examined. The SOG had higher depression scores (median (IQR) 6.0 (3-12)) than CG (5.0 (2-10)) p<0.001, and were more likely to report moderate-severe depressive symptoms (37% versus 27% p<0.001). The groups did not differ on anxiety. The SOG, compared with the CG, were more likely to live alone (21% versus 17%), receive a disability pension (21% versus 15%), earn ≤$40.000/year (51% versus 41% all p<0.05), and were less likely to be employed (46% versus 53%), university or higher educated (17% versus 26%), or have health insurance (50% versus 60% all p ≤ 0.01). Moderate-severe depression was positively associated with cumulative stressors of severe obesity, socioeconomic disadvantage, and obesity- and diabetes-related comorbidity. Severely obese people living with type 2 diabetes have cumulative stressors related to health, disability, demographic and socioeconomic factors, and impaired emotional well-being.
Publisher: AMPCo
Date: 02-2018
DOI: 10.5694/MJA17.00535
Publisher: Wiley
Date: 05-02-2020
DOI: 10.1111/DME.14240
Abstract: Hypoglycaemia is the most frequent complication of treatment with insulin or insulin secretagogues in people with diabetes. Severe hypoglycaemia, i.e. an event requiring external help because of cognitive dysfunction, is associated with a higher risk of adverse cardiovascular outcomes and all‐cause mortality, but underlying mechanism(s) are poorly understood. There is also a gap in the understanding of the clinical, psychological and health economic impact of ‘non‐severe’ hypoglycaemia and the glucose level below which hypoglycaemia causes harm. To increase understanding of hypoglycaemia by addressing the above issues over a 4‐year period. Hypo‐RESOLVE is structured across eight work packages, each with a distinct focus. We will construct a large, sustainable database including hypoglycaemia data from clinical trials to examine predictors of hypoglycaemia and establish glucose threshold(s) below which hypoglycaemia constitutes a risk for adverse biomedical and psychological outcomes, and increases healthcare costs. We will also investigate the mechanism(s) underlying the antecedents and consequences of hypoglycaemia, the significance of glucose sensor‐detected hypoglycaemia, the impact of hypoglycaemia in families, and the costs of hypoglycaemia for healthcare systems. The outcomes of Hypo‐RESOLVE will inform evidence‐based definitions regarding the classification of hypoglycaemia in diabetes for use in daily clinical practice, future clinical trials and as a benchmark for comparing glucose‐lowering interventions and strategies across trials. Stakeholders will be engaged to achieve broadly adopted agreement. Hypo‐RESOLVE will advance our understanding and refine the classification of hypoglycaemia, with the ultimate aim being to alleviate the burden and consequences of hypoglycaemia in people with diabetes.
Publisher: Mary Ann Liebert Inc
Date: 02-2015
Publisher: AMPCo
Date: 08-2016
DOI: 10.5694/MJA16.00556
Publisher: Springer Science and Business Media LLC
Date: 28-08-2015
DOI: 10.1007/S10865-014-9592-3
Abstract: People with diabetes have a higher risk of emotional distress (anxiety, depression) than non-diabetic or healthy controls. Therefore, identification of factors that can decrease emotional distress is relevant. The aim of the present study was to examine (1) the association between facets of mindfulness and emotional distress and (2) whether mindfulness might moderate the association between potential adverse conditions (stressful life events and comorbidity) and emotional distress. Analyses were conducted using cross-sectional data (Management and Impact for Long-term Empowerment and Success--Netherlands): 666 participants with diabetes (type 1 or type 2) completed measures of mindfulness (Five Facet Mindfulness Questionnaire-Short Form FFMQ-SF), depressive symptoms (Patient Health Questionnaire PHQ-9), and anxiety symptoms (General Anxiety Disorder assessment GAD-7). Hierarchical multiple regression analyses showed significant associations between mindfulness facets (acting with awareness, non-judging, and non-reacting) and symptoms of anxiety and depression (β = -0.20 to -0.33, all p < 0.001). These mindfulness facets appeared to have a moderating effect on the association between stressful life events and depression and anxiety (all p < 0.01). However, the association between co-morbidity and emotional distress was largely not moderated by mindfulness. In conclusion, mindfulness is negatively related to both depression and anxiety symptoms in people with diabetes and shows promise as a potentially protective characteristic against the influence of stressful events on emotional well-being.
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: Springer Science and Business Media LLC
Date: 27-03-2022
DOI: 10.1186/S12888-022-03840-3
Abstract: There is increasing recognition of the substantial burden of mental health disorders at an in idual and population level, including consequent demand on mental health services. Lifestyle-based mental healthcare offers an additional approach to existing services with potential to help alleviate system burden. Despite the latest Royal Australian New Zealand College of Psychiatrists guidelines recommending that lifestyle is a ‘first-line’, ‘non-negotiable’ treatment for mood disorders, few such programs exist within clinical practice. Additionally, there are limited data to determine whether lifestyle approaches are equivalent to established treatments. Using an in idually randomised group treatment design, we aim to address this gap by evaluating an integrated lifestyle program (CALM) compared to an established therapy (psychotherapy), both delivered via telehealth. It is hypothesised that the CALM program will not be inferior to psychotherapy with respect to depressive symptoms at 8 weeks. The study is being conducted in partnership with Barwon Health’s Mental Health, Drugs & Alcohol Service (Geelong, Victoria), from which 184 participants from its service and surrounding regions are being recruited. Eligible participants with elevated psychological distress are being randomised to CALM or psychotherapy. Each takes a trans-diagnostic approach, and comprises four weekly (weeks 1-4) and two fortnightly (weeks 6 and 8) 90-min, group-based sessions delivered via Zoom (digital video conferencing platform). CALM focuses on enhancing knowledge, behavioural skills and support for improving dietary and physical activity behaviours, delivered by an Accredited Exercise Physiologist and Accredited Practising Dietitian. Psychotherapy uses cognitive behavioural therapy (CBT) delivered by a Psychologist or Clinical Psychologist, and Provisional Psychologist. Data collection occurs at baseline and 8 weeks. The primary outcome is depressive symptoms (assessed via the Patient Health Questionnaire-9) at 8 weeks. Societal and healthcare costs will be estimated to determine the cost-effectiveness of the CALM program. A process evaluation will determine its reach, adoption, implementation and maintenance. If the CALM program is non-inferior to psychotherapy, this study will provide the first evidence to support lifestyle-based mental healthcare as an additional care model to support in iduals experiencing psychological distress. Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12621000387820 , Registered 8 April 2021.
Publisher: American Diabetes Association
Date: 11-01-2023
DOI: 10.2337/DC22-1237
Abstract: To investigate the association between age at diagnosis of type 2 diabetes and depressive symptoms, diabetes-specific distress, and self-compassion among adults with type 2 diabetes. This analysis used data from the Chronotype of Patients with Type 2 Diabetes and Effect on Glycemic Control (CODEC) cross-sectional study. Information was collected on depressive symptoms, diabetes-specific distress, and self-compassion, measured using validated self-report questionnaires, in addition to sociodemographic and clinical data. Multivariable regression models, adjusted for diabetes duration, sex, ethnicity, deprivation status, prescription of antidepressants (selective serotonin reuptake inhibitors), and BMI were used to investigate the association between age at diagnosis of type 2 diabetes and each of the three psychological outcomes. A total of 706 participants were included 64 (9.1%) were diagnosed with type 2 diabetes at & years, 422 (59.8%) between 40 and 59 years, and 220 (31.2%) at ≥60 years of age. After adjustment for key confounders, including diabetes duration, younger age at diagnosis was significantly associated with higher levels of depressive symptoms (βadj: −0.18 [95% CI −0.25 to −0.10] P & 0.01) and diabetes-specific distress (βadj: −0.03 [95% CI −0.04 to −0.02] P & 0.01) and lower levels of self-compassion (βadj: 0.01 [95% CI 0.00 to 0.02] P & 0.01). Diagnosis of type 2 diabetes at a younger age is associated with lower psychological well-being, suggesting the need for clinical vigilance and the availability of age-appropriate psychosocial support.
Publisher: Wiley
Date: 28-03-2015
DOI: 10.1111/DME.12739
Abstract: To examine sociodemographic, clinical and psychological factors associated with fear of hypoglycaemia in adults with Type 1 diabetes. Data were obtained from Diabetes MILES - The Netherlands, an online self-report national survey. This cross-sectional analysis focused on participants with Type 1 diabetes who completed the 18-item Hypoglycaemia Fear Survey - Second Version Worry subscale (HFS-II-W possible total score range 0-72, higher scores indicating higher fear) (n = 288). To explore correlates of fear of hypoglycaemia, a hierarchical linear regression analysis was performed in participants with full data on sociodemographic, clinical and psychological factors (n = 232 younger and more highly educated than those excluded). HFS-II-W mean score was 11.1 ± 11.1. Gender, age, education and having a partner (model 1) were not associated with fear of hypoglycaemia. In model 2, history of severe hypoglycaemia (irrespective of number of events) was associated with (greater) fear of hypoglycaemia, whereas diabetes duration, pump therapy and HbA1c were not. Type D personality was positively correlated (model 3), as were symptoms of depression, but not anxiety (model 4). Adding loneliness (model 5) did not improve the model. The fully adjusted analysis showed that fear of hypoglycaemia was associated with depressive symptoms (β = 0.38, P < 0.001) and history of hypoglycaemia (1-2 events: β = 0.30, P < 0.001 ≥ 3 events: β = 0.19, P = 0.002). Total explained variance was 23%. Depressive symptoms and history of hypoglycaemia are associated with fear of hypoglycaemia in adults with Type 1 diabetes. These factors may help to identify people with excessive fear, who may particularly benefit from interventions to reduce hypoglycaemia risk and worries.
Publisher: Springer Science and Business Media LLC
Date: 07-2008
Publisher: Wiley
Date: 09-2008
DOI: 10.1002/PDI.1280
Publisher: American Diabetes Association
Date: 14-10-2020
DOI: 10.2337/DC20-1447
Abstract: To investigate glycemic and psychosocial outcomes with hybrid closed-loop (HCL) versus user-determined insulin dosing with multiple daily injections (MDI) or insulin pump (i.e., standard therapy for most adults with type 1 diabetes). Adults with type 1 diabetes using MDI or insulin pump without continuous glucose monitoring (CGM) were randomized to 26 weeks of HCL (Medtronic 670G) or continuation of current therapy. The primary outcome was masked CGM time in range (TIR 70–180 mg/dL) during the final 3 weeks. Participants were randomized to HCL (n = 61) or control (n = 59). Baseline mean (SD) age was 44.2 (11.7) years, HbA1c was 7.4% (0.9%) (57 [10] mmol/mol), 53% were women, and 51% used MDI. HCL TIR increased from (baseline) 55% (13%) to (26 weeks) 70% (10%) with the control group unchanged: (baseline) 55% (12%) and (26 weeks) 55% (13%) (difference 15% [95% CI 11, 19] P & 0.0001). For HCL, HbA1c was lower (median [95% CI] difference −0.4% [−0.6, −0.2] −4 mmol/mol [−7, −2] P & 0.0001) and diabetes-specific positive well-being was higher (difference 1.2 [95% CI 0.4, 1.9] P & 0.0048) without a deterioration in diabetes distress, perceived sleep quality, or cognition. Seventeen (9 device-related) versus 13 serious adverse events occurred in the HCL and control groups, respectively. In adults with type 1 diabetes, 26 weeks of HCL improved TIR, HbA1c, and their sense of satisfaction from managing their diabetes compared with those continuing with user-determined insulin dosing and self-monitoring of blood glucose. For most people living with type 1 diabetes globally, this trial demonstrates that HCL is feasible, acceptable, and advantageous.
Publisher: BMJ
Date: 21-06-2010
DOI: 10.1136/BMJ.C2921
Publisher: Elsevier BV
Date: 07-2010
DOI: 10.1016/J.DIABRES.2010.03.017
Abstract: To explore long-term outcomes of participation in a Dose Adjustment For Normal Eating (DAFNE) training course, which provided one-off exposure to structured education in intensive insulin therapy to people with established Type 1 diabetes. A cohort design follow-up of original trial participants at a mean of 44 months (range: 37-51 months) in hospital diabetes clinics in three English health districts. 104 (74%) original participants provided biomedical data 88 (63%) completed questionnaires including the ADDQoL, measuring impact of diabetes on quality of life (QoL). At 44 months, mean improvement in HbA(1c) from baseline was 0.36% (9.32+/-1.1% to 8.96+/-1.2%, p<0.01) remaining significant but deteriorated from 12 months (p<0.05). Improvements in QoL seen at 12 months were sustained at 44 (e.g. impact of diabetes on dietary freedom: -1.78+/-2.33 at 44 months versus -4.27+/-2.94, baseline, p<0.0001 versus 1.80+/-2.32 at 12 months, ns). Similar results were obtained using last observation carried forward for patients not supplying follow-up data. The impact of a single DAFNE course on glycaemic control remains apparent in the long term, although further interventions will be required to achieve recommended HbA(1c). In contrast, improvements in QoL and other patient-reported outcomes are well maintained over approximately 4 years.
Publisher: Cambridge University Press (CUP)
Date: 17-07-2022
DOI: 10.1017/S0033291720002251
Abstract: Over the past 15 years, there has been substantial growth in web-based psychological interventions. We summarize evidence regarding the efficacy of web-based self-directed psychological interventions on depressive, anxiety and distress symptoms in people living with a chronic health condition. We searched Medline, PsycINFO, CINAHL, EMBASE databases and Cochrane Database from 1990 to 1 May 2019. English language papers of randomized controlled trials (usual care or waitlist control) of web-based psychological interventions with a primary or secondary aim to reduce anxiety, depression or distress in adults with a chronic health condition were eligible. Results were assessed using narrative synthases and random-effects meta-analyses. In total 70 eligible studies across 17 health conditions [most commonly: cancer ( k = 20), chronic pain ( k = 9), arthritis ( k = 6) and multiple sclerosis ( k = 5), diabetes ( k = 4), fibromyalgia ( k = 4)] were identified. Interventions were based on CBT principles in 46 (66%) studies and 42 (60%) included a facilitator. When combining all chronic health conditions, web-based interventions were more efficacious than control conditions in reducing symptoms of depression g = 0.30 (95% CI 0.22–0.39), anxiety g = 0.19 (95% CI 0.12–0.27), and distress g = 0.36 (95% CI 0.23–0.49). Evidence regarding effectiveness for specific chronic health conditions was inconsistent. While self-guided online psychological interventions may help to reduce symptoms of anxiety, depression and distress in people with chronic health conditions in general, it is unclear if these interventions are effective for specific health conditions. More high-quality evidence is needed before definite conclusions can be made.
Publisher: Springer Science and Business Media LLC
Date: 20-05-2021
Publisher: Elsevier BV
Date: 09-2012
DOI: 10.1016/J.DIABRES.2012.03.015
Abstract: Diabetes is the fastest growing chronic condition in Australia, affecting 1.7 million Australians, requiring daily self-care, and known to reduce quantity and quality of life. On average, people with diabetes experience greater emotional distress than those without diabetes. One source of distress can be the language used to refer to diabetes, its management and the person with diabetes. The way verbal and written language is used reflects and shapes people's thoughts, beliefs and behaviours. Language has the power to persuade, change or reinforce beliefs and stereotypes - for better or worse. Words do more than reflect people's reality: they create reality and affect how people view the world and their diabetes. Language needs to engage people with diabetes and support their self-care efforts. Importantly, language that de-motivates or induces fear, guilt or distress needs to be avoided and countered. Diabetes Australia believes optimal communication increases the motivation, health and well-being of people with diabetes, and that careless or negative language can be de-motivating, is often inaccurate, and can be harmful. Diabetes Australia developed this position statement to encourage greater awareness of the language surrounding diabetes and provide recommendations for more careful and positive language use.
Publisher: Springer Science and Business Media LLC
Date: 20-12-2022
DOI: 10.1007/S00125-022-05847-7
Abstract: The aims of this study were to assess cognitions relating to hypoglycaemia in adults with type 1 diabetes and impaired awareness of hypoglycaemia before and after the multimodal HypoCOMPaSS intervention, and to determine cognitive predictors of incomplete response (one or more severe hypoglycaemic episodes over 24 months). This analysis included 91 adults with type 1 diabetes and impaired awareness of hypoglycaemia who completed the Attitudes to Awareness of Hypoglycaemia (A2A) questionnaire before, 24 weeks and 24 months after the intervention, which comprised a short psycho-educational programme with optimisation of insulin therapy and glucose monitoring. The age and diabetes duration of the participants were 48±12 and 29±12 years, respectively (mean±SD). At baseline, 91% reported one or more severe hypoglycaemic episodes over the preceding 12 months this decreased to % at 24 weeks and after 24 months ( p =0.001). The attitudinal barrier ‘hyperglycaemia avoidance prioritised’ (η 2 p =0.250, p =0.001) decreased from baseline to 24 weeks, and this decrease was maintained at 24 months (mean±SD=5.3±0.3 vs 4.3±0.3 vs 4.0±0.3). The decrease in ‘asymptomatic hypoglycaemia normalised’ from baseline (η 2 p =0.113, p =0.045) was significant at 24 weeks (1.5±0.3 vs 0.8±0.2). Predictors of incomplete hypoglycaemia response (one or more further episodes of severe hypoglycaemia) were higher baseline rates of severe hypoglycaemia, higher baseline scores for ‘asymptomatic hypoglycaemia normalised’, reduced change in ‘asymptomatic hypoglycaemia normalised’ scores at 24 weeks, and lower baseline ‘hypoglycaemia concern minimised’ scores (all p .05). Participation in the HypoCOMPaSS RCT was associated with improvements in hypoglycaemia-associated cognitions, with ‘hyperglycaemia avoidance prioritised’ most prevalent. Incomplete prevention of subsequent severe hypoglycaemia episodes was associated with persistence of the cognition ‘asymptomatic hypoglycaemia normalised’. Understanding and addressing cognitive barriers to hypoglycaemia avoidance is important in in iduals prone to severe hypoglycaemia episodes. www.isrctn.org : ISRCTN52164803 and eudract.ema.europa.eu : EudraCT2009-015396-27.
Publisher: Wiley
Date: 17-10-2017
DOI: 10.1111/DME.13520
Publisher: JMIR Publications Inc.
Date: 17-11-2019
Abstract: mbodied conversational agents (ECAs) are increasingly used in health care apps however, their acceptability in type 2 diabetes (T2D) self-management apps has not yet been investigated. his study aimed to evaluate the acceptability of the ECA (Laura) used to deliver diabetes self-management education and support in the My Diabetes Coach (MDC) app. sequential mixed methods design was applied. Adults with T2D allocated to the intervention arm of the MDC trial used the MDC app over a period of 12 months. At 6 months, they completed questions assessing their interaction with, and attitudes toward, the ECA. In-depth qualitative interviews were conducted with a subs le of the participants from the intervention arm to explore their experiences of using the ECA. The interview questions included the participants’ perceptions of Laura, including their initial impression of her (and how this changed over time), her personality, and human character. The quantitative and qualitative data were interpreted using integrated synthesis. f the 93 intervention participants, 44 (47%) were women the mean (SD) age of the participants was 55 (SD 10) years and the baseline glycated hemoglobin A1c level was 7.3% (SD 1.5%). Overall, 66 of the 93 participants (71%) provided survey responses. Of these, most described Laura as being helpful (57/66, 86%), friendly (57/66, 86%), competent (56/66, 85%), trustworthy (48/66, 73%), and likable (40/66, 61%). Some described Laura as not real (18/66, 27%), boring (26/66, 39%), and annoying (20/66, 30%). Participants reported that interacting with Laura made them feel more motivated (29/66, 44%), comfortable (24/66, 36%), confident (14/66, 21%), happy (11/66, 17%), and hopeful (8/66, 12%). Furthermore, 20% (13/66) of the participants were frustrated by their interaction with Laura, and 17% (11/66) of the participants reported that interacting with Laura made them feel guilty. A total of 4 themes emerged from the qualitative data (N=19): (1) perceived role: a friendly coach rather than a health professional (2) perceived support: emotional and motivational support (3) embodiment preference acceptability of a human-like character and (4) room for improvement: need for greater congruence between Laura’s words and actions. hese findings suggest that an ECA is an acceptable means to deliver T2D self-management education and support. A human-like character providing ongoing, friendly, nonjudgmental, emotional, and motivational support is well received. Nevertheless, the ECA can be improved by increasing congruence between its verbal and nonverbal communication and accommodating user preferences. ustralian New Zealand Clinical Trials Registry CTRN12614001229662 xshn6pd
Publisher: Elsevier BV
Date: 05-2013
DOI: 10.1016/J.DIABRES.2013.03.015
Abstract: To investigate differences in access to services and health outcomes between people living with Type 1 (T1DM) and Type 2 (T2DM) diabetes in rural/regional and metropolitan areas. Diabetes MILES--Australia was a national postal/online survey of persons registered with the National Diabetes Services Scheme. Selected variables, including utilisation of health care services and self-care indicators, were analysed for 3338 respondents with T1DM (41%) or T2DM (59%). Respondents from rural/regional (n=1574, 48%) and metropolitan areas were represented equally (n=1700, 52%). After adjusting for diabetes duration, demographic and socioeconomic variables, rural/regional respondents with T1DM (RR 0.90, 95% CI 0.83-0.97) and T2DM (RR 0.69, 95% CI 0.59-0.81) were less likely to report consulting an endocrinologist during the past 12 months. Rural/regional respondents with T1DM were more than twice as likely to have accessed a community ractice nurse for diabetes care (RR 2.22, 95% CI 1.25-3.93) while those with T2DM were more likely to have accessed a diabetes educator (RR 1.21, 95% CI 1.07-1.36) or dietician (RR 1.17, 95% CI 1.07-1.36). For the T1DM and T2DM groups were no differences between rural/regional and metropolitan respondents in self-reported hypoglycaemic events during past week and the majority of self-care indicators. Despite a lack of access to medical specialists, respondents with T1DM and T2DM living in rural/regional areas did not report worse health or self-care indicators. The results suggest that multidisciplinary primary services in rural areas may be providing additional care for people with diabetes, compensating for poor access to specialists.
Publisher: American Diabetes Association
Date: 26-04-2017
DOI: 10.2337/DC16-2688
Abstract: Despite the challenges of living with type 1 diabetes, many adolescents achieve “resilient outcomes”: high engagement in self-management behaviors such as self-monitoring of blood glucose (SMBG), good quality of life (QOL), and within-target glycemic outcomes (HbA1c). Adaptive diabetes-related behaviors (i.e., “strengths”) are associated with resilient outcomes, yet the combination of risks and strengths in relation to resilient outcomes is unclear. The aim of this study was to investigate relations among diabetes strengths and resilient outcomes in the context of psychological and family risk factors. A total of 471 Australian adolescents with type 1 diabetes (mean age 15.7 ± 1.9 years diabetes duration 6.9 ± 4.2 years 62% female 53% using insulin pumps) completed a national cross-sectional survey about their diabetes-related strengths, risk factors (depressive/anxiety symptoms, family conflict), and resilient outcomes (SMBG frequency, general QOL, HbA1c). Greater diabetes strengths were significantly related to resilient outcomes: more frequent SMBG (r = 0.39), lower HbA1c (r = −0.31), and higher general QOL (r = 0.50), as well as to lower risks: fewer depressive (r = −0.45) and anxiety (r = −0.40) symptoms and less conflict (r = 0.28). In multivariate regressions, diabetes strengths consistently related to all resilient outcomes beyond significant risk factors. In a large s le of Australian adolescents, diabetes strengths were strongly related to key resilient outcomes, even in the presence of well-documented psychological and family risk factors. More research is needed to determine whether strengths reduce or buffer other risks. Given the associations with self-management, HbA1c, and general QOL, monitoring and enhancing diabetes strengths may support resilience promotion during a vulnerable developmental period.
Publisher: Wiley
Date: 27-10-2021
DOI: 10.1111/DME.14727
Abstract: Hypoglycaemic episodes and fear of hypoglycaemia can be burdensome for adults with type 1 diabetes. This study explored support needs relating to hypoglycaemia among adults with type 1 diabetes living in Denmark, Germany, the Netherlands and the United Kingdom. Respondents participated in a web‐based qualitative study involving four open‐ended questions that asked what they wished other people understood about hypoglycaemia and what other people could do differently to support them with hypoglycaemia. Responses were analyzed using reflexive thematic analysis. Participants were 219 adults with type 1 diabetes (mean ± SD age 39 ± 13 years mean ± SD diabetes duration 20 ± 14 years). They described unmet needs relating to: (1) Clinical support , involving access to new diabetes technologies, training on hypoglycaemia prevention, personalised care and psychological support (2) Practical support , involving family and friends better supporting them with hypoglycaemia management and prevention (3) Education for other people , involving others becoming more informed about hypoglycaemia and (4) An appreciation of the burden , involving others recognizing the experience and impact of episodes, and the burden of living with the risk of hypoglycaemia. Adults with type 1 diabetes report several unmet support needs relating to hypoglycaemia. Service delivery should be person‐centred and prioritise the in idual's support needs. Clinical conversations are needed to identify the in idual's support needs and develop tailored support plans. People with diabetes and their family members should be offered hypoglycaemia‐specific education and training.
Publisher: Wiley
Date: 14-12-2019
DOI: 10.1111/DME.13873
Abstract: Prospective memory has been long considered a fundamental cognitive ability for optimal medication taking, but the role of prospective memory errors (termed 'slips') in diabetes self-care is unclear. Our aim was to examine associations between prospective memory and medication taking in adults with Type 1 and Type 2 diabetes mellitus. Some 901 adults with Type 1 diabetes and 927 with Type 2 diabetes completed a cross-sectional survey focused on the psychological and behavioural aspects of living with diabetes. Respondents reported whether they had forgotten to take their diabetes medication over the previous 14 days. Twenty-four per cent (n = 220) of adults with Type 1 diabetes and 23% (n = 211) with Type 2 diabetes reported that they had forgotten their medication at least once over the previous 14 days. This was associated with more prospective memory slips in adults with Type 1 diabetes [odds ratio (OR) 1.09, 95% confidence interval (CI) 1.05 to 1.13 P < 0.001] and Type 2 diabetes (OR 1.10, 95% CI 1.05 to 1.15 P < 0.001) and with younger age (both groups), insulin pump use (Type 1 diabetes), insulin treatment (Type 2 diabetes), less frequent blood glucose checks (Type 1 diabetes) and higher HbA These findings suggest that forgetting medication is relatively common among adults with Type 1 or Type 2 diabetes, and provide preliminary evidence for its relationship with self-reported prospective memory slips.
Publisher: JMIR Publications Inc.
Date: 17-05-2020
Abstract: elivering self-management support to people with type 2 diabetes mellitus is essential to reduce the health system burden and to empower people with the skills, knowledge, and confidence needed to take an active role in managing their own health. his study aims to evaluate the adoption, use, and effectiveness of the My Diabetes Coach (MDC) program, an app-based interactive embodied conversational agent, i Laura /i , designed to support diabetes self-management in the home setting over 12 months. his randomized controlled trial evaluated both the implementation and effectiveness of the MDC program. Adults with type 2 diabetes in Australia were recruited and randomized to the intervention arm (MDC) or the control arm (usual care). Program use was tracked over 12 months. Coprimary outcomes included changes in glycated hemoglobin (HbA sub c /sub ) and health-related quality of life (HRQoL). Data were assessed at baseline and at 6 and 12 months, and analyzed using linear mixed-effects regression models. total of 187 adults with type 2 diabetes (mean 57 years, SD 10 years 41.7% women) were recruited and randomly allocated to the intervention (n=93) and control (n=94) arms. MDC program users (92/93 participants) completed 1942 chats with i Laura /i , averaging 243 min (SD 212) per person over 12 months. Compared with baseline, the mean estimated HbA sub c /sub decreased in both arms at 12 months (intervention: 0.33% and control: 0.20%), but the net differences between the two arms in change of HbA sub c /sub (−0.04%, 95% CI −0.45 to 0.36 i P /i =.83) was not statistically significant. At 12 months, HRQoL utility scores improved in the intervention arm, compared with the control arm (between-arm difference: 0.04, 95% CI 0.00 to 0.07 i P /i =.04). he MDC program was successfully adopted and used by in iduals with type 2 diabetes and significantly improved the users’ HRQoL. These findings suggest the potential for wider implementation of technology-enabled conversation-based programs for supporting diabetes self-management. Future studies should focus on strategies to maintain program usage and HbA sub c /sub improvement. ustralia New Zealand Clinical Trials Registry (ACTRN) 12614001229662 anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614001229662
Publisher: Wiley
Date: 19-09-2014
DOI: 10.1111/DME.12306
Abstract: To investigate whether diabetes self-care attitudes, behaviours and perceived burden, particularly related to weight management, diet and physical activity, differ between adults with Type 2 diabetes who are severely obese and matched non-severely obese control subjects. The 1795 respondents to the Diabetes MILES--Australia national survey had Type 2 diabetes and reported height and weight data, enabling BMI calculation: 530 (30%) were severely obese (BMI ≥ 35 kg/m(2) median BMI = 41.6 kg/m(2)) and these were matched with 530 control subjects (BMI < 35 kg/m(2) median BMI = 28.2 kg/m(2)). Diabetes self-care behaviours, attitudes and burden were measured with the Diabetes Self-Care Inventory-Revised. Within-group and between-group trends were examined. The group with BMI ≥ 35 kg/m(2) was less likely to achieve healthy diet and exercise targets, placed less importance on diet and exercise recommendations, and found the burden of diet and exercise recommendations to be greater than the group with BMI 45 kg/m(2). There were no between-group differences in other aspects of diabetes self-care: self-monitoring of blood glucose, use of medications and smoking. Moderate-to-severe symptoms of depression were independently associated with reduced likelihood of healthy diet and physical activity, and with greater burden associated with diet, physical activity and weight management. Severely obese people with diabetes demonstrated self-care attitudes, behaviours and burdens that infer barriers to weight loss. However, other important diabetes self-care behaviours are supported equally by severely obese and non-severely obese in iduals.
Publisher: BMJ
Date: 02-2022
DOI: 10.1136/BMJOPEN-2021-051651
Abstract: Hypoglycaemia is a frequent adverse event and major barrier for achieving optimal blood glucose levels in people with type 1 or type 2 diabetes using insulin. The Hypo-RESOLVE (Hypoglycaemia—Redefining SOLutions for better liVEs) consortium aims to further our understanding of the day-to-day impact of hypoglycaemia. The Hypo-METRICS (Hypoglycaemia—MEasurement, ThResholds and ImpaCtS) application (app) is a novel app for smartphones. This app is developed as part of the Hypo-RESOLVE project, using ecological momentary assessment methods that will minimise recall bias and allow for robust investigation of the day-to-day impact of hypoglycaemia. In this paper, the development and planned psychometric analyses of the app are described. The three phases of development of the Hypo-METRICS app are: (1) establish a working group—comprising diabetologists, psychologists and people with diabetes—to define the problem and identify relevant areas of daily functioning (2) develop app items, with user-testing, and implement into the app platform and (3) plan a large-scale, multicountry study including interviews with users and psychometric validation. The app includes 7 modules (29 unique items) assessing: self-report of hypoglycaemic episodes (during the day and night, respectively), sleep quality, well-being/cognitive function, social interactions, fear of hypoglycaemia/hyperglycaemia and work roductivity. The app is designed for use within three fixed time intervals per day (morning, afternoon and evening). The first version was released mid-2020 for use (in conjunction with continuous glucose monitoring and activity tracking) in the Hypo-METRICS study an international observational longitudinal study. As part of this study, semistructured user-experience interviews and psychometric analyses will be conducted. Use of the novel Hypo-METRICS app in a multicountry clinical study has received ethical approval in each of the five countries involved (Oxford B Research Ethics Committee, CMO Region Arnhem-Nijmegen, Ethikkommission der Medizinischen Universität Graz, Videnskabsetisk Komite for Region Hovedstaden and the Comite Die Protection Des Personnes SUD Mediterranne IV). The results from the study will be published in peer review journals and presented at national and international conferences. NCT04304963 .
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.DIABRES.2019.01.026
Abstract: The Problem Areas In Diabetes (PAID) questionnaire is widely used to assess emotional distress related to living with diabetes, although it is lengthy for routine clinical use. Our aim was to determine whether the original 20-item PAID questionnaire can be abbreviated, whilst maintaining its reliability, validity and utility. We analysed data from the UK DAFNE (Dose Adjustment For Normal Eating) education programme for adults with Type 1 diabetes. Data were analysed at baseline (n = 1547) and 1-year post intervention (n = 846). Exploratory factor analysis (EFA) with principal axis factoring method was used to examine PAID responses within a random half of the baseline data (n = 746). Then, two confirmatory factor analyses (CFA) were conducted using the remaining baseline (n = 801) and 1-year data. Reliability, predictive validity, convergent validity and responsiveness were also examined. Based on the EFA results, which were corroborated by CFA, an 11-item PAID questionnaire was identified with a cut-off score of 18 indicating severe diabetes distress. In the current s le, this brief version had high internal consistency (Cronbach's α = 0.93). Predictive validity was demonstrated with the PAID-11 identifying severe diabetes distress from the original 20-item measure, with 95% sensitivity and 96% specificity. Convergent validity was demonstrated by strong positive correlations with HADS anxiety and depressive symptoms (average r = 0.65 and r = 0.55, respectively), while ergent validity was shown with weaker correlations with EQ5D health status (average r = 0.37). Based on present results, PAID-11 appears to be a valid and reliable measure, which seems suitable for use as a brief tool for the detection of diabetes distress in adults with type 1 diabetes. Importantly, this tool may reduce participant burden in multi-measure studies. However, further studies are urgently needed to determine the validity and utility of PAID-11 beyond the UK DAFNE population.
Publisher: Wiley
Date: 04-08-2019
DOI: 10.1111/DME.14067
Abstract: Hypoglycaemia affects many people with Type 2 diabetes using insulin and other glucose-lowering therapies. This systematic review examined the impact of severe hypoglycaemia (episodes requiring external assistance) on psychological outcomes (e.g. emotional well-being, health status and quality of life) in adults with Type 2 diabetes. MEDLINE Complete, PsycINFO and CINAHL databases were searched for peer-reviewed empirical studies, published in English, reporting the occurrence and severity of hypoglycaemia and its relationship with patient-reported outcomes (PROs) in adults with Type 2 diabetes. Data were extracted from published reports and analysed. Of 3756 potentially relevant abstracts, 29 studies met the inclusion criteria. Most reported cross-sectional data and s le sizes varied widely (N = 71 to 17 563). Although definitions of mild and severe hypoglycaemia were largely consistent between studies, additional non-standard categorizations (e.g. moderate, very severe) were apparent and recall periods varied. Overall, severe hypoglycaemia was associated with increased fear of hypoglycaemia and decreased emotional well-being, health status and diabetes-specific quality of life. Effect sizes show that the association with fear of hypoglycaemia was stronger than with general health status. Notwithstanding the limitations of the empirical studies, these findings indicate that severe hypoglycaemia in adults with Type 2 diabetes (insulin- and non-insulin-treated) is associated with impaired psychological outcomes. Healthcare professionals should address the psychological impact of severe hypoglycaemia during clinical consultations, to support in iduals to minimize exposure to, and the psychological consequences of, severe hypoglycaemia.
Publisher: BMJ
Date: 26-01-2009
DOI: 10.1136/BMJ.B85
Publisher: Wiley
Date: 08-04-2014
DOI: 10.1111/DME.12441
Publisher: Springer Science and Business Media LLC
Date: 19-12-2017
DOI: 10.1007/S40271-017-0289-X
Abstract: We aimed to (a) culturally and linguistically adapt the Type 1 Diabetes Stigma Assessment Scale (DSAS-1) from English (for Australia) into Danish and (b) examine psychometric properties of the measure among Danish adults with type 1 diabetes. We performed a forward-backward translation, face validity interviews with experts and cognitive debriefing of the Danish version (DSAS-1 DK) with ten adults from the target group. The DSAS-1 DK was then completed by 1594 adults with type 1 diabetes. Electronic clinical records provided age, diabetes duration, diabetes-related complications, and glycemic control [glycated hemoglobin (HbA1c)]. We examined internal consistency, construct validity and structural validity of the DSAS-1 DK using exploratory and confirmatory factor analysis in a cross-validation design. The translated measure was found acceptable by the experts and target group, with only minor adaptations required for the Danish context. The DSAS-1 DK structure was best represented by a three-factor model representing the subscales 'Treated Differently,' 'Blame and Judgement,' and 'Identity Concern' (α = 0.88-0.89). The results also provided some support for calculation of a total score (19-item scale α = 0.75). The subscales and total scale demonstrated satisfactory convergent and discriminant validity. Good structural validity was demonstrated for the three-factor model for four out of five indices [normed χ The DSAS-1 DK has a confirmed three-factor structure, consistent with the original Australian English version. The measure is now validated and available to advance research into the stigma perceived and experienced by adults with type 1 diabetes in a Danish context.
Publisher: Springer Science and Business Media LLC
Date: 2016
DOI: 10.1007/S11892-015-0694-2
Abstract: Diabetes distress (DD) refers to the negative emotions arising from living with diabetes and the burden of self-management. Among adults, the prevalence and significance of DD are well established, but this is not the case among adolescents. This systematic review investigated among adolescents with type 1 diabetes: the prevalence of DD demographic, clinical, behavioral and psychosocial correlates of DD and interventions that reduce DD. Consistent with adult studies, around one third of adolescents experience elevated DD and this is frequently associated with suboptimal glycemic control, low self-efficacy and reduced self-care. Three measures of DD have been developed specifically for adolescents, as those designed for adults may not be sufficiently sensitive to adolescent concerns. Interventions reducing DD in the short term include strategies such as cognitive restructuring, goal setting and problem solving. Further work is needed to investigate sustainability of effect. Rigorous research is needed to progress this field among adolescents.
Publisher: Elsevier BV
Date: 11-2008
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.JDIACOMP.2016.03.027
Abstract: As type 2 diabetes (T2DM) is a progressive chronic condition, regular clinical review and treatment intensification are critical for prevention of long-term complications. Our aim was to explore the personal impact of insulin therapy, both positive and negative consequences, and attitudes towards future insulin intensification. Twenty face-to-face interviews were conducted, and transcripts were analysed using thematic inductive analysis. Eligible participants were adults with T2DM, using insulin injections for <4years. Participants were mostly men (n=13, 65%), (median (range)) aged 65 (43-76) years, living with T2DM for 11.5 (2-27) years. Five themes emerged regarding the consequences (positive and negative) of insulin therapy, including: physical impact, personal control, emotional well-being, freedom/flexibility, (concerns about) others' reactions. Increased inconvenience and the perceived seriousness of using fast-acting insulin were both reported as barriers to future insulin intensification, despite most participants being receptive to the idea of administering additional injections. Positive and negative experiences of insulin therapy were reported by adults with T2DM and most were receptive to insulin intensification despite reported barriers. These findings may inform clinical interactions with people with T2DM and interventions to promote receptiveness to insulin initiation and intensification.
Publisher: Wiley
Date: 18-06-2021
DOI: 10.1111/DME.14611
Abstract: To examine psychosocial and behavioural impacts of the novel coronavirus disease 2019 (COVID‐19) pandemic and lockdown restrictions among adults with type 2 diabetes. Participants enrolled in the PRogrEssion of DIabetic ComplicaTions (PREDICT) cohort study in Melbourne, Australia ( n = 489 with a baseline assessment pre‐2020) were invited to complete a phone/online follow‐up assessment in mid‐2020 (i.e., amidst COVID‐19 lockdown restrictions). Repeated assessments that were compared with pre‐COVID‐19 baseline levels included anxiety symptoms (7‐item Generalised Anxiety Disorder scale [GAD‐7]), depressive symptoms (8‐item Patient Health Questionnaire [PHQ‐8]), diabetes distress (Problem Areas in Diabetes scale [PAID]), physical activity/sedentary behaviour, alcohol consumption and diabetes self‐management behaviours. Additional once‐off measures at follow‐up included COVID‐19‐specific worry, quality of life (QoL), and healthcare appointment changes (telehealth engagement and appointment cancellations/avoidance). Among 470 respondents (96% aged 66 ± 9 years, 69% men), at least ‘moderate’ worry about COVID‐19 infection was reported by 31%, and 29%–73% reported negative impacts on QoL dimensions (greatest for: leisure activities, feelings about the future, emotional well‐being). Younger participants reported more negative impacts ( p 0.05). Overall, anxiety/depressive symptoms were similar at follow‐up compared with pre‐COVID‐19, but diabetes distress reduced ( p 0.001). Worse trajectories of anxiety/depressive symptoms were observed among those who reported COVID‐19‐specific worry or negative QoL impacts ( p 0.05). Physical activity trended lower (~10%), but sitting time, alcohol consumption and glucose‐monitoring frequency remained unchanged. 73% of participants used telehealth, but 43% cancelled a healthcare appointment and 39% avoided new appointments despite perceived need. COVID‐19 lockdown restrictions negatively impacted QoL, some behavioural risk factors and healthcare utilisation in adults with type 2 diabetes. However, generalised anxiety and depressive symptoms remained relatively stable.
Publisher: Springer Science and Business Media LLC
Date: 16-01-2013
DOI: 10.1007/S40271-012-0001-0
Abstract: A comprehensive understanding of the social and psychological impact of diabetes mellitus is important for informing policy and practice. One potentially significant, yet under-researched, issue is the social stigma surrounding diabetes. This narrative review draws on literature about health-related stigma in diabetes and other chronic conditions in order to develop a framework for understanding diabetes-related stigma. Our review of the literature found that people who do not have diabetes assume that diabetes is not a stigmatized condition. In contrast, people with diabetes report that stigma is a significant concern to them, experienced across many life domains, e.g., in the workplace, in relationships. The experience of diabetes-related stigma has a significant negative impact on many aspects of psychological well-being and may also result in sub-optimal clinical outcomes for people with diabetes. We propose a framework that highlights the causes (attitudes of blame, feelings of fear and disgust, and the felt need to enforce social norms and avoid disease), experiences (being judged, rejected, and discriminated against), and consequences (e.g., distress, poorer psychological well-being, and sub-optimal self-care) of diabetes-related stigma and also identifies potential mitigating strategies to reduce diabetes-related stigma and/or enhance coping and resilience amongst people with diabetes. The systematic investigation of the experiences, causes, and consequences of diabetes-related stigma is an urgent research priority.
Publisher: Elsevier BV
Date: 03-2021
Publisher: JMIR Publications Inc.
Date: 07-06-2021
DOI: 10.2196/25409
Abstract: Automated insulin delivery (AID) systems have been shown to be safe and effective in reducing hyperglycemia and hypoglycemia but are not universally available, accessible, or affordable. Therefore, user-driven open-source AID systems are becoming increasingly popular. This study aims to investigate the motivations for which people with diabetes (types 1, 2, and other) or their caregivers decide to build and use a personalized open-source AID. A cross-sectional web-based survey was conducted to assess personal motivations and associated self-reported clinical outcomes. Of 897 participants from 35 countries, 80.5% (722) were adults with diabetes and 19.5% (175) were caregivers of children with diabetes. Primary motivations to commence open-source AID included improving glycemic outcomes (476/509 adults, 93.5%, and 95/100 caregivers, 95%), reducing acute (443/508 adults, 87.2%, and 96/100 caregivers, 96%) and long-term (421/505 adults, 83.3%, and 91/100 caregivers, 91%) complication risk, interacting less frequently with diabetes technology (413/509 adults, 81.1% 86/100 caregivers, 86%), improving their or child’s sleep quality (364/508 adults, 71.6%, and 80/100 caregivers, 80%), increasing their or child’s life expectancy (381/507 adults, 75.1%, and 84/100 caregivers, 84%), lack of commercially available AID systems (359/507 adults, 70.8%, and 79/99 caregivers, 80%), and unachieved therapy goals with available therapy options (348/509 adults, 68.4%, and 69/100 caregivers, 69%). Improving their own sleep quality was an almost universal motivator for caregivers (94/100, 94%). Significant improvements, independent of age and gender, were observed in self-reported glycated hemoglobin (HbA1c), 7.14% (SD 1.13% 54.5 mmol/mol, SD 12.4) to 6.24% (SD 0.64% 44.7 mmol/mol, SD 7.0 P .001), and time in range (62.96%, SD 16.18%, to 80.34%, SD 9.41% P .001). These results highlight the unmet needs of people with diabetes, provide new insights into the evolving phenomenon of open-source AID technology, and indicate improved clinical outcomes. This study may inform health care professionals and policy makers about the opportunities provided by open-source AID systems. RR2-10.2196/15368
Publisher: Mary Ann Liebert Inc
Date: 05-2022
Abstract: There is limited evidence supporting the recommendation that drivers with insulin-treated diabetes need to start journeys with glucose >90 mg/dL. Glucose levels of drivers with type 1 diabetes were monitored for 3 weeks using masked continuous glucose monitoring (CGM). Eighteen drivers (median [IQR] age 40 [35, 51] years 11 men) undertook 475 trips (duration 15 [13, 21] min). Hypoglycemia did not occur in any trip starting with glucose >90 mg/dL (92%
Publisher: American Diabetes Association
Date: 10-2002
Publisher: Springer Science and Business Media LLC
Date: 13-07-2016
Publisher: Elsevier BV
Date: 11-0112
DOI: 10.1016/J.DIABRES.2016.09.023
Abstract: In a survey of Australian drivers with type 1 diabetes, three-quarters reported not checking their blood glucose consistently before driving. They reported lack of health professional recommendation of this behaviour, less concern about safety, and preference for consuming fast-acting glucose, which may be less effective for mitigating risk.
Publisher: Elsevier BV
Date: 08-2020
Publisher: Elsevier BV
Date: 02-2018
Publisher: Wiley
Date: 17-08-2016
DOI: 10.1111/DME.13183
Publisher: Springer Science and Business Media LLC
Date: 26-02-2013
Abstract: Achieving optimal outcomes in type 2 diabetes (T2DM) involves several demanding self-care behaviours, e.g. managing diet, activity, medications, monitoring glucose levels, footcare. The Self-Care Inventory-Revised (SCI-R) is valid for use in people with T2DM in the US. Our aim was to determine its suitability for use in the UK. 353 people with T2DM participated in the AT.LANTUS Follow-on study, completing measures of diabetes self-care (SCI-R), generic and diabetes-specific well-being (W-BQ28), and diabetes treatment satisfaction (DTSQ). Statistical analyses were conducted to explore structure, reliability, and validity of the SCI-R. Principal components analysis indicated a 13-item scale (items loading .39) with satisfactory internal consistency reliability (α = 0.77), although neither this model nor any alternatives were confirmed in the confirmatory factor analysis. Acceptability was high ( % completion for all but one item) ceiling effects were demonstrated for six items. As expected, convergent validity (correlations between self-care behaviours) was found for few items. Divergent validity was supported by expected low correlations between SCI-R total and well-being (r s = 0.02-0.21) and treatment satisfaction (r s = 0.29). Known-groups validity was partially supported with significant differences in SCI-R total by HbA 1c (≤7.5% (58 mmol/mol): 72 ± 11, .5% (58 mmol/mol): 68 ± 14, p 0.05) and diabetes duration (≤16 years: 67 ± 13, years: 71 ± 12, p 0.001) but not by presence/absence of complications or by insulin treatment algorithm. The SCI-R is a brief, valid and reliable measure of self-care in people with T2DM in the UK. However, ceiling effects raise concerns about its potential for responsiveness in clinical trials. In idual items may be more useful clinically than the total score.
Publisher: Wiley
Date: 26-09-2022
DOI: 10.1111/DME.14944
Abstract: To explore the association between the use of glycaemic technologies and person‐reported outcomes (PROs) in adults with type 1 diabetes (T1D). We included T1D and technology publications reporting on PROs since 2014. Only randomised controlled trials and cohort studies that used validated PRO measures (PROMs) were considered. T1D studies reported on a broad range of validated PROMs, mainly as secondary outcome measures. Most studies examined continuous glucose monitoring (CGM), intermittently scanned CGM (isCGM), and the role of continuous subcutaneous insulin infusion (CSII), including sensor‐augmented CSII and closed loop systems. Generally, studies demonstrated a positive impact of technology on hypoglycaemia‐specific and diabetes‐specific PROs, including reduced fear of hypoglycaemia and diabetes distress, and greater satisfaction with diabetes treatment. In contrast, generic PROMs (including measures of health/functional status, emotional well‐being, depressive symptoms, and sleep quality) were less likely to demonstrate improvements associated with the use of glycaemic technologies. Several studies showed contradictory findings, which may relate to study design, population and length of follow‐up. Differences in PRO findings were apparent between randomised controlled trials and cohort studies, which may be due to different populations studied and/or disparity between trial and real‐world conditions. PROs are usually assessed as secondary outcomes in glycaemic technology studies. Hypoglycaemia‐specific and diabetes‐specific, but not generic, PROs show the benefits of glycaemic technologies, and deserve a more central role in future studies as well as routine clinical care.
Publisher: Wiley
Date: 08-09-2022
DOI: 10.1111/DME.14945
Abstract: Racial and ethnic disparities exist in gestational diabetes prevalence and risk of subsequent type 2 diabetes mellitus (T2DM). Postpartum engagement in healthy behaviours is recommended for prevention and early detection of T2DM, yet uptake is low among women from erse cultural backgrounds. Greater understanding of factors impacting postpartum health behaviours is needed. Applying the Theoretical Domains Framework (TDF) and Capability , Opportunity , Motivation‐Behaviour (COM‐B) model, our aim was to synthesise barriers to and enablers of postpartum health behaviours among women from erse cultural backgrounds with prior GDM and identify relevant intervention components. Databases, reference lists and grey literature were searched from September 2017 to April 2021. Two reviewers screened articles independently against inclusion criteria and extracted data. Using an inductive–deductive model, themes were mapped to the TDF and COM‐B model. After screening 5148 citations and 139 full texts, we included 35 studies ( N = 787 participants). The main ethnicities included Asian (43%), Indigenous (15%) and African (11%). Barriers and enablers focused on Capability (e.g. knowledge), Opportunity (e.g. competing demands, social support from family, friends and healthcare professionals, culturally appropriate education and resources) and Motivation (e.g. negative emotions, perceived consequences and necessity of health behaviours, social/cultural identity). Five relevant intervention functions are identified to link the barriers and enablers to evidence‐based recommendations for communications to support behaviour change. We provide a conceptual model to inform recommendations regarding the development of messaging and interventions to support women from erse cultural backgrounds in engaging in healthy behaviours to reduce risk of T2DM.
Publisher: Springer Science and Business Media LLC
Date: 09-11-2022
DOI: 10.1186/S12909-022-03821-W
Abstract: Diabetes distress is a commonly experienced negative emotional response to the ongoing burden of diabetes. Holistic diabetes care, including attention to diabetes distress, is recommended in clinical guidelines, yet not routinely implemented. Diabetes health professionals have highlighted lack of training as a barrier to implementation of psychological care. Therefore, we developed an e-learning: ‘Diabetes distress e-learning: A course for diabetes educators’ to address this need. This pilot study aimed to examine the feasibility of evaluating the e-learning in a randomised controlled trial study, the acceptability of the e-learning to credentialled diabetes educators (CDEs) and preliminary evidence of its effect upon CDEs’ diabetes distress-related knowledge, motivation, confidence, behavioural skills, and barriers to implementation. A pilot, unblinded, 2-armed, parallel group randomised controlled trial. Participants were recruited during a 4-month timeframe. Eligible participants were CDEs for ≥ 1 year providing care to ≥ 10 adults with type 1 or type 2 diabetes per week. Participants were randomly allocated (1:1 computer automated) to 1 of 2 learning activities: diabetes distress e-learning (intervention) or diabetes distress chapter (active control). They had 4 weeks to access the activity. They completed online surveys at baseline, 2-week and 12-week follow-up. Seventy-four eligible CDEs (36 intervention, 38 active control) participated. At baseline, recognition of the clinical importance of diabetes distress was high but knowledge and confidence to provide support were low-to-moderate. Engagement with learning activities was high (intervention: 83% active control: 92%). Fifty-five percent returned at least 1 follow-up survey. All 30 intervention participants who returned the 2-week follow-up survey deemed the e-learning high quality and relevant. Systemic barriers (e.g., financial limitations and access to mental health professionals) to supporting people with diabetes distress were common at baseline and follow-up. The e-learning was acceptable to CDEs. The study design was feasible but needs modification to improve follow-up survey return. The e-learning showed potential for improving diabetes distress-related knowledge, confidence and asking behaviours, but systemic barriers to implementation remained. Systemic barriers need to be addressed to facilitate implementation of support for diabetes distress in clinical practice. Future larger-scale evaluation of the e-learning is warranted.
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: Elsevier BV
Date: 04-2015
DOI: 10.1016/J.APPET.2015.01.006
Abstract: Although healthy food choices are important in the management of diabetes, making dietary adaptations is often challenging. Previous research has shown that people with type 2 diabetes are less likely to benefit from dietary advice if they tend to eat in response to emotions or external cues. Since high levels of dispositional mindfulness have been associated with greater awareness of healthy dietary practices in students and in the general population, it is relevant to study the association between dispositional mindfulness and eating behaviour in people with type 1 or 2 diabetes. We analysed data from Diabetes MILES - The Netherlands, a national observational survey in which 634 adults with type 1 or 2 diabetes completed the Dutch Eating Behaviour Questionnaire (to assess restrained, external and emotional eating behaviour) and the Five Facet Mindfulness Questionnaire-Short Form (to assess dispositional mindfulness), in addition to other psychosocial measures. After controlling for potential confounders, including demographics, clinical variables and emotional distress, hierarchical linear regression analyses showed that higher levels of dispositional mindfulness were associated with eating behaviours that were more restrained (β = 0.10) and less external (β = -0.11) and emotional (β = -0.20). The mindfulness subscale 'acting with awareness' was the strongest predictor of both external and emotional eating behaviour, whereas for emotional eating, 'describing' and 'being non-judgemental' were also predictive. These findings suggest that there is an association between dispositional mindfulness and eating behaviour in adults with type 1 or 2 diabetes. Since mindfulness interventions increase levels of dispositional mindfulness, future studies could examine if these interventions are also effective in helping people with diabetes to reduce emotional or external eating behaviour, and to improve the quality of their diet.
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: Wiley
Date: 20-09-2015
DOI: 10.1111/DME.12768
Publisher: Springer Science and Business Media LLC
Date: 30-10-2012
Abstract: As the number of people with diabetes is increasing rapidly worldwide, a more thorough understanding of the psychosocial aspects of living with this condition has become an important health care priority. While our knowledge has grown substantially over the past two decades with respect to the physical, emotional and social difficulties that people with diabetes may encounter, many important issues remain to be elucidated. Under the umbrella of the Diabetes MILES (Management and Impact for Long-term Empowerment and Success) Study International Collaborative, Diabetes MILES – The Netherlands aims to examine how Dutch adults with diabetes manage their condition and how it affects their lives. Topics of special interest in Diabetes MILES - The Netherlands include subtypes of depression, Type D personality, mindfulness, sleep and sexual functioning. Diabetes MILES – The Netherlands was designed as a national online observational study among adults with diabetes. In addition to a main set of self-report measures, the survey consisted of five complementary modules to which participants were allocated randomly. From September to October 2011, a total of 3,960 in iduals with diabetes (40% type 1, 53% type 2) completed the battery of questionnaires covering a broad range of topics, including general health, self-management, emotional well-being and contact with health care providers. People with self-reported type 1 diabetes (specifically those on insulin pump therapy) were over-represented, as were those using insulin among respondents with self-reported type 2 diabetes. People from ethnic minorities were under-represented. The sex distribution was fairly equal in the total s le, participants spanned a broad age range (19–90 years), and diabetes duration ranged from recent diagnosis to living with the condition for over fifty years. The Diabetes MILES Study enables detailed investigation of the psychosocial aspects of living with diabetes and an opportunity to put these findings in an international context. With several papers planned resulting from a pooled Australian-Dutch dataset and data collections planned in other countries, the Diabetes MILES Study International Collaborative will contribute substantially to identifying potentially unmet needs of those living with diabetes and to inform clinical research and care across the globe.
Publisher: Wiley
Date: 07-10-2021
DOI: 10.1111/DME.14706
Abstract: To conduct a systematic review of published studies reporting on the longitudinal impacts of hypoglycaemia on quality of life (QoL) in adults with type 2 diabetes. Database searches with no restrictions by language or date were conducted in MEDLINE, Cochrane Library, CINAHL and PsycINFO. Studies were included for review if they used a longitudinal design (e.g. cohort studies, randomised controlled trials) and reported on the association between hypoglycaemia and changes over time in patient‐reported outcomes related to QoL. In all, 20 longitudinal studies published between 1998 and 2020, representing 50,429 adults with type 2 diabetes, were selected for review. A descriptive synthesis following Synthesis Without Meta‐analysis guidelines indicated that self‐treated symptomatic hypoglycaemia was followed by impairments in daily functioning along with elevated symptoms of generalised anxiety, diabetes distress and fear of hypoglycaemia. Severe hypoglycaemic events were associated with reduced confidence in diabetes self‐management and lower ratings of perceived health over time. Frequent hypoglycaemia was followed by reduced energy levels and diminished emotional well‐being. There was insufficient evidence, however, to conclude that hypoglycaemia impacted sleep quality, depressive symptoms, general mood, social support or overall diabetes‐specific QoL. Longitudinal evidence in this review suggests hypoglycaemia is a common occurrence among adults with type 2 diabetes that impacts key facets in the physical and psychological domains of QoL. Nonetheless, additional longitudinal research is needed—in particular, studies targeting erse forms of hypoglycaemia, more varied facets of QoL and outcomes assessed using hypoglycaemia‐specific measures.
Publisher: Trans Tech Publications Ltd.
Date: 15-09-2005
Publisher: Wiley
Date: 07-10-2022
DOI: 10.1111/DME.14708
Abstract: An emerging group of people with type 1 diabetes are not waiting for commercial solutions, choosing to manage their condition with open‐source artificial pancreas systems (APS). Our aim was to explore their perspectives on the future of APS. Semi‐structured telephone interviews were conducted (in Australia, October 2018 to January 2019) with 23 adults with type 1 diabetes currently using open‐source APS. Interviews were recorded, transcribed and analysed thematically. Participants described five key features of open‐source APS they value: compatibility, user‐led design, customisability, ability to evolve faster and community‐driven. They attributed the success of the open‐source APS movement to benefits they derive from these features: choice, solutions that meet their needs, ownership, staying one step ahead and real‐time support. They expressed hope that future commercial products and healthcare would benefit from their learnings and from collaboration with the open‐source APS community. Participants believed that there will always be a place for the open‐source community. It will continue to build on and advance commercial products, respond to user needs, offering a higher degree of control and customisation than afforded by commercial products and generating optimism for the future. Participants desired that future commercial diabetes technologies would be inspired by the open‐source community and developed collaboratively with people with diabetes.
Publisher: BMJ
Date: 02-2017
Publisher: Hindawi Limited
Date: 11-03-2020
DOI: 10.1111/PEDI.13001
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.DIABRES.2015.07.008
Abstract: Despite growing recognition of the impact of sleep on diabetes, a clear profile of people with diabetes regarding subjective sleep impairment has yet to be established. This study examines: (1) subjective sleep characteristics in adults with type 1 and type 2 diabetes (2) the relationship of poor subjective sleep quality with glycaemic control, self-care and daytime functioning (3) possible risk markers for poor sleep quality. In a cross-sectional study, Dutch adults with type 1 (n=267) or type 2 diabetes (n=361) completed an online survey, including the Pittsburgh Sleep Quality Index (PSQI), socio-demographic, clinical, self-care and psychological measures. Poor sleep quality (PSQI-score >5) was reported by 31% of adults with type 1 and 42% of adults with type 2 diabetes. Participants with good and poor sleep quality did not differ in self-reported HbA1c or the frequency of meeting lifestyle recommendations. Poor sleep quality was related to a higher self-care burden and higher levels of daytime sleepiness, fatigue, depressive and anxiety symptoms, and diabetes-specific distress. In multivariable logistic regression analyses examining risk markers, poor sleep quality was associated with depressive symptoms in adults with type 1 (OR=1.39, 95% CI 1.25-1.54) and type 2 diabetes (OR=1.31, 1.16-1.47), and with being female in those with type 2 diabetes (OR=2.72, 1.42-5.20). Poor subjective sleep quality is prevalent both in adults with type 1 and type 2 diabetes, and is related to poor daytime functioning and higher self-care burden. The temporal relation with depression and merits of therapy should be explored.
Publisher: Springer Science and Business Media LLC
Date: 12-02-2012
Publisher: Elsevier BV
Date: 10-2014
Abstract: A socioeconomic gradient exists in Australia for type 2 diabetes mellitus (T2DM). It remains unclear whether economic hardship is associated with T2DM self-management behaviours. Cross-sectional data from a subset of the Diabetes MILES - Australia study were used (n=915). The Economic Hardship Questionnaire was used to assess hardship. Outcomes included: healthy eating and physical activity (Diabetes Self-Care Inventory - Revised), medication-taking behaviour (Medication Adherence Rating Scales) and frequency of self-monitoring of blood glucose (SMBG). Regression modelling was used to explore the respective relationships. Greater economic hardship was significantly associated with sub-optimal medication-taking (Coefficient: -0.86, 95%CI -1.54, -0.18), and decreased likelihood of regular physical activity (Odds Ratio: 0.47, 0.29, 0.77). However, after adjustments for a range of variables, these relationships did not hold. Being employed and higher depression levels were significantly associated with less-frequent SMBG, sub-optimal medication-taking and less-regular healthy eating. Engaging in physical activity was strongly associated with healthy eating. Employment, older age and depressive symptoms, not economic hardship, were commonly associated with diabetes self-management. Work-based interventions that promote T2DM self-management in younger, working populations that focus on negative emotions may be beneficial.
Publisher: BMJ
Date: 23-07-2014
Publisher: AMPCo
Date: 23-06-2020
DOI: 10.5694/MJA2.50666
Publisher: American Diabetes Association
Date: 2022
DOI: 10.2337/CD20-0071
Abstract: There has been little recognition that people with type 2 diabetes are vulnerable to weight stigma and diabetes stigma and almost no research examining the implications of these forms of stigma for their health and well-being. This study examined health behavior correlates of weight stigma and diabetes stigma in 1,227 adults with type 2 diabetes. Results showed that experiencing weight stigma in health care, experiencing differential treatment from others because of their diabetes, and engaging in self-stigma for diabetes and body weight were each significantly associated with increased frequency of binge eating and eating as a coping strategy to deal with negative feelings. Internalizing weight stigma was also significantly associated with lower levels of physical activity and worse self-rated health. These findings suggest that initiatives to improve the health and well-being of people with type 2 diabetes must consider the potentially harmful roles of weight stigma and diabetes stigma.
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.DIABRES.2017.01.002
Abstract: We aimed to investigate predictors of insulin uptake, and change in insulin appraisals, among adults with type 2 diabetes mellitus (T2DM) who participated in the Stepping Up trial. The Stepping Up model of care, supporting timely insulin initiation in primary care, was evaluated in a two-armed cluster-randomised controlled trial. Participants were 266 adults (mean±SD age 62±10years 39% women) with T2DM (median (IQR) duration 8.5 (5, 13)years) from 74 primary care practices (Stepping Up intervention: 57%, control 43%). At 12months, 47% (n=126) had commenced insulin. Controlling for randomisation, logistic regression was used to explore baseline predictors of insulin uptake, including: demographic and clinical characteristics, emotional wellbeing (depressive symptoms and diabetes-related distress), insulin treatment appraisals, and, 'willingness' to initiate insulin. Two-way analysis of variance examined effects of, and interaction between, randomisation and insulin uptake on 12-month change in insulin appraisals. Participants using insulin at 12months were more likely (all p<0.05) than those with non-insulin-treated T2DM to report: lower socioeconomic status, higher baseline HbA1c (median difference: 0.3% 3mmol/mol), greater willingness to commence insulin (very willing: 27% vs 12%), and less negative and more positive insulin appraisals. All contributed significantly to the final model (χ Controlling for randomisation, 12-month insulin use was predicted by higher baseline HbA1c and 'willingness' to use insulin if recommended. Negative insulin appraisals reduced following insulin initiation.
Publisher: American Chemical Society (ACS)
Date: 06-05-2019
Abstract: Four-dimensional (4D) printable light-powered materials have emerged as a new generation of materials for the development of functional devices. The design of these types of materials is mostly based on the trans-cis transformation of azobenzene moieties in a liquid crystalline elastomer (LCE) matrix, in which the motion is triggered by ultraviolet (UV) irradiation. In this paper, we first report on a direct laser printable photoresist for producing light-powered 4D structures with enhanced mechanical properties and near-infrared (NIR) responsive mechanical deformation. The reported nanocomposite design is based on the photothermal effects of gold nanorods (AuNRs), which can induce the nematic-to-isotropic transition of LCE upon exposure to NIR irradiation. The miscibility between AuNRs and LCE is enhanced by thiol functionalization. Appropriate printing parameters are determined, and nanocomposites containing 0-3 wt % of AuNR loading are fabricated via femtosecond two-photon direct laser writing. The effects of the AuNR loading fraction and laser power on the light-powered actuating performance are evaluated. It is found that the nanocomposite with AuNR loading of 3 wt % demonstrates the maximum percentage (20%) of elongation under an NIR laser power of 2 W. An increase in laser power can lead to faster deformation but slower restoration. The nanocomposites demonstrate relatively good stability. Even after 300 actuation cycles, 80% of the elongation magnitude can be retained. In addition, an improvement of 80% in the complex modulus of the nanocomposites, due to the inclusion of AuNRs, is observed.
Publisher: BMJ
Date: 11-2016
Publisher: Wiley
Date: 08-11-2019
DOI: 10.1111/DME.14165
Publisher: Springer Science and Business Media LLC
Date: 02-02-2021
DOI: 10.1007/S00125-021-05382-X
Abstract: It is generally accepted that hypoglycaemia can negatively impact the quality of life (QoL) of people living with diabetes. However, the suitability of patient-reported outcome measures (PROMs) used to assess this impact is unclear. The aim of this systematic review was to identify PROMs used to assess the impact of hypoglycaemia on QoL and examine their quality and psychometric properties. Systematic searches (MEDLINE, EMBASE, PsycINFO, CINAHL and The Cochrane Library databases) were undertaken to identify published articles reporting on the development or validation of hypoglycaemia-specific PROMs used to assess the impact of hypoglycaemia on QoL (or domains of QoL) in adults with diabetes. A protocol was developed and registered with PROSPERO (registration no. CRD42019125153). Studies were assessed for inclusion at title/abstract stage by one reviewer. Full-text articles were scrutinised where considered relevant or potentially relevant or where doubt existed. Twenty per cent of articles were assessed by a second reviewer. PROMS were evaluated, according to COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines, and data were extracted independently by two reviewers against COSMIN criteria. Assessment of each PROM’s content validity included reviewer ratings ( N = 16) of relevance, comprehensiveness and comprehensibility: by researchers ( n = 6) clinicians ( n = 6) and adults with diabetes ( n = 4). Of the 214 PROMs used to assess the impact of hypoglycaemia on QoL (or domains of QoL), eight hypoglycaemia-specific PROMS were identified and subjected to full evaluation: the Fear of Hypoglycemia 15-item scale the Hypoglycemia Fear Survey the Hypoglycemia Fear Survey version II the Hypoglycemia Fear Survey-II short-form the Hypoglycemic Attitudes and Behavior Scale the Hypoglycemic Confidence Scale the QoLHYPO questionnaire and the Treatment-Related Impact Measure-Non-severe Hypoglycemic Events (TRIM-HYPO) questionnaire. Content validity was rated as ‘inconsistent’, with most as ‘(very) low’ quality, while structural validity was deemed ‘unsatisfactory’ or 'indeterminate'. Other measurement properties (e.g. reliability) varied, and evidence gaps were apparent across all PROMs. None of the identified studies addressed cross-cultural validity or measurement error. Criterion validity and responsiveness were not assessed due to the lack of a ‘gold standard’ measure of the impact of hypoglycaemia on QoL against which to compare the PROMS. None of the hypoglycaemia-specific PROMs identified had sufficient evidence to demonstrate satisfactory validity, reliability and responsiveness. All were limited in terms of content and structural validity, which restricts their utility for assessing the impact of hypoglycaemia on QoL in the clinic or research setting. Further research is needed to address the content validity of existing PROMs, or the development of new PROM(s), for the purpose of assessing the impact of hypoglycaemia on QoL. CRD42019125153
Publisher: Elsevier BV
Date: 07-2020
Publisher: Oxford University Press (OUP)
Date: 09-07-2015
Publisher: Wiley
Date: 09-11-2018
DOI: 10.1002/PEN.24976
Publisher: Wiley
Date: 29-11-2022
DOI: 10.1111/DME.15007
Abstract: Assessment of patient‐reported outcome measures (PROMs), including quality of life (QoL), is essential in diabetes research and care. However, a recent review concluded that current hypoglycaemia‐specific PROMs have limited evidence of validity, reliability and responsiveness for assessing the impact of hypoglycaemia on QoL in people living with diabetes. None of the PROMs identified could be used directly to inform the cost‐effectiveness of treatments and interventions. There is a need for a new hypoglycaemia‐specific QoL PROM, which can be used directly to inform economic evaluations. This project has three aims: (a) To develop draft PROM content for measuring the impact of hypoglycaemia on QoL in adults with diabetes. (b) To refine the draft content using cognitive debriefing interviews and psychometrics. This will result in a condition‐specific PROM that can be used to quantify the impact of hypoglycaemia upon QoL. (c) To generate a preference‐based measure (PBM) that will enable utility values to be calculated for economic evaluation. A mixed‐methods, three‐stage design is used: (a) Qualitative interviews will inform the draft PROM content. (b) Cognitive debriefing interview data will be used to refine the draft PROM content. The PROM will be administered in a large‐scale survey to enable psychometric validation. Final item selection for the PROM will be informed by psychometric performance, translatability assessment and input from stakeholder groups. (c) A classification system will be generated, comprising a reduced number of items from the PROM. A valuation survey will be conducted to derive a value set for the PBM.
Publisher: Informa UK Limited
Date: 03-03-2020
Publisher: Elsevier BV
Date: 11-2008
Publisher: Mary Ann Liebert Inc
Date: 12-2016
Abstract: We compared glycemia, treatment satisfaction, sleep quality, and cognition using a nighttime Android-based hybrid closed-loop system (Android-HCLS) with sensor-augmented pump with low-glucose suspend function (SAP-LGS) in people with type 1 diabetes. An open-label, prospective, randomized crossover study of 16 adults (mean [SD] age 42.1 [9.6] years) and 12 adolescents (15.2 [1.6] years) was conducted. All participants completed four consecutive nights at home with Android-HCLS (proportional integral derivative with insulin feedback algorithm Medtronic) and SAP-LGS. percent continuous glucose monitoring (CGM) time (00:00-08:00 h) within target range (72-144 mg/dL). Secondary endpoints: percent CGM time above target (>144 mg/dL) below target (<72 mg/dL) glycemic variability (SD) symptomatic hypoglycemia adult treatment satisfaction sleep quality and cognitive function. The primary outcome for all participants was not statistically different between Android-HCLS and SAP-LGS (mean [SD] 59.4 [17.9]% vs. 53.1 [18]% p = 0.14). Adults had greater percent time within target range (57.7 [18.6]% vs. 44.5 [14.5]% p < 0.006) less time above target (42.0 [18.7]% vs. 52.6 [16.5]% p = 0.034) lower glycemic variability (35 [10.7] mg/dL vs. 46 [10.7] mg/dL p = 0.003) and less (median [IQR]) time below target (0.0 [0.0-0.4]% vs. 0.80 [0.0-3.9]% p = 0.025). In adolescents, time below target was lower with Android-HCLS vs. SAP-LGS (0.0 [0.0-0.0]% vs. 1.8 [0.1-7.9]% p = 0.011). Nocturnal symptomatic hypoglycemia was less (1 vs. 10 p = 0.007) in adolescents, but not adults (5 vs. 13 p = 0.059). In adults, treatment satisfaction increased by 10 points (p < 0.02). Sleep quality and cognition did not differ. Android-HCLS in both adults and adolescents reduced nocturnal hypoglycemia and, in adults, improved overnight time in target range and treatment satisfaction compared with SAP-LGS.
Publisher: Springer Science and Business Media LLC
Date: 07-09-2013
Publisher: American Diabetes Association
Date: 16-04-2018
DOI: 10.2337/DC17-2682
Abstract: Severe hypoglycemia is a feared complication of type 1 diabetes yet, few trials have targeted prevention using optimized self-management (educational, therapeutic, and technological support). We aimed to investigate whether improved awareness and reduced severe hypoglycemia, achieved during an intensive randomized clinical trial (RCT), were sustained after return to routine care. Ninety-six adults with type 1 diabetes (29 ± 12 years’ duration) and impaired awareness of hypoglycemia at five U.K. tertiary referral diabetes centers were recruited into a 24-week 2 × 2 factorial RCT (HypoCOMPaSS). Participants were randomized to pump (continuous subcutaneous insulin infusion [CSII]) or multiple daily injections (MDIs) and real-time continuous glucose monitoring (RT-CGM) or self-monitoring of blood glucose (SMBG), with equal education/attention to all groups. At 24 weeks, participants returned to routine care with follow-up until 24 months, including free choice of MDI/CSII RT-CGM vs. SMBG comparison continued to 24 months. Primary outcome was mean difference (baseline to 24 months [between groups]) in hypoglycemia awareness. Improvement in hypoglycemia awareness was sustained (Gold score at baseline 5.1 ± 1.1 vs. 24 months 3.7 ± 1.9 P & 0.0001). Severe hypoglycemia rate was reduced from 8.9 ± 12.8 episodes erson-year over the 12 months prestudy to 0.4 ± 0.8 over 24 months (P & 0.0001). HbA1c improved (baseline 8.2 ± 3.2% [66 ± 12 mmol/mol] vs. 24 months 7.7 ± 3.1% [61 ± 10 mmol/mol] P = 0.003). Improvement in treatment satisfaction and reduced fear of hypoglycemia were sustained. There were no significant differences between interventions at 24 months. Optimized insulin replacement and glucose monitoring underpinned by hypoglycemia-focused structured education should be provided to all with type 1 diabetes complicated by impaired awareness of hypoglycemia.
Publisher: Wiley
Date: 15-11-2017
DOI: 10.1111/DME.13507
Abstract: To develop and validate a self-report measure designed to assess perceived and experienced stigma for adults with Type 1 diabetes: the Type 1 Diabetes Stigma Assessment Scale (DSAS-1). A large item-pool (64 items) was drafted based on qualitative data from interviews with 27 adults with Type 1 diabetes. Eleven adults with Type 1 diabetes completed the draft questionnaire (responding to items using a five-point Likert scale), and participated in cognitive debriefing interviews. Based on their feedback, the item-pool was reduced and refined. Adults with Type 1 diabetes (N=898) completed an online survey including the draft stigma questionnaire (41 items) and other validated measures. Psychometric validation included principal components analysis and confirmatory factor analysis (split s les), internal consistency reliability assessment and Spearman's rho correlations. Scale reduction techniques resulted in 19 items (α=0.93). An unforced three-factor solution suggested three subscales: Treated Differently (six items, α=0.89) Blame and Judgement (six items, α=0.88) and Identity Concerns (seven items, α=0.89). This was corroborated with a confirmatory factor analysis, which demonstrated reasonable model fit with the three factors less so for a single-factor model. Satisfactory concurrent, convergent and discriminant validity were demonstrated. The 19-item DSAS-1 is a valid and reliable measure of the perceptions and experiences of Type 1 diabetes stigma. This novel, relatively brief measure has satisfactory psychometric properties. The DSAS-1 is now available for investigations into the nature and magnitude of the relationships between diabetes stigma and diabetes self-care behaviours and outcomes.
Publisher: Wiley
Date: 04-2009
DOI: 10.1111/J.1464-5491.2009.02682.X
Abstract: Quality of life (QoL) is recognized widely as an important health outcome in diabetes, where the burden of self-management places great demands on the in idual. However, the concept of QoL remains ambiguous and poorly defined. The aim of our review is to clarify the measurement of QoL in terms of conceptualization, terminology and psychometric properties, to review the instruments that have been used most frequently to assess QoL in diabetes research and make recommendations for how to select measures appropriately. A systematic literature search was conducted to identify the ten measures most frequently used to assess QoL in diabetes research (including clinical trials) from 1995 to March 2008. Six thousand and eight-five abstracts were identified and screened for instrument names. Of the ten instruments most frequently used to assess 'QoL', only three actually do so [i.e. the generic World Health Organization Quality of Life (WHOQOL) and the diabetes-specific Diabetes Quality of Life (DQOL) and Audit of Diabetes-Dependent Quality of Life (ADDQoL)]. Seven instruments more accurately measure health status [Short-Form 36 (SF-36), EuroQoL 5-Dimension (EQ-5D)], treatment satisfaction [Diabetes Treatment Satisfaction Questionnaire (DTSQ)] and psychological well-being [Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS), Well-Being Questionnaire (W-BQ), Problem Areas in Diabetes (PAID)]. No single measure can suit every purpose or application but, when measures are selected inappropriately and data misinterpreted, any conclusions drawn are fundamentally flawed. If we value QoL as a therapeutic goal, we must ensure that the instruments we use are both valid and reliable. QoL assessment has the proven potential to identify ways in which treatments can be tailored to reduce the burden of diabetes. With careful consideration, appropriate measures can be selected and truly robust assessments undertaken successfully.
Publisher: JMIR Publications Inc.
Date: 23-08-2022
Publisher: AMPCo
Date: 11-2015
DOI: 10.5694/MJA15.00639
Publisher: Wiley
Date: 22-06-2022
DOI: 10.1111/DME.14892
Abstract: Hypoglycaemia is a significant burden to people living with diabetes and an impediment to achieving optimal glycaemic outcomes. The use of continuous glucose monitoring (CGM) has improved the capacity to assess duration and level of hypoglycaemia. The personal impact of sensor‐detected hypoglycaemia (SDH) is unclear. Hypo‐METRICS is an observational study designed to define the threshold and duration of sensor glucose that provides the optimal sensitivity and specificity for events that people living with diabetes experience as hypoglycaemia. We will recruit 600 participants: 350 with insulin‐treated type 2 diabetes, 200 with type 1 diabetes and awareness of hypoglycaemia and 50 with type 1 diabetes and impaired awareness of hypoglycaemia who have recent experience of hypoglycaemia. Participants will wear a blinded CGM device and an actigraphy monitor to differentiate awake and sleep times for 10 weeks. Participants will be asked to complete three short surveys each day using a bespoke mobile phone app, a technique known as ecological momentary assessment. Participants will also record all episodes of self‐detected hypoglycaemia on the mobile app. We will use particle Markov chain Monte Carlo optimization to identify the optimal threshold and duration of SDH that have optimum sensitivity and specificity for detecting patient‐reported hypoglycaemia. Key secondary objectives include measuring the impact of symptomatic and asymptomatic SDH on daily functioning and health economic outcomes. The protocol was approved by local ethical boards in all participating centres. Study results will be shared with participants, in peer‐reviewed journal publications and conference presentations.
Publisher: Wiley
Date: 16-01-2022
DOI: 10.1111/DME.14772
Abstract: Women with prior gestational diabetes have nearly 10 times the risk of developing type 2 diabetes. Postpartum screening for type 2 diabetes is recommended for early diagnosis and management, yet uptake is low. This work updates a previous systematic review and advances it through the application of the Theoretical Domains Framework (TDF) to synthesise personal‐level factors impacting type 2 diabetes screening and the Capability, Opportunity, Motivation‐Behaviour model (COM‐B), to develop messaging recommendations for use in clinical practice and screening promotion interventions. We searched seven academic databases from September 2017 (prior review) to April 2021, reference lists and grey literature. Two reviewers independently screened articles against inclusion criteria (qualitative studies exploring factors impacting postpartum diabetes screening, any language) and extracted data. Using an inductive‐deductive model, we coded determinants to the TDF and mapped onto the COM‐B model. We identified 38 eligible papers from 34 studies ( N = 1291 participants). Most (71%) reported s le sizes of N ≥ 16. The ratio of barriers to enablers was three to one. Eight key TDF domains were identified. Evidence‐based recommendations include addressing knowledge, risk perception, fear of diabetes diagnosis, low prioritisation of personal health and fatalism. The risk of bias was low and confidence in findings was moderate to high. A limitation was conceptual overlap between TDF domains, which we addressed via the study procedure. The theoretical categorisation of determinants enables the development of messaging and interventions at the personal level, to promote women's uptake of postpartum type 2 diabetes screening.
Publisher: Wiley
Date: 04-09-2015
DOI: 10.1111/DOM.12528
Abstract: To test the hypothesis that a 'basal plus' regimen--adding once-daily main-meal fast-acting insulin to basal insulin once daily--would be non-inferior to biphasic insulin twice daily as assessed by glycated haemoglobin (HbA1c) concentration (predefined as ≤0.4%), but would provide superior treatment satisfaction. This open-label trial enrolled adults to an 8- or 12-week run-in period, during which oral therapies except metformin were stopped and insulin glargine dose was titrated. Those with fasting glucose 7% (53 mmol/mol) were randomized to insulin glargine/glulisine once daily (n = 170) or insulin aspart/aspart protamine 30/70 twice daily (n = 165) for 24 weeks, with dose titration to glucose targets using standardized algorithms. For HbA1c, the basal plus regimen was non-inferior to biphasic insulin (least squares mean difference, 0.21%, upper 97.5% confidence limit 0.38%) meeting the predefined non-inferiority margin of 0.4%. Treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire change version and Insulin Treatment Satisfaction Questionnaire total scores) significantly favoured basal plus. No difference was observed between the basal plus and the biphasic insulin groups in responders (HbA1c <7%, 20.6 vs 27.9% p = 0.12), weight gain (2.06 vs 2.50 kg p = 0.2), diabetes-specific quality of life (Audit of Diabetes-Dependent Quality of Life average weighted impact (AWI) score) and generic health status (five-dimension European Quality of Life questionnaire). Overall hypoglycaemia rates were similar between groups (15.3 vs 18.2 events atient-year p = 0.22) nocturnal hypoglycaemia was higher with the basal plus regimen (5.7 vs 3.6 events atient-year p = 0.02). In long-standing type 2 diabetes with suboptimal glycaemia despite oral therapies and basal insulin, the basal plus regimen was non-inferior to biphasic insulin for biomedical outcomes, with a similar overall hypoglycaemia rate but more nocturnal events.
Publisher: Springer Science and Business Media LLC
Date: 09-2010
Publisher: Wiley
Date: 27-07-2023
DOI: 10.1111/DME.15186
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.MARPOLBUL.2017.07.010
Abstract: An increasing number of studies highlight the risk of plastic pollution in the marine environment. However, systematic longitudinal data on the distribution and abundance of plastic debris remain sparse. Here we present the results of a two-year study of plastic pollution within the Tasman Sea, contrasted with a further year of data from the same region, in order to document how the density of debris varies across years in this area. Surface net tows were collected between Hobart, Tasmania and Sydney, Australia during the spring of 2013 and 2014 and compared with a subset of data from autumn 2012 from the same region. Substantial inter-annual variation in mean plastic abundance was observed over the three year period, ranging from to 248.04-3711.64pieceskm
Publisher: JMIR Publications Inc.
Date: 23-02-2020
DOI: 10.2196/15007
Abstract: Health professionals have expressed unmet needs, including lacking the skills, confidence, training, and resources needed to properly attend to the psychological needs of people with diabetes. Informed by needs assessments, this study aimed to develop practical, evidence-based resources to support health professionals to address the emotional needs of adults with type 1 or type 2 diabetes. We developed a new handbook and toolkit informed by formative evaluation, including literature reviews, stakeholder consultation and review, and a qualitative study. In the qualitative study, health professionals participated in interviews after reading sections of the handbook and toolkit. The literature review uncovered that psychological problems are common among adults with diabetes, but health professionals lack resources to provide related support. We planned and drafted resources to fill this unmet need, guided by stakeholder consultation and an Expert Reference Group (ERG). Before finalizing the resources, we implemented feedback received from stakeholders (ERG, health professionals, academics, and people with diabetes). The resulting resources were the practical, evidence-based Diabetes and Emotional Health handbook and toolkit. A total of 19 health professionals took part in the qualitative study about the handbook and toolkit. They viewed the resources favorably, felt empowered to support people with diabetes experiencing psychological problems, and felt motivated to share the resources with others. Some gave ex les of how they had used the handbook in clinical practice. A perceived highlight was the inclusion of a process model outlining 7 steps for identifying and supporting people with emotional problems: the 7 A’s model. With funding from the National Diabetes Services Scheme (NDSS), more than 2400 copies of Diabetes and Emotional Health have been distributed. It is freely available on the Web. The NDSS is an initiative of the Australian Government administered with the assistance of Diabetes Australia. The new evidence-based resources are perceived by stakeholders as effective aids to assist health professionals in providing emotional support to adults with diabetes. The 7 A’s model may have clinical utility for routine monitoring of other psychological and health-related problems, as part of person-centered clinical care.
Publisher: Elsevier BV
Date: 11-2008
Publisher: Wiley
Date: 05-02-2021
DOI: 10.1111/DME.14524
Abstract: To compare the acceptability, reliability and validity of five contemporary diabetes‐specific quality of life (QoL) scales among adults with type 1 diabetes in the United Kingdom and Australia. Adults with type 1 diabetes (UK = 1139, Australia = 439) completed a cross‐sectional, online survey including ADDQoL‐19, DCP, DIDP, DSQOLS and Diabetes QoL‐Q, presented in randomised order. After completing each scale, participants rated it for clarity, relevance, ease of completion, length and comprehensiveness. We examined scale acceptability (scale completion and user ratings), response patterns, structure (exploratory and confirmatory factor analyses) and validity (convergent, concurrent, ergent and known groups). To assess cross‐country reproducibility, analyses conducted on the UK dataset were replicated in the Australian dataset. Findings were largely consistent between countries. All scales were acceptable to participants: ≥90% completing all items, and ≥80% positive user ratings, except for DSQOLS’ length. Scale structure was not supported for the DCP. Overall, in terms of acceptability and psychometric evaluation, the DIDP was the strongest performing scale while the ADDQoL‐19 and Diabetes QoL‐Q scales also performed well. These findings suggest that the recently developed brief (7 items), neutrally worded DIDP scale is acceptable to adults with type 1 diabetes and has the strongest psychometric performance. However, questionnaire selection should always be considered in the context of the research aims, study design and population, as well as the wider published evidence regarding both the development and responsiveness of the scales.
Publisher: Wiley
Date: 30-05-2013
DOI: 10.1111/DME.12227
Abstract: To determine the barriers to and enablers of engaging with specialist diabetes care and the service requirements of young adults with Type 1 diabetes mellitus from a low socio-economic, multicultural region. A cross-sectional survey targeted 357 young adults with Type 1 diabetes, aged 18-30 years. Participants completed questions about barriers/enablers to accessing diabetes care and service preferences, self-reported HbA(1c), plus measures of diabetes-related distress (Problem Areas in Diabetes), depression/anxiety (Hospital Anxiety and Depression Scale), and illness perceptions (Brief Illness Perceptions Questionnaire). Eighty-six (24%) responses were received [55 (64%) female mean ± sd age 24 ± 4 years diabetes duration 12 ± 7 years HbA(1c) 68 ± 16 mmol/mol (8.4 ± 1.5%)]. Logistical barriers to attending diabetes care were reported for ex le, time constraints (30%), transportation (26%) and cost (21%). However, 'a previous unsatisfactory diabetes health experience' was cited as a barrier by 27%. Enablers were largely matched to overcoming these barriers. Over 90% preferred a multidisciplinary team environment, close to home, with after-hours appointment times. Forty per cent reported severe diabetes-related distress, 19% reported moderate-to-severe depressive symptoms and 50% reported moderate-to-severe anxiety. Among these young adults with Type 1 diabetes, glycaemic control was suboptimal and emotional distress common. They had identifiable logistical barriers to accessing and maintaining contact with diabetes care services, which can be addressed with flexible service provision. A substantial minority were discouraged by previous unsatisfactory experiences, suggesting health providers need to improve their interactions with young adults. This research will inform the design of life-stage-appropriate diabetes services targeting optimal engagement, access, attendance and ultimately improved healthcare outcomes in this vulnerable population.
Publisher: BMJ
Date: 09-2021
DOI: 10.1136/BMJOPEN-2020-045853
Abstract: To develop a theory and evidence-based web intervention to reduce psychological barriers towards insulin therapy among adults with non-insulin-treated type 2 diabetes (T2D). Salient psychological barriers towards insulin were identified from the literature and classified using the Theoretical Domains Framework (TDF). Relevant TDF domains were mapped to evidence-based behaviour change techniques (BCTs), which informed the content for each barrier. Acceptability was explored using cognitive debriefing interviews (n=6 adults with T2D). ‘Is Insulin Right for Me’ addresses eight barriers, phrased as common questions: Does insulin mean my diabetes is more serious? Do insulin injections cause complications? Is it my fault I need to inject insulin? Will I gain weight? Will injecting hurt? What about hypos? Will injecting insulin be a burden? What will others think of me? BCTs, including persuasive communication and modelling/demonstration, were delivered using appropriate methods (eg, demonstration of the injection process). Participant suggestions for improvement included clear and direct messages, normalising insulin and avoiding confronting images. ‘Is Insulin Right for Me’ is the first theory and evidence-based, web intervention designed to reduce psychological barriers towards insulin therapy for adults with T2D. Evaluation is needed to determine its impact on negative appraisals and receptiveness towards insulin.
Publisher: Mary Ann Liebert Inc
Date: 12-2016
Abstract: The use of mobile applications ("apps") for diabetes management is a rapidly developing area and has relevance to adolescents who tend to be early technology adopters. Apps may be useful for supporting self-management or connecting young people with type 1 diabetes (T1D) with their peers. However, outside controlled trials testing the effectiveness of apps, little is known about app usage in this population. Our aim was to explore app usage among adolescents with T1D. Diabetes MILES Youth-Australia is a national, online cross-sectional survey focused on behavioral and psychosocial aspects relevant to adolescents with T1D. Associations between app usage and demographic, clinical, and psychosocial variables were analyzed using logistic regression. In total, 425 adolescents with T1D responded to the app questions (mean age, 16 ± 2 years 62% female diabetes duration 7 ± 4 years). Overall, 21% (n = 87) indicated that they used an app for diabetes management. Of these, 89% (n = 77) reported carbohydrate counting as the most common purpose. Of those not using apps, 44% (n = 149) indicated that this was due either to no awareness of suitable apps or a belief that apps could not help. App usage was associated significantly with shorter T1D duration, higher socioeconomic status, and at least seven daily blood glucose checks. Only one in five respondents were using apps to support their diabetes management most apps used were not diabetes specific. App users can be characterized as having a more recent T1D diagnosis, checking blood glucose more frequently, and being from a middle-to-high socioeconomic background.
Publisher: BMJ
Date: 03-2021
DOI: 10.1136/BMJOPEN-2020-044888
Abstract: Type 2 diabetes is a global health priority. People with diabetes are more likely to experience mental health problems relative to people without diabetes. Diabetes guidelines recommend assessment of depression and diabetes distress during diabetes care. This systematic review will examine the effect of routinely assessing and addressing depression and diabetes distress using patient-reported outcome measures in improving outcomes among adults with type 2 diabetes. MEDLINE, Embase, CINAHL Complete, PsycInfo, The Cochrane Library and Cochrane Central Register of Controlled Trials will be searched using a prespecified strategy using a prespecified Population, Intervention, Comparator, Outcomes, Setting and study design strategy. The date range of the search of all databases will be from inception to 3 August 2020. Randomised controlled trials, interrupted time-series studies, prospective and retrospective cohort studies, case–control studies and analytical cross-sectional studies published in peer-reviewed journals in the English language will be included. Two review authors will independently screen abstracts and full texts with disagreements resolved by a third reviewer, if required, using Covidence software. Two reviewers will undertake risk of bias assessment using checklists appropriate to study design. Data will be extracted using prespecified template. A narrative synthesis will be conducted, with a meta-analysis, if appropriate. Ethics approval is not required for this review of published studies. Presentation of results will follow the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidance. Findings will be disseminated via peer-reviewed publication and conference presentations. CRD42020200246.
Publisher: JMIR Publications Inc.
Date: 17-07-2020
DOI: 10.2196/16692
Abstract: Diabetes self-management apps have the potential to improve self-management in people with type 2 diabetes (T2D). Although efficacy trials provide evidence of health benefits, premature disengagement from apps is common. Therefore, it is important to understand the factors that influence engagement in real-world settings. This study aims to explore users’ real-world experiences with the My Diabetes Coach (MDC) self-management app. We conducted telephone-based interviews with participants who had accessed the MDC self-management app via their smartphone for up to 12 months. Interviews focused on user characteristics the context within which the app was used barriers and facilitators of app use and the design, content, and delivery of support within the app. A total of 19 adults with T2D (8/19, 42% women mean age 60, SD 14 years) were interviewed. Of the 19 interviewees, 8 (42%) had T2D for years, 42% (n=8) had T2D for 5-10 years, and 16% (n=3) had T2D for years. In total, 2 themes were constructed from interview data: (1) the moderating effect of diabetes self-management styles on needs, preferences, and expectations and (2) factors influencing users’ engagement with the app: one size does not fit all. User characteristics, the context of use, and features of the app interact and influence engagement. Promoting engagement is vital if diabetes self-management apps are to become a useful complement to clinical care in supporting optimal self-management. Australia New Zealand Clinical Trials Registry CTRN126140012296 URL www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366925& isReview=true
Publisher: Elsevier BV
Date: 11-2008
Publisher: Frontiers Media SA
Date: 29-03-2019
Publisher: Wiley
Date: 02-03-2023
DOI: 10.1111/DME.15071
Abstract: To summarize and critically appraise evidence regarding the effectiveness of educational and/or behavioural interventions in reducing fear of hypoglycaemia among adults with type 1 diabetes. Systematic searches of medical and psychology databases were conducted. Risk‐of‐bias was assessed using the Joanna Briggs Institute Critical Appraisal Tools. Data were synthesized using random‐effects meta‐analyses for randomized controlled trials (RCTs) and narrative synthesis for observational studies. Five RCTs ( N = 682) and seven observational studies ( N = 1519) met the inclusion criteria, reporting on behavioural, structured education and cognitive‐behavioural therapy (CBT) interventions. Most studies assessed fear of hypoglycaemia using the Hypoglycaemia Fear Survey Worry (HFS‐W) and Behaviour (HFS‐B) subscales. Mean fear of hypoglycaemia at baseline was relatively low across studies. Meta‐analyses showed a significant effect of interventions on HFS‐W (SMD = −0.17, p = 0.032) but not on HFS‐B scores (SMD = −0.34, p = 0.113). Across RCTs, Blood Glucose Awareness Training (BGAT) had the largest effect on HFS‐W and HFS‐B scores, and one CBT‐based program was as effective as BGAT in reducing HFS‐B scores. Observational studies showed that Dose Adjustment for Normal Eating (DAFNE) was associated with significant fear of hypoglycaemia reductions. Current evidence suggests that educational and behavioural interventions can reduce fear of hypoglycaemia. However, no study to date has examined these interventions among people with high fear of hypoglycaemia.
Publisher: Wiley
Date: 23-08-2023
DOI: 10.1111/DME.15195
Abstract: To examine the psychometric properties of the Diabetes Management Experiences Questionnaire (DME‐Q). Adapted from the validated Glucose Monitoring Experiences Questionnaire, the DME‐Q captures satisfaction with diabetes management irrespective of treatment modalities. The DME‐Q was completed by adults with type 1 diabetes as part of a randomized controlled trial comparing hybrid closed loop (HCL) to standard therapy. Most psychometric properties were examined with pre‐randomization data ( n = 149) responsiveness was examined using baseline and 26‐week follow‐up data ( n = 120). Pre‐randomization, participants' mean age was 44 ± 12 years, 52% were women. HbA1c was 61 ± 11 mmol/mol (7.8 ± 1.0%), diabetes duration was 24 ± 12 years and 47% used an insulin pump prior to the trial. A forced three‐factor analysis revealed three expected domains, that is, ‘Convenience’, ‘Effectiveness’ and ‘Intrusiveness’, and a forced one‐factor solution was also satisfactory. Internal consistency reliability was strong for the three subscales ( range = 0.74–0.84) and ‘Total satisfaction’ = 0.85). Convergent validity was demonstrated with moderate correlations between DME‐Q ‘Total satisfaction’ and diabetes distress (PAID: r s = −0.57) and treatment satisfaction (DTSQ r s = 0.58). Divergent validity was demonstrated with a weak correlation with prospective/retrospective memory (PRMQ: r s = −0.16 and − 0.13 respectively). Responsiveness was demonstrated, as participants randomized to HCL had higher ‘Effectiveness’ and ‘Total satisfaction’ scores than those randomized to standard therapy. The 22‐item DME‐Q is a brief, acceptable, reliable measure with satisfactory structural and construct validity, which is responsive to intervention. The DME‐Q is likely to be useful for evaluation of new pharmaceutical agents and technologies in research and clinical settings.
Publisher: Springer Science and Business Media LLC
Date: 27-02-2013
Publisher: Springer Science and Business Media LLC
Date: 31-05-2018
Publisher: American Diabetes Association
Date: 13-11-2013
DOI: 10.2337/DC13-1004
Abstract: Impaired awareness of hypoglycemia (IAH) and defective counterregulation significantly increase severe hypoglycemia risk in type 1 diabetes (T1D). We evaluated restoration of IAH/defective counterregulation by a treatment strategy targeted at hypoglycemia avoidance in adults with T1D with IAH (Gold score ≥4) participating in the U.K.-based multicenter HypoCOMPaSS randomized controlled trial. Eighteen subjects with T1D and IAH (mean ± SD age 50 ± 9 years, T1D duration 35 ± 10 years, HbA1c 8.1 ± 1.0% [65 ± 10.9 mmol/mol]) underwent stepped hyperinsulinemic-hypoglycemic cl studies before and after a 6-month intervention. The intervention comprised the HypoCOMPaSS education tool in all and randomized allocation, in a 2 × 2 factorial study design, to multiple daily insulin analog injections or continuous subcutaneous insulin infusion therapy and conventional glucose monitoring or real-time continuous glucose monitoring. Symptoms, cognitive function, and counterregulatory hormones were measured at each glucose plateau (5.0, 3.8, 3.4, 2.8, and 2.4 mmol/L), with each step lasting 40 min with subjects kept blinded to their actual glucose value throughout cl studies. After intervention, glucose concentrations at which subjects first felt hypoglycemic increased (mean ± SE from 2.6 ± 0.1 to 3.1 ± 0.2 mmol/L, P = 0.02), and symptom and plasma metanephrine responses to hypoglycemia were higher (median area under curve for symptoms, 580 [interquartile range {IQR} 420–780] vs. 710 [460–1,260], P = 0.02 metanephrine, 2,412 [−3,026 to 7,279] vs. 5,180 [−771 to 11,513], P = 0.01). Glycemic threshold for deterioration of cognitive function measured by four-choice reaction time was unchanged, while the color-word Stroop test showed a degree of adaptation. Even in long-standing T1D, IAH and defective counterregulation may be improved by a clinical strategy aimed at hypoglycemia avoidance.
Publisher: JMIR Publications Inc.
Date: 02-09-2020
DOI: 10.2196/17785
Abstract: Managing type 2 diabetes (T2D) requires progressive lifestyle changes and, sometimes, pharmacological treatment intensification. General practitioners (GPs) are integral to this process but can find pharmacological treatment intensification challenging because of the complexity of continually emerging treatment options. This study aimed to use a co-design method to develop and pretest a clinical decision support (CDS) tool prototype (GlycASSIST) embedded within an electronic medical record, which uses evidence-based guidelines to provide GPs and people with T2D with recommendations for setting glycated hemoglobin (HbA1c) targets and intensifying treatment together in real time in consultations. The literature on T2D-related CDS tools informed the initial GlycASSIST design. A two-part co-design method was then used. Initial feedback was sought via interviews and focus groups with clinicians (4 GPs, 5 endocrinologists, and 3 diabetes educators) and 6 people with T2D. Following refinements, 8 GPs participated in mock consultations in which they had access to GlycASSIST. Six people with T2D viewed a similar mock consultation. Participants provided feedback on the functionality of GlycASSIST and its role in supporting shared decision making (SDM) and treatment intensification. Clinicians and people with T2D believed that GlycASSIST could support SDM (although this was not always observed in the mock consultations) and in idualized treatment intensification. They recommended that GlycASSIST includes less information while maintaining relevance and credibility and using graphs and colors to enhance visual appeal. Maintaining clinical autonomy was important to GPs, as they wanted the capacity to override GlycASSIST’s recommendations when appropriate. Clinicians requested easier screen navigation and greater prescribing guidance and capabilities. GlycASSIST was perceived to achieve its purpose of facilitating treatment intensification and was acceptable to people with T2D and GPs. The GlycASSIST prototype is being refined based on these findings to prepare for quantitative evaluation.
Publisher: JMIR Publications Inc.
Date: 31-10-2020
Abstract: utomated insulin delivery (AID) systems have been shown to be safe and effective in reducing hyperglycemia and hypoglycemia but are not universally available, accessible, or affordable. Therefore, user-driven open-source AID systems are becoming increasingly popular. his study aims to investigate the motivations for which people with diabetes (types 1, 2, and other) or their caregivers decide to build and use a personalized open-source AID. cross-sectional web-based survey was conducted to assess personal motivations and associated self-reported clinical outcomes. f 897 participants from 35 countries, 80.5% (722) were adults with diabetes and 19.5% (175) were caregivers of children with diabetes. Primary motivations to commence open-source AID included improving glycemic outcomes (476/509 adults, 93.5%, and 95/100 caregivers, 95%), reducing acute (443/508 adults, 87.2%, and 96/100 caregivers, 96%) and long-term (421/505 adults, 83.3%, and 91/100 caregivers, 91%) complication risk, interacting less frequently with diabetes technology (413/509 adults, 81.1% 86/100 caregivers, 86%), improving their or child’s sleep quality (364/508 adults, 71.6%, and 80/100 caregivers, 80%), increasing their or child’s life expectancy (381/507 adults, 75.1%, and 84/100 caregivers, 84%), lack of commercially available AID systems (359/507 adults, 70.8%, and 79/99 caregivers, 80%), and unachieved therapy goals with available therapy options (348/509 adults, 68.4%, and 69/100 caregivers, 69%). Improving their own sleep quality was an almost universal motivator for caregivers (94/100, 94%). Significant improvements, independent of age and gender, were observed in self-reported glycated hemoglobin (HbA sub c /sub ), 7.14% (SD 1.13% 54.5 mmol/mol, SD 12.4) to 6.24% (SD 0.64% 44.7 mmol/mol, SD 7.0 i P /i & .001), and time in range (62.96%, SD 16.18%, to 80.34%, SD 9.41% i P /i & .001). hese results highlight the unmet needs of people with diabetes, provide new insights into the evolving phenomenon of open-source AID technology, and indicate improved clinical outcomes. This study may inform health care professionals and policy makers about the opportunities provided by open-source AID systems. > R2-10.2196/15368
Publisher: American Diabetes Association
Date: 11-08-2016
DOI: 10.2337/DC16-0117
Abstract: To develop and validate a self-report measure of perceived and experienced stigma for use with adults with type 2 diabetes: the Type 2 Diabetes Stigma Assessment Scale (DSAS-2). An item pool was drafted based on qualitative data from 25 adults with type 2 diabetes and content from other health-related stigma questionnaires. Thirteen adults with type 2 diabetes completed 57 draft diabetes stigma items and participated in cognitive debriefing interviews. Based on participant feedback, the pool was reduced to 48 items with a 5-point Likert scale (strongly disagree to strongly agree). A total of 1,064 adults with type 2 diabetes completed a survey including these 48 items and other validated measures. Data were subject to principal components analysis and Spearman ρ correlations. The scale was reduced to 19 items, with an unforced three-factor solution indicative of three subscales: Treated Differently (6 items, α = 0.88), Blame and Judgment (7 items, α = 0.90), and Self-stigma (6 items, α = 0.90). A forced one-factor solution supported the calculation of a total score (α = 0.95). Satisfactory concurrent, convergent, and discriminant validity were demonstrated. The 19-item DSAS-2 is a reliable and valid measure of type 2 diabetes stigma. A rigorous design and validation process has resulted in a relatively brief measure of perceived and experienced stigma in type 2 diabetes. The novel scale has satisfactory psychometric properties and is now available to facilitate much-needed research in this field.
Publisher: Wiley
Date: 05-11-2014
DOI: 10.1111/DME.12598
Abstract: To compare the effectiveness and acceptability of self-monitoring of blood glucose with self-monitoring of urine glucose in adults with newly diagnosed Type 2 diabetes. We conducted a multi-site cluster randomized controlled trial with practice-level randomization. Participants attended a structured group education programme, which included a module on self-monitoring using blood glucose or urine glucose monitoring. HbA1c and other biomedical measures as well as psychosocial data were collected at 6, 12 and 18 months. A total of 292 participants with Type 2 diabetes were recruited from 75 practices. HbA1c levels were significantly lower at 18 months than at baseline in both the blood monitoring group [mean (se) -12 (2) mmol/mol -1.1 (0.2) %] and the urine monitoring group [mean (se) -13 (2) mmol/mol -1.2 (0.2)%], with no difference between groups [mean difference adjusted for cluster effect and baseline value = -1 mmol/mol (95% CI -3, 2) -0.1% (95% CI -0.3, 0.2)]. Similar improvements were observed for the other biomedical outcomes, with no differences between groups. Both groups showed improvements in total treatment satisfaction, generic well-being, and diabetes-specific well-being, and had a less threatening view of diabetes, with no differences between groups at 18 months. Approximately one in five participants in the urine monitoring arm switched to blood monitoring, while those in the blood monitoring arm rarely switched (18 vs 1% at 18 months P < 0.001). Participants with newly diagnosed Type 2 diabetes who attended structured education showed similar improvements in HbA1c levels at 18 months, regardless of whether they were assigned to blood or urine self-monitoring.
Publisher: American Physical Society (APS)
Date: 15-03-2021
Publisher: Cold Spring Harbor Laboratory
Date: 27-01-2023
DOI: 10.1101/2023.01.26.525742
Abstract: Existing phenotype ontologies were originally developed to represent phenotypes that manifest as a character state in relation to a wild-type or other reference. However, these do not include the phenotypic trait or attribute categories required for the annotation of genome-wide association studies (GWAS), Quantitative Trait Loci (QTL) mappings or any population-focused measurable trait data. Moreover, variations in gene expression in response to environmental disturbances even without any genetic alterations can also be associated with particular biological attributes. The integration of trait and biological attribute information with an ever increasing body of chemical, environmental and biological data greatly facilitates computational analyses and it is also highly relevant to biomedical and clinical applications. The Ontology of Biological Attributes (OBA) is a formalised, species-independent collection of interoperable phenotypic trait categories that is intended to fulfil a data integration role. OBA is a standardised representational framework for observable attributes that are characteristics of biological entities, organisms, or parts of organisms. OBA has a modular design which provides several benefits for users and data integrators, including an automated and meaningful classification of trait terms computed on the basis of logical inferences drawn from domain-specific ontologies for cells, anatomical and other relevant entities. The logical axioms in OBA also provide a previously missing bridge that can computationally link Mendelian phenotypes with GWAS and quantitative traits. The term components in OBA provide semantic links and enable knowledge and data integration across specialised research community boundaries, thereby breaking silos.
Publisher: American Diabetes Association
Date: 04-09-2020
DOI: 10.2337/DC19-0630
Abstract: The HypoCOMPaSS study was designed to test the hypothesis that successful avoidance of biochemical hypoglycemia without compromising overall glycemic control would restore sufficient hypoglycemia awareness to prevent recurrent severe hypoglycemia in the majority of participants with established type 1 diabetes. Before starting the study, we planned to investigate associations between baseline characteristics and recurrent severe hypoglycemia over 2 years’ follow-up. A total of 96 adults with type 1 diabetes and impaired awareness of hypoglycemia participated in a 24-week 2 × 2 factorial randomized controlled trial comparing insulin delivery and glucose monitoring modalities, with the goal of rigorous biochemical hypoglycemia avoidance. The analysis included 71 participants who had experienced severe hypoglycemia in the 12-month prestudy with confirmed absence (complete responder) or presence (incomplete responder) of severe hypoglycemia over 24 months’ follow-up. There were 43 (61%) complete responders and 28 (39%) incomplete responders experiencing mean ± SD 1.5 ± 1.0 severe hypoglycemia events erson-year. At 24 months, incomplete responders spent no more time with glucose ≤3 mmol/L (1.4 ± 2.1% vs. 3.0 ± 4.8% for complete responders P = 0.26), with lower total daily insulin dose (0.45 vs. 0.58 units/24 h P = 0.01) and greater impairment of hypoglycemia awareness (Clarke score: 3.8 ± 2.2 vs. 2.0 ± 1.9 P = 0.01). Baseline severe hypoglycemia rate (16.9 ± 16.3 vs. 6.4 ± 10.8 events erson-year P = 0.002) and fear of hypoglycemia were higher in incomplete responders. Peripheral neuropathy was more prevalent in incomplete responders (11 [39%] vs. 2 [4.7%] P & 0.001) with a trend toward increased autonomic neuropathy. Recurrent severe hypoglycemia was associated with higher preintervention severe hypoglycemia rate, fear of hypoglycemia, and concomitant neuropathy.
Publisher: Elsevier BV
Date: 04-2021
Publisher: Elsevier BV
Date: 09-2021
Publisher: AMPCo
Date: 10-2011
DOI: 10.5694/MJA11.10508
Publisher: American Diabetes Association
Date: 06-2019
DOI: 10.2337/DB19-102-LB
Abstract: Introduction: Reviewing rCGM patterns may prompt lifestyle or therapeutic changes to achieve glycaemic targets but evidence for rCGM use in primary care management of T2D is limited. Methods: Two-arm RCT. Participants: Adults with T2D, HbA1c ≥0.5% above target, prescribed ≥2 non-insulin glycemia medications or insulin. Intervention: 1-hour diabetes education and (at 0/3/6/9/12 months): HbA1c assessment + wearing FreeStyle Libre Pro (Abbott) for up to 14 days prior to being discussed at a clinic visit. Physicians were trained in interpreting ambulatory glucose profiles. Control: 3-monthly ‘usual care’ clinic visits + r-CGM device worn (blinded, research data) at 0 and 12 months. Primary outcome: difference in mean HbA1c at 12 months. Secondary outcomes: mean differences in time in range (TIR: 4-10 mmol/L) and diabetes-specific distress (PAID) at 12 months, and HbA1c at 6 months. ITT analysis. Results: In 25 primary care practices, participants were: 299 adults with T2D, aged (mean(SD)) 60(10) years, HbA1c: 8.9(1.2)%, diabetes duration (median(IQR)) of 12(8,20) years. At 12 months, the between-group difference in mean HbA1c was 0.2% (p=0.112). The estimated mean percentage TIR was 8.4% higher in the intervention than the control arm (p=0.004). Diabetes-specific distress did not differ between arms (0.5 p=0.71). At 6 months, HbA1c was significantly lower in the intervention arm (0.5% p& .001). We found little evidence of changes in the number of glycemic medications in either arm. Discussion: Use of 3-monthly rCGM in adults with T2D in primary care does not improve HbA1c at 12 months. We showed a statistically and clinically significant reduction in HbA1c at 6 months in the intervention group, as well as significant improvements in TIR at 12 months, with no change in diabetes distress. Our findings suggest the primary impact of r-CGM use on HbA1c in this setting is short term, and not associated with increase in the number of diabetes medications. J. Furler: Research Support Self Abbott, Sanofi. D.N. O’Neal: None. J. Speight: Research Support Self AstraZeneca, Medtronic, Sanofi. Speaker’s Bureau Self Novo Nordisk A/S, Roche Diabetes Care. J.E. Manski-Nankervis: Research Support Self Australian National Health and Medical Research Council, Boehringer Ingelheim International GmbH, Diabetes Australia, Eli Lilly and Company. Speaker’s Bureau Self RACGP. S. Thuraisingam: None. E. Holmes-Truscott: Research Support Self Sanofi. Speaker’s Bureau Self Novo Nordisk Inc. K.R. De La Rue: None. L.E. Ginnivan: None. R.C. Doyle: None. K. Khunti: Advisory Panel Self Amgen Inc., AstraZeneca, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. Consultant Self AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis, Servier, Takeda Pharmaceutical Company Limited. Research Support Self AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis. Speaker’s Bureau Self AstraZeneca, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Menarini Group, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi, Servier, Takeda Pharmaceutical Company Limited. M. Catchpool: None. K. Dalziel: None. J.I. Chiang: None. I. Blackberry: None. R. Audehm: Advisory Panel Self AstraZeneca, Novartis Pharmaceuticals Corporation. M. Kennedy: Advisory Panel Self AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novo Nordisk Inc., Sanofi. M.J. Clark: None. A.J. Jenkins: Advisory Panel Self Abbott, Australian Diabetes Society, Medtronic. Research Support Self Abbott, GlySens Incorporated, Medtronic, Mylan. Speaker’s Bureau Self Eli Lilly and Company, Novo Nordisk Inc. A.S. Januszewski: None. D. Liew: Advisory Panel Self AstraZeneca, Bayer AG. Research Support Self AbbVie Inc., AstraZeneca, Bristol-Myers Squibb Company, CSL Behring, Pfizer Inc. P.M. Clarke: None. J.D. Best: Consultant Self Abbott. National Health and Medical Research Council of Australia (APP1104241) Sanofi Australia Abbott Diabetes Care
Publisher: Elsevier BV
Date: 02-2018
Publisher: Wiley
Date: 25-09-2009
Publisher: Wiley
Date: 05-02-2019
DOI: 10.1111/DME.14199
Abstract: Optimal diabetes management requires daily selfmanagement. While little time is spent with health professionals, they can have a substantial impact on how a person manages and feels about living with diabetes. The aim of this qualitative study was to explore what people with diabetes wish their health professionals understood about living with diabetes. Thematic analysis was conducted of responses to a single open‐ended question, ‘What do you wish your health professional understood about living with diabetes?’, which was part of the Diabetes MILES‐2 survey, assessing the psychological and behavioural aspects of living with type 1 or type 2 diabetes in Australian adults. In total, 1316 responses (56% response rate) were collected, with 1190 responses included for analysis (54% from respondents with type 1 diabetes, 46% from those with type 2 diabetes). Seven major themes emerged respondents wished their health professional understood: 1) the potential barriers to diabetes management 2) that it is ‘easier said than done’ 3) the social/emotional impact 4) that they want, need and deserve more 5) that judgements, assumptions and negative perspective are not helpful 6) more about diabetes and 7) that the respondent is the expert in his/her diabetes. Other comments suggested satisfactory experiences with health professionals, highlighting that some respondents had no wish for their health professional to understand more. This study highlights that, although some adults with diabetes are satisfied with their health professionals’ understanding of living with diabetes, many report unmet needs and perceive a lack of person‐centred care from their health professionals.
Publisher: BMJ
Date: 15-01-2014
DOI: 10.1136/BMJ.G153
Publisher: Wiley
Date: 04-02-2020
DOI: 10.1111/DME.14196
Abstract: Over the past 25 years, there has been significant acknowledgement of the importance of assessing the impact of diabetes on quality of life. Yet, despite the development of several diabetes-specific quality of life measures, the challenges we faced in 1995 remain. There is little consensus on the definition of quality of life because of the complexity and subjectivity of the concept. General quality of life comprises several domains of life, and these are highly in idualized. Assessing the impact of diabetes on these life domains adds to the complexity. While comprehensive diabetes-specific quality-of-life measures typically increase respondent burden, brief questionnaires may not capture all relevant/important domains. Today, the lack of resolution of these challenges may explain why the impact of diabetes on quality of life is not systematically assessed in research or clinical care. Few researchers report detailed rationales for assessment, there is often a mismatch between the concept of interest and the measure selected, and data are misinterpreted as assessing the impact of diabetes on quality of life when, in reality, related but distinct constructs have been assessed, such as diabetes distress, treatment satisfaction or health status. While significant efforts are being made to increase routine monitoring of psychological well-being and understand the lived experience, no guidelines currently recommend routine clinical assessment of diabetes-specific quality of life, and there is no consensus on which questionnaire(s) to use. The gaps identified in this review need urgent attention, starting with recognition that assessment of diabetes-specific quality of life is as important as biomedical markers, if we are to improve the lives of people with diabetes.
Publisher: BMJ
Date: 08-03-2017
DOI: 10.1136/BMJ.J783
Publisher: American Diabetes Association
Date: 06-2022
DOI: 10.2337/DB22-583-P
Abstract: Background: Use of open-source automated insulin delivery (AID) is associated with improved psychosocial outcomes among people with type 1 diabetes (T1D) . However, research to date has been qualitative or used study-specific single items. There is a need for quantitative research using validated measures in larger s les. Method: We conducted an international online survey to examine the psychosocial outcomes of open-source AID users and non-users. Validated questionnaires assessed diabetes-specific quality of life (QoL) , impact of the COVID-pandemic on diabetes-specific QoL, diabetes specific-positive well-being, diabetes treatment satisfaction, diabetes distress, fear of hypoglycaemia, general emotional well-being, and subjective sleep quality. Results: 587 participants completed at least one questionnaire, including 447 adults using open-source AID (mean age 43, 42% women) and 140 non-users (mean age 40, 64% women) . Table 1 shows significant between-group differences for all questionnaire scores. Discussion: Adults with T1D using open-source AID report significantly better psychosocial outcomes than non-users. Due to the cross-sectional design of this study, we cannot make any causal inferences about the use of these devices. Further research is needed to examine the reasons for these differences. J.Schipp: None. T.C.Skinner: None. J.Speight: Advisory Panel Insulet Corporation, Research Support Novo Nordisk, Sanofi. C.Hendrieckx: None. K.Braune: None. S.O'donnell: None. H.Ballhausen: None. B.Cleal: None. M.Wäldchen: None. C.Knoll: None. K.A.Gajewska: None. European Commission Horizon 2020 (823902)
Publisher: Informa UK Limited
Date: 08-04-2021
Publisher: Wiley
Date: 12-09-2014
DOI: 10.1111/DME.12566
Abstract: Young adults with Type 2 diabetes have higher physical morbidity and mortality than other diabetes sub-groups, but differences in psychosocial outcomes have not yet been investigated. We sought to compare depression and anxiety symptoms and self-care behaviours of young adults with Type 2 diabetes with two matched control groups. Using cross-sectional survey data from the Australian and Dutch Diabetes Management and Impact for Long-term Empowerment and Success (MILES) studies, we matched 93 young adults (aged 18-39 years) with Type 2 diabetes (case group) with: (i) 93 older adults ( ≥ 40 years) with Type 2 diabetes (Type 2 diabetes control group matched on country, gender, education, diabetes duration and insulin use) and (ii) 93 young adults with Type 1 diabetes (Type 1 diabetes control group matched on country, gender, age and education). Groups were compared with regard to depression symptoms (nine-item Patient Health Questionnaire), anxiety symptoms (seven-item Generalised Anxiety Disorder questionnaire) and frequency of selected self-care behaviours (single item per behaviour). Participants in the case group had higher depression scores (Cohen's d = 0.40) and were more likely to have clinically meaningful depressive symptoms (Cramer's V = 0.23) than those in the Type 2 diabetes control group. Participants in the case group had statistically equivalent depression scores to the Type 1 diabetes control group. The groups did not differ in anxiety scores. Those in the case group were less likely than both control groups to take insulin as recommended (Cramer's V = 0.24-0.34), but there were no significant differences between the groups in oral medication-taking. The case group were less likely than the Type 2 diabetes control group to eat healthily (Cramer's V = 0.16), and less likely than the Type 1 diabetes control group to be physically active (Cramer's V = 0.15). Our results suggest that Type 2 diabetes is as challenging as Type 1 diabetes for young adults and more so than for older adults. Young adults with Type 2 diabetes may require more intensive psychological and self-care support than their older counterparts.
Publisher: Wiley
Date: 27-11-2021
DOI: 10.1111/DME.14747
Abstract: To assess the cost‐effectiveness of professional‐mode flash glucose monitoring in adults with type 2 diabetes in general practice compared with usual clinical care. An economic evaluation was conducted as a component of the GP‐OSMOTIC trial, a pragmatic multicentre 12‐month randomised controlled trial enrolling 299 adults with type 2 diabetes in Victoria, Australia. The economic evaluation was conducted from an Australian healthcare sector perspective with a lifetime horizon. Health‐related quality of life (EQ‐5D) and total healthcare costs were compared between the intervention and the usual care group within the trial period. The 'UKPDS Outcomes Model 2' was used to simulate post‐trial lifetime costs, life expectancy and quality‐adjusted life years (QALYs). No significant difference in health‐related quality of life and costs was found between the two groups within the trial period. Professional‐mode flash glucose monitoring yielded greater QALYs (0.03 [95% CI: 0.02, 0.04]) and a higher cost (A$3807 [95% CI: 3604, 4007]) compared with usual clinical care using a lifetime horizon under the trial‐based monitoring frequency, considered not cost‐effective (incremental cost‐effectiveness ratio = A$120,228). The intervention becomes cost‐effective if sensor price is reduced to lower than 50%, or monitoring frequency is decreased to once per year while maintaining the same treatment effect on HbA 1c . Including professional‐mode flash glucose monitoring every 3 months as part of a management plan for people with type 2 diabetes in general practice is not cost‐effective, but could be if the sensor price or monitoring frequency can be reduced.
Publisher: Springer Science and Business Media LLC
Date: 14-06-2015
DOI: 10.1007/S10865-015-9649-Y
Abstract: Few studies have identified determinants of glycemic control (HbA1c) and diabetes-specific quality of life (DSQoL) in adults with type 1 diabetes. To identify factors predicting outcomes following structured diabetes education. 262 participants completed biomedical and questionnaire assessments before, and throughout 1 year of follow-up. The proportion of variance explained ranged from 28 to 62 % (DSQoLS) and 14-20 % (HbA1c). When change in psychosocial variables were examined, reduced hypoglycemia fear, lower 'perceived diabetes seriousness', greater self-efficacy and well-being predicted QoL improvements from baseline to 3-months. Increased frequency of blood glucose testing predicted improvements in HbA1c from baseline to 6-months. Greater benefits may be achieved if programs focus explicitly on psychosocial factors. Self-care behaviours did not predict HbA1c suggesting existing assessment tools need refinement. Evaluation of treatment mechanisms in self-management programs is recommended.
Publisher: SAGE Publications
Date: 2014
Abstract: Severe hypoglycaemia affects approximately one in three people with type 1 diabetes and is the most serious side effect of insulin therapy. Our aim was to explore in idualistic drivers of severe hypoglycaemia events. In-depth semi-structured interviews were conducted with a purposive s le of 17 adults with type 1 diabetes and a history of recurrent severe hypoglycaemia, to elicit experiences of hypoglycaemia (symptoms/awareness, progression from mild to severe and strategies for prevention/treatment). Interviews were analysed using an adapted grounded theory approach. Three main themes emerged: hypoglycaemia-induced cognitive impairment, behavioural factors and psychological factors. Despite experiencing early hypoglycaemic symptoms, in iduals often delayed intervention due to impaired/distracted attention, inaccurate risk assessment, embarrassment, worry about rebound hyperglycaemia or unavailability of preferred glucose source. Delay coupled with use of a slow-acting glucose source compromised prevention of severe hypoglycaemia. Our qualitative data highlight the multifaceted, idiosyncratic nature of severe hypoglycaemia and confirm that in iduals with a history of recurrent severe hypoglycaemia may have specific thought and behaviour risk profiles. In idualised prevention plans are required, emphasising both the need to attend actively to mild hypoglycaemic symptoms and to intervene promptly with an appropriate, patient-preferred glucose source to prevent progression to severe hypoglycaemia.
Publisher: Wiley
Date: 03-2014
DOI: 10.1002/DMRR.2492
Abstract: Hypoglycaemia remains an over-riding factor limiting optimal glycaemic control in type 1 diabetes. Severe hypoglycaemia is prevalent in almost half of those with long-duration diabetes and is one of the most feared diabetes-related complications. In this review, we present an overview of the increasing body of literature seeking to elucidate the underlying pathophysiology of severe hypoglycaemia and the limited evidence behind the strategies employed to prevent episodes. Drivers of severe hypoglycaemia including impaired counter-regulation, hypoglycaemia-associated autonomic failure, psychosocial and behavioural factors and neuroimaging correlates are discussed. Treatment strategies encompassing structured education, insulin analogue regimens, continuous subcutaneous insulin infusion pumps, continuous glucose sensing and beta-cell replacement therapies have been employed, yet there is little randomized controlled trial evidence demonstrating effectiveness of new technologies in reducing severe hypoglycaemia. Optimally designed interventional trials evaluating these existing technologies and using modern methods of teaching patients flexible insulin use within structured education programmes with the specific goal of preventing severe hypoglycaemia are required. In iduals at high risk need to be monitored with meticulous collection of data on awareness, as well as frequency and severity of all hypoglycaemic episodes.
Publisher: Hindawi Limited
Date: 23-01-2022
DOI: 10.1111/PEDI.13308
Abstract: This systematic review aims to summarize and critically evaluate the current evidence regarding the impact of hypoglycaemia in children and adolescents with type 1 diabetes on parental quality of life. MEDLINE, PsycINFO, CINAHL, and the Cochrane Library were searched. Inclusion criteria were: 1) quantitative design, 2) included parents of children or adolescents with type 1 diabetes, 3) assessment of hypoglycemia in children/adolescents with type 1 diabetes, 4) assessment of parent quality of life (or related domains of life), and 5) analysis of the relationship(s) between the child's hypoglycaemia and parents' quality of life. The data were summarised in accordance with Synthesis Without Meta-Analysis Guidelines. Twelve studies were included, reporting data from 1895 parents across six countries. Ten studies were cross-sectional two included prospective data. Evidence suggested that greater frequency and severity of hypoglycemia was associated with greater parental fear of hypoglycemia, emotional distress and family burden. Children's hypoglycaemia has a negative impact on the well-being of parents, but there is an absence of evidence regarding the impact on their overall quality of life. Research into the hypoglycaemia-specific quality of life of parents is needed to explore the impact on various areas, such as social and physical dimensions.
Publisher: Elsevier BV
Date: 04-2016
DOI: 10.1016/J.DIABRES.2015.12.011
Abstract: To determine 'hypothetical willingness' to initiate insulin, and identify associated factors, among adults with type 2 diabetes (T2DM) in primary care for whom insulin is clinically indicated. Eligible participants were adults with T2DM with an HbA1c ≥7.5% (58mmol/mol) and prescribed maximum oral hypoglycaemic agents. A total of 261 participants were recruited from 74 Victorian general practices: mean age 62±10 years 39% (n=103) women diabetes duration 10±6 years HbA1c 9.0±1.3% (75±14mmol/mol). Data collected by the Stepping Up Study: demographic and clinical characteristics, 'willingness' to initiate insulin, insulin appraisals, depressive symptoms, and diabetes-related distress. A multinomial regression investigated predictors of 'willingness'. Nineteen percent (n=50) were 'very willing' to initiate insulin, if recommended. The final regression model (R(2)=.44, χ(2)(12) 145.91, p<.001) demonstrated higher socioeconomic status and less negative attitudes to insulin were associated with increased willingness to initiate insulin. Among adults with T2DM for whom insulin is clinically indicated, only one in five are 'very willing' to begin insulin therapy. Independent of demographics, clinical factors and emotional wellbeing, insulin appraisals were associated with 'willingness'. This study highlights the importance of addressing attitudinal barriers to insulin therapy among adults with T2DM in primary care to improve insulin receptiveness.
Publisher: Wiley
Date: 08-2001
DOI: 10.1046/J.1464-5491.2001.00537.X
Abstract: To present the ADKnowl measure of diabetes-related knowledge and evaluate its use in identifying the nature and extent of patient and health professional knowledge deficits. The ADKnowl was used in a large-scale study of 789 patients (451 treated with insulin and 338 treated with tablets and/or diet) attending for annual review at one of two hospital out-patient diabetes clinics Knowledge deficits were apparent in the patients. For ex le, 57% did not recognize the inaccuracy of the statement 'fresh fruit can be eaten freely with little effect on blood glucose levels'. Seventy-five percent of patients did not know that it is advisable to trim toenails to the shape of the toe. Knowledge deficits were identified for many other areas of diabetes management, e.g. prevention of hypoglycaemia, avoidance of ketoacidosis. Sixteen health professionals at the clinics answered the same items. Contrary to recommendations, 25% of health professionals thought that fresh fruit could be eaten freely. Seventy-five percent of health professionals did not know the current recommendations for trimming toenails. As expected, HbA1c did correlate with scores from two specific items, while HbA1c did not correlate with summed ADKnowl score. Patient knowledge deficits were identified. Some specific knowledge deficits among health professionals may be the cause of some patient knowledge deficits. The ADKnowl is a useful tool in assessing both patient and health professional knowledge deficits and is available for use in a context of continuing evaluation.
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.DIABRES.2017.07.005
Abstract: Screening for depression is recommended internationally. The World Health Organization's 5-item Well-being Index (WHO-5) is used clinically to screen for depression but its empirical suitability for this purpose is not well documented. We investigated the psychometric properties of the WHO-5 and its suitability for identifying likely depression in Australian adults with diabetes. The Diabetes MILES - Australia study dataset provided a s le of N=3249 who completed the WHO-5 (positively-worded 5-item measure of emotional well-being) and the PHQ-9 (9-item measure of depressive symptoms). Analyses were conducted for the full s le, and separately by diabetes type and treatment (type 1, non-insulin-treated type 2, and insulin-treated type 2 diabetes). Construct (convergent and factorial) validity and reliability of the WHO-5 were examined. ROC analyses were used to examine the sensitivity and specificity of the WHO-5 as a depression screening instrument, comparing two commonly used WHO-5 cut-off values (≤7 and <13) with the PHQ-9. For the whole s le, the WHO-5 demonstrated satisfactory internal consistency reliability (α=0.90) and convergent validity with the PHQ-9 (r=-0.73, p<0.001). Confirmatory factor analysis partially supported factorial validity: Χ These findings support use of a WHO-5 cut-point of <13 to identify likely depression in Australian adults with diabetes, regardless of type/treatment.
Publisher: American Diabetes Association
Date: 06-2021
DOI: 10.2337/DB22-233-OR
Abstract: Aim: To examine how hypoglycemia while asleep impacts self-reported daily functioning among adults with type 1 diabetes (T1D) . Methods: On 70 consecutive mornings, 250 people with T1D wearing a continuous glucose monitor reported sleep quality, mood, and alertness via the Hypo-METRICS smartphone app. Each night was categorized based on presence (+) or absence (-) of person-reported hypoglycemia (PRH) and sensor-detected hypoglycemia (SDH) into one of four types (see Figure 1, Type A-D) . Multilevel regression assessed associations between hypoglycemia and daily functioning (unstandardized coefficients (β) on original 0-scale) , adjusted for baseline demographic, clinical and psychological factors. Results: In the first 54 adults (52% women, age[M±SD]: 45±15 years) , nighttime PRH (Type C & D, Figure 1) was associated with reduced subjective sleep quality (C: β=-0.67 D: β=-0.58) , mood (C: β=-0.43 D: β=-0.58) and alertness (C: β=-0.34, p=0.015 D: β=-0.46) (all p& .0unless specified) compared to nights without hypoglycemia (Type A) . Nights with SDH only (Type B) showed no significant reductions in sleep, mood or alertness (p& .05) . Conclusion: These novel data show the potentially pivotal role of the subjective experience of hypoglycemia for sleep quality, mood and alertness. U.Soeholm: Research Support Novo Nordisk A/S. E.Renard: Consultant Abbott, AstraZeneca, Boehringer Ingelheim International GmbH, Dexcom, Inc., Insulet Corporation, LifeScan, Lilly, Novo Nordisk, Roche Diabetes Care, Sanofi, Tandem Diabetes Care, Inc. E.J.Abbink: None. P.M.Baumann: None. S.R.Heller: Advisory Panel Eli Lilly and Company, Medtronic, Mylan N.V., Zealand Pharma A/S, Zucara Therapeutics, Other Relationship Eli Lilly and Company, Research Support Dexcom, Inc., Speaker's Bureau Novo Nordisk A/S. B.E.De galan: Research Support Novo Nordisk. U.Pedersen-bjergaard: Advisory Panel Novo Nordisk A/S, Sanofi. M.Evans: Advisory Panel Pila Pharma, Zucara Therapeutics, Other Relationship Abbott Diabetes, Dexcom, Inc., Medtronic, Novo Nordisk, Research Support AstraZeneca, Sanofi, Speaker's Bureau Lilly Diabetes. D.Pollard: Other Relationship Novo Nordisk. R.J.Mccrimmon: Advisory Panel Novo Nordisk, Sanofi, Research Support Diabetes UK, European Union, MedImmune. S.A.Amiel: Advisory Panel Medtronic, Novo Nordisk, Other Relationship Sanofi. M.M.Broadley: None. C.Hendrieckx: None. J.Speight: Advisory Panel Insulet Corporation, Research Support Novo Nordisk, Sanofi. P.Choudhary: Advisory Panel Abbott Diabetes, Lilly Diabetes, Medtronic, Research Support Novo Nordisk, Speaker's Bureau Dexcom, Inc., Glooko, Inc., Insulet Corporation, Sanofi. F.Pouwer: Research Support Eli Lilly and Company, Novo Nordisk, Sanofi. N.Zaremba: None. P.Divilly: None. G.Martine-edith: Other Relationship Novo Nordisk. G.Nefs: None. Z.Mahmoudi: Employee Novo Nordisk A/S. J.K.Mader: Advisory Panel Abbott Diabetes, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Medtronic, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Roche Diabetes Care, Sanofi-Aventis Deutschland GmbH, Speaker's Bureau Abbott Diabetes, Eli Lilly and Company, Medtronic, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Roche Diabetes Care, Sanofi-Aventis Deutschland GmbH, Servier Laboratories, Stock/Shareholder decide Clinical Software GmbH. M.Cigler: None. This work was supported by the Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement 777460
Publisher: Public Library of Science (PLoS)
Date: 02-12-2021
DOI: 10.1371/JOURNAL.PONE.0260896
Abstract: To conduct a systematic review to examine associations between hypoglycemia and quality of life (QoL) in children and adolescents with type 1 diabetes. Four databases (Medline, Cochrane Library, CINAHL, PsycINFO) were searched systematically in November 2019 and searches were updated in September 2021. Studies were eligible if they included children and/or adolescents with type 1 diabetes, reported on the association between hypoglycemia and QoL (or related outcomes), had a quantitative design, and were published in a peer-reviewed journal after 2000. A protocol was registered the International Prospective Register of Systematic Reviews (PROSPERO CRD42020154023). Studies were evaluated using the Joanna Briggs Institute’s critical appraisal tool. A narrative synthesis was conducted by outcome and hypoglycemia severity. In total, 27 studies met inclusion criteria. No hypoglycemia-specific measures of QoL were identified. Evidence for an association between SH and (domains) of generic and diabetes-specific QoL was too limited to draw conclusions, due to heterogenous definitions and operationalizations of hypoglycemia and outcomes across studies. SH was associated with greater worry about hypoglycemia, but was not clearly associated with diabetes distress, depression, anxiety, disordered eating or posttraumatic stress disorder. Although limited, some evidence suggests that more recent, more frequent, or more severe episodes of hypoglycemia may be associated with adverse outcomes and that the context in which hypoglycemia takes places might be important in relation to its impact. There is insufficient evidence regarding the impact of hypoglycemia on QoL in children and adolescents with type 1 diabetes at this stage. There is a need for further research to examine this relationship, ideally using hypoglycemia-specific QoL measures.
Publisher: Elsevier BV
Date: 08-2019
DOI: 10.1016/J.JDIACOMP.2019.04.013
Abstract: We examined: (a) the prevalence of comorbid elevated symptoms of anxiety/depression (b) its demographic/clinical correlates (c) associations with self-care behaviors, by diabetes type. Cross-sectional self-report data of 6590 adults with diabetes (42% type 1 58% type 2) from the Australian and Dutch Diabetes MILES studies were used. Elevated symptoms of anxiety/depression were defined as GAD-7 ≥ 10/PHQ-9 ≥ 10. In both diabetes types, comorbid elevated symptoms of anxiety/depression were present in 9% and symptoms of anxiety alone in 2% symptoms of depression alone were present in 8% of adults with type 1 diabetes and 11% with type 2 diabetes. Shorter diabetes duration (type 1 only) was the only characteristic that distinguished those with comorbid elevated symptoms of anxiety/depression but not those with symptoms of anxiety/depression alone from the reference group (no/minimal symptoms of anxiety/depression). Those with comorbid elevated symptoms of anxiety/depression had increased odds of sub-optimal diabetes self-care behaviors compared with the reference group, with higher odds than those with symptoms of anxiety or depression alone. Comorbid elevated symptoms of anxiety/depression affected one in ten respondents, who also had increased odds of suboptimal diabetes self-care. Those with shorter type 1 diabetes duration may be at increased risk.
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: Mary Ann Liebert Inc
Date: 07-2019
Publisher: Wiley
Date: 25-06-2007
Publisher: Elsevier BV
Date: 03-2005
DOI: 10.1053/J.AJKD.2004.11.010
Abstract: Quality and effectiveness of care can be enhanced through the use of condition-specific measures of satisfaction with treatment. The aim of the present study was to design and develop a measure of satisfaction with treatment for patients with chronic kidney failure (CKF) for use in routine clinical care and clinical trials. The Renal Treatment Satisfaction Questionnaire (RTSQ) was designed to be suitable for people using any of the various treatment modalities for CKF. Items measure satisfaction with aspects of treatment, including convenience, flexibility, freedom, and satisfaction to continue with present form of treatment. A 12-item RTSQ was investigated at a UK hospital-based renal unit, using data from 140 outpatients undergoing renal replacement therapy (hemodialysis, n = 35 continuous ambulatory peritoneal dialysis, n = 57 transplantation, n = 46). An 11-item scale was developed from the original 12-item version, with a single factor accounting for 59% of the variance and item loadings greater than 0.58. Scale reliability was excellent (alpha = 0.93) in the full s le and proved robust to analysis in separate treatment subgroups. As expected, RTSQ scores differed significantly ( P < 0.0001) between the transplantation and other treatment groups. Those who had received a transplant expressed greater overall satisfaction, with specific advantages of transplantation shown by all in idual items, including convenience, time, lifestyle, freedom, and satisfaction to continue current treatment. The RTSQ provides a brief reliable measure of satisfaction with treatment for patients with CKF that is suitable for use in routine clinical care and clinical trials.
Publisher: AMPCo
Date: 2013
DOI: 10.5694/MJA12.11489
Publisher: Springer Science and Business Media LLC
Date: 06-2012
DOI: 10.2165/11597490-000000000-00000
Abstract: Hereditary angioedema (HAE) is a rare, debilitating, potentially life-threatening condition characterized by recurrent acute attacks of edema of the skin, face/upper airway, and gastrointestinal and urogenital tracts. During a laryngeal attack, people with HAE may be at risk of suffocation, while other attacks are often associated with intense pain, disfigurement, disability, and/or vomiting. The intensity of some symptoms is known only to the person experiencing them. Thus, interview studies are needed to explore such experience and patient-reported outcome measures (PROMs) are required for systematic assessment of symptoms in the clinical setting and in clinical trials of treatments for acute HAE attacks. The aim of this interview study was to assess the content validity and suitability of four visual analog scale (VAS) instruments for use in clinical studies. The VAS instruments were designed to assess symptoms at abdominal, oro-facial-pharyngeal-laryngeal, peripheral, and urogenital attack locations. This is the first known study to report qualitative data about the patient's experience of the rare disorder, HAE. Semi-structured exploratory and cognitive debriefing interviews were conducted with 27 adults with a confirmed clinical/laboratory diagnosis of HAE (baseline plasma level of functional plasma protein C1 esterase inhibitor [C1INH] <50% of normal without evidence for acquired angioedema). There were 17 participants from the US and 10 from Italy, with mean age 42.5 (SD 14.5) years, range 18-72 years, mean HAE duration 21.3 (SD 14.1) years, range 1-45 years, 67% female, and 44% VAS-naïve. Experience of acute angioedema attacks was first explored, noting spontaneous mentions by participants of HAE symptomatology. Cognitive debriefing of the VAS instruments was undertaken to assess the suitability, comprehensibility, and relevance of the VAS items. Asymptomatic participants completed the VAS instruments relevant to their angioedema experience, reporting as if they were experiencing an acute angioedema attack at the time. Interviews were conducted in the clinic setting in the US and Italy over an 8-month period. Participants mentioned spontaneously almost all aspects of acute angioedema attacks covered by the four VAS instruments, thus providing strong support for inclusion of nearly all VAS items, with no important symptoms missing. Predominant symptoms found to be associated with acute angioedema attacks were edema and pain, and there was evidence of varying degrees of disruption to everyday activities supporting the inclusion of an overall severity item reflecting the disabling effects of HAE symptoms. VAS item wording was understood by participants. This interview study explored and reported the patient experience of HAE attacks. It demonstrated the content validity of the four anatomical location HAE VAS instruments and their suitability for use in clinical trials of recombinant human C1INH (rhC1INH) treatment for ascertaining trial participants' assessments of the severity of acute angioedema symptoms.
Publisher: American Diabetes Association
Date: 06-2020
DOI: 10.2337/DB20-999-P
Abstract: Background: Few long-term RCTs compare Hybrid Closed Loop (HCL) insulin delivery to manual (non-HCL) insulin dosing in type 1 diabetes (T1D). Objective: To examine glycemic and psychosocial outcomes in adults with T1D using HCL vs. manual insulin dosing with self-monitoring of blood glucose (SMBG) for 6 months. Methods: Adults using multiple daily injections or pumps with SMBG were randomized 1:1 after insulin dose optimization to 26 weeks of HCL (Medtronic 670G) or continuation of current therapy. The primary outcome was time in target range (70-180mg/dL) with masked CGM during the final 3 weeks. Secondary outcomes included other CGM metrics, HbA1c, treatment satisfaction (DTSQs) and diabetes distress (PAID). Intention to treat analysis was performed with ANCOVA or rank sum test. Results: HCL and control groups were well balanced at baseline (Table). At 26 weeks, mean (95% CI) CGM time in range with HCL was greater by 14.8% (11.1, 18.5), with reduced high and low glucose time, and lower HbA1c. There were no between-group differences in treatment satisfaction or diabetes distress (Table). Conclusions: HCL provided a significant and sustained glycemic benefit compared with standard therapy. Results will inform potential users and health professionals and a cost-benefit analysis may facilitate HCL access. S.A. McAuley: Advisory Panel Self Medtronic. Research Support Self Medtronic, Roche Diabetes Care. Speaker’s Bureau Self Lilly Diabetes, Roche Diabetes Care. M.H. Lee: Research Support Self Medtronic. Speaker’s Bureau Self AstraZeneca, Medtronic. B. Paldus: Research Support Self JDRF. Speaker’s Bureau Self Australian Diabetes Society, Medtronic. S. Vogrin: None. M.B. Abraham: Speaker’s Bureau Self Lilly Diabetes. L. Bach: None. M. Burt: None. N. Cohen: Advisory Panel Self Abbott, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes. Research Support Self Ypsomed AG. Speaker’s Bureau Self Novo Nordisk A/S. P.G. Colman: None. E.A. Davis: None. C. Hendrieckx: None. M. de Bock: None. J. Holmes-Walker: None. J. Kaye: Advisory Panel Self Abbott. Speaker’s Bureau Self AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Novo Nordisk Inc. K. Kumareswaran: None. R. MacIsaac: None. R.W. McCallum: None. C.M. Sims: Stock/Shareholder Self Medtronic. J. Speight: Research Support Self Abbott, AstraZeneca, Medtronic, Sanofi-Aventis. Speaker’s Bureau Self American Diabetes Association, Australian Diabetes Society, Roche Diabetes Care. S. Stranks: Advisory Panel Self AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Sanofi-Aventis. S. Trawley: None. V. Sundararajan: None. G. Ward: None. A.C. Keech: Advisory Panel Self Amgen, Kowa Research Institute, Inc. Consultant Self Sanofi-Aventis. Speaker’s Bureau Self Abbott, Amgen. A. Jenkins: Advisory Panel Self Abbott, Medtronic. Research Support Self Abbott, GlySens Incorporated, Medtronic, Sanofi-Aventis. T. Jones: Other Relationship Self Medtronic. D.N. ONeal: None.
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.DIABRES.2019.03.020
Abstract: To investigate the validity and reliability of the 6-item DAWN2 Impact of Diabetes Profile (DIDP), and the modified 7-item DIDP, which includes assessment of dietary freedom. The online, cross-sectional, Australian MILES-2 survey included the DIDP and other validated measures, to examine convergent, discriminant and known-groups validity. The DIDP was completed by 2207 adults with diabetes (Type 1: n = 1012 Type 2 insulin: n = 504 non-insulin: n = 691). Data were subjected to exploratory factor analysis, internal consistency reliability and univariate statistics, conducted separately by diabetes type/treatment. The DIDP was highly acceptable: 99% completion rate. One-factor solutions were supported for the 6-item and 7-item DIDP scales, in all diabetes type/treatment groups (variance explained range: 6-item: 59-67%, 7-item: 55-62%), with satisfactory internal consistency (α = 0.85-0.90). Known-groups validity was demonstrated, by diabetes type and complications presence/absence, as was satisfactory convergent and discriminant validity. The DIDP meets the need for a brief, contemporary, valid and reliable measure of the perceived impact of diabetes on quality of life, suitable for adults with Type 1 or Type 2 diabetes mellitus. The 6-item and 7-item scales have psychometric equivalence. Use of the seventh item can be informed by research questions.
Publisher: American Diabetes Association
Date: 17-01-2013
DOI: 10.2337/DC12-0080
Abstract: To determine whether improvements in glycemic control and diabetes-specific quality of life (QoL) scores reported in research studies for the type 1 diabetes structured education program Dose Adjustment For Normal Eating (DAFNE) are also found when the intervention is delivered within routine U.K. health care. Before and after evaluation of DAFNE to assess impact on glycemic control and QoL among 262 adults with type 1 diabetes. There were significant improvements in HbA1c from baseline to 6 and 12 months (from 9.1 to 8.6 and 8.8%, respectively) in a subgroup with suboptimal control. QoL was significantly improved by 3 months and maintained at both follow-up points. Longer-term improved glycemic control and QoL is achievable among adults with type 1 diabetes through delivery of structured education in routine care, albeit with smaller effect sizes than reported in trials.
Publisher: Elsevier BV
Date: 04-2015
DOI: 10.1016/J.DIABRES.2015.01.015
Abstract: Type D personality - defined as high negative affectivity (NA) and high social inhibition (SI) - has been associated with adverse cardiovascular prognosis. We explored the differential associations of Type D personality and its constituent components with health behaviors, emotional distress and standard biomedical risk factors as potential risk mechanisms in adults with diabetes. 3314 Dutch adults with self-reported type 1 or 2 diabetes completed an online survey, including the DS14 Type D Scale. AN(C)OVAs and X(2) tests were used to compare participants scoring (i) low on NA and SI (ii) high on SI only (iii) high on NA only (iv) high on NA and SI (Type D). Participants with Type D personality (29%) were less likely to follow a healthy diet or to consult healthcare professionals in case of problems with diabetes management than those scoring high on neither or only one component. They also reported more barriers surrounding medication use, diabetes-specific social anxiety, loneliness and symptoms of depression and anxiety. There were no differences in standard biomedical risk factors (body mass index, blood pressure, cholesterol, HbA1c). After adjustment for demographics, clinical characteristics, NA, and SI in multivariable logistic regression analyses, Type D personality was independently associated with 2 to 3-fold increased odds of suboptimal health behaviors and over 15-fold increased odds of general emotional distress. Type D personality was not related to standard biomedical risk factors, but was associated with unhealthy behaviors and negative emotions that are likely to have adverse impact on adults with diabetes.
Publisher: Springer Science and Business Media LLC
Date: 02-03-2020
DOI: 10.1186/S12886-020-1311-Y
Abstract: Young adults with type 2 diabetes (aged 18–39 years) are at risk of early onset and rapid progression of diabetic retinopathy, the leading cause of blindness and vision loss in working age adults. Early detection via retinal screening can prevent most vision loss, yet screening rates are consistently lower among this priority population than the general diabetes population. We aimed to test the effect of a tailored, evidence-based brief health behaviour change intervention (leaflet) on self-reported screening uptake, and previously identified social cognitive determinants of retinal screening. A pragmatic, two-arm randomised controlled trial was conducted from September 2014 to April 2015. Participants were stratified by prior screening uptake (Yes/No) and randomly allocated to intervention (leaflet) or ‘usual care’ control (no leaflet). Primary outcome was self-reported screening uptake four weeks post-intervention for ‘No’ participants who had not previously screened for diabetic retinopathy. Secondary outcome variables were changes in knowledge, attitudes, normative beliefs, intention and behavioural skills for all participants, irrespective of prior screening behaviour. To assess intervention effects on secondary outcome variables, we conducted independent s les t-tests (two-tailed) on pre-post change scores. 129 young adults (26% no prior retinal screen) completed baseline 101 completed post-intervention. Power to determine effect on the primary outcome was curtailed by low recruitment of in iduals with no prior retinal screen and loss to follow-up. Attrition was associated significantly with country of birth, language spoken at home, and marital status. Significant intervention effect was observed for one secondary outcome variable: knowledge of diabetic retinopathy ( p = .03) with moderate effect (partial eta squared η 2 = .05) no adverse effects were reported. Control group participants received the leaflet at study completion. This study confirms that a well-designed eye health and retinal screening promotion leaflet can increase knowledge of diabetic retinopathy, an important screening predictor. The study highlights the challenges of conducting ‘real-world’ health behaviour change research with this priority population, providing insights for clinicians and researchers. Strategies to recruit, engage and retain hard-to-reach populations are discussed including nonconventional alternatives to randomised controlled trial designs. Trial registration: ACTRN12614001110673, UTN No.: U1111–1161-9803. Registered 20 October 2014 - retrospectively registered www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367127 .
Publisher: Elsevier BV
Date: 06-0033
Publisher: Wiley
Date: 19-08-2013
DOI: 10.1111/DME.12270
Abstract: To estimate the cost-effectiveness of training in flexible intensive insulin therapy [as provided in the Dose Adjustment for Normal Eating (DAFNE) structured education programme] compared with no training for adults with Type 1 diabetes mellitus in the UK using the Sheffield Type 1 Diabetes Policy Model. The Sheffield Type 1 Diabetes Policy Model was used to simulate the development of long-term microvascular and macrovascular diabetes-related complications and the occurrence of diabetes-related adverse events in 5000 adults with Type 1 diabetes. Total costs and quality-adjusted life years were estimated from a National Health Service perspective over a lifetime horizon, discounted at a rate of 3.5%. The treatment effectiveness of DAFNE was modelled as a reduction in HbA1c that affected the risk of developing long-term diabetes-related complications. Probabilistic and structural sensitivity analyses were conducted. DAFNE resulted in greater life expectancy and reduced incidence of some diabetes-related complications compared with no DAFNE. DAFNE was found to generate an average of 0.0294 additional quality-adjusted life years for an additional cost of £426 per patient, leading to an incremental cost-effectiveness ratio of £14 400 compared with no DAFNE. There was a 54% probability that DAFNE would be cost-effective at a willingness-to-pay threshold of £20 000 per quality-adjusted life year. The results of this study suggest that DAFNE is a cost-effective structured education programme for people with Type 1 diabetes and support its provision by the National Health Service in the UK.
Publisher: Wiley
Date: 13-09-2013
Publisher: Elsevier BV
Date: 08-2020
Publisher: Springer Science and Business Media LLC
Date: 24-05-2018
DOI: 10.1007/S11892-018-1007-3
Abstract: Young adults with type 2 diabetes (T2D, 18-39 years) experience early-onset and rapid progression of diabetic retinopathy (DR), the leading cause of vision loss for working age adults. Despite this, uptake of retinal screening, the crucial first step in preventing vision loss from DR, is low. The aim of this review is to summarize the clinical and psychosocial factors affecting uptake of retinal screening. Barriers include lack of diabetes-related symptoms, low personal DR risk perception, high rates of depression and diabetes-related distress, fatalism about inevitability of complications, time and financial constraints, disengagement with existing diabetes self-management services, and perceived stigma due to having a condition associated with older adults. Young adults with T2D are an under-researched population who face an accumulation of barriers to retinal screening. Tailored interventions that address the needs, characteristics, and priorities of young adults with T2D are warranted.
Publisher: Elsevier BV
Date: 10-2022
DOI: 10.1016/J.PCD.2022.08.004
Abstract: To culturally and linguistically adapt the Type 2 Diabetes Stigma Assessment Scale (DSAS-2) into Arabic and assess its psychometric properties. Following forward-backward translation of the DSAS-2, the Content Validity Index (CVI) was assessed. Cognitive debriefing and pilot testing were conducted with adults with T2DM. The Arabic DSAS-2 was included in a multi-center, cross-sectional study (N = 327) Arabic-speaking adults with type 2 diabetes. Psychometric analyses included exploratory and confirmatory factor analysis (EFA/CFA), internal consistency reliability, and convergent validity. The Arabic DSAS-2 was considered appropriate, with an excellent CVI (0.98). Unforced EFA revealed a satisfactory three-factor structure, indicating the same subscales as the original instrument ('Treated differently', 'Blame and judgment', 'Self-stigma'). EFA for three factors showed good indicators (KMO=0.924 Bartlett's test of sphericity χ2 = 4063.709, df=171, p 0.001). Internal consistency was satisfactory for both the three-factor structure (α = 0.91, α = 0.88, and α = 0.88, respectively) and the single factor (α = 0.94). CFA results were inconclusive. Although fit indices improved for the single-factor model, compared to the three-factor, they remained inadequate. The total scale demonstrated satisfactory convergent validity with self-esteem. The Arabic DSAS-2 has excellent reliability and acceptable validity, supporting a three-factor structure as well as the use of a total score.
Publisher: Human Kinetics
Date: 03-2017
Abstract: To examine associations between physical activity (PA) and depressive symptoms among adults with type 2 diabetes mellitus (Type 2 DM), and whether associations varied according to weight status. Diabetes MILES–Australia is a national survey of adults with diabetes, focused on behavioral and psychosocial issues. Data from 705 respondents with Type 2 DM were analyzed, including: demographic and clinical characteristics, PA (IPAQ-SF), depressive symptoms (PHQ-9), and BMI (self-reported height and weight). Data analysis was performed using ANCOVA. Respondents were aged 59 ± 8 years 50% women. PA was negatively associated with depressive symptoms for the overall s le (η p 2 = 0.04, P .001) and all weight categories separately: healthy (η p 2 0.11 P = .041,), overweight (η p 2 = 0.04, P = .025) and obese (η p 2 = 0.03, P = .007). For people who were healthy (BMI 18.5 to 24.9) or overweight (BMI 25 to 29.9), high amounts of PA were significantly associated with fewer depressive symptoms for adults who were obese (BMI ≥ 30) however, both moderate and high amounts were associated with fewer depressive symptoms. PA is associated with fewer depressive symptoms among adults with Type 2DM, however the amount of PA associated with fewer depressive symptoms varies according to weight status. Lower amounts of PA might be required for people who are obese to achieve meaningful reductions in depressive symptoms compared with those who are healthy weight or overweight. Further research is needed to establish the direction of the relationship between PA and depressive symptoms.
Publisher: Wiley
Date: 14-07-2015
DOI: 10.1111/DME.12824
Abstract: To design and conduct preliminary validation of a measure of hypoglycaemia awareness and problematic hypoglycaemia, the Hypoglycaemia Awareness Questionnaire. Exploratory and cognitive debriefing interviews were conducted with 17 adults (nine of whom were women) with Type 1 diabetes (mean ± sd age 48 ± 10 years). Questionnaire items were modified in consultation with diabetologists sychologists. Psychometric validation was undertaken using data from 120 adults (53 women) with Type 1 diabetes (mean ± sd age 44 ± 16 years 50% with clinically diagnosed impaired awareness of hypoglycaemia), who completed the following questionnaires: the Hypoglycaemia Awareness Questionnaire, the Gold score, the Clarke questionnaire and the Problem Areas in Diabetes questionnaire. Iterative design resulted in 33 items eliciting responses about awareness of hypoglycaemia when awake/asleep and hypoglycaemia frequency, severity and impact (healthcare utilization). Psychometric analysis identified three subscales reflecting ‘impaired awareness’, ‘symptom level’ and ‘symptom frequency’. Convergent validity was indicated by strong correlations between the ‘impaired awareness’ subscale and existing measures of awareness: (Gold: r s =0.75, P 0.01 Clarke: r s =0.76, P 0.01). Divergent validity was indicated by weaker correlations with diabetes‐related distress (Problem Areas in Diabetes: r s =0.25, P 0.01) and HbA 1c (r s =‐0.05, non‐significant). The ‘impaired awareness’ subscale and other items discriminated between those with impaired and intact awareness (Gold score). The ‘impaired awareness’ subscale and other items contributed significantly to models explaining the occurrence of severe hypoglycaemia and hypoglycaemia when asleep. This preliminary validation shows the Hypoglycaemia Awareness Questionnaire has robust face and content validity satisfactory structure internal reliability convergent, ergent and known groups validity. The impaired awareness subscale and other items contribute significantly to models explaining recall of severe and nocturnal hypoglycaemia. Prospective validation, including determination of a threshold to identify impaired awareness, is now warranted.
Publisher: Wiley
Date: 13-03-2018
DOI: 10.1111/DME.13598
Abstract: To explore factors associated with negative insulin appraisals among adults with Type 2 diabetes, including perceived and experienced diabetes stigma. The second Diabetes MILES - Australia study (MILES-2) is a national survey of adults with diabetes, focused on behavioural and psychosocial issues. Subgroup analyses were conducted on the responses of 456 adults with insulin-treated Type 2 diabetes (38% women mean ± sd age: 61.2 ± 8.8 years diabetes duration: 14.5 ± 7.5 years years using insulin: 6.4 ± 5.5). Participants completed validated measures of perceived and experienced diabetes stigma (Type 2 Diabetes Stigma Assessment Scale), insulin appraisals [Insulin Treatment Appraisal Scale (ITAS)] and known correlates of insulin appraisals: diabetes-specific distress (Problem Areas In Diabetes scale) and diabetes-specific self-efficacy (Confidence in Diabetes Self-care scale). A multiple linear regression was conducted (N = 279) to determine the contribution of those variables found to be associated with ITAS Negative scores. Univariable analyses revealed negative insulin appraisals were associated with demographic and self-care characteristics (age, employment status, BMI, years using insulin, injections per day), self-efficacy, diabetes-specific distress and diabetes stigma (all P < 0.01). Number of injections per day [regression coefficient [95% confidence interval]: 0.74 [0.08, 1.40] P = 0.028], self-efficacy [-0.12 [-0.19, -0.06] P < 0.001] and diabetes stigma [0.39 (0.31, 0.46) P < 0.001) significantly and independently contributed to the final multivariable model, explaining 58% of the variance in ITAS Negative scores. The independent contribution of diabetes-specific distress was suppressed following the inclusion of diabetes stigma. This study represents the first step in understanding the relationship between perceived and experienced diabetes stigma and negative insulin appraisals, and provides quantitative evidence for the strong, independent relationship between these two important constructs.
Publisher: Elsevier BV
Date: 2021
Publisher: Wiley
Date: 27-12-2019
DOI: 10.1111/DME.14205
Abstract: Almost 100 years since the discovery of insulin, hypoglycaemia remains a barrier for people with type 1 diabetes to achieve and maintain blood glucose at levels which prevent long-term diabetes-related complications. Although hypoglycaemia is primarily attributable to the limitations of current treatment and defective hormonal counter-regulation in type 1 diabetes, the central role of psycho-behavioural factors in preventing, recognizing and treating hypoglycaemia has been acknowledged since the early 1980s. Over the past 25 years, as documented in the present review, there has been a substantial increase in psycho-behavioural research focused on understanding the experience and impact of hypoglycaemia. The significant contributions have been in understanding the impact of hypoglycaemia on a person's emotional well-being and aspects of life (e.g. sleep, driving, work/social life), identifying modifiable psychological and behavioural risk factors, as well as in developing psycho-behavioural interventions to prevent and better manage (severe) hypoglycaemia. The impact of hypoglycaemia on family members has also been confirmed. Structured diabetes education programmes and psycho-behavioural interventions with a focus on hypoglycaemia have both been shown to be effective in addressing problematic hypoglycaemia. However, the findings have also revealed the complexity of the problem and the need for a personalized approach, taking into account the in idual's knowledge of, and emotional/behavioural reactions to hypoglycaemia. Evidence is emerging that people with persistent and recurrent severe hypoglycaemia, characterized by deeply entrenched cognitions and lack of concern around hypoglycaemia, can benefit from tailored cognitive behavioural therapy.
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.JDIACOMP.2016.11.013
Abstract: To assess prevalence of severe hypoglycemia, awareness and symptoms of hypoglycemia, and their associations with self-monitoring of blood glucose. Diabetes MILES-Australia Study participants completed validated questionnaires and study-specific items. Of 642 adults with type 1 diabetes, 21% reported ≥1 severe hypoglycemic event in the past six months, and 21% reported impaired awareness of hypoglycemia (IAH). Severe hypoglycemia was increased four-fold for those with IAH compared with intact awareness (1.4±3.9 versus 0.3±1.0). Of those with IAH, 92% perceived autonomic and 88% neuroglycopenic symptoms, albeit at lower glucose thresholds compared to people with intact awareness. Those with IAH were more likely to perceive both symptom types at the same glucose level or to perceive neuroglycopenic symptoms first (all p<0.001). Eighteen percent with IAH treated hypoglycemia only when they perceived symptoms and another 18% only when their capillary glucose was <3.0mmol/L. One in five adults with type 1 diabetes had IAH or experienced severe hypoglycemia in the past sixmonths. Total loss of hypoglycemia symptoms was rare most people with IAH retained autonomic symptoms, perceived at relatively low glucose levels. Frequent self-monitoring of blood glucose prompted early recognition and treatment of hypoglycemia, suggesting severe hypoglycemia risk can be minimized.
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.AMJCARD.2016.07.006
Abstract: N-terminal pro-B-type natriuretic (NT-proBNP) is expressed in the heart and brain, and serum levels are elevated in acute heart and brain diseases. We aimed to assess the possible association between serum levels and neurological outcome and death in comatose patients resuscitated from out-of-hospital cardiac arrest (OHCA). Of the 939 comatose OHCA patients enrolled and randomized in the Targeted Temperature Management (TTM) trial to TTM at 33°C or 36°C for 24 hours, 700 were included in the biomarker substudy. Of these, 647 (92%) had serum levels of NT-proBNP measured 24, 48, and 72 hours after return of spontaneous circulation (ROSC). Neurological outcome was evaluated by the Cerebral Performance Category (CPC) score and modified Rankin Scale (mRS) at 6 months. Six hundred thirty-eight patients (99%) had serum NT-proBNP levels ≥125 pg/ml. Patients with TTM at 33°C had significantly lower NT-proBNP serum levels (median 1,472 pg/ml) than those in the 36°C group (1,914 pg/ml) at 24 hours after ROSC, p <0.01 but not at 48 and 72 hours. At 24 hours, an increase in NT-proBNP quartile was associated with death (Plogrank median were independently associated with poor neurological outcome (odds ratio, ORCPC 2.02, CI 1.34 to 3.05, p <0.001 ORmRS 2.28, CI 1.50 to 3.46, p <0.001) adjusted for potential confounders. The association was diminished at 48 and 72 hours after ROSC. In conclusion, NT-proBNP serum levels are increased in comatose OHCA patients. Furthermore, serum NT-proBNP levels are affected by level of TTM and are associated with death and poor neurological outcome.
Publisher: Wiley
Date: 17-04-2012
DOI: 10.1111/J.1463-1326.2012.01595.X
Abstract: Incretin-based therapies have a glucose-dependent mode of action that results in excellent glucose-lowering efficacy with very low risk of hypoglycaemia, and weight neutrality [dipeptidyl peptidase-4 (DPP-4) inhibitors] or weight loss [glucagon-like peptide-1 (GLP-1) receptor agonists], in people with type 2 diabetes mellitus (T2DM). Patient-reported outcomes (PROs) complement physician evaluations of efficacy and tolerability and offer insights into the subjective experience of using modern diabetes treatments. We conducted a systematic search of clinical trials of the GLP-1 receptor agonists liraglutide, exenatide and long-acting exenatide, one of which included the oral DPP-4 inhibitor sitagliptin as a comparator. No other PRO data for DPP-4 inhibitors were identified. This review summarizes PRO data from eight clinical trials, the majority of which used the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and/or Impact of Weight on Quality of Life-Lite (IWQOL-Lite) to evaluate patient experience. People with T2DM were highly satisfied with modern incretin-based therapies compared with traditional therapies. Treatment satisfaction (including perceptions of convenience and flexibility) was high and generally higher with GLP-1 agonists in association with their greater glucose-lowering efficacy and tendency to facilitate weight loss. Weight-related quality of life (QoL) also improved in people using incretin therapies. The glycaemic improvements achieved with GLP-1 receptor agonists, coupled with the low incidence of hypoglycaemia and ability to cause weight loss, seemed to offset potential concern about injections. It is plausible that superior patient-reported benefits found in clinical trials may translate into improved, clinically meaningful, long-term outcomes through increased treatment acceptability. Long-term, prospective data are needed to ascertain whether this is the case in practice.
Publisher: Elsevier BV
Date: 2020
Publisher: Springer Science and Business Media LLC
Date: 2014
Publisher: BMJ
Date: 05-2022
DOI: 10.1136/BMJOPEN-2021-054650
Abstract: This study examined the effect of using patient-reported outcome measures (PROMs) routinely to assess and address depressive symptoms and diabetes distress among adults with type 2 diabetes. A systematic review of published peer-reviewed studies. Medline, Embase, CINAHL Complete, PsycINFO, The Cochrane Library and Cochrane Central Register of Controlled Trials were searched. Studies including adults with type 2 diabetes, published in English, from the inception of the databases to 24 February 2022 inclusive and where the intervention included completion of a PROM of depressive symptoms and/or diabetes distress, with feedback of the responses to a healthcare professional. Using Covidence software, screening and risk of bias assessment were conducted by two reviewers independently with any disagreements resolved by a third reviewer. The search identified 4512 citations, of which 163 full-text citations were assessed for eligibility, and nine studies met the inclusion criteria. Five studies involved assessment of depressive symptoms only, two studies assessed diabetes distress only, and two studies assessed both. All studies had an associated cointervention. When depressive symptoms were assessed (n=7), a statistically significant between-group difference in depressive symptoms was observed in five studies with a clinically significant ( 0.5%) between-group difference in HbA1c in two studies. When diabetes distress was assessed (n=4), one study demonstrated statistically significant difference in depressive symptoms and diabetes distress with a clinically significant between-group difference in HbA1c observed in two studies. Studies are sparse in which PROMs are used to assess and address depressive symptoms or diabetes distress during routine clinical care of adults with type 2 diabetes. Further research is warranted to understand how to integrate PROMs into clinical care efficiently and determine appropriate interventions to manage identified problem areas. CRD42020200246.
Publisher: Wiley
Date: 2002
DOI: 10.1002/DMRR.279
Abstract: Efforts to prevent complications of diabetes often overlook the impact of the condition and its treatment on current quality of life (QoL). The Diabetes Treatment Satisfaction Questionnaire (DTSQ) has proved valuable for understanding and measuring patients' treatment satisfaction in assessments of new treatments and strategies. For ex le, the DTSQ has demonstrated improved patient satisfaction with fast-acting insulin lispro versus standard soluble insulin and with long-acting insulin glargine versus NPH insulin. However, improvements in treatment satisfaction are often inferred to be improvements in overall QoL without recognizing the limited scope of the satisfaction measure. It is necessary to evaluate not only satisfaction with treatment per se but also the impact of diabetes and its treatment on a broad range of life domains in order to assess the impact on QoL. The Audit of Diabetes-Dependent Quality of Life (ADDQoL) measure is a diabetes-specific instrument that assesses the impact of diabetes on 18 life domains. Use of the ADDQoL with people with type 1 or type 2 diabetes has shown, on average, almost universally negative impact of diabetes on all domains. Significant differences have also been shown in the magnitude of effect between insulin-treated and non-insulin-treated patients and patients with and without complications. The negative impact of diabetes on QoL has been observed despite high levels of treatment satisfaction (as measured by the DTSQ). The greatest negative impact was observed for the domain 'Freedom to eat as I wish', indicating the strong influence of dietary restrictions on QoL. Studies to assess the outcomes of treatment approaches designed to improve dietary flexibility are under way.
Publisher: Wiley
Date: 22-02-2012
DOI: 10.1111/J.1464-5491.2011.03416.X
Abstract: As a common side effect of insulin treatment for diabetes, hypoglycaemia is a constant threat and can have far-reaching and potentially devastating consequences, including immediate physical injury as well as more pervasive cognitive, behavioural and emotional effects. Moreover, as a significant limiting factor in achieving optimal glycaemic control, exposure to hypoglycaemia can influence diabetes self-management. Although hypoglycaemia is known to occur in Type 2 diabetes, its morbidity and impact on the in idual are not well recognized. The aim of the current review is to examine published evidence to achieve a synthesis of the scope and significance of the potential detriment caused by hypoglycaemia to in iduals with Type 2 diabetes. The implications of these observations for treatment and research have also been considered. A narrative review was performed of empirical papers published in English since 1966, reporting the effect of hypoglycaemia on quality of life and related outcomes (including generic and diabetes-specific quality of life, emotional well-being and health utilities) in Type 2 diabetes. Research demonstrates the potential impact of hypoglycaemia on the lives of people with Type 2 diabetes, from an association with depressive symptoms and heightened anxiety, to impairment of the ability to drive, work and function in ways that are important for quality of life. Few studies consider hypoglycaemia as an explanatory variable in combination with quality of life or related primary endpoints. As a consequence, there is a pressing need for high-quality research into the overall impact of hypoglycaemia on the lives of people with Type 2 diabetes.
Publisher: American Diabetes Association
Date: 07-03-2016
DOI: 10.2337/DC15-2431
Publisher: Elsevier BV
Date: 10-2020
Publisher: JMIR Publications Inc.
Date: 10-02-2020
Abstract: anaging type 2 diabetes (T2D) requires progressive lifestyle changes and, sometimes, pharmacological treatment intensification. General practitioners (GPs) are integral to this process but can find pharmacological treatment intensification challenging because of the complexity of continually emerging treatment options. his study aimed to use a co-design method to develop and pretest a clinical decision support (CDS) tool prototype (GlycASSIST) embedded within an electronic medical record, which uses evidence-based guidelines to provide GPs and people with T2D with recommendations for setting glycated hemoglobin (HbA1c) targets and intensifying treatment together in real time in consultations. he literature on T2D-related CDS tools informed the initial GlycASSIST design. A two-part co-design method was then used. Initial feedback was sought via interviews and focus groups with clinicians (4 GPs, 5 endocrinologists, and 3 diabetes educators) and 6 people with T2D. Following refinements, 8 GPs participated in mock consultations in which they had access to GlycASSIST. Six people with T2D viewed a similar mock consultation. Participants provided feedback on the functionality of GlycASSIST and its role in supporting shared decision making (SDM) and treatment intensification. linicians and people with T2D believed that GlycASSIST could support SDM (although this was not always observed in the mock consultations) and in idualized treatment intensification. They recommended that GlycASSIST includes less information while maintaining relevance and credibility and using graphs and colors to enhance visual appeal. Maintaining clinical autonomy was important to GPs, as they wanted the capacity to override GlycASSIST’s recommendations when appropriate. Clinicians requested easier screen navigation and greater prescribing guidance and capabilities. lycASSIST was perceived to achieve its purpose of facilitating treatment intensification and was acceptable to people with T2D and GPs. The GlycASSIST prototype is being refined based on these findings to prepare for quantitative evaluation.
Publisher: Springer Science and Business Media LLC
Date: 15-11-2021
Publisher: JMIR Publications Inc.
Date: 31-10-2019
Abstract: iabetes self-management apps have the potential to improve self-management in people with type 2 diabetes (T2D). Although efficacy trials provide evidence of health benefits, premature disengagement from apps is common. Therefore, it is important to understand the factors that influence engagement in real-world settings. his study aims to explore users’ real-world experiences with the i My Diabetes Coach /i (MDC) self-management app. e conducted telephone-based interviews with participants who had accessed the MDC self-management app via their smartphone for up to 12 months. Interviews focused on user characteristics the context within which the app was used barriers and facilitators of app use and the design, content, and delivery of support within the app. total of 19 adults with T2D (8/19, 42% women mean age 60, SD 14 years) were interviewed. Of the 19 interviewees, 8 (42%) had T2D for & years, 42% (n=8) had T2D for 5-10 years, and 16% (n=3) had T2D for & years. In total, 2 themes were constructed from interview data: (1) the moderating effect of diabetes self-management styles on needs, preferences, and expectations and (2) factors influencing users’ engagement with the app: one size does not fit all. ser characteristics, the context of use, and features of the app interact and influence engagement. Promoting engagement is vital if diabetes self-management apps are to become a useful complement to clinical care in supporting optimal self-management. ustralia New Zealand Clinical Trials Registry CTRN126140012296 URL www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366925& isReview=true
Publisher: Elsevier BV
Date: 04-2015
Publisher: AMPCo
Date: 02-2016
DOI: 10.5694/MJA16.01105
Publisher: BMJ
Date: 08-2022
DOI: 10.1136/BMJDRC-2022-002890
Abstract: The aim of this study was to determine the psychometric properties of the 12-Item Hypoglycemia Impact Profile (HIP12), a brief measure of the impact of hypoglycemia on quality of life (QoL) among adults with type 1 (T1D) or type 2 diabetes (T2D). Adults with T1D (n=1071) or T2D (n=194) participating in the multicountry, online study, ‘Your SAY: Hypoglycemia’, completed the HIP12. Psychometric analyses were undertaken to determine acceptability, structural validity, internal consistency, convergent/ ergent validity, and known-groups validity. Most (98%) participants completed all items on the HIP12. The expected one-factor solution was supported for T1D, T2D, native English speaker, and non-native English speaker groups. Internal consistency was high across all groups (ω=0.91–0.93). Convergent and ergent validity were satisfactory. Known-groups validity was demonstrated for both diabetes types, by frequency of severe hypoglycemia (0 vs ≥1 episode in the past 12 months) and self-treated episodes ( vs 2–4 vs ≥5 per week). The measure also discriminated by awareness of hypoglycemia in those with T1D. The HIP12 is an acceptable, internally consistent, and valid tool for assessing the impact of hypoglycemia on QoL among adults with T1D. The findings in the relatively small s le with T2D are encouraging and warrant replication in a larger s le.
Publisher: American Diabetes Association
Date: 06-2019
DOI: 10.2337/DB19-809-P
Abstract: Aims: To compare the acceptability, reliability and validity of five contemporary diabetes-specific quality of life (QoL) scales. Methods: Adults with type 1 diabetes in the UK (N=1139) and Australia (N=439) completed a cross-sectional, online survey including: ADDQoL, DCP, DIDP, DSQoLS and QoL-Q diabetes (scales randomised to control for order effects). Participants rated each scale for clarity, relevance, ease of completion, length, and comprehensiveness. Scales were compared in terms of acceptability, response patterns, structure, reliability and validity. To assess cross-country reproducibility, analyses conducted on the UK s le were replicated in the Australian s le. Results: Findings (summarized in Table 1) were largely consistent between countries. The strongest scale overall was the DIDP, a brief (7-item), neutrally-worded scale with balanced response options. ADDQoL and QoL-Q diabetes also performed well across most criteria. Conclusions: This is the first empirical study to compare the user acceptability and psychometric properties of five contemporary diabetes-specific QoL scales. These findings may inform assessment of diabetes-specific QoL in routine care and clinical trials, but should be considered in the context of published evidence of the development and responsiveness of the scales. J. Speight: Research Support Self AstraZeneca, Medtronic, Sanofi. Speaker's Bureau Self Novo Nordisk A/S, Roche Diabetes Care. E. Holmes-Truscott: Research Support Self Sanofi. Speaker's Bureau Self Novo Nordisk Inc. C. Hendrieckx: None. E. Coates: None. S.R. Heller: Advisory Panel Self Eli Lilly and Company, Novo Nordisk A/S, Sanofi-Aventis, Takeda Pharmaceutical Company Limited, Zealand Pharma A/S. Consultant Self Novo Nordisk A/S. Speaker's Bureau Self Eli Lilly and Company, Novo Nordisk A/S. D. Cooke: None. UK National Institute for Health Research (RP-PG-0514-20013 to S.R.H.)
Publisher: Mary Ann Liebert Inc
Date: 12-2019
Publisher: Oxford University Press (OUP)
Date: 05-2020
DOI: 10.1093/ABM/KAAA009
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: Elsevier BV
Date: 06-2010
DOI: 10.1111/J.1524-4733.2010.00696.X
Abstract: Generic patient-reported outcome (PRO) measures underestimate the impact of polycystic ovary syndrome (PCOS) on quality of life (QoL). The aim of this review was to identify PCOS-specific QoL measures and establish whether their development history and measurement properties support their use in clinical trials. A systematic search was conducted using terms synonymous with "PCOS" and "QoL." Following identification of measures, further searches were undertaken using the questionnaire name and abbreviation to explore its use, development history, and demonstrated measurement properties. Of 56 abstracts screened, 21 reported using PRO measures. One PCOS-specific QoL measure was identified: the PolyCystic Ovary Syndrome Questionnaire (PCOSQ). Nine papers show that the PCOSQ's development history is somewhat incomplete, and that it does not have good content validity. The PCOSQ subscales demonstrate acceptable levels of reliability (0.70-0.97) and partial known-groups validity as well as convergent/ ergent validity with other PRO instruments. Responsiveness to change is variable and minimally important differences have not been established. The PCOSQ is the only condition-specific measure of the impact of PCOS on QoL. Additional research is required to ensure its comprehensiveness, sensitivity, and to guide interpretation prior to including in clinical trials.
Publisher: Springer Science and Business Media LLC
Date: 18-09-2021
DOI: 10.1007/S12671-021-01754-X
Abstract: The objectives of this study were to investigate the associations of dispositional mindfulness and its facets with diet quality in Dutch adults with type 1 diabetes and type 2 diabetes and to evaluate the potential mediating role of emotional distress in these associations. This was a cross-sectional study using data from the Diabetes MILES-The Netherlands. In total, 296 adults with type 1 diabetes and 364 with type 2 diabetes completed questionnaires. We assessed dispositional mindfulness by the Five Facet Mindfulness Questionnaire-Short Form, including total mindfulness and five facets: observing, describing, acting with awareness, being non-judgmental, and being non-reactive, and diet quality by the Dutch Healthy Diet 2015-index. Linear regression models were used to estimate the association. Mediation effects of depressive symptoms, anxiety symptoms, and diabetes-related distress were evaluated using the PROCESS macro with bias-corrected bootstrapped confidence intervals. Higher scores on the total mindfulness ( β = 0.14, p = 0.02) and the observing facet ( β = 0.15, p = 0.01) were significantly associated with higher diet quality in people with type 1 diabetes only, after adjustment for demographic factors. These associations were not mediated by depressive symptoms, anxiety symptoms, or diabetes-related distress. In adults with type 1 diabetes (but not type 2), higher dispositional mindfulness levels were associated with more optimal diet quality. Higher mindfulness in general and observing in particular were related to a healthier diet with higher quality in Dutch adults with type 1 diabetes. Further longitudinal studies are warranted to understand the temporal relationship between mindfulness and diet quality.
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: Springer Science and Business Media LLC
Date: 23-11-2013
Publisher: Wiley
Date: 30-06-2010
DOI: 10.1111/J.1464-5491.2010.03029.X
Abstract: For selected in iduals with complex Type 1 diabetes, pancreatic islet transplantation (IT) offers the potential of excellent glycaemic control without significant hypoglycaemia, balanced by the need for ongoing systemic immunosuppression. Increasingly, patient-reported outcomes (PROs) are considered alongside biomedical outcomes as a measure of transplant success. PROs in IT have not previously been compared directly with the closest alternate treatment option, pancreas transplant alone (PTA) or pancreas after kidney (PAK). We used a Population, Intervention, Comparisons, Outcomes (PICO) strategy to search Scopus and screened 314 references for inclusion. Twelve studies [including PRO assessment of PAK, PTA, islet-after kidney (IAK) and islet transplant alone (ITA) n = 7-205] used a total of nine specified and two unspecified PRO measures. Results were mixed but identified some benefits which remained apparent up to 36 months post-transplant, including improvements in fear of hypoglycaemia, as well as some aspects of diabetes-specific quality of life (QoL) and general health status. Negative outcomes included short-term pain associated with the procedure, immunosuppressant side effects and depressed mood associated with loss of graft function. The mixed results may be attributable to limited s le sizes. Also, some PRO measures may lack sensitivity to detect actual changes, as they exclude issues and domains of life likely to be important for QoL post-transplantation and when patients may no longer perceive themselves to have diabetes. Thus, the full impact of islet ancreas transplantation (alone or after kidney) on QoL is unknown. Furthermore, no studies have assessed patient satisfaction, which may highlight further advantages and disadvantages of transplantation.
Publisher: Wiley
Date: 17-04-2022
DOI: 10.5694/MJA2.51482
Abstract: Type 2 diabetes in young adults (nominally, 18-30 years of age) is a more aggressive condition than that seen in older age, with a greater risk of major morbidity and early mortality. This first Australian consensus statement on the management of type 2 diabetes in young adults considers areas where existing type 2 diabetes guidance, directed mainly towards older adults, may not be appropriate or relevant for the young adult population. Where applicable, recommendations are harmonised with current national guidance for type 2 diabetes in children and adolescents (aged < 18 years). The full statement is available at www.diabetessociety.com.au, www.adea.com.au and www.apeg.org.au. Advice is provided on important aspects of care including screening, diabetes type, psychological care, lifestyle, glycaemic targets, pharmacological agents, cardiovascular disease risk management, comorbidity assessment, contraception and pregnancy planning, and patient-centred education. Special considerations for Aboriginal and Torres Strait Islander Australians are highlighted separately. Management recommendations for young adults, which differ from those for adults, include: ▪screening for diabetes in young adults with overweight or obesity and additional risk factors, including in utero exposure to type 2 diabetes or gestational diabetes mellitus ▪more stringent glucose targets (glycated haemoglobin ≤ 6.5% [≤ 48 mmol/mol]) ▪in the context of obesity or higher cardio-renal risk, glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors are preferred second line agents ▪β-cell decline is more rapid, so frequent review, early treatment intensification and avoidance of therapeutic inertia are indicated ▪a blood pressure target of < 130/80 mmHg, as the adult target of ≤ 140/90 mmHg is too high ▪absolute cardiovascular disease risk calculators are not likely to be accurate in this age group early statin use should therefore be considered and ▪a multidisciplinary model of care including an endocrinologist and a certified diabetes educator.
Publisher: Springer Science and Business Media LLC
Date: 12-08-2016
Publisher: BMJ
Date: 02-2017
Publisher: Wiley
Date: 22-01-2022
DOI: 10.1111/DME.14790
Abstract: To explore the preferences of adults with type 2 diabetes regarding the approach to weight management discussions in clinical care. Online survey of Australian adults with type 2 diabetes, recruited via a national diabetes registry. Three open‐ended questions explored participants’ experiences and ideal approach to discussing weight management with health professionals. Data subjected to inductive thematic template analysis. Participants were 254 adults, 58% aged 60+ years, 52% women and 35% insulin‐treated. Five themes were developed to categorise participants’ preferences for, as well as differing experiences of, weight management discussions: (1) collaborative, person‐centred care: working together to make decisions and achieve outcomes, taking personal context into consideration (2) balanced communication: open, clear messages encouraging action, empathy and kindness (3) quality advice: knowledgeable health professionals, providing specific details or instructions (4) weight management intervention: suitable modalities to address weight management and (5) system‐wide support: referral and access to appropriate multi‐disciplinary care. Participants expressed preferences for discussing weight management in collaborative, person‐centred consultations, with quality advice and personalised interventions across the health system, delivered with empathy. By adopting these recommendations, health professionals may build constructive partnerships with adults with type 2 diabetes and foster weight management.
Publisher: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.PCD.2015.06.006
Abstract: To investigate the contribution of general and diabetes-specific emotional wellbeing and beliefs about medicines in the prediction of insulin therapy appraisals in adults with non-insulin-treated type 2 diabetes. The s le included Diabetes MILES-Australia cross-sectional survey participants whose primary diabetes treatment was oral hypoglycaemic agents (N=313 49% women mean±SD age: 57±9 years diabetes duration: 7±6 years). They completed validated measures of beliefs about the 'harm' and 'overuse' of medications in general (BMQ General) 'concerns' about and 'necessity' of current diabetes medications (BMQ Specific) negative insulin therapy appraisals (ITAS) depression (PHQ-9) anxiety (GAD-7), and diabetes distress (DDS-17). Factors associated with ITAS Negative scores were examined using hierarchical multiple regressions. Twenty-two percent of the variance in ITAS Negative scores (52±10), was explained by: number of complications (β=-.15, p=.005), DDS-17 subscale 'emotional burden' (β=.23, p<.001), and 'concerns' about current diabetes treatment (β=.29, p<.001). General beliefs about medications and general emotional wellbeing did not contribute significantly to the model. Psychological insulin resistance may reflect broader distress about diabetes and concerns about its treatment but not general beliefs about medicines, depression or anxiety. Reducing diabetes distress and current treatment concerns may improve attitudes towards insulin as a potential therapeutic option.
Publisher: Elsevier BV
Date: 09-2011
Publisher: Wiley
Date: 15-07-2014
DOI: 10.1111/DME.12494
Abstract: To establish the prevalence and incidence of type 1 and type 2 diabetes in people with an intellectual and developmental disability and determine their impact on health and well-being and to appraise the evidence available to inform good practice in diabetes management for people with intellectual and developmental disabilities. We conducted separate searches of multiple databases (EMBASE, CINAHL, MEDLINE, PsycINFO, SCOPUS, Web of Science, PUBMED and Cochrane Library) to find relevant articles. A total of 13 studies were identified: 13 addressed the prevalence of diabetes in people with intellectual and developmental disability, three addressed the impact of diabetes on their health and well-being and three addressed the management of diabetes. The prevalence of diabetes in people with intellectual and developmental disability remains uncertain, and the incidence of diabetes in this group of people is unknown. There is some evidence to support the assertion that people with intellectual and developmental disability might be at greater risk of diabetes than the general population. Overall, the quality of the evidence on which to base prevention and management strategies is variable. There is a paucity of research focusing on the prevalence, incidence and impact of diabetes among people with intellectual and developmental disability. Further research is needed to inform policy and practice in this area and, in particular, work is needed to develop methodologies, evaluation tools, educational resources and diabetes care support services appropriate to the needs of people with intellectual and developmental disability.
Publisher: Elsevier BV
Date: 11-2005
Publisher: Wiley
Date: 06-08-2021
DOI: 10.1111/DME.14666
Abstract: To summarize and critically appraise the recent qualitative evidence regarding the impact of hypoglycaemia on the quality of life of family members of adults with type 1 or type 2 diabetes. Four databases were searched systematically (MEDLINE, PsycINFO, CINAHL and Cochrane Library), and results were screened for eligibility. Article quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Data were extracted, coded and analysed using thematic analysis. The systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) and Enhancing transparency in reporting of qualitative research (ENTREQ) guidelines. Eight qualitative studies were included in the final review. The majority of participants were partners or spouses of adults with type 1 diabetes. Thematic synthesis resulted in six analytical themes: ‘Hypoglycaemia alters everyday life, reducing freedoms and increasing disruptions’, ‘Hypoglycaemia has an adverse impact on sleep’, ‘Hypoglycaemia negatively changes the relationship with the person with diabetes’, ‘Hypoglycaemia negatively impacts emotional well‐being’, ‘The detection, prevention, and treatment of hypoglycaemia consumes time and energy’ and ‘Family members have unmet needs for informational and emotional support regarding hypoglycaemia’. Across the six analytical themes, family members described how hypoglycaemia has a severe negative impact on different aspects of their lives, including daily living, personal relationships and emotional well‐being. Family members experience the impact of hypoglycaemia as a major recurrent challenge in their lives. The unmet needs of family members need further attention in research and clinical practice.
Publisher: Informa Healthcare
Date: 11-01-2013
DOI: 10.1185/03007995.2012.761957
Abstract: There is debate in the literature about the effectiveness of self-monitoring of blood glucose (SMBG) for people with type 2 diabetes (T2DM) who do not use insulin. Several recent systematic reviews and meta-analyses conclude that SMBG does not have any clinical benefit for this group. We critically appraise the available evidence, and argue whether SMBG is warranted for people with non-insulin-treated T2DM. Considerable heterogeneity exists amongst the literature, and aspects of the methodology of some of these studies confound interpretation of results. Recent evidence demonstrates that when SMBG is 'structured', incorporated as part of a complex intervention, and embedded within education and collaborative care, improvements in average blood glucose levels result. In contrast, studies that do not apply SMBG systematically, or that assess a low frequency SMBG regimen that precludes identification and interpretation of SMBG patterns, are not clinically effective. Psychosocial outcomes, such as self-efficacy and diabetes-related distress, and other clinical outcomes, such as hypoglycaemia detection, should also be considered as important clinical endpoints. This is not a systematic literature review. The literature is limited by a lack of studies evaluating a 'structured' approach to SMBG. It is the quality, not quantity, of SMBG that makes a difference to outcomes for people with non-insulin-treated T2DM. The benefits of 'structured' SMBG should be considered as part of a complex intervention when making decisions about policy and practice, and assumptions about the benefits of SMBG for people with non-insulin-treated T2DM should be challenged.
Publisher: BMJ
Date: 11-2019
DOI: 10.1136/BMJDRC-2019-000701
Abstract: In a s le of adults with type 2 diabetes mellitus (T2DM), the aim of this study was to examine whether self-reported physical activity level is associated with recall of specific physical activity-related interactions used by general practitioners (GP). Adults with T2DM completed an online survey reporting physical activity behaviors and recall of 14 GP–patient interactions about physical activity, mapped onto discrete behavior change techniques (BCT). Stepped logistical regression examined associations between recommended physical activity (≥600 MET-min/week) and GP–patient interactions, controlling for body mass index, diabetes-related comorbidities, depressive symptoms and self-efficacy. In total, 381 respondents (55% men, mean±SD age: 62±10 years and T2DM duration 8±8 years) provided complete data. Most (73%) reported receiving ‘general advice’, while interactions related to goal setting, monitoring, and relapse prevention were least commonly reported (all %). Self-reported achievement of the recommended physical activity level was significantly associated with recall of GP interactions involving praise for ‘efforts to be active’ (OR 2.1 95% CI 1.24 to 3.53), ‘lost weight’ (OR 1.81 95% CI 1.05 to 3.12) or lowering ‘glucose levels as a result of being active’ (OR 1.75 95% CI 1.03 to 2.96). Findings suggest GPs can be somewhat effective in promoting physical activity with simple, positive, reinforcing messages/interactions. Future research to develop and evaluate very brief primary care BCT-based physical activity interventions is needed.
Publisher: Springer Science and Business Media LLC
Date: 14-03-2012
Publisher: Mary Ann Liebert Inc
Date: 12-2013
Publisher: American Diabetes Association
Date: 12-07-2014
DOI: 10.2337/DC14-0030
Abstract: To determine whether impaired awareness of hypoglycemia (IAH) can be improved and severe hypoglycemia (SH) prevented in type 1 diabetes, we compared an insulin pump (continuous subcutaneous insulin infusion [CSII]) with multiple daily injections (MDIs) and adjuvant real-time continuous glucose monitoring (RT) with conventional self-monitoring of blood glucose (SMBG). A 24-week 2 × 2 factorial randomized controlled trial in adults with type 1 diabetes and IAH was conducted. All received comparable education, support, and congruent therapeutic targets aimed at rigorous avoidance of biochemical hypoglycemia without relaxing overall control. Primary end point was between-intervention difference in 24-week hypoglycemia awareness (Gold score). A total of 96 participants (mean diabetes duration 29 years) were randomized. Overall, biochemical hypoglycemia (≤3.0 mmol/L) decreased (53 ± 63 to 24 ± 56 min/24 h P = 0.004 [t test]) without deterioration in HbA1c. Hypoglycemia awareness improved (5.1 ± 1.1 to 4.1 ± 1.6 P = 0.0001 [t test]) with decreased SH (8.9 ± 13.4 to 0.8 ± 1.8 episodes atient-year P = 0.0001 [t test]). At 24 weeks, there was no significant difference in awareness comparing CSII with MDI (4.1 ± 1.6 vs. 4.2 ± 1.7 difference 0.1 95% CI −0.6 to 0.8) and RT with SMBG (4.3 ± 1.6 vs. 4.0 ± 1.7 difference −0.3 95% CI −1.0 to 0.4). Between-group analyses demonstrated comparable reductions in SH, fear of hypoglycemia, and insulin doses with equivalent HbA1c. Treatment satisfaction was higher with CSII than MDI (32 ± 3 vs. 29 ± 6 P = 0.0003 [t test]), but comparable with SMBG and RT (30 ± 5 vs. 30 ± 5 P = 0.79 [t test]). Hypoglycemia awareness can be improved and recurrent SH prevented in long-standing type 1 diabetes without relaxing HbA1c. Similar biomedical outcomes can be attained with conventional MDI and SMBG regimens compared with CSII/RT, although satisfaction was higher with CSII.
Publisher: Elsevier BV
Date: 08-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2016
Publisher: Wiley
Date: 27-02-2018
DOI: 10.1111/DME.13594
Publisher: Wiley
Date: 06-2020
DOI: 10.1111/DME.14320
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.
Publisher: SAGE Publications
Date: 10-01-2017
Abstract: The purpose of the paper is to explore the notion of a diabetes language restricted code or “dialect” and its effect on people with diabetes. Language is a complex phenomenon comprising verbal and nonverbal components used to communicate in human interactions. Information was collected from a literature review, during clinical consultations, and from an email survey. Language and the way clinicians use language affect motivation, behaviors, and outcomes of people with diabetes. Language is influenced by culture, experience, and familiarity with words and their use and is idiosyncratic. “Diabetes” is a particular restricted code or dialect that people with diabetes gradually learn to speak, usually after they are diagnosed with diabetes. The diabetes dialect contains many metric and target words and very few positive, encouraging words, and it is often discriminatory, negative, judgmental, labelling, distressing, and stigmatizing: for ex le, victim, sufferer, and lifestyle disease. Language codes/dialects can compound the already high levels of emotional distress and self-care burden associated with living with diabetes and can affect outcomes. The information presented in this article will be useful for clinicians caring for people with diabetes and will be helpful for professionals who develop information for people with diabetes and those who create policies and guidelines.
Publisher: SAGE Publications
Date: 22-04-2017
Abstract: While there is evidence that spouses can impact the self-management of adults with type 2 diabetes mellitus, less is known about the influence of the wider social network. This qualitative study explored the perceived impact of the family as well as friends and work colleagues on type 2 diabetes mellitus self-management. A total of 25 adults with type 2 diabetes mellitus participated in semi-structured interviews regarding their social experiences of living with diabetes. Deductive thematic analysis was applied to the data. Pre-existing themes of health-related social control and social support were identified in the wider social network, with additional themes of non-involvement and unintentional undermining also emerging.
Publisher: Elsevier BV
Date: 10-2022
DOI: 10.1016/J.PCD.2022.08.001
Abstract: Diabetes distress is experienced by up to 36% of adults with type 2 diabetes. Australian type 2 diabetes guidelines recommend annual assessment of diabetes distress in general practice. This study explores general practitioners' knowledge, current practice, and factors influencing implementation of guidelines, including Person Reported Outcome Measure (PROM) use. A cross-sectional online survey was disseminated via e-mail to 4776 Australian general practitioners listed on the Australasian Medical Publishing Company database. 264 (5%) surveys were returned. 75% indicated that general practitioners were the most appropriate professionals to assess diabetes distress. Sixteen percent reported asking about diabetes distress during type 2 diabetes consultations more than half the time, with 13% using a PROM more than half the time: 64% use the Kessler-10, and 1.9% use the Problem Areas in Diabetes (PAID) scale. While general practitioners had positive beliefs about the consequences of assessing and addressing diabetes distress, they also reported barriers in motivation, environment, and knowledge of guidelines. Most respondents endorsed general practitioners' role in assessing diabetes distress, but few ask about or assess diabetes distress in routine consultations. To support uptake of guideline recommendations for diabetes-specific PROM use, environmental factors, specifically time, need to be addressed.
Publisher: SAGE Publications
Date: 22-04-2018
Abstract: This study used Rasch analysis to examine the psychometric validity of the Diabetes Distress Scale and the Problem Areas in Diabetes scale to assess diabetes distress in 3338 adults with diabetes (1609 completed the Problem Areas in Diabetes scale ( n = 675 type 1 diabetes n = 934 type 2 diabetes) and 1705 completed the Diabetes Distress Scale ( n = 693 type 1 diabetes n = 1012 type 2 diabetes)). While criterion and convergent validity were good, Rasch analysis revealed suboptimal precision and targeting, and item misfit. Unresolvable multidimensionality within the Diabetes Distress Scale suggests a total score should be avoided, while suboptimal precision suggests that the Physician-related and Interpersonal distress subscales should be used cautiously.
Publisher: Elsevier BV
Date: 03-2014
DOI: 10.1016/J.DIABRES.2013.12.005
Abstract: To investigate severe hypoglycaemia (SH) in adults with type 1 diabetes and its associations with impaired awareness of hypoglycaemia (IAH), clinical, psychological and socio-demographic factors. Attendees of three specialist diabetes clinics in Melbourne, Australia completed questions about frequency of SH in the past six months impaired awareness of hypoglycaemia (Gold score) and measures of general emotional well-being (WHO-5), diabetes-specific positive well-being (subscale of W-BQ28), diabetes-related distress (PAID) and fear of hypoglycaemia (HFS). Of 422 participants (mean ± SD age 37.5 ± 15.0 years 54% women), 78 (18.5%) reported at least one SH event and 86 (20.5%) had IAH. SH and IAH frequencies were similar at all clinics. In total, 194 SH events were reported, with 10 people experiencing 40% of events. Compared with those without SH, participants with SH had longer diabetes duration, were younger at diabetes onset and more likely to have IAH (p<0.01). Those with SH had greater fear of hypoglycaemia and diabetes-related distress, poorer general emotional well-being, and lower diabetes-specific positive well-being, (p<0.01). There were no associations with age, gender, insulin regimen or HbA1c. This study has identified that SH and IAH in Australian adults with type 1 diabetes exist at similar levels to those reported in US and European research. SH was significantly associated with IAH and fear of hypoglycaemia. Assessment of hypoglycaemia, IAH and psychological well-being as part of a routine diabetes clinic visit was well accepted by attendees and enabled identification of those who may benefit from medical, educational or therapeutic interventions.
Publisher: American Diabetes Association
Date: 13-04-2013
DOI: 10.2337/DC12-0076
Abstract: To develop a linguistically and psychometrically validated U.K. English (U.K./Ireland) version of the Diabetes-Specific Quality-of-Life Scale (DSQOLS) for adults with type 1 diabetes. We conducted independent forward and backward translation of the validated German DSQOLS. An iterative interview study with health professionals (n = 3) and adults with type 1 diabetes (n = 8) established linguistic validity. The DSQOLS was included in three Dose Adjustment for Normal Eating (DAFNE) studies (total N = 1,071). Exploratory factor analysis (EFA) was undertaken to examine questionnaire structure. Concurrent and discriminant validity, internal consistency, and reliability were assessed. EFA indicated a six-factor structure for the DSQOLS (social aspects, fear of hypoglycemia, dietary restrictions, physical complaints, anxiety about the future, and daily hassles). High internal consistency reliability was found for these factors and the weighted treatment satisfaction scale (α = 0.85–0.94). All subscales were moderately, positively correlated with the Audit of Diabetes-Dependent Quality-of-Life (ADDQoL) measure, demonstrating evidence of concurrent validity. Lower DSQOLS subscale scores [indicating impaired quality of life (QoL)] were associated with the presence of diabetes-related complications. The DSQOLS captures the impact of detailed aspects of modern type 1 diabetes management (e.g., carbohydrate counting and flexible insulin dose adjustment) that are now routine in many parts of the U.K. and Ireland. The U.K. English version of the DSQOLS offers a valuable tool for assessing the impact of treatment approaches on QoL in adults with type 1 diabetes.
Publisher: Informa UK Limited
Date: 08-10-2018
DOI: 10.1080/08870446.2018.1508684
Abstract: To examine whether in idual differences in Type D personality (combination of negative affectivity (NA) and social inhibition (SI)) could explain heterogeneity in perceived social support and relationship adjustment (intimate partner relationship) among people living with diabetes. In the Diabetes MILES-The Netherlands survey, 621 adults with type 1 or type 2 diabetes (54% female, age: 56 ± 14 years) completed measures of Type D personality (DS14), perceived social support and relationship adjustment. We used established DS14 cut-off scores to indicate Type D personality, high NA only, high SI only and reference groups. Participants from the Type D and NA only groups perceived lower levels of social support (Welch[3,259] = 37.27, p < 0.001), and relationship adjustment (Welch[3,191] = 14.74 p < 0.01) than those from the SI only and reference groups. Type D was associated with lower social support (lowest quartile adjusted OR = 8.73 95%CI = 5.05 ∼ 15.09 p < 0.001) and lower relationship adjustment (lowest quartile adjusted OR = 3.70 95%CI = 2.10 ∼ 6.53 p < 0.001). Type D was also associated with increased levels of loneliness. Participants with Type D and participants with high NA only tend to experience less social support and less relationship adjustment. Type D personality was also associated with more loneliness. Experiencing lower social support and relationship adjustment may complicate coping and self-management in people with diabetes.
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Jane Speight.