Diabetes Distress In Adults Research Articles

Coping strategies for managing diabetes distress in adults with type 1 and type 2 diabetes: a cross-sectional study on use and perceived usefulness

Coping strategies for managing diabetes distress in adults with type 1 and type 2 diabetes: a cross-sectional study on use and perceived usefulness

Effectiveness of the MyDiaMate application in reducing diabetes distress in adults with type 1 diabetes: Study protocol of the multi-national, randomised-controlled MyREMEDY trial.

Diabetes distress is common among people with type 1 diabetes (T1D), negatively affecting quality of life, self management, and diabetes outcomes. E-health-based interventions could be an effective and low-cost way to improve the psychological care for people with T1D experiencing diabetes distress. The MyREMEDY study aims to test the effectiveness of the online unguided self-help intervention MyDiaMate in decreasing diabetes distress in adults with T1D. MyDiaMate is based on Cognitive Behavioural Therapy and consists of eight modules, each focusing on a different aspect of living with T1D that is often experienced as burdensome (e.g. hypoglycaemia, fatigue). The effectiveness of MyDiaMate will be tested through a randomised-controlled trial across four European countries (the Netherlands, Germany, Spain and the United Kingdom). Six hundred and sixty adults (N = 165 per country) with T1D will be recruited and randomised with a balance of 2:1 into the intervention and care as usual groups. Intervention group members receive access to MyDiaMate for 6 months, care as usual group members receive access after 3 months for 3 months. Participants fill in questionnaires at 0 (baseline), 3 (effectiveness) and 6 months (follow-up). Primary outcome is diabetes distress at 3 months. Secondary outcomes are emotional well-being, psychological self-efficacy in relation to diabetes, social engagement, fatigue, and glycaemic outcomes. Moreover, logdata of MyDiaMate use is passively collected. Linear mixed model analyses will be used to test the effectiveness of MyDiaMate along with identifying which user subgroup benefits most from MyDiaMate use. Clinicaltrials.gov NCT06308549.

655-P: Realizing the Hidden Emotional Burden—Systematic Detection of Diabetes Distress in Adults with Type 1 Diabetes in Routine Consultations

655-P: Realizing the Hidden Emotional Burden—Systematic Detection of Diabetes Distress in Adults with Type 1 Diabetes in Routine Consultations

700-P: Recent and Lifetime Experiences with Diabetes Distress in Adults with Type 1 Diabetes

700-P: Recent and Lifetime Experiences with Diabetes Distress in Adults with Type 1 Diabetes

Prevalence and Correlators of Diabetes Distress in Adults with Type 2 Diabetes: A Cross-Sectional Study.

To address the prevalence of diabetes distress (DD) and its correlators in adults with type 2 diabetes. During 2021 and 2022, we conducted a cross-sectional study in three Class A tertiary comprehensive hospitals in China, and received 947 participants who completed a printed survey covering DD, demographic, diabetic, physiological, and psychosocial factors. We used Jonckheere-Terpstra, chi-square, and Fisher's exact tests to assess intergroup differences between different levels of DD. We used ordinal logistic regression analysis to analyze correlators of DD further. The prevalence of DD was 34.64%. In univariate analysis, those with lower satisfaction with financial status, longer durations of diabetes, more complications, higher glycemia, more severe insomnia, treatment by medications only, poorer lifestyle interventions, fewer self-care activities, more types and frequencies of insulin injections, and spending more money and time on treatment were susceptible to DD. Type D personality, negative illness perceptions, negative coping styles, and psychological effects of major life events were related to higher DD. Hope, self-efficacy, positive coping styles, and social support can reduce DD. In ordinal logistic regression analysis, hypoglycemic episode (β=-1.118, p=0.019, "have hypoglycemic" as reference) and Brief Illness Perception Questionnaire (β=0.090, p<0.001) were significant positive correlators for DD, while diet intervention (β=0.803, p=0.022, "have diet intervention" as reference), money spent on diabetes treatment (β<-0.001, p=0.035), and SES (β=-0.257, p<0.001) were significant negative correlators. More than one-third of Chinese adults with type 2 diabetes experience moderate or high levels of DD. DD was associated with financial, diabetic, physiological, and psychosocial status.

The relationships between variables of glycated hemoglobin and diabetes distress in patients with type 1 and type 2 diabetes mellitus

Background. Diabetes distress is among potential barriers for people with diabetes mellitus (DM) to reach glycemic goals. Accumulating evidence suggests diabetes distress may be linked to individuals’ emotion regulation capacities. The purpose of this study was to explicate the relationships between variables of glyca­ted hemoglobin (HbA1c), diabetes distress, emotion regulation, and self-care variables through the analysis of cross-sectional data from individuals with type 1 and type 2 DM. Materials and methods. We used structural equation modeling to assess the cross-sectional relationships between variables of HbA1c, diabetes distress, emotion regulation, and self-care variables through the analysis of cross-sectional data from 132 individuals with type 1 and type 2 DM. After giving informed consent for their data to be used for research purposes without identifying them, study participants were examined by clinical psychologists with a structured clinical assessment and a series of other assessments relevant to DM. Results. While participants with type 2 DM differed from those with type 1 DM in terms of age, duration of DM, insulin dependence, and self-care, no significant diffe­rences were observed between the groups in sex, HbA1c levels, diabetes distress, emotion regulation-experience, or emotion regulation-skill scores. Study examined two potential explanatory models with one of them showing a more comprehensive view of the data revealing a total effect of poor emotional regulation on HbA1c levels. Diabetes distress in adults is linked to increased negative emotionality (emotion regulation-experience) and reduced skill at emotional regulation (emotion regulation-skill), both of which are associated with elevated HbA1c levels, and these relationships are stronger than those in diabetes self-care. Conclusions. This study suggests that in people with DM, elevated HbA1c levels and diabetes distress are linked to poor emotion regulation. These data emphasize that targeting difficulties in emotion regulation may hold promise for maximizing improvement in diabetes distress and HbA1c in individuals with DM.

Significant reduction in diabetes distress and improvements in psychosocial outcomes: A pilot test of an intervention to reduce diabetes distress in adults with type 1 diabetes and moderate-to-severe diabetes distress (REDUCE).

To pilot-test an intervention, co-designed with people with type 1 diabetes (T1DM) and diabetes specialist nurses, to reduce diabetes distress (DD) in adults with T1DM and moderate-to-severe DD. A group-based programme to reduce DD in people with T1DM and moderate-to-severe DD (REDUCE) was pilot-tested in four groups with five bi-weekly two and a half-hour meetings facilitated by two trained diabetes specialist nurses. Data collection included baseline and post-intervention questionnaires measuring DD and psychosocial outcomes and semi-structured interviews with participants post-intervention (n = 18). Data were analysed using descriptive statistics and systematic text condensation. Twenty-five adults with T1DM participated in the study. The median age and diabetes duration of participants were 50 (IQR: 32;57.5) years and 26 (IQR: 18;45) years, respectively. Seventeen (68%) were women. The pilot study showed a significant reduction in DD (measured by Type 1 Diabetes Distress Scale) between baseline and post-intervention from 2.6 ± 0.7 to 1.9 ± 0.6 (mean ± SD) (p < 0.001). The largest reductions were seen on the subscales: powerlessness 1.2 ± 1.1, eating distress 0.9 ± 1.2 and fear of hypoglycaemia 0.8 ± 1.0 (mean ± SD). Significant improvements were also seen for quality of life, diabetes empowerment and emotion regulation. Qualitative data showed that REDUCE supported participants in verbalizing emotions and seeing worries in a more constructive perspective. Acknowledgement of negative diabetes experiences eased negative self-judgments. Sharing experiences among peers increased relatedness and reduced loneliness. Participation in REDUCE was associated with significant reduction in DD and significant increase in quality of life. Larger scale studies are planned to determine sustained effectiveness of REDUCE.

213-OR: ADA Presidents' Select Abstract: EMBARK—A Randomized, Controlled Trial Comparing Three Approaches to Reducing Diabetes Distress in Adults with Type 1 Diabetes

Diabetes distress (DD) refers to the fears, worries and burdens associated with the diabetes experience. DD is common, distinct from depression, and associated with glycemic and disease management. EMBARK is a randomized, controlled clinical trial comparing three interventions to reduce DD among adults with type 1 diabetes (T1D). Following baseline assessment, participants were randomly assigned to either: (1) Streamline, an educator-led education and management program, (2) TunedIn, a psychologist-led program focused exclusively on reducing DD, or (3) FixIt, an integration of StreamLine and TunedIn. All interventions were group-based (8 to 12 members) and virtual, including initial workshop(s), 1:1 phone calls, and follow-up meetings over a 4-month period. Recruitment occurred through clinics and community organizations in the U.S. Inclusion criteria were: T1D diagnosis, elevated DD (≥ 2.0 T1-DDS score), age ≥ 21 years, HbA1c ≥ 7.5% (58 mmol/mol), and English speaking. Regression analyses recorded change in DD from baseline to immediate post-intervention. A total of 300 adults with T1D participated (M±SD 46±15 years of age, 79% female, HbA1c 8.3%±0.9 (67 mmol/mol), T1-DDS score 2.8±0.8). Large and clinically meaningful reductions in total DD score occurred for each of the three study arms at follow-up (p &amp;lt; .001). The greatest DD reductions occurred in the FixIt intervention (Δ .88±.80), followed by TunedIn (Δ .59±.70), and then Streamline (Δ .48±.71); with DD reductions significantly greater in FixIt compared to Streamline (p = .005). The same pattern of results was evident in comparisons for the DD sources of Powerlessness (p &amp;lt; .001), Management (p = .06), Hypoglycemia (p = .009), and Physician Distress (p = .01). These preliminary findings highlight the benefit of focusing directly on the emotional side of diabetes to reduce DD and indicate that DD reductions are greatest when education and emotional DD-targeted interventions are integrated. Disclosure D.M.Hessler: Consultant; Lilly. A.Ahmann: Advisory Panel; Medtronic. U.Masharani: Research Support; Clementia Pharmaceuticals. L.Fisher: Consultant; Abbott Diabetes, Eli Lilly and Company, Research Support; Ascensia Diabetes Care. L.A.Strycker: None. W.H.Polonsky: Consultant; Abbott Diabetes, Boehringer Ingelheim and Eli Lilly Alliance, Eli Lilly and Company, Insulet Corporation, Intuity Medical, Inc., MannKind Corporation, Provention Bio, Inc., Sanofi-Aventis U.S., Vertex Pharmaceuticals Incorporated. S.Guzman: Consultant; Abbott Diabetes. G.Aleppo: Advisory Panel; Medscape, Consultant; Bayer Inc., Insulet Corporation, Research Support; Dexcom, Inc., Eli Lilly and Company, Emmes, Insulet Corporation, Fractyl Health, Inc., WellDoc, Speaker's Bureau; Dexcom, Inc. E.Stephens: None. S.Kim: None. N.B.Argento: Advisory Panel; Dexcom, Inc., Eli Lilly and Company, ConvaTec Inc., Diabeloop SA, Senseonics, Speaker's Bureau; Dexcom, Inc., Boehringer Ingelheim and Eli Lilly Alliance, Novo Nordisk, MannKind Corporation, Zealand Pharma A/S, Xeris Pharmaceuticals, Inc., Eli Lilly and Company. Funding National Institutes of Health (5R01DK121241)

SA32 Bridging the Gap for Type 2 Diabetes Management and Peer-Support Interventions for Mental Health Comorbidities in Adult Patients: A Systematic Review

Both depression and diabetes distress can negatively impact self-management behaviors among adult patients living with type 2 diabetes (T2D). The primary objective of this systematic review was to report evidence and gaps in the literature for the impact of peer support interventions on two mental health comorbidities—depression and diabetes distress in adults living with T2D.

Clinically significant depressive symptoms and high diabetes distress in adults with type 1 and type 2 diabetes in Appalachian Ohio.

In rural southeastern Ohio, the prevalence of diabetes is 19.9%, nearly double the national average of 10.5%. Despite the high rate of diabetes, its impact on the region is understudied; one such understudied topic is psychosocial difficulties. People with diabetes experience disproportionately higher rates of major depressive disorder (MDD), clinically significant depressive symptoms, and diabetes distress. Diabetes distress refers to the negative emotional experience of living with diabetes. It reflects an individual's worries, concerns, and fears about living a chronic and progressive disease. To assess the prevalence of diabetes distress as well as comorbid, clinically significant depressive symptoms and diabetes distress among patients in southeastern Ohio; and to assess impact of depressive symptoms and diabetes distress on A1C levels, diabetes self care behaviors, and diabetes quality of life (DQOL). In this cross sectional survey study, individuals aged 18years and older, diagnosed with type 1 (T1D) or type 2 (T2D) diabetes, who were able to read and speak English, and living in southeastern Ohio were invited to participate. Participants completed the Diabetes Distress Scale for T2D or T1D, the Patient Health Questionnaire-9, the Self Care Inventory-Revised, and the DQOL Scale as part of the study survey. Participants completed the survey via an online questionnaire service or mailed packets. Chi square tests determined the comorbidity of clinically significant depressive symptoms and high diabetes distress levels by type of diabetes. Multiple regression models examined the relationships among clinically significant depressive symptoms, diabetes distress scores, A1C levels, self care behaviors, and DQOL scores. Statistical significance was defined as a p<0.05. A total of 325 adults participated (mean±standard deviation [SD] age, 41.6±19.2years; 131 (40.7%) with T1D; 194 (59.7%) with T2D; mean±SD A1C, 7.5±1.6%; mean±SD duration, 12.4±9.6years). Of the 325 participants, 70 (21.5%) indicated clinically significant depressive symptoms, with 29 (22.3%) T1D participants and 41 (21.0%) T2D participants reporting clinically significant depressive symptoms. A total of 92 (28.3%) participants reported high diabetes distress (39 (30.5%) T1D participants and 53 (27.5%) T2D participants). Forty-eight participants (15.0%) screened positive for both clinically significant depressive symptoms and high diabetes distress. Regression models showed that higher diabetes distress scores were associated with fewer self care behaviors (T1D, b=-0.268, p=0.030; T2D, b=-0.312, p<0.001) and lower DQOL (T1D, b=0.726, p<0.001; T2D, b=0.501, p<0.001). Further, more depressive symptoms were associated with lower DQOL in participants with T2D (b=0.363, p<0.001). Higher diabetes distress scores were not associated with higher A1C levels in participants with T1D or T2D; however, increased depressive symptoms were associated with higher A1C levels in participants with T2D (b=0.390, p<0.001). Findings showed that adults in southeastern Ohio experienced high levels of diabetes distress and co-occurring clinically significant depressive symptoms that were within range of data from previous studies. These findings highlight the importance of routine screening for both clinically significant depressive symptoms and diabetes distress. Future longitudinal research is needed to confirm these findings and examine the evolution of these relationships over time.

Social support and diabetes distress among adults with type 2 diabetes covered by Alabama Medicaid.

Diabetes distress affects approximately 36% of adults with diabetes and is associated with worse diabetes self-management and poor glycaemic control. We characterized participants' diabetes distress and studied the relationship between social support and diabetes distress. In this cross-sectional study, we surveyed a population-based sample of adults with type 2 diabetes covered by Alabama Medicaid. We used the Diabetes Distress Scale assessing emotional burden, physician-related, regimen-related and interpersonal distress. We assessed participants' level of diabetes-specific social support and satisfaction with this support, categorized as low or moderate-high. We performed multivariable logistic regression of diabetes distress by level of and satisfaction with social support, adjusting for demographics, disease severity, self-efficacy and depressive symptoms. In all, 1147 individuals participated; 73% were women, 41% White, 58% Black and 3% Hispanic. Low level of or satisfaction with social support was reported by 11% of participants; 7% of participants had severe diabetes distress. Participants with low satisfaction with social support were statistically significantly more likely to have severe diabetes distress than those with moderate-high satisfaction, adjusted odds ratio 2.43 (95% CI 1.30, 4.54). Interventions addressing diabetes distress in adults with type 2 diabetes may benefit from a focus on improving diabetes-specific social support.

Diabetes distress instruments in adults with Type 1 diabetes: A systematic review using the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) checklist.

To identify all extant instruments used to measure diabetes distress in adults with Type 1 diabetes and to evaluate the evidence for the measurement properties of these instruments. Medline, Embase, CINAHL plus and PsycINFO were systematically searched from inception up until 12 March 2020 for all publications which evaluated the psychometric properties of diabetes distress measurement instruments. The quality of the methodology and the measurement properties in the identified studies were evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Seven out of the 7656 articles retrieved in the search were included in the final review. Four diabetes distress measurement instruments were identified, none of which displayed evidence for all measurement properties specified in the COSMIN guidelines. The Problem Areas in Diabetes-11 (PAID-11) demonstrated the best psychometric properties, displaying strong evidence for structural validity, internal consistency, hypothesis testing, responsiveness and criterion validity. The Problem Areas in Diabetes scale (PAID) was the most frequently investigated instrument, demonstrating good relevance and hypothesis testing across four studies; however, concerns remain over its factor structure. The PAID-11 appears to be the most psychometrically sound instrument for measuring diabetes distress in adults with Type 1 diabetes, displaying strong evidence for a range of measurement properties. However, as only one study evaluated this instrument and its content validity has yet to be assessed, further validation is warranted. Additional qualitative work is needed to assess the content validity of these instruments among individuals with Type 1 diabetes.

Emotional Regulation and Diabetes Distress in Adults With Type 1 and Type 2 Diabetes.

To explore the correlates of diabetes-related distress (DD) with psychometrically valid assessments of emotional regulation in individuals with type 1 and type 2 diabetes. Adults with diabetes (n = 298) were assessed for psychological issues possibly associated with diabetes and were further evaluated with measures of negative emotional experience (ER-Exp) and skill at regulating such experiences (ER-Skill) and measures of DD, perceived psychosocial stress, diabetes literacy, and diabetes self-care. ER-Exp was directly related to DD, while ER-Skill was inversely related to DD. Together, these ER variables displayed a medium-size relationship (β = 0.45) with DD. Inclusion of variables related to diabetes self-care and perceived psychosocial stress was associated with only an 18% reduction (i.e., β = 0.45 to β = 0.38) in the strength of this relationship, while the magnitude of relationships between DD and perceived psychosocial stress (β = 0.15) and diabetes self-care (β = -0.09) was relatively small. These data suggest that DD is meaningfully linked with negative emotionality, and skill at regulating such emotions, in adults with diabetes. This relationship appears to be stronger than that between DD and perceived psychological stress or diabetes self-care. If so, DD (and possibly A1C) may be improved in those with diabetes and difficulties with negative emotionality.

Diabetes Distress in Adults Living With Type 1 and Type 2 Diabetes: A Public Health Issue

The concept of chronic disease distress is not new. Many chronic health conditions, including cancer, lung disease, chronic pain, inflammatory bowel disease and others, come with significant emotional and psychological burden. In the diabetes world, there has been sufficient scientific study into distress such that that it is possible to demonstrate its importance as a public health issue and to propose system changes that could serve to benefit not only diabetes but other chronic illnesses. This is an important topic of examination as diabetes rates are climbing quickly and significant rates of diabetes distress are following (1–6).

Economic costs of implementing group interventions to reduce diabetes distress in adults with type 1 diabetes mellitus in the T1-REDEEM trial

AimsThis study evaluated the implementation costs of two group interventions, one focused on diabetes education (KnowIt) and one focused directly on diabetes distress (OnTrack), that reduced diabetes distress and HbA1C in adults with poorly controlled type 1 diabetes (T1DM) in the T1-REDEEM trial. MethodsResources used to provide interventions were enumerated using activity-based micro-costing methods. Costs were assigned to resources in 2017 US dollars. US median wage and benefit rates were used to calculate costs of staff time. Cost per unit change was calculated for diabetes distress and HbA1C. ResultsFor both interventions, per participant implementation costs were approximately $250 and cost per 1.0 percentage point (11 mmol/mol) change in HbA1C was $1400. Cost per unit change in diabetes distress was $364 for KnowIt and $335 for OnTrack. No statistically significant differences in costs were observed. ConclusionsThis is the first study to examine the costs of implementing interventions targeting diabetes distress in the context of T1DM. Both interventions had per participant implementation costs in the lower end of the range of previously examined diabetes self-management interventions ($219 to $5390). These inventions and their costs merit further attention because reducing diabetes distress may impact long term T1DM outcomes.Clinical Trials Registration: ClinicalTrials.govNCT02175732

859-P: Social Support and Diabetes Distress among Adults with Alabama Medicaid

Background: Diabetes distress affects up to 45% of adults with diabetes and is associated with reduced treatment adherence and poor glycemic control. We evaluated diabetes distress and the relationship between social support and diabetes distress in adults with Medicaid. Methods: We surveyed a population-based sample of adults, aged 19 to 64 years old, covered by Alabama Medicaid, and diagnosed with type 2 diabetes. Diabetes distress was measured with the 17-item Diabetes Distress Scale (DDS) assessing emotional burden, physician-related distress, regimen-related distress, and interpersonal distress. A score of &amp;lt;2 indicates little/no distress, 2-2.9 moderate distress, and ≥3 high distress. Social support was assessed by the question “How much support do you get for dealing with your diabetes?” and responses were categorized as low, moderate, or high social support. We performed multivariate logistic regression of diabetes distress by social support, adjusting for demographics, disease severity, self-efficacy, and depressive symptoms. Results: In total, 541 individuals participated; 72% were female, 40% white, 58% black, and 3% Hispanic. Mean diabetes distress score was 1.7 (SD 0.88); 72.8% of participants had little/no diabetes distress, 16.8% moderate distress, and 10.4% high distress. Most participants (56.9%) reported high social support, but 13.5% reported low and 29.6% moderate social support. Participants who reported low and moderate social support were significantly more likely to have high diabetes distress (≥3) than those who reported high social support, adjusted odds ratio 14.3 (95% CI 5.2, 39.1) and 4.2 (95% CI 1.6, 10.7), respectively. This relationship was present for each diabetes distress domain, with particularly strong relationships between low social support and high interpersonal and regimen-related distress. Conclusions: Interventions seeking to reduce diabetes distress in adults with type 2 diabetes may benefit from a focus on improving social support. Disclosure C.A. Presley: None. F.L. Mondesir: None. A.A. Agne: None. K.R. Riggs: None. M. Pisu: None. E.B. Levitan: Consultant; Self; Novartis Pharmaceuticals Corporation. Research Support; Self; Amgen Inc. J.M. Bronstein: None. A. Cherrington: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases

813-P: Similarities and Differences in Adults’ Experiences with Type 1 and Type 2 Diabetes Distress

Diabetes is one of the biggest health problems in the U.S., affecting 9.4% of the population and 19.9% of people in southeastern Ohio. Despite the high prevalence of diabetes, it is understudied in this region. One critical outcome that has not been addressed is diabetes distress. The purpose of this study was to explore experiences of diabetes distress in adults with type 1 diabetes (T1D) and type 2 diabetes (T2D). A purposive sample of 36 adults participated in in-depth interviews (55.6% T2D, duration=13.9±13.6 years, A1C=7.6±1.9%, 58.3% on insulin; age=45.8±19.8 years; 58.3% female; 91.7% white). Two researchers independently coded the interviews, met to resolve discrepancies, and agreed on themes. Qualitative analysis revealed 4 themes: 1) Relentless Burden of Self-Care: Both T1D and T2D participants described how hard it was to manage the daily aspects of diabetes, with blood glucose monitoring reported as the most challenging behavior; 2) Perceived Lack of Support: The majority of T1D and T2D participants felt that family and friends did not understand how difficult it was to live with diabetes. Many of these participants chose to hide their diagnosis for fear of stigmatization; 3) Worry about the Inevitability of Complications: All of the participants addressed fears about developing complications, with several experiencing debilitating distress; and 4) Uncertainties about the Cost and Quality of Care: T2D participants voiced more concerns about the cost of care. With rising drug and diabetes supply costs, T2D participants expressed more unease about their future. Further, many T2D participants felt that their primary care providers did not know enough about diabetes to take care of them properly. T1D participants did not report these views. In conclusion, T1D and T2D shared more common experiences with diabetes distress than not. In southeastern Ohio, people with T1D and T2D diabetes may benefit from group interventions that incorporate problem-solving therapy and emotion regulation. Disclosure E.A. Beverly: None. R.G. Rennie: None. E.H. Guseman: None. A. Healy: None. Funding American Osteopathic Association (1291708718)

PAID-11: A brief measure of diabetes distress validated in adults with type 1 diabetes

ObjectiveThe 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. MethodsWe 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. ResultsBased 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 sample, 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 divergent validity was shown with weaker correlations with EQ5D health status (average r = 0.37). ConclusionsBased 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.

The effectiveness of an emotion-focused educational programme in reducing diabetes distress in adults with type 2 diabetes mellitus at 12-month follow-up: a cluster randomized controlled trial.

Background:Diabetes distress (DD) is an increasingly important part of clinical medicine, diabetes self-management and research topic in people with diabetes mellitus. The present study evaluated the effectiveness of a value-based emotion-focused educational program in Malay adults with type 2 diabetes (VEMOFIT) at 12-month follow-up compared with a program with systematic attention to participants’ emotions (attention-control).Methods:VEMOFIT consisted of four biweekly group sessions and a booster session after 3 months; the attention-control program consisted of three sessions over the same period. Intention-to-treat analysis with multilevel mixed modelling was done to estimate the intervention effect.Results:Participants (n = 124) randomized to VEMOFIT (n = 53) or attention-control (n = 71). Mean (SD) age 55.7 (9.7) years, median diabetes duration 7.0 (8.0) years and mean HbA1c level 9.7% (82 mmol/mol). The mean DD (DDS-17 scale) level decreased in both groups (from 3.4 to 3.3 versus 3.1–2.5, respectively), significantly more in the attention-control group [adjusted difference −0.6, 95% confidence interval (CI) −1.1, −0.2]. The VEMOFIT group had a significant improvement in self-efficacy (DMSES, range 0–200; adjusted difference 16.4, 99.4% CI 1.9, 30.9). Other outcomes did not differ.Conclusions:Because the attention-control program resulted in a decreased DD 1 year later, its implementation on a larger scale seems justified.Trial registration:NCT02730078; NMRR-15-1144-24803

The Importance of Addressing Depression and Diabetes Distress in Adults with Type 2 Diabetes

People with type 2 diabetes often experience two common mental health conditions: depression and diabetes distress. Both increase a patient's risk for mortality, poor disease management, diabetes-related complications, and poor quality of life. The American Diabetes Association and the U.S. Preventive Services Task Force recommend routine evaluations for these conditions in adults for optimal disease management and prevention of life-threatening complications. However, barriers exist within primary care and specialty settings that make screening for depression and diabetes distress challenging. Depression and diabetes distress influence diabetes self-care and diabetes control and barriers in clinical care practice that can hinder detection and management of psychosocial issues in diabetes care. This paper highlights opportunities to increase mental health screenings and provides strategies to help providers address depression and diabetes distress in patients with type 2 diabetes.