Diabetes-specific Distress Research Articles

Psychosocial functioning and glycemic control in emerging adults with Type 1 diabetes: A 5-year follow-up study.

The principal aim of this study was to examine the longitudinal interplay of depressive symptoms, diabetes-specific perceptions and distress, and glycemic control in emerging adults with Type 1 diabetes. Emerging adults with Type 1 diabetes (18-30 years old) participated in a 2-wave longitudinal study spanning 5 years (N = 164 at Time 1). Patients completed questionnaires on depressive symptoms, diabetes-specific distress (treatment-related, food-related, emotional, and social support problems), and illness perceptions (consequences and personal control) at baseline and follow-up. HbA1c values were obtained from treating clinicians. The authors investigated the directionality of effects using cross-lagged path analysis. Stronger perceptions of control predicted a relative decrease in treatment-related problems 5 years later, whereas stronger perceptions of consequences predicted a relative increase in depressive symptoms, treatment-related, food-related, emotional, and social support problems over time. Furthermore, higher depressive symptoms predicted a relative increase in social support problems 5 years later. None of the study variables were related to changes in glycemic control over time. Our findings stress the importance of addressing patients' perceptions and beliefs about their diabetes. Clinicians should find a delicate balance between stressing the importance of diabetes care and preventing patients from feeling overwhelmed or engulfed by the burden of diabetes care. Furthermore, our findings advocate for depression screening and treatment as key elements in holistic diabetes care, given the relatively high prevalence of elevated depressive symptoms in this population.

Building the evidence for integrated care for type 2 diabetes: a pilot study.

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.

Easing diabetes’ psychological burden

Easing diabetes’ psychological burden

The OnTrack Diabetes Web-Based Program for Type 2 Diabetes and Dysphoria Self-Management: A Randomized Controlled Trial Protocol.

BackgroundThe prevalence of type 2 diabetes is rising with the majority of patients practicing inadequate disease self-management. Depression, anxiety, and diabetes-specific distress present motivational challenges to adequate self-care. Health systems globally struggle to deliver routine services that are accessible to the entire population, in particular in rural areas. Web-based diabetes self-management interventions can provide frequent, accessible support regardless of time and locationObjectiveThis paper describes the protocol of an Australian national randomized controlled trial (RCT) of the OnTrack Diabetes program, an automated, interactive, self-guided Web program aimed to improve glycemic control, diabetes self-care, and dysphoria symptoms in type 2 diabetes patients.MethodsA small pilot trial is conducted that primarily tests program functionality, efficacy, and user acceptability and satisfaction. This is followed by the main RCT, which compares 3 treatments: (1) delayed program access: usual diabetes care for 3 months postbaseline followed by access to the full OnTrack Diabetes program; (2) immediate program: full access to the self-guided program from baseline onward; and (3) immediate program plus therapist support via Functional Imagery Training (FIT). Measures are administered at baseline and at 3, 6, and 12 months postbaseline. Primary outcomes are diabetes self-care behaviors (physical activity participation, diet, medication adherence, and blood glucose monitoring), glycated hemoglobin A1c (HbA1c) level, and diabetes-specific distress. Secondary outcomes are depression, anxiety, self-efficacy and adherence, and quality of life. Exposure data in terms of program uptake, use, time on each page, and program completion, as well as implementation feasibility will be conducted.ResultsThis trial is currently underway with funding support from the Wesley Research Institute in Brisbane, Australia.ConclusionsThis is the first known trial of an automated, self-guided, Web-based support program that uses a holistic approach in targeting both type 2 diabetes self-management and dysphoria. Findings will inform the feasibility of implementing such a program on an ongoing basis, including in rural and regional locations.Trial RegistrationAustralian and New Zealand Clinical Trials Registration number: ACTRN12612000620820; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12612000620820 (Archived by WebCite at http://www.webcitation.org/6a3BeXC5m).

Subjective sleep impairment in adults with type 1 or type 2 diabetes: Results from Diabetes MILES—The Netherlands

AimsDespite 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. MethodsIn 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. ResultsPoor 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). ConclusionsPoor 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.

New treatments for erectile dysfunction

Erectile dysfunction (ED) is common in men with diabetes and is associated with microvascular disease, maladaptation to chronic illness, poor quality of life, and increased levels of diabetes-specific health distress. Traditionally, most diabetologists were poor at asking about ED and patients themselves are not always forthcoming with information, given the embarrassing nature of the disease. However, times are changing and the inclusion of screening for ED in Quality and Outcomes Framework and current general practice templates emphasises its current importance. Licensed treatments have been limited in their application towards the provision of symptomatic relief and are offset by adverse effects, intolerance, limited effectiveness and contraindications in the presence of co-existent cardiovascular disease. This review critically considers the utility of novel treatments for ED in diabetes that have been developed to overcome these barriers.

Longitudinal relationship between diabetes-specific emotional distress and follow-up HbA1c in adults with Type 1 diabetes mellitus.

AimTo examine whether diabetes-specific emotional distress was related to follow-up glycaemic control in adults with Type 1 diabetes mellitus.MethodsAdults with Type 1 diabetes mellitus completed the Diabetes Distress Scale and reported sociodemographic information when attending a clinical consultation at a university endocrinology unit. Blood samples to determine baseline HbA1c were taken during consultations. All respondents’ HbA1c measurements registered from January 2009 to December 2011 were collected from medical records. The relationship between baseline diabetes-specific emotional distress and HbA1c was examined with linear mixed-effects models in 175 patients with complete data.ResultsAfter controlling for confounders, baseline diabetes-specific emotional distress and glycaemic control were significantly associated (fixed-effect coefficient 0.40, P < 0.001) and the regimen-related distress subscale had the strongest association with glycaemic control (fixed-effect coefficient 0.47, P < 0.001). The two-item measure of diabetes-specific distress had a weaker but still significant association with glycaemic control (fixed-effect coefficient 0.31, P < 0.001). None of these relationships was significant after adjusting for the baseline HbA1c.ConclusionsPeople with elevated baseline diabetes-specific emotional distress are at risk of prolonged suboptimum glycaemic control; therefore, elevated diabetes-specific emotional distress, especially regimen-related distress, might be an important marker for prolonged suboptimum glycaemic control, and might indicate a need for special attention regarding patient self-management.What’s new? In adults with Type 1 diabetes, elevated baseline diabetes-specific emotional distress is associated with worse glycaemic control over a 1–3-year period and regimen-related distress had the strongest association with subsequent glycaemic control. Baseline diabetes-specific emotional distress is associated with the stable component of glycaemic control and does not account for within-individual change in glycaemic control over 1–3 years. Elevated diabetes-specific emotional distress may be an important marker for risk of prolonged suboptimum glycaemic control.

Does kindness matter? Self-compassion buffers the negative impact of diabetes-distress on HbA1c.

Higher self-compassion is associated with mental and physical health benefits in both healthy and chronically ill populations. The current study investigated the role of self-compassion in predicting depression, diabetes-specific distress and HbA1c in patients with diabetes. To assess the specific operationalization of negative emotionality that best predicted HbA1c and to test whether self-compassion would buffer HbA1c in patients with diabetes against the negative effects of distress. Patients with diabetes (n = 110) completed measures assessing trait self-compassion, depression and diabetes-distress. HbA1c results were obtained through medical records. As expected, diabetes-specific distress was a better predictor of HbA1c than depression; self-compassion moderated the relationship between distress and HbA1c such that higher distress predicted higher HbA1c at lower levels of self-compassion, but not at higher levels of self-compassion. In addition to further demonstrating the link between distress and metabolic outcomes, these findings suggest that self-compassion might buffer patients from the negative metabolic consequences of diabetes-distress.

Annual Psychological Screening in Youth and Young Adults with Type 1 Diabetes.

AimYouth and young adults with type 1 diabetes are at a great risk for developing depression and diabetes specific distress, therefore, systematic psychological screening is recommended. Routine psychological screening was implemented in Slovene diabetes clinic for children, adolescents and young adults in 2012. One-year results are presented.MethodsAdolescents and young adults (N = 159, aged 11 – 25 years), attending the obligatory yearly educational outpatient visit at University Children’s Hospital, Ljubljana, Slovenia, were examined using questionnaires measuring depression (depression scale from Slovene version of Trauma Symptom Checklist for Children) and diabetes distress (Diabetes Distress Screening Scale). Six additional items were included to assess the fear of hypoglycemia and family support. Socio-demographic and diabetes-related data were collected. Questionnaires were analyzed by a psychologist, and the patients that scored above cut-off point were invited to an individual psychological assessment.ResultsOf the sample, 1.3 % reached the threshold for elevated depressive symptoms, and 32.7 % reported significant diabetes distress. The need for psychological support from a specialist was expressed by 5.0 %. There were statistically significant associations between all psychological variables; moreover, better glycemic control was associated with lower diabetes distress and better family support. Nine patients (5.7 %) started with psychological treatment according to the referrals after screening.ConclusionsThe results after one year of psychological screening in Slovene type 1 diabetes population displayed small rates of depression and a large proportion of diabetes distress. Only a small percentage of patients attended the offered individual psychological assessment.

Efficacy of a web-based intervention with mobile phone support in treating depressive symptoms in adults with type 1 and type 2 diabetes: a randomized controlled trial.

Depression is common in diabetes and linked to adverse health outcomes. This study evaluated the efficacy of a guided web-based intervention in reducing depression in adults with type 1 and type 2 diabetes. A total of 260 participants with diabetes and elevated depressive symptoms (Center for Epidemiologic Studies Depression Scale [CES-D ≥23]) were randomly assigned to the GET.ON Mood Enhancer Diabetes (a guided self-help intervention, n = 130) or a brief online unguided psychoeducation program for depression (n = 130). The primary outcome was depressive symptoms severity (CES-D). The secondary outcomes included diabetes-specific emotional distress (Problem Areas in Diabetes [PAID] scale) and participant satisfaction (adaption CSQ-8). Data were collected at baseline and 2 months after randomization. To identify differences in outcome between the groups, we used analyses of covariance with the baseline CES-D score as covariate on both intent-to-treat (ITT) and per-protocol (PP) basis. Compared with the control group, the intervention group showed significantly less depressive symptom severity at posttreatment based on ITT (d = 0.89) and PP analyses (d = 1.00). The intervention participants displayed a significantly larger reduction in diabetes-specific emotional distress (d = 0.58, ITT). The intervention appeared to be acceptable to the participants; 95% (n = 121) would recommend the training to a friend with diabetes in need of psychological help. A guided, web-based intervention to reduce depression in adults with type 1 and type 2 diabetes is effective in reducing both depressive symptoms and diabetes-specific emotional distress.

Psychological themes that influence self-management of type 1 diabetes.

It has long been accepted that psychological factors adversely influence efforts to optimise glycaemic control. These are often unrecognised in terms of clinical assessment and therefore under reported. This essay presents an introduction to psychological issues that interact with psychiatric co-morbidities and diabetes-specific distress, and a case scenario illustrating the interconnectedness of presenting problems and themes. In the way that we cannot separate carbohydrate counting, blood glucose monitoring and insulin dose adjustment in the understanding of a presenting problem such as poor control, so we cannot separate the concurrent thoughts, feelings, and behaviours. Each of these emotional aspects are self-managed either through avoidance, or by delayed disclosure and are frequently associated with poor health outcomes. There is a requirement for the healthcare team to be sensitised to these issues and to develop styles of communication that are empathic, reflective and non judgemental. A brief outline of evidence-based psychotherapy treatments is given.

Is social support universally adaptive in diabetes? A correlational study in an Arabic-speaking population with type 2 diabetes.

The purpose of this study was to assess the relationship between diabetes self-care, diabetes-specific emotional distress, and social support and glycemic control (hemoglobin A1C levels: HbA1c) among a sample of Lebanese adults with type 2 diabetes. A descriptive correlational design was adapted with descriptive statistics and multiple logistic regressions for analyses. A convenience sample of 140 adults diagnosed with type 2 diabetes was recruited from 2 diabetes clinics in Greater Beirut. Participants were asked to complete 4 questionnaires in Arabic. Significant associations (P < .05) were found between following a general diet for more than 3.5 days per week and higher social support and HbA1c levels of 7% or more. Social support was positively associated with HbA1c levels such that participants with uncontrolled glycemic levels, as evidenced by higher values for HbA1c, received more support from their social network.

Negative association between depression and diabetes control only when accompanied by diabetes-specific distress.

Evidence of the negative impact of depression on glycaemic control is equivocal, and diabetes-related distress has been proposed as potential mediator. 466 diabetes patients were cross-sectionally assessed for depression (Center for Epidemiologic Studies Depression Scale), diabetes-related distress (Diabetes Distress Scale), and glycaemic control (HbA1c). We distinguished the associations of depression and diabetes distress with glycaemic control using analysis of variance and multiple regression. Neither patients with depression only nor diabetes distress only differed significantly from controls regarding HbA1c. However, HbA1c was substantially increased when both conditions were present (9.2 vs. 8.6 %, P = 0.01). As in previous studies, we observed a significant association between depression and hyperglycaemia (P < 0.01). However, a mediation analysis revealed that this association in fact depended on the presence of diabetes distress (P < 0.01). Depression seems to be associated with hyperglycaemia particularly when accompanied by diabetes distress, suggesting that adjusting clinical procedures regarding diabetes distress may facilitate the identification and care of high-risk patients.

Psychometric properties of the Thai version of the Diabetes Distress Scale in diabetic seniors.

BackgroundThe Diabetes Distress Scale (DDS) is an important measure of diabetes-related emotional distress that has been widely used in the Western world. In Thailand, there is a lack of reliable and valid scales for assessing distress levels in diabetes patients, specifically in older adults.ObjectivesThe main objectives of this study were to adapt the DDS for use in Thai diabetic elderly and to evaluate its psychometric properties.MethodsThe 17-item DDS was linguistically adapted using forward–backward translation and administered to 170 diabetic patients ≥60 years selected from diabetes outpatient clinics of four hospitals in Buriram, Thailand. Statistical analyses included exploratory factor analysis, internal consistency, convergent validity, and test–retest reliability.ResultsDuring factor analysis, a three-factor solution was found to be reasonable for the sub-dimensions of emotional and regimen-related burden (ten items), physician- and nurse-related distress (four items), and diabetes-related interpersonal distress (three items). The Cronbach’s alpha coefficient for the total score was 0.95 and varied between 0.85 and 0.96 in the three subscales. The results provided evidence that supports the convergent validity of the Thai version of the DDS as well as its stability.ConclusionThe Thai version of the DDS has acceptable psychometric properties. It enables assessment of diabetes-specific distress in elderly patients and has the advantage of being easy to use in both clinical and research settings.

Relationships of diabetes-specific emotional distress, depression, anxiety, and overall well-being with HbA1c in adult persons with type 1 diabetes

ObjectiveEmotional problems are common in adults with diabetes, and knowledge about how different indicators of emotional problems are related with glycemic control is required. The aim was to examine the relationships of diabetes-specific emotional distress, depression, anxiety, and overall well-being with glycosylated hemoglobin (HbA1c). MethodsOf the 319 adults with type 1 diabetes attending the endocrinology outpatient clinic at a university hospital in Norway, 235 (74%) completed the Diabetes Distress Scale, the Problem Areas in Diabetes Survey, the Hospital Anxiety and Depression Scale, and the World Health Organization-Five Well-Being Index. Blood samples were taken at the time of data collection to determine HbA1c. Regression analyses examined associations of diabetes-specific emotional distress, anxiety, depression, and overall well-being with HbA1c. The relationship between diabetes-specific emotional distress and HbA1c was tested for nonlinearity. ResultsDiabetes-specific emotional distress was related to glycemic control (DDS total: unstandardized coefficient=0.038, P<.001; PAID total: coefficient=0.021, P=.007), but depression, anxiety, and overall well-being were not. On the DDS, only regimen-related distress was independently related to HbA1c (coefficient=0.056, P<.001). A difference of 0.5 standard deviation of baseline regimen distress is associated with a difference of 0.6 in HbA1c. No significant nonlinearity was detected in the relationship between diabetes-specific distress and HbA1c. ConclusionsTo stimulate adequate care strategies, health personnel should acknowledge depression and diabetes-specific emotional distress as different conditions in clinical consultations. Addressing diabetes-specific emotional distress, in particular regimen distress, in clinical consultation might improve glycemic control.

“Knowing That You’re Not the Only One”: Perspectives on Group-Based Cognitive-Behavioral Therapy for Adherence and Depression (CBT-AD) in Adults With Type 1 Diabetes

Depression and illness-specific distress are more common among adults with Type 1 diabetes (T1DM) than the general population and have been associated with poorer control of blood glucose and increased risk for serious diabetes-related complications. Treatment nonadherence has also been associated with depressive symptoms and diabetes-related distress, and has repeatedly been suggested as an important modifiable behavioral pathway linking depression and diabetes outcomes. The present study reports on the feasibility and acceptability of a pilot intervention using group-based cognitive-behavioral therapy to improve treatment adherence among adults with T1DM and elevated levels of diabetes-related distress or depressive symptoms. We describe the components of the intervention and utilize qualitative data along with descriptive outcome data. Our findings suggest that participation in the group was acceptable and associated with reductions in depressive symptoms and diabetes-specific distress. Challenges to feasibility and future directions are discussed.

Nurse-led telecoaching of people with type 2 diabetes in primary care: rationale, design and baseline data of a randomized controlled trial

BackgroundDespite the efforts of the healthcare community to improve the quality of diabetes care, about 50% of people with type 2 diabetes do not reach their treatment targets, increasing the risk of future micro-and macro-vascular complications. Diabetes self-management education has been shown to contribute to better disease control. However, it is not known which strategies involving educational programs are cost-effective. Telehealth applications might support chronic disease management. Transferability of successful distant patient self-management support programs to the Belgian setting needs to be confirmed by studies of a high methodological quality. “The COACH Program” was developed in Australia as target driven educational telephone delivered intervention to support people with different chronic conditions. It proved to be effective in patients with coronary heart disease after hospitalization. Clinical and cost-effectiveness of The COACH Program in people with type 2 diabetes in Belgium needs to be assessed.Methods/DesignRandomized controlled trial in patients with type 2 diabetes. Patients were selected based on their medication consumption data and were recruited by their sickness fund. They were randomized to receive either usual care plus “The COACH Program” or usual care alone. The study will assess the difference in outcomes between groups. The primary outcome measure is the level of HbA1c. The secondary outcomes are: Total Cholesterol, LDL-Cholesterol, HDL-Cholesterol, Triglycerides, Blood Pressure, body mass index, smoking status; proportion of people at target for HbA1c, LDL-Cholesterol and Blood Pressure; self-perceived health status, diabetes-specific emotional distress and satisfaction with diabetes care. The follow-up period is 18 months. Within-trial and modeled cost-utility analyses, to project effects over life-time horizon beyond the trial duration, will be undertaken from the perspective of the health care system if the intervention is effective.DiscussionThe study will enhance our understanding of the potential of telehealth in diabetes management in Belgium. Research on the clinical effectiveness and the cost-effectiveness is essential to support policy makers in future reimbursement and implementation decisions.Trial registrationBelgian number: B322201213625. ClinicalTrials.gov Identifier: NCT01612520

Efficacy and cost-effectiveness of a web-based intervention with mobile phone support to treat depressive symptoms in adults with diabetes mellitus type 1 and type 2: design of a randomised controlled trial

BackgroundA diagnosis of diabetes mellitus types 1 or 2 doubles the odds of a comorbid depressive disorder. The combined diseases have a wide range of adverse outcomes, such as a lower quality of life, poorer diabetes outcomes and increased healthcare utilisation. Diabetes patients with depression can be treated effectively with psychotherapy, but access to psychological care is limited. In this study we will examine the efficacy and cost-effectiveness of a newly developed web-based intervention (GET.ON Mood Enhancer Diabetes) for people with diabetes and comorbid depressive symptoms.Methods/DesignA two-arm randomised controlled trial will be conducted. Adults with diabetes (type 1 or type 2) with increased depression scores (> 22 on the German version of the Center for Epidemiological Studies Depression Scale (CES-D)) will be included. Eligible participants will be recruited through advertisement in diabetes patient journals and via a large-scale German health insurance company. The participants will be randomly assigned to either a 6-week minimally guided web-based self-help program or an online psychoeducation program on depression. The study will include 260 participants, which will enable us to detect a statistically significant difference with a group effect size of d = 0.35 at a power of 80% and a significance level of p = 0.05. The primary outcome measure will be the level of depression as assessed by the CES-D. The secondary outcome measures will be: diabetes-specific emotional distress, glycaemic control, self-management behaviour and the participants’ satisfaction with the intervention. Online self-assessments will be collected at baseline and after a 2 months period, with additional follow-up measurements 6 and 12 months after randomisation. The data will be analysed on an intention-to-treat basis and per protocol. In addition, we will conduct an economic evaluation from a societal perspective.DiscussionIf this intervention is shown to be cost-effective, it has considerable potential for implementing psychological care for large numbers of people with diabetes and comorbid depression in routine practice and improve health outcomes.Trial registrationGerman Clinical Trial Register (DRKS): DRKS00004748.

Diabetes education improves depressive state in newly diagnosed patients with Type 2 diabetes

The prevalence of depression is relatively high in individuals with diabetes. However, screening and monitoring of depressive state in patients with diabetes is still neglected in developing countries and the treatment of diabetes-related depression is rarely performed in these countries. In this study, our aim was to study the role of diabetes education in the improvement of depressive state in newly diagnosed patients with type 2 diabetes. The Dutch version of the center for epidemiological studies depression scale (CES-D scale) and the problem areas in diabetes (PAID) questionnaire were used to assess depression and diabetes-specific emotional distress in 1200 newly diagnosed male adult patients with type 2 diabetes before and after a two-week diabetes education by professionally trained nurses. Pearson correlation and regression analysis were used to analyze the factors related to depression in patients with type 2 diabetes. The incidence of depression in newly diagnosed patients with type 2 diabetes was 28%, and the rate of diabetes-specific emotional distress was 65.5%. High education levels, low income were correlated to depression in individuals with diabetes. After two weeks of diabetes education, the incidence of depression and diabetes-specific emotional distress decreased significantly to 20.5% (P < 0.05) and 11% (P < 0.001), respectively. The incidence of depression, especially diabetes-specific emotional distress, was relatively high in newly diagnosed patients with type 2 diabetes. The depression state could be improved by diabetes education.

Weight loss on a structured hypocaloric diet with or without exercise improves emotional distress and quality of life in overweight and obese patients with type 2 diabetes.

To evaluate the effects of a caloric restricted weight loss program with or without supervised resistance exercise training (EX) on diabetes-related emotional distress and quality of life (QOL) in overweight and obese patients with type2 diabetes. In a parallel design, 106 men and women with type2 diabetes were randomized to a prescriptive 16-week caloric restricted diet (D; 6,000-7,000kJ/day), with (n=65) or without (n=41) EX (three times per week). Bodyweight, glycated hemoglobin, diabetes-specific emotional distress (Problem Areas in Diabetes [PAID] questionnaire) and QOL (Diabetes-39 [D-39] questionnaire) was assessed pre- and post-intervention. A total of 84 participants completed the study (D n=33, D+EX n=51). Weight loss was significantly greater in D+EX compared with D (-11.4±5.8 vs -8.8±5.8kg, P=0.04 time×diet). Overall, there were significant improvements in glycated hemoglobin, PAID total score and the D-39 dimensions of 'diabetes control', 'anxiety and worry', 'sexual functioning', 'energy and mobility', 'overall rating of QOL' and 'severity of diabetes' (P≤0.01 for time). The D-39 dimension, 'social burden', did not change (P=0.07 for time). There was no difference between groups in the response for any of these variables (P≥0.10). A structured caloric restricted diet with or without EX improves emotional distress and QOL in overweight and obese patients with type 2 diabetes. This trial was registered with Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au; ACTR No: ACTRN12608000206325).