Diabetes-specific Well-being Research Articles

Standardising personalised diabetes care across European health settings: A person-centred outcome set agreed in a multinational Delphi study.

Standardised person-reported outcomes (PRO) data can contextualise clinical outcomes enabling precision diabetes monitoring and care. Comprehensive outcome sets can guide this process, but their implementation in routine diabetes care has remained challenging and unsuccessful at international level. We aimed to address this by developing a person-centred outcome set for Type 1 and Type 2 diabetes, using a methodology with prospects for increased implementability and sustainability in international health settings. We used a three-round questionnaire-based Delphi study to reach consensus on the outcome set. We invited key stakeholders from 19 countries via purposive snowball sampling, namely people with diabetes (N = 94), healthcare professionals (N = 65), industry (N = 22) and health authorities (N = 3), to vote on the relevance and measurement frequency of 64 previously identified clinical and person-reported outcomes. Subsequent consensus meetings concluded the study. The list of preliminary outcomes was shortlisted via the consensus process to 46 outcomes (27 clinical outcomes and 19 PROs). Two main collection times were recommended: (1) linked to a medical visit (e.g. diabetes-specific well-being, symptoms and psychological health) and (2) annually (e.g. clinical data, general well-being and diabetes self management-related outcomes). PROs are often considered in a non-standardised way in routine diabetes care. We propose a person-centred outcome set for diabetes, specifically considering psychosocial and behavioural aspects, which was agreed by four international key stakeholder groups. It guides standardised collection of meaningful outcomes at scale, supporting individual and population level healthcare decision making. It will be implemented and tested in Europe as part of the H2O project.

Relationships between personality, emotional well-being, self-efficacy and weight management among adults with type 2 diabetes: Results from a cross-sectional survey.

The objective of this study was to examine the associations between personality, general and diabetes-specific well-being and self-efficacy, and weight management indicators, among adults with type 2 diabetes. In addition, to examine whether personality provides incremental explanation of variance in weight management indicators. Australian adults with type 2 diabetes (N = 270; 56% women; age: 61±12 years) were recruited via the national diabetes registry. An online survey included measures of: personality (HEXACO-PI-R), weight management indicators (physical activity, healthy diet, body mass index [BMI]), general well-being (WHO-5), general self-efficacy (GSE), diabetes distress (DDS) and diabetes self-efficacy (DMSES). Analyses included bivariate correlations and linear regression, adjusted for demographic, clinical, and psychological variables. All six personality domains showed significant correlation with at least one weight management indicator: physical activity with extraversion (r = .28), conscientiousness (r = .18) and openness (r = .19); healthy diet with honesty-humility (r = .19), extraversion (r = .24), and agreeableness (r = .14); and BMI with emotionality (r = .20) and extraversion (r = -.20). The strongest associations with general and diabetes-specific well-being and self-efficacy were apparent for extraversion, emotionality and conscientiousness (range: r = -.47-.66). Beyond covariates, personality domains explained additional variance for physical activity (Adjusted R2 = .31, R2 difference = .03, p = .03; openness: β = .16, p = .02, emotionality: β = .15, p = .04) and healthy diet (Adjusted R2 = .19, R2 difference = .03, p = .02; honesty-humility: β = .20, p = .002, extraversion: β = .19, p = .04) but not BMI. This study shows that personality is associated with weight management indicators and psychological factors among adults with type 2 diabetes. Further research is needed, including objective measurement of weight management indictors, to examine how personality influences the experience of type 2 diabetes.

Web-based Acceptance and Commitment Therapy (ACT) for adults with type 1 diabetes: A single case experimental design (SCED)

A randomised multiple-baseline single case experimental design (SCED) was used to examine feasibility, acceptability, and preliminary effectiveness of an online Acceptance and Commitment Therapy (ACT) intervention for adults with Type 1 diabetes (T1D). Consenting participants reporting diabetes-specific distress (n = 25) were randomised to baseline length (1–3 weeks) before completing a six-week online ACT intervention, followed by one-month follow-up (FU). The primary outcome assessed generic and diabetes-specific well-being, measured at pre, post, and FU using the Well-Being Questionnaire. Secondary outcomes were: diabetes-dependent quality of life (Audit of Diabetes-Dependent Quality of Life at pre, post, FU); mood and anxiety measured daily using visual analogue scales (VAS); diabetes self-management (daily self-management activities VAS, and pre, post, FU measurements using the Diabetes Self-Management Questionnaire); glycaemic control (information from continuous glucose monitoring devices and daily self-monitoring of blood glucose); and psychological flexibility (Multidimensional Psychological Flexibility Inventory at pre, post, FU). Nine participants completed all phases of the study, rating the intervention as highly acceptable. Most participants showed clinically significant improvements in generic well-being (n = 5) and diabetes-specific well-being (n = 7) at follow-up. Diabetes-dependent QoL reliably improved at follow-up for three participants. Improvements in mood (n = 7) and anxiety (n = 6) were observed across phase comparisons. Most participants reported a significant increase in physical activity (n = 5) across phases. A positive trend of increased time in blood glucose range from baseline to intervention was observed for four participants. Psychological flexibility significantly increased from baseline to follow-up for seven participants. Interpretation of the findings was considered in the context of limitations including high rates of attrition (55%).

Stability of shared appraisal: The role of attachment and implications for relationships and health

In the context of coping with chronic illness, shared appraisal refers to one person’s perception that the illness is a shared issue. Despite increasing research linking shared appraisal to positive relationship and health outcomes, whether it is static or fluctuates across time has not yet been investigated. Fluctuations in shared appraisal may affect patient and spouse well-being and influence disease management. We investigated the association of daily shared appraisal fluctuations (operationalized as intraindividual standard deviations) to relationship satisfaction, psychological well-being, and diabetes-specific well-being over 2 weeks among 199 couples in which one person had type 1 diabetes. In addition, we examined attachment insecurity as a correlate of shared appraisal fluctuations. Individuals higher in anxiety or avoidance may more frequently reevaluate their relationship. Thus, their shared appraisal may be more reactive to daily events. Actor–partner interdependence models showed greater fluctuations in spouse appraisal were associated with lower patient relationship satisfaction (partner effect) but not with spouse relationship satisfaction and with greater spouse psychological distress (actor effect) but not patient psychological distress. There were no actor or partner effects of patient appraisal fluctuations on these outcomes. In terms of diabetes outcomes, regression analyses showed that greater fluctuations in patient and spouse appraisal were each associated with higher patient diabetes distress, and greater fluctuations in spouse appraisal were associated with lower patient self-care. Higher attachment anxiety was related to greater appraisal fluctuations in the spouse but not the patient. These findings highlight the importance of spouse appraisal stability for spouse relationships and well-being and for patient diabetes outcomes and suggest that attachment insecurity may be implicated in the instability of shared appraisal.

Self-monitoring of blood glucose versus self-monitoring of urine glucose in adults with newly diagnosed Type 2 diabetes receiving structured education: a cluster randomized controlled trial.

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 18months. A total of 292 participants with Type 2 diabetes were recruited from 75 practices. HbA1c levels were significantly lower at 18months 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 = -1mmol/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 18months. 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 18months; P<0.001). Participants with newly diagnosed Type 2 diabetes who attended structured education showed similar improvements in HbA1c levels at 18months, regardless of whether they were assigned to blood or urine self-monitoring.

Psychometric validation of the Self-Care Inventory-Revised (SCI-R) in UK adults with type 2 diabetes using data from the AT.LANTUS Follow-on study.

BackgroundAchieving 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.Methods353 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.ResultsPrincipal components analysis indicated a 13-item scale (items loading >0.39) 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 (>95% 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 (rs = 0.02-0.21) and treatment satisfaction (rs = 0.29). Known-groups validity was partially supported with significant differences in SCI-R total by HbA1c (≤7.5% (58 mmol/mol): 72 ± 11, >7.5% (58 mmol/mol): 68 ± 14, p < 0.05) and diabetes duration (≤16 years: 67 ± 13, >16 years: 71 ± 12, p < 0.001) but not by presence/absence of complications or by insulin treatment algorithm.ConclusionsThe 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. Individual items may be more useful clinically than the total score.

Generic and diabetes‐specific well‐being in the AT.LANTUS Follow‐on study: further psychometric validation of the W‐BQ28 indicates its utility in research and clinical practice in Type 2 diabetes in the UK

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, divergent 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); divergent 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.