Problem Areas In Diabetes Scale Research Articles

Association of type 2 diabetes with family history of diabetes, diabetes biomarkers, mental and physical disorders in a Kenyan setting

This study aimed to determine the degree of family relations and associated socio-demographics characteristics, clinical/physical and mental disorders in type 2 diabetes mellitus in a Kenyan diabetes clinic. This study was part of a large multicentre study whose protocol and results had been published. It took place at the outpatient diabetes clinic at a County Teaching and Referral Hospital in South East Kenya involving 182 participants. We used a socio-demographic questionnaire, the Hamilton Depression (HAM-D) and PHQ-9 rating scales for depression, the MINI International Neuropsychiatric Interview (MINI; V5 or V6) for DSM-5 diagnoses, the WHO-5 Well-being scale and Problem Areas in Diabetes Scale (PAID). We extracted from the notes all physical conditions. We enquired about similar conditions in 1st and 2nd degree relatives. Descriptive, Chi-square test, Fisher’s exact test, one way ANOVA, and Multinomial logistic regression analysis were conducted to test achievements of our specific aims. Of the 182 patients who participated in the study, 45.1% (82/182) reported a family history of diabetes. Conditions significantly (p < 0.05) associated with a degree of family history of diabetes were retinopathy, duration of diabetes (years), hypertension, and depressive disorder. On average 11.5% (21/182) scored severe depression (≥ 10) on PHQ-9 and 85.2% (115/182) scored good well-being (≥ 13 points). All DSM-5 psychiatric conditions were found in the 182 patients in varying prevalence regardless of relations. In addition, amongst the 182 patients, the highest prevalence was poor well-being on the WHO quality of life tool. This was followed by post-traumatic disorders (current), suicidality, and psychotic lifetime on DSM-5. The least prevalent on DSM-5 was eating disorders. Some type 2 diabetes mellitus physical disorders and depression have increased incidence in closely related patients. Overall, for all the patients, the prevalence of all DSM-5 diagnoses varied from 0.5 to 9.9%.

Diabetes-related stress in older adults with type 2 diabetes and chronic complication: Multiple effects of social-ecological support on self-management behavior.

This study aims to explore the relationship among diabetes-related distress, social-ecological support, and self-management behavior in older adults with type 2 diabetes mellitus (T2DM) and chronic complications. This cross-sectional study included older adults with T2DM in Shanghai, China, between January and July 2022. The problem areas in diabetes scale (PAID), the chronic illness resource survey (CIRS), and the diabetes self-management behavior for older (DSMB-O) were employed. A total of 264 participants (157 [59.47%] males, aged 71.07 ± 6.47 years) were included; their T2DM duration ranged from 5 to 30 years, with an average of 11.19 ± 6.96 years. The DSMB-O scores were negatively correlated with the PAID scores and positively correlated with CIRS scores. The CIRS scores were negatively correlated with the PAID scores. CIRS had a positive direct effect on DSMB-O, and CIRS had an indirect effect on DSMB-O through PAID. CIRS had a total effect on DSMB-O through PAID. The mediating effect made up 28.89% of the total effect. In older adults with T2DM and chronic complications, chronic illness resources were correlated with diabetes-related distress and self-management behavior. Chronic illness resources had both a direct effect on self-management behavior and an indirect effect through diabetes-related distress.

The role of peer social relationships in psychological distress and quality of life among adolescents with type 1 diabetes mellitus: a longitudinal study

BackgroundAdolescents with type 1 diabetes mellitus suffer from diabetes distress and poor health-related quality of life (HRQOL) since living with the condition that differentiates them from their peers. The present study investigated the effects of peer support and stress on diabetes distress and HRQOL and whether positive coping mediated the effects.MethodsWe used a prospective study design. A total of 201 adolescents with type 1 diabetes mellitus from 20 cities in 4 provinces were recruited.Participants complete two separate surveys at approximately 18-month intervals. The scales employed at both Time 1 and Time 2 included the Diabetes-Specific Peer Support Measure, Diabetes Stress Questionnaire for Youths, Simplified Coping Style Questionnaire, 5-item Problem Areas in Diabetes Scale, and the Diabetes Quality of Life for Youth scale.ResultsBaseline peer stress directly predicted diabetes distress and HRQOL at 18 months, even controlling for age, gender, and peer support. However, the direct effect of baseline peer support on 18-month diabetes distress and HRQOL was insignificant. Baseline peer support indirectly affected diabetes distress and HRQOL at 18 months through positive coping, indicating that positive coping plays a mediating role.ConclusionThe findings suggest that peer social relationships, especially peer stress, and positive coping are promising intervention targets for adolescents facing challenges in psychosocial adaptation.

Prevalence and predictors of diabetes distress and depression in people with type 1 diabetes.

People living with diabetes often encounter psychosocial challenges, including diabetes distress and depression. Despite this, little research has focused on the co-occurrence of these conditions. This study aimed to explore the prevalence of depressive symptoms and diabetes distress in people with type 1 diabetes in Kuwait and to identify clinical and demographic factors associated with these conditions. A total of 832 people with type 1 diabetes (females: 54.1%, mean age: 29 ± 8.5 years), were invited to participate in Dose Adjustment for Normal Eating (DAFNE) course. Diabetes distress was measured using the Problem Areas in Diabetes (PAID) scale and depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). Depressive symptoms were defined as PHQ-9 scores ≥10. Data on biomedical outcomes, lifestyle factors, and sociodemographic information were collected. The prevalence rates of diabetes distress and depressive symptoms were 27.8% and 38.3%, respectively. Notably, 19.6% of people experienced both conditions. In the regression analysis, PAID scale and PHQ-9 scores were significantly associated, patients with higher score on depressive symptoms scale were more likely to suffer diabetes distress (B= 2.65, p < 0.001). Female sex (odds ratio [OR]= 2.2, 95% CI= 1.5, 3.2), higher hemoglobin A1c levels (OR= 1.6, 95% CI= 1.0, 2.5), obesity (OR= 1.7, 95% CI= 1.1, 2.8), inactivity (OR= 2.4, 95% CI= 1.6, 3.6), microvascular complications (OR= 2.8, 95% CI= 1.5, 5.4), and lipohypertrophy (OR= 1.7, 95% CI= 1.1, 2.5) were associated with greater odds for the co-occurrence of diabetes distress and depressive symptoms (p< 0.05 for all). The majority of people with type 1 diabetes in Kuwait experience both diabetes distress and depressive symptoms. The strong correlation between diabetes distress and depressive symptoms suggests mutual predictability. The co-occurrence of both symptoms is associated with many sociodemographic and clinical factors.

Prospective health care costs and lost work days associated with diabetes-related distress and depression symptoms among 1488 individuals with diabetes

The aim of this study was to investigating the impact of major depression symptoms and diabetes-related distress on future health care costs and lost workdays in individuals with diabetes. We linked survey data from a random sample of a German statutory health insurance (SHI) with diabetes (n = 1488, 63.0% male, mean age 66.9 years) with their SHI data one year after the survey. Within the survey data we identified major depression symptoms (Patient Health Questionnaire-9) and diabetes-related distress (Problem Areas in Diabetes Scale). We retrieved health care costs and lost workdays from SHI data. To assess the impact of major depression symptoms and diabetes-related distress on health care costs and lost workdays, we adjusted regression models for age, sex, education, employment status, and diabetes duration, type, and severity. Major depression symptoms were associated with significantly higher costs (by a factor of 1.49; 95% CI: 1.18–1.88). Lost workdays were also more likely for respondents with depression symptoms (RR1.34; 0.97–1.86). Health care costs (by a factor of 0.81; 0.66–1.01) and the risk of lost workdays (RR 0.86; 0.62–1.18) may be lower among respondents with high diabetes-related distress. While major depression and diabetes-related distress have overlapping indicators, our results indicate different impacts on health care costs.

The Clinical Relevance of Diabetes Distress versus Major Depression in Type 2 Diabetes: A Latent Class Analysis from the Fremantle Diabetes Study Phase II.

The nosological position and clinical relevance of the concept of diabetes distress (DD) are uncertain. The aim of this study was to use latent class analysis (LCA) to categorise classes of people with type 2 diabetes and to compare their characteristics. Data from 662 participants in the longitudinal observational Fremantle Diabetes Study Phase II were analysed. LCA identified latent subgroups based on individual responses to the Patient Health Questionnaire-9, the Generalised Anxiety Disorder Scale, and the 5-item Problem Areas in Diabetes Scale. Four classes were identified: Class 1 (65.7%, no symptoms), Class 2 (14.0%, DD), Class 3 (12.6%, subsyndromal depression (SSD)), and Class 4 (7.6%, major depression (MD)). Multinomial regression analysis with Class 1 as reference showed significant associations between the DD class and Southern European and Asian ethnic background, HbA1c, and BMI. The SSD class was significantly associated with HbA1c, cerebrovascular disease, and coronary heart disease (CHD). The MD class had significant associations with age (inversely), Southern European ethnic background, HbA1c, BMI, and CHD. In conclusion, LCA identified a pure DD group comprising 14.0% of participants. The only variable uniquely associated with the DD class was Asian ethnic background. Although identification of DD may have some utility in assessing the psychological wellbeing of individuals with type 2 diabetes, it adds little to the assessment of depressive disorder and its significant clinical sequalae.

Psychosocial Outcomes Among Users and Nonusers of Open-Source Automated Insulin Delivery Systems: Multinational Survey of Adults With Type 1 Diabetes.

Emerging research suggests that open-source automated insulin delivery (AID) may reduce diabetes burden and improve sleep quality and quality of life (QoL). However, the evidence is mostly qualitative or uses unvalidated, study-specific, single items. Validated person-reported outcome measures (PROMs) have demonstrated the benefits of other diabetes technologies. The relative lack of research investigating open-source AID using PROMs has been considered a missed opportunity. This study aimed to examine the psychosocial outcomes of adults with type 1 diabetes using and not using open-source AID systems using a comprehensive set of validated PROMs in a real-world, multinational, cross-sectional study. Adults with type 1 diabetes completed 8 validated measures of general emotional well-being (5-item World Health Organization Well-Being Index), sleep quality (Pittsburgh Sleep Quality Index), diabetes-specific QoL (modified DAWN Impact of Diabetes Profile), diabetes-specific positive well-being (4-item subscale of the 28-item Well-Being Questionnaire), diabetes treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire), diabetes distress (20-item Problem Areas in Diabetes scale), fear of hypoglycemia (short form of the Hypoglycemia Fear Survey II), and a measure of the impact of COVID-19 on QoL. Independent groups 2-tailed t tests and Mann-Whitney U tests compared PROM scores between adults with type 1 diabetes using and not using open-source AID. An analysis of covariance was used to adjust for potentially confounding variables, including all sociodemographic and clinical characteristics that differed by use of open-source AID. In total, 592 participants were eligible (attempting at least 1 questionnaire), including 451 using open-source AID (mean age 43, SD 13 years; n=189, 41.9% women) and 141 nonusers (mean age 40, SD 13 years; n=90, 63.8% women). Adults using open-source AID reported significantly better general emotional well-being and subjective sleep quality, as well as better diabetes-specific QoL, positive well-being, and treatment satisfaction. They also reported significantly less diabetes distress, fear of hypoglycemia, and perceived less impact of the COVID-19 pandemic on their QoL. All were medium-to-large effects (Cohen d=0.5-1.5). The differences between groups remained significant after adjusting for sociodemographic and clinical characteristics. Adults with type 1 diabetes using open-source AID report significantly better psychosocial outcomes than those not using these systems, after adjusting for sociodemographic and clinical characteristics. Using validated, quantitative measures, this real-world study corroborates the beneficial psychosocial outcomes described previously in qualitative studies or using unvalidated study-specific items.

Validation of Chinese version of the 5-item WHO well-being index in type 2 diabetes mellitus patients

BackgroundFor better disease management and improved prognosis, early identification of co-morbid depression in diabetic patients is warranted. the WHO-5 well-being index (WHO-5) has been used to screen for depression in diabetic patients, and its Chinese version (WHO-5-C) has been validated. However, its psychometric properties remain to be further validated in the type 2 diabetes patient population. The aim of our study was to examine the reliability and validity of the WHO-5-C in patients with type 2 diabetes mellitus.MethodsThe cross-sectional study was conducted on 200 patients from July 2014 to March 2015. All patients should complete the WHO-5-C, the Patient Health Questionnaire-9 (PHQ-9), the 20-item Problem Areas in Diabetes Scale (PAID-20), the Mini International Neuropsychiatric Interview (M.I.N.I), and Hamilton Rating Scale for Depression (HAM-D). Internal consistency of WHO-5 was revealed by Cronbach’s alpha, and constructive validity by confirmatory factor analysis (CFA). Relationship with PHQ-9, HAM-D, and PAID-20 was examined for concurrent validity, and ROC analysis was performed for criterion validity.ResultsThe WHO-5-C presented satisfactory reliability (Cronbach’s alpha = 0.88). CFA confirmed the unidimensional factor structure of WHO-5-C. The WHO-5-C had significant negative correlation with HAM-D (r = -0.610), PHQ-9 (r = -0.694) and PAID-20 (r = -0.466), confirming good concurrent validity. Using M.I.N.I as the gold standard, the cut-off value of WHO-5-C was 42, with a sensitivity of 0.83 and specificity of 0.75.ConclusionThe WHO-5-C holds satisfactory reliability and validity that is suitable for depression screening in type 2 diabetes patients as a short and convenient instrument.

The Japanese version of Problem Areas in Diabetes Scale: a clinical and research tool to assess emotional functioning among people with diabetes.

The purpose of this study was to develop the Japanese version of the Problem Areas in Diabetes (PAID) scale, a measure of emotional adjustment to diabetes that has been translated into Japanese by our group. A total of 418 Japanese people with diabetes attending our outpatient clinic participated (n = 65 type 1 and n = 353 type 2). We assessed the internal reliability of the PAID, examined correlations of the PAID with conceptually related psychosocial constructs, evaluated mean differences in the PAID between diabetes treatment groups, and examined correlations of the PAID with diabetes self-care behaviours and selected treatment outcomes. Results showed that the PAID had excellent reliability (Cronbach alpha = 0.934). The PAID correlated significantly with the Diabetes Treatment Satisfaction Questionnaire (r = -0.593, p < 0.0001) and the positive wellbeing (r = -0.396, p < 0.0001), negative wellbeing (r = -0.640, p < 0.0001) and energy (r = -0.444, p < 0.0001) subscales of the Wellbeing Questionnaire. Adherence to diet was negatively correlated with PAID score (r = -0.263, p < 0.0001). The frequency of recent hypoglycemia and number of chronic complications (retinopathy, nephropathy and neuropathy) were positively correlated with PAID scores. PAID was weakly correlated with HbA1c (r = 0.13, p = 0.01). In conclusion, the Japanese version of the PAID demonstrated good internal reliability and evidence of concurrent and discriminant validity. The PAID measures the impact of diabetes, diabetes treatment and treatment outcomes on the emotions of people with diabetes. The results provide encouraging evidence for the clinical utility of the PAID in Japanese people with diabetes.

Validation of the type 1 diabetes distress scale (T1-DDS) in a large Danish cohort: Content validation and psychometric properties

AimTo validate the Type 1 Diabetes Distress Scale (T1-DDS) in a large sample of adults with Type 1 diabetes (T1D) from diabetes clinics in Denmark. MethodsAltogether 40 adults with T1D were interviewed to explore the content of T1-DDS in a Danish setting and to validate the translation of the T1-DDS into Danish. Subsequently, a survey including T1-DDS, the Problem Areas In Diabetes scale (PAID-20), fear of hypoglycemia, social support, and diabetes duration was answered by 2201 people with T1D. Other person characteristics were collected from the National Patient Register. HbA1c was obtained from the Clinical Laboratory Information System. Data distribution, internal consistency, convergent and construct validity, factor structure, three weeks retest, and cut-points were explored. ResultsInterview data supported the relevance of all T1-DDS items for the assessment of diabetes distress among adults with T1D. The T1-DDS showed good content and acceptable construct validity, and the ability to detect high diabetes distress levels. A high correlation between T1-DDS and PAID-20 (rho = 0.91) was found. The retest scores showed a good reliability (all rho ≥0.68) with the highest variability in the Friends/Family Distress and Physician Distress subscales and the lowest variability in the Powerlessness and Eating Distress subscales of the T1-DDS. Qualitative findings pointed out relevant concerns of people with T1D, which were not included in the T1-DDS. ConclusionThe study supports the use of the Danish T1-DDS, but also highlights that existing diabetes distress questionnaires including T1-DDS do not cover all potential diabetes stressors and worries.

Supplemental Material for Psychometric Properties of the German Teen and Parent Versions of the Problem Areas in Diabetes Scale (PAID)

Supplemental Material for Psychometric Properties of the German Teen and Parent Versions of the Problem Areas in Diabetes Scale (PAID)

The Attitude of Patients with Diabedes Type 2 and the Analysis of The Correlation Between the Problem Fields

Araştırma iki aşamalı olarak yürütülmüştür. İlk aşamada Diyabette Problem Alanları Ölçeği’nin Türkçe’ye uyarlanarak geçerlik güvenirliğini değerlendirmek için metodolojik; ikinci aşamada ise Tip-2 diyabet hastalarının hastalığa karşı tutumları ve problem alanları arasındaki ilişkiyi belirlemek amacıyla tanımlayıcı olarak yapılmıştır.&#x0D; Araştırmanın evreni Ekim Atatürk Üniversitesi Yakutiye Araştırma Hastanesi İç Hastalıkları Ana Bilim Dalı Endokrinoloji Polikliniğine başvuran, en az bir yıldır Tip 2 diyabet tanısı almış, bilinci açık ve araştırmayı kabul eden hastalar oluşturmaktadır. Araştırmanın örneklemini ise olasılıksız örneklem yöntemiyle rastlantısal olarak seçilen 138 hasta oluşturmuştur. Verilerin toplanmasında hastaların sosyo-demografik özelliklerini içeren bir form, Diyabette Problem Alanları Ölçeği ve Diyabet Tutum Ölçeği kullanılmıştır. Veriler cronbach alfa, pearson korelasyon tekniği ve faktör analizi ile değerlendirilmiştir.&#x0D; Araştırmanın birinci aşamasında Diyabette Problem Alanları Ölçeğinin alfa güvenirlik katsayısının 0.88 olduğu ve tek faktörden oluştuğu belirlenmiştir. Yapılan bu analizler sonucu ölçeğin geçerlik ve güvenirliğe sahip olduğu belirlenmiştir.&#x0D; Araştırma kapsamına alınan hastaların diyabete yönelik pozitif tutuma sahip oldukları belirlenmiş, diyabet tutum ölçeği toplam puan ortalaması 73.7±9.3 olarak saptanmıştır. Hastaların diyabette kısmen ciddi problem yaşadıkları ve diyabette problem alanları ölçek puan ortalamasının 57.0±15.1 olduğu bulunmuştur.

Capturing Diabetes-Related Distress and Burden From the Perspective of Patients With Type 1 or Type 2 Diabetes: Protocol for an Explorative Mixed Methods Study.

BackgroundDiabetes is one of the most common diseases worldwide and is associated with increased morbidity, mortality, and reduced quality of life. Many patients experience high diabetes-related distress as well as depression and anxiety symptoms, which are associated with poor diabetes self-management. As disease management is a central component in diabetes treatment, poor management enhances the occurrence of micro- and macrovascular complications. This emphasizes the relevance of reducing diabetes-related distress and providing adequate treatment options addressing the individual psychosocial burden of patients with diabetes. Since patients’ perspectives diverge significantly from those of practitioners in terms of relevant treatment aspects, the patient perspective on, for example, barriers to and facilitators of diabetes treatment is crucial for adequate and effective treatment as well as improvements to self-management and therefore, needs to be further explored.ObjectiveThis study aims to examine diabetes-related distress, the course of distress throughout diabetes management, as well as barriers and facilitating factors in dealing with diabetes from the individual perspective of patients with type 1 and type 2 diabetes.MethodsThe study employs a mixed methods design combining qualitative and quantitative data. Semistructured interviews (N=40) will be conducted with patients with type 1 diabetes (n=20) and patients with type 2 diabetes (n=20). The primary outcomes comprise (1) diabetes-related distress, (2) the severity of distress, (3) the course of distress throughout diabetes management, (4) barriers, and (5) facilitating factors. Questionnaires will provide data on the following secondary outcomes: diabetes-related emotional distress (the Problem Areas in Diabetes scale), symptoms of depression and anxiety (Patient Health Questionnaire, German version), personality functioning (Operationalized Psychodynamic Diagnosis-Structure Questionnaire), mentalizing capacities (Mentalization Questionnaire), epistemic trust (Epistemic Trust, Mistrust and Credulity Questionnaire) and experiences of child maltreatment (Childhood Trauma Questionnaire), and the overall health status of the patient (routine medical data).ResultsAs of April 2022, the conceptualization phase of the study was finalized. Ethics approval was received in January 2022 from the local ethics committee of the Justus Liebig University Giessen – Faculty of Medicine (AZ 161/21).ConclusionsThis study will provide insights into the individual perspective of patients with type 1 and type 2 diabetes regarding their experiences with diabetes management and what they perceive to be relevant, obstructive, or beneficial. The insights gained could help further tailor diabetes treatment to the individual needs of patients with diabetes and therefore optimize diabetes self-management.Trial RegistrationGerman Clinical Trial Register DRKS00024999; https://tinyurl.com/2wb4xdh8International Registered Report Identifier (IRRID)PRR1-10.2196/38477

626-P: TheraKey Diabetes 3.0 App: Better Self-Management, Well-Being, Adherence, and Less Diabetes Distress of People with Diabetes

Aim: The TheraKey Diabetes 3.0 app supports people with diabetes (PwD) during diabetes diagnosis and in the further course of the disease by providing personalized content (e.g., information, graphics, educational videos, testimonials, worksheets, interactive elements) , knowledge and skills for better self-management and coping with the diabetes disease or therapy in everyday life. This study examined the effect in terms of patient-reported outcomes. Methods: Online survey of users of MyTherakey Diabetes 3.0 with a pre-post design at 4 (t1) and 12 weeks (t2) . 185 PwD (15,1% type 1 diabetes (T1D) , 79.5% type 2 diabetes (T2D) , 43,2% female, average age 53.5 years, diabetes duration 3,6 (± 7,2) years, BMI 32,3 (± 7,8) kg/m², 34,6% insulin therapy, HbA1c 8,3 ± 2,5%) . Response rate at t2: 55% (n=105) . Diabetes Self-Management: Diabetes Self-Management Questionnaire (DSMQ) , Problem Areas in Diabetes Scale (PAID-5) . Well-being: WHO-5. Active Patient Participation: Patient Activation Measure (PAM-13D) . Self-efficacy expectancy: General Self-efficacy Scale (GSE) . Health literacy: European Health Literacy Survey (HLS-EU-Q16) . Adherence: MARS D. Results: (t2) : DSMQ: 10,5 ± 10,8/13,3 ± 9,5, p&amp;lt;.0 (t1 p&amp;lt;.001) . WHO-5: 10,5 ± 4,4/11,7 ± 4,1, p=.0 (t1 p= .006) . PAID-5: 33,4 ± 22,5/29,6 ± 21,5, p=.015 (t1 p=.181) . MARS-D: 6,3 ± 1,7/6,8 ± 2,5, p=.022 (t1 p=.432) . PAM-13D: 42,7 ± 4,8/43,4 ± 5,1, p=.136 (t1 p=.426) . GSE: 21,4 ± 5,1/21,8 ± 5,0, p=.297 (t1 p=.167) . HLS-EU-Q16: 13,8 ± 7,4/12,4 ± 8,1, p=.036 (t1 p=.793) . Subgroup analyses show that PwD with short (&amp;lt; 1 year) and long duration of diabetes (&amp;lt; 5 years) and PwD-T2D benefit most. Conclusion: After 3 months of using the diabetes app, patient-relevant benefits can be observed in terms of improved self-management, better well-being, reduced diabetes-related burden, and better adherence. It remains unclear why health literacy is declining. The TheraKey 3.0 can positively support PwD in managing their diabetes. Disclosure B.Kulzer: Advisory Panel; Bayer AG, Bayer AG, Becton, Dickinson and Company, Becton, Dickinson and Company, Berlin-Chemie AG, Berlin-Chemie AG, Dexcom, Inc., Dexcom, Inc., Insulet Corporation, Novo Nordisk, Roche Diabetes Care, Sanofi, Sanofi-Aventis Deutschland GmbH, Research Support; Novo Nordisk, Roche Diabetes Care. D.Ehrmann: Advisory Panel; Dexcom, Inc., Consultant; mySugr, Roche Diabetes Care, Speaker's Bureau; Berlin-Chemie AG, Dexcom, Inc. T.Roos: None. N.Hermanns: Advisory Panel; Abbott Diabetes, Research Support; Becton, Dickinson and Company, Roche Diagnostics, Speaker's Bureau; Berlin-Chemie AG, Novo Nordisk, Sanofi.

0600 The moderating effect of comorbid insomnia on the association of obstructive sleep apnea with mood, and with diabetes-related distress in adults with type 2 diabetes

Abstract Introduction Previous findings showed that insomnia in persons with type 2 diabetes (T2D) may have a greater impact on mood disturbances than obstructive sleep apnea (OSA) and that insomnia contributed to the severity of diabetes-related distress. This study examined insomnia severity as a moderator of the association between OSA severity with mood, and with diabetes-related distress in adults with OSA and T2D. Methods This secondary analysis used pooled baseline data (N=240) from two independent randomized controlled trials that evaluating the efficacy of OSA and insomnia treatment in persons with T2D. OSA (apnea-hypopnea index [AHI] ≥ 5 events per hour) was determined by in-home ApneaLinkPlus®. Insomnia severity was measured by the Insomnia Severity Index, mood by the Profile of Mood States, and diabetes-related distress by the Problem Areas in Diabetes Scale. Possible moderator effect of insomnia severity was examined using hierarchical multiple linear regression analysis, controlling for demographic characteristics and restless leg syndrome (RLS). Results Participants were middle-aged (mean age ± SD [years] = 57.80 ± 10.17), White (65%), educated post high school (56.3%), evenly distributed by gender (49.6% female) and marital status (47.9%), with 34.3% reporting financial difficulty. Participants had poorly controlled diabetes (mean HbA1c ± SD [%] = 7.93 ± 1.62) and 15.5% reported symptoms of RLS. Insomnia severity had a moderating effect on the association between OSA severity and mood states (b = -.048, p = .017). Insomnia severity had no significant moderating effect on the relationship between OSA severity and diabetes-related distress (b = -.009, p = .458), but independently increased the level of diabetes-related distress (b =1.133, p &amp;lt; .001). Conclusion Insomnia severity moderated the association between OSA severity and mood states in adults with OSA and T2DM. Counterintuitively, as OSA severity increased, the level of mood disturbances decreased depending on insomnia severity. In addition, insomnia was independently associated with diabetes-related distress. These findings suggest that insomnia may be the primary underlying sleep disorder which is associated with psychological factors in persons with T2D. Findings need further investigation because psychological factors are known to be associated with worse glycemic control. Support (If Any) The NIH funded the parent studies (R01-DK0960281; K24-NR016685) and the CTSI grants (UL1-RR024153; UL1-TR000005)

Exploring Problem Areas of Elderly Patients with Diabetes and the Support Provided by Their Family

Objective: Diabetes increases problems in emotional areas particularly among the elderly patients by aggravating negative emotions such as loss, anxiety and fear and makes these patients need higher level of family support. This study aims at exploring problematic areas of the elderly diabetic patients and their family support levels.&#x0D; Methods: The data of this descriptive study were collected by the researcher by conducting a face to face interview with 218 elderly diabetic patients who presented to Endocrine Polyclinics of State Hospital between October 2015 and October 2016. To collect the data, “Patient Information Form”, “Problem Areas in Diabetes Scale (PAID)” and “Hensarling’s Diabetes Family Support Scale (HDFSS)” were used.&#x0D; Results: Although problem areas among the patients were found to be fewer than expected; it was found that there were significant differences between problem areas and “sex, diabetes time, treatment type, length of oral antidiabetic medicine use and insulin use, development of diabetes-related complication and hospitalization due to these complications in the recent year” (p

Real-World Use of Continuous Glucose Monitoring Systems Among Adolescents and Young Adults With Type 1 Diabetes: Reduced Burden, but Little Interest in Data Analysis.

Since 2016, German health insurance companies reimburse continuous glucose monitoring (CGM) systems for persons with insulin-dependent diabetes, leading to a tremendous increase of CGM use. This study assessed the use of CGM, the satisfaction with, and the data analysis behavior among young people. During a diabetes camp for young people from all over Germany, participants anonymously answered a questionnaire on their method of glucose monitoring, satisfaction and quality of CGM use, HbA1c, and diabetes distress (Problem Areas in Diabetes Scale [PAID]-5). A total of 308 participants (age 21.4 ± 3.5 years; 73% female; diabetes duration 10.1 ± 5.9 years) completed the questionnaire. Approximately, 25% used self-monitoring of blood glucose (SMBG), 46% intermittent-scanning continuous glucose monitoring (iscCGM), and 30% real-time continuous glucose monitoring (rtCGM). Mean HbA1c was slightly, but not significantly, higher among SMBG users compared with CGM users (8.0% ± 1.9% vs. 7.7% ± 1.4%; P = .791). Diabetes distress was not associated with the method of glucose monitoring (SMBG 5.6 vs. iscCGM 6.2 vs. rtCGM 6.5; P = .386). Overall, satisfaction with CGM use was very high; 98% of the CGM users reported better well-being with CGM compared with previous SMBG use. Only 19% of CGM users reported regular data analyses; their HbA1c was lower compared with other CGM users (7.2% ± 1.2% vs. 7.7% ± 1.4%; P = .039). In this large sample of young people, 75% were using a CGM system. Treatment satisfaction was very high, but CGM use was not associated with reduced diabetes distress or better glycemic control. However, young people who regularly analyzed their CGM data reported lower HbA1c levels.

Psychrometric Properties of the Arabic Version of the Problem Areas in Diabetes Scale in Primary Care.

BackgroundThe Problem Areas in Diabetes (PAID) scale is a reliable and valid tool that is widely used for diabetes-distress screening, but the Arabic version of the scale lacks validity and reliability analysis in primary healthcare (PHC) patients. Our study aimed to evaluate the psychometric properties of the Arabic version of the PAID (AR-PAID) scale among Egyptian patients with type 2 diabetes mellitus (T2DM) in PHC settings.MethodsWe conducted a cross-sectional study on a convenience sample of 200 patients from six rural PHC settings in the Ismailia governorate. The confirmatory factor analysis (CFA) was performed to test the goodness-of-fit to the predefined models of the PAID. Convergent construct was evaluated through correlations with the Arabic versions of the Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and 5-item World Health Organization Well-Being Index (WHO-5), additionally glycated hemoglobin (HbA1c) levels. Discriminant validity was evaluated through associations with patients' sociodemographic and clinical characteristics. Reliability was evaluated through internal consistency (Cronbach's α) and test-retest reliability analysis (intraclass correlation coefficient, ICC).ResultsThe CFA demonstrated the best fit for a four-factor model. The AR-PAID was significantly correlated with the following measures: PHQ-9 (rho = 0.71, p < 0.001), GAD-7 (rho = 0.50, p < 0.001), WHO-5 (rho = −0.69, p < 0.001), and HbA1c (rho = 0.36, p < 0.001), supporting sound convergent validity. Discriminant validity was satisfactory demonstrated. Internal consistency was excellent (α = 0.96) and test-retest reliability was stable (ICC = 0.97).ConclusionsThe AR-PAID scale is a valid and reliable instrument for diabetes-distress screening in primary care patients with T2DM that can be used in clinical settings and research. Further research is needed to validate short forms of the AR-PAID scale.

Psychological Characteristics and Goals of Caregivers Choosing Continuous Glucose Monitoring for Children With Type 1 Diabetes.

Continuous glucose monitoring (CGM) can improve glycemic outcomes in pediatric type 1 diabetes management. However, its impact on the psychosocial functioning of caregivers is less well described. The objectives of this pilot study were to explore caregiver reasons for adding CGM to their child's type 1 diabetes management, parental psychosocial function before initiating CGM, and the relationship between the two. Thirty-two families with a child with type 1 diabetes from Rainbow Babies and Children's Hospital diabetes clinics who were initiating CGM were recruited over 3 months. Before CGM initiation, the caregivers completed the Fear of Hypoglycemia Scale, State-Trait Anxiety Inventory, Problem Areas in Diabetes Scale, and a questionnaire assessing their primary reason for starting CGM. Participant characteristics and questionnaire results were summarized with descriptive statistics. Participants were grouped by reason for starting CGM, and results were compared among groups using ANOVA and reporting the global F test. Fifty percent of respondents indicated that they were starting CGM to optimize glycemic control. The majority of parents (71.8%) expressed worry about helplessness during a hypoglycemic episode. There were no statistically significant differences in patient characteristics or questionnaire results between groups. Forty-three percent of participating families started using CGM during the study's 8-month follow-up period. The main reason (64%) for not starting CGM was not having the chance to start the process of obtaining a CGM system. There were no statistically significant differences between children who did and did not start CGM. Caregivers have different reasons for starting CGM for their child with type 1 diabetes. Further studies are needed to understand whether these reasons are related to differences in psychosocial functioning. Despite interest in starting CGM, there remain barriers to implementation.

Effect of Diabetes Distress and Self-care Activities on the Quality of Life of Type 2 Diabetic Patients: A Structural Equation Model

Background: Diabetes has debilitating and dangerous effects on any of the vital organs in the body. Its impact on quality of life, as well as the variables that impact it, is of great importance. Objectives: This study was conducted to design a structural equation model of the effect of diabetes distress and self-care activities on the quality of life of type 2 diabetes mellitus (T2DM) patients. Methods: This descriptive cross-sectional study included 398 patients with T2DM referred to medical centers affiliated with Ahvaz Jundishapur University of Medical Sciences in 2020; they were selected by convenience sampling method. Data collection tools included the Problem Areas in Diabetes Scale (PAID) used to identify depression and emotional stress associated with diabetes, Audit of Diabetes-Dependent Quality of Life 19 (ADDQoL-19) used to assess the physical, mental, and social status of patients, and Summary of Diabetes Self-care Activities used to evaluate the self-care behaviors of diabetic patients. Data were analyzed using SPSS version 26, Hayes PROCESS macro version 3.5, and path analysis regression. Results: The mean scores of diabetes distress, self-care activities, and quality of life were 3.69 ± 12.39, 65.57 ± 12.11, and 56.94 ± 18.62, respectively. Path analysis regression showed that for every 1-unit increase in the score of diabetes distress, quality of life decreased by 0.249, and for every 1-unit increase in the score of self-care activities, quality of life increased by 0.183 (P &lt; 0.001). Also, for every 1-unit increase in the score of self-care activities, diabetes distress increased by 0.138 (P &lt; 0.006). Conclusions: This study showed that T2DM patients who engaged in more diabetes self-care activities had a higher health-related quality of life. Also, patients with higher levels of diabetes-specific emotional distress have a lower health-related quality of life. Training on identifying and reducing the factors affecting distress and those promoting self-care behaviors in diabetic patients is highly recommended.