Problem Areas In Diabetes Survey Research Articles

Impact of diabetes distress on glycemic control and diabetic complications in type 2 diabetes mellitus

The effect of diabetes distress on glycemic control and its association with diabetes complications is still poorly understood. We aimed to study the clinical features of patients with high diabetes distress, focusing on changes in glycemic control and risk of diabetic complications. From the Korean National Diabetes Program data, we investigated 1862 individuals with type 2 diabetes mellitus (T2DM) who completed diabetic complication studies and the Korean version of the Problem Areas in Diabetes Survey (PAID-K). A total score of PAID-K ≥ 40 was considered indicative of high distress. Individuals with high distress (n = 589) had significantly higher levels of glycated hemoglobin than those without distress (7.4% vs. 7.1%, p < 0.001). This trend persisted throughout the 3-year follow-up period. Higher PAID-K scores were associated with younger age, female gender, longer duration of diabetes, and higher carbohydrate intake (all p < 0.05). There was a significant association between high distress and diabetic neuropathy (adjusted odds ratio, 1.63; p = 0.002), but no significant association was found with other complications, including retinopathy, albuminuria, and carotid artery plaque. In conclusion, high diabetes distress was associated with uncontrolled hyperglycemia and higher odds of having diabetic neuropathy.

679-P: Impact of Diabetes Distress on Glycemic Control, Diet Behaviors, and Diabetic Complications in Type 2 Diabetes Mellitus

Background: We investigated the clinical features of patients with high diabetes distress, focusing on changes in glycemic control, dietary behaviors, and risk of diabetic complications. Methods: From the Korean National Diabetes Program data, we investigated 1,862 individuals with type 2 diabetes mellitus (T2DM) who completed the Korean version of the Problem Areas in Diabetes Survey (PAID-K). A total score ≥40 was considered indicative of high distress. Results: Individuals with high distress (n=589) had significantly higher levels of glycated hemoglobin (HbA1c) than those without distress, and this trend persisted for three years. In a subgroup of individuals with HbA1c &amp;lt;6.5% at baseline, patients with high distress were less likely to maintain HbA1c &amp;lt;6.5% after three years of follow-up (41.2% vs. 60.6%, p=0.007). Higher PAID-K scores were associated with younger age, longer duration of diabetes, higher HbA1c level, higher carbohydrate intake, and lower fiber intake (all p&amp;lt;0.05). There was a significant association between high distress and diabetic neuropathy (adjusted odds ratio, 1.63; p=0.002), but no significant association was found with other complications, including retinopathy, albuminuria, and carotid artery plaque. Conclusion: High diabetes distress was associated with uncontrolled hyperglycemia, a high-carbohydrate and low-fiber diet, and higher odds of diabetic neuropathy. Disclosure Y.Cho: None. Y.Kim: None. D.Seo: None. S.Ahn: None. S.Hong: None. S.Kim: None.

1161-P: Patterns of Diabetes Distress (DD) and Glycemic Outcomes in Teens with Type 1 Diabetes (T1D)

Background: DD distracts from T1D self-management, contributing to suboptimal glycemia. Yet, DD can change day-to-day and over time. We compared A1c trends in teens with increasing vs. decreasing DD over time. Methods: At baseline, 6, 12, and 18 months, participants (N=301) ages 13-17 years completed the Problem Areas in Diabetes Survey—Pediatric scale; higher scores indicate more DD with ≥41 indicating elevated DD. We identified three trajectories: participants with low baseline DD, who then reported persistent high DD; participants with high baseline DD, who then had persistent low DD levels; all others. Mean A1c levels were compared at baseline and 18 months. Results: At baseline, participants (49% male, 78% white) were 15.0±1.3 years old with T1D duration 6.5±3.7 years; 59% used insulin pumps; 12% used CGM; A1c was 8.5±1.1%. Twenty-six participants (9%) had elevated DD at baseline and then low DD at subsequent time points; A1c did not change significantly from 0 to 18 months for these participants (p=.33). Thirty-five participants (12%) had low DD at baseline and then elevated DD at subsequent time points; A1c increased significantly from 0 to 18 months for these participants (p=.01). The remaining participants (n=240) had varying levels of DD with no significant change in A1C (p=.05). Conclusion: Adolescents who initially had low DD and reported increasing DD over time may be at risk for worsening glycemic outcomes. Disclosure K.Wentzell: None. L.J.Tinsley: None. L.K.Volkening: None. D.E.Mcgill: Employee; Vertex Pharmaceuticals Incorporated. B.J.Anderson-thomas: None. L.M.Laffel: Advisory Panel; Medtronic, Lilly Diabetes, Novo Nordisk, Vertex Pharmaceuticals Incorporated, Roche Diagnostics, Provention Bio, Inc., Consultant; Dexcom, Inc., Janssen Pharmaceuticals, Inc., Medscape. Funding National Institutes of Health (T32DK007260); National Institute of Diabetes and Digestive and Kidney Diseases (R01DK095273); JDRF (2-SRA-2014-253-M-B)

Diabetes Distress Is Associated With Future Risk of Progression of Diabetic Nephropathy in Adults With Type 2 Diabetes: A Prospective Cohort Study (Diabetes Distress and Care Registry at Tenri [DDCRT23

ObjectivesOur aim in this study was to investigate the prospective association between diabetes distress assessed with Problem Areas in Diabetes (PAID) survey scores at baseline and the subsequent risk of development or progression of diabetic nephropathy in people with type 2 diabetes. MethodsLongitudinal data were acquired from 2,845 individuals with type 2 diabetes registered in a Japanese diabetes registry. A Cox proportional hazards model was used to adjust for possible confounders to examine the prospective association between baseline diabetes distress (PAID score ≥40) and the development or progression of albuminuria. ResultsMean patient age, body mass index, and glycated hemoglobin level were 64.8 years, 24.5 kg/m2, and 57.4 mmol/mol (7.5%), respectively. We did not observe a significant association between diabetes distress and the subsequent risk of diabetic nephropathy development from normoalbuminuria to microalbuminuria/macroalbuminuria (multivariable-adjusted hazard ratio [HR]=0.95 over 4.2 years, 95% confidence interval [CI] 0.77 to 1.17, p=0.640); however, we identified a significant association for progression from microalbuminuria to macroalbuminuria (multivariable-adjusted HR=1.34 over 7.0 years, 95% CI 1.01 to 1.80, p=0.045). Stratification by sex revealed a significant association between diabetes distress and the subsequent risk of progressing diabetic nephropathy (HR=1.45, 95% CI 1.06 to 1.98, p=0.019) in males, but not females (HR=1.42, 95% CI 0.95 to 2.14, p=0.087). ConclusionsDiabetes distress at baseline, assessed using the PAID survey, was associated with a subsequent risk of progressing diabetic nephropathy independent of possible confounders in males, but not females, with type 2 diabetes.

787-P: Quality of Life and Psychological Well-Being among Children with Diabetes Using Open-Source Automated Insulin Delivery Systems: Findings from a Global Survey

Background: Open-source automated insulin delivery (AID) systems have shown to be safe and effective in clinical and real-world studies and to increase quality of life (QoL) in adult users. However, there is a lack of evidence on the effect on health-related QoL and general wellbeing in children and their caregivers. Therefore, the aim of this study was to assess the QoL of children and adolescents with diabetes using open-source AID systems using validated measures. Method: In this cross-sectional, population-based global online survey we examined the caregiver-reported QoL and psychological well-being of users and non-users of open-source AID. Validated questionnaires assessed general emotional wellbeing (WHO-5 Well-being Index) , diabetes-specific QoL (Problem Areas in Diabetes Survey - Parent Revised version (PAID-PR) , Pediatric Quality of Life Inventory (PedsQL, diabetes module) and subjective sleep quality (Pittsburgh Sleep Quality Index (PSQI)) . Results: In total 188 caregivers from 27 countries completed at least one questionnaire on behalf of their children, including 132 children with type 1 diabetes using open-source AID (mean age 11.5 (SD 3.5) , 48% female) and 56 children with type 1 diabetes who were non-users at the time of the survey (mean age 10.4 (SD 3.3) , 41% female) . All questionnaire scores showed significant between-group differences with the AID users reporting higher general (WHO-5: p&amp;lt;0.001) , diabetes-related (PAID: p=0.029; PedsQL: p=0.016) and sleep-related QoL (PSQI: p&amp;lt;0.001) . Discussion: The results show the beneficial impact that open-source AID systems have on the QoL and psychological well-being of children and adolescents, and can therefore help to inform academia, regulatory decision- and policymakers about the potential that open-source AID systems hold. Further research is needed to examine the reasons for the differences between the groups. Disclosure C.Knoll: None. K.Raile: Other Relationship; Dexcom, Inc. K.Braune: None. H.Ballhausen: None. J.Schipp: None. T.C.Skinner: None. M.Wäldchen: None. S.O'donnell: None. K.A.Gajewska: None. B.Cleal: None. Funding European Commission's Horizon 2020 Research and Innovation Program under the Marie Skłodowska-Curie Action Research and Innovation Staff Exchange (RISE) (grant agreement number 823902)

1301-P: Factors Predicting Diabetes Distress over 18 Months in Teens with Type 1 Diabetes (T1D)

Background: Teens with T1D are burdened by physical, social, and emotional challenges that can lead to diabetes distress, impacting self-care and health outcomes. We assessed diabetes distress and associated factors in teens with T1D over 18 months. Methods: At baseline, 6, 12, and 18 months, teens (N=301), ages 13-17 years, completed the Problem Areas in Diabetes Survey - Pediatric version (PAID-Peds), a validated 20-item survey measuring diabetes distress over the past month. Higher scores (range 0-100) indicate more distress; ≥41 = high distress. Mixed linear models assessed factors associated with changing diabetes distress over time. Results: At baseline, teens (49% male, 78% white) were 15.0±1.3 (M±SD) years old with T1D duration 6.5±3.7 years; 84% were from 2-parent families. Youth checked BG 4.5±1.9 x/day; 59% were pump-treated; A1c was 8.5±1.1%. At baseline, 45% of teens endorsed high diabetes distress and females were disproportionately affected (54% vs. 36% of males, p&amp;lt;.01). In follow-up, 75% of teens with high baseline distress and 24% of teens with low baseline distress endorsed high distress at ≥50% of follow-up time points. High baseline distress strongly predicted subsequent distress (OR 9.6 [95% CI: 5.6, 16.5], p&amp;lt;.0001). Female sex and increasing A1c predicted increasing distress. In teens with high baseline distress, decreasing BG monitoring predicted increasing distress. In those without high baseline distress, only increasing A1c predicted increasing distress. Factors such as zBMI, race, family structure, household income, parental education, pump use, or use of continuous glucose monitors did not predict distress over time. Discussion: A substantial proportion of teens with T1D experience high diabetes distress. Rising A1c is a major factor associated with worsening diabetes distress over time. Interventions targeting teens with diabetes distress and/or increasing A1c may positively impact self-care and simultaneously help to manage distress and improve A1c. Disclosure D.E. McGill: None. L.K. Volkening: None. P.V. Commissariat: None. R.M. Wasserman: None. B. Anderson: None. L.M. Laffel: Advisory Panel; Self; Roche Diabetes Care. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., ConvaTec Inc., Dexcom, Inc., Insulet Corporation, Insulogic LLC, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc., Sanofi US. Funding National Institutes of Health (R01DK095273, K12DK094721, P30DK036836), JDRF (2-SRA-2014-253-M-B)

841-P: Clinically Elevated T1D Distress and Depression in Parents of Kids with New-Onset Type 1 Diabetes (T1D)

We applied existing clinical cut-points for T1D distress to examine cross-sectional and prospective relations between distress and depression in 127 parents of 5-9-year-olds with new-onset T1D. Parents completed the Problem Areas in Diabetes Survey- Parent Revised (PAID-PR) and the Center for Epidemiologic Studies-Depression Scale-Revised (CESD-R) at baseline, 6, 12, 18, and 24 months post-baseline. We used clinical cut-points &amp;gt;3.11 (item mean) and &amp;gt;16 (total score) for the PAID-PR and CESD-R, respectively, to identify parents with elevated scores. We used unadjusted odds ratios to explore cross-sectional and prospective relations between parents’ scores. At baseline, kids were 7.5±1.3 years-old and 4.7±3.2 months from diagnosis. 68% of parents had PAID-PR scores &amp;gt;3.11 at baseline, dropping to 25-38% of parents later. 21-28% of parents had CESD-R scores &amp;gt;16 across all visits. Compared to parents without elevated PAID-PR scores at 6 months, parents with elevated PAID-PR scores were more likely to have elevated CESD-R scores at 6, 12, 18, and 24 months (ORs: 3.5-7.8, p’s ≤ .05) and these relations persisted. While elevated T1D distress may be common for parents shortly after their child’s diagnosis, our data suggest persistent elevated T1D distress is a risk factor for current and subsequent parental depression. Thus, we need interventions to treat T1D distress in parents of kids with new-onset T1D. Disclosure A.E. Noser: None. M.A. Clements: Advisory Panel; Self; Glooko, Inc. Consultant; Self; Eli Lilly and Company. Speaker's Bureau; Self; Medtronic. A. Monzon: None. S. Majidi: None. S.R. Patton: None. Funding National Institutes of Health

High Diabetes Distress Among Ethnic Minorities Is Not Explained by Metabolic, Cardiovascular, or Lifestyle Factors: Findings From the Dutch Diabetes Pearl Cohort.

Diabetes distress among patients from ethnic minorities is still poorly understood. We investigated the association between ethnicity and diabetes distress among ethnic minority groups of people with type 2 diabetes in the Netherlands, focusing on the possible effects of glycemic control, lifestyle factors, cardiovascular risk factors, and diabetes complications. Cross-sectional data from the Dutch Diabetes Pearl cohort included people with type 2 diabetes from primary, secondary, and tertiary diabetes care programs. We used the 20-item Problem Areas in Diabetes Survey (PAID) scale to assess diabetes distress; a score ≥40 is considered to represent high distress. Ethnicity was estimated on the basis of country of birth. Sociodemographic and lifestyle data were self-reported; cardiovascular and metabolic data were retrieved from medical charts. Logistic regression analysis determined the association between ethnicity and diabetes distress, with Caucasians as the reference group. Diabetes distress scores and ethnicity were available for 4,191 people with type 2 diabetes: 3,684 were Caucasian, 83 were Asian, 51 were Moroccan, 92 were African, 134 were Latin American, 46 were Turkish, and 101 were Hindustani-Surinamese. Overall, participants in minority groups had worse health outcomes than those of Caucasian descent, and diabetes distress was more prevalent (ranging from 9.6 to 31.7%, compared with 5.8% among Caucasians), even after adjusting for age, sex, education level, alcohol use, smoking, BMI, lipid profile, HbA1c, medication use, and the presence of diabetes complications. Among people with type 2 diabetes in the Netherlands, ethnicity is independently associated with high diabetes distress. Further research is warranted to explain the higher prevalence of diabetes distress in minority groups and to develop effective interventions.

Diabetes Distress and All-Cause Mortality in Patients with Type 2 Diabetes—A Prospective Cohort Study

We studied a cohort of 3,3Japanese patients with type 2 diabetes to determine the prospective association between diabetes distress measured by problem areas in diabetes (PAID) survey at baseline and subsequent risk of all-cause mortality. Longitudinal data were obtained from this cohort who completed the PAID survey at baseline. We excluded patients with a past history of any cancer. We categorized PAID total score into quintiles and assessed the independent correlation with all-cause mortality using the Cox proportional hazards model adjusted for potential confounders [age, gender, BMI, HbA1c, diabetes therapy, urine albumin/creatinine ratio, retinopathy, diabetic neuropathy, and past medical history]. Mean patient age, BMI, and HbA1c level were 64.9 years, 24.6 kg/m2, and 7.5% (57.6 mmol/mol), respectively. Median total PAID score was 29 overall, and 21, 25, 30, 39, and 55 for the1st to 5th quintiles, respectively. We observed 251 of any death cases during median follow-up of 6.1 years. Compared with the 1st quintile of PAID score, the multi-variable adjusted hazard ratios of all-cause mortality were 1.11 (95% CI, 0.78-1.60; p = 0.56), 0.87 (95% CI, 0.56-1.35; p = 0.524), 0.95 (95% CI, 0.62-1.44; p = 0.802), and 1.60 (95% CI, 1.09-2.35; p = 0.016). In conclusion, diabetes distress measured by the PAID survey was associated with a subsequent risk of all-cause mortality in patients with type 2 diabetes. Disclosure Y. Hayashino: None. S. Okamura: None. S. Tsujii: None. H. Ishii: None.

Large-Scale Cross-Sectional Study of the Problem Areas in Diabetes Survey among Japanese Patients with Type 2 Diabetes Mellitus

Introduction: Diabetes treatment has unique aspects that require behavior modification among patients in terms of food consumption, exercise and others. The emotional burden among patients that is caused by diabetes treatment and diabetes-related morbidity in itself often causes patients to have trouble carrying out daily activities and makes the maintenance of glycemic control difficult. The aim of this study was to investigate the association between glycemic control and the Problem Areas in Diabetes (PAID) scores which is an indicator of emotional burden among Japanese patients with type 2 diabetes mellitus (T2DM) on a large scale. Methods: Data from 3511 patients with T2DM were obtained from the Diabetes Registry in Kanagawa. We used PAID scores to evaluate diabetes-related emotional distress. For 3432 patients who answered completely, we assessed the association between PAID scores and HbA1c and other background factors, while adjusting for possible confounding factors. Results: The mean age, body mass index, disease duration and HbA1c level were 63.2 years, 25.3 kg/m2, 12.5 years, and 7.53%, respectively. The mean PAID score was 43.3 points. Five point five percent were severely burdened patients who scored more than 70 points. There was a significant correlation between PAID scores and HbA1c (ρ=0.025, p&amp;lt;0.001), and higher HbA1c levels were associated with higher PAID scores. Sex (female; p&amp;lt;0.0001), younger age (p&amp;lt;0.0001), higher BMI (p&amp;lt;0.0001), diabetic neuropathy (p&amp;lt;0.0001), diabetic retinopathy (p&amp;lt;0.0001), and diabetic foot (p&amp;lt;0.0037) were all associated with higher PAID scores. In the multiple regression analysis, HbA1c level (p&amp;lt;0.0001), diabetic retinopathy (p=0.003) and injection therapy (p=0.0001) were independent factors affecting PAID scores. Conclusions: Treatment to maintain normal levels of HbA1c may prevent the onset of diabetic retinopathy; moreover, it will reduce the emotional burden among patients with diabetes. Disclosure K. Takahashi: None. M. Shinoda: None. R. Sakamoto: None. J. Suzuki: None. T. Yamakawa: None. Y. Terauchi: Research Support; Self; MSD K.K.. Speaker's Bureau; Self; MSD K.K.. Advisory Panel; Self; MSD K.K.. Research Support; Self; Ono Pharmaceutical Co., Ltd.. Speaker's Bureau; Self; Ono Pharmaceutical Co., Ltd.. Research Support; Self; Novartis Pharma K.K., Boehringer Ingelheim GmbH. Speaker's Bureau; Self; Boehringer Ingelheim GmbH. Advisory Panel; Self; Boehringer Ingelheim GmbH. Research Support; Self; Mitsubishi Tanabe Pharma Corporation. Speaker's Bureau; Self; Mitsubishi Tanabe Pharma Corporation. Advisory Panel; Self; Mitsubishi Tanabe Pharma Corporation. Research Support; Self; Daiichi Sankyo Company, Limited. Speaker's Bureau; Self; Daiichi Sankyo Company, Limited. Advisory Panel; Self; Daiichi Sankyo Company, Limited. Research Support; Self; Sanwa Kagaku Kenkyusho Co., Ltd.. Speaker's Bureau; Self; Sanwa Kagaku Kenkyusho Co., Ltd.. Research Support; Self; Novo Nordisk Inc.. Speaker's Bureau; Self; Novo Nordisk Inc.. Advisory Panel; Self; Novo Nordisk Inc.. Research Support; Self; Eli Lilly and Company. Speaker's Bureau; Self; Eli Lilly and Company. Advisory Panel; Self; Eli Lilly and Company. Research Support; Self; Sanofi. Speaker's Bureau; Self; Sanofi. Advisory Panel; Self; Sanofi. Research Support; Self; Sumitomo Dainippon Pharma Co., Ltd.. Speaker's Bureau; Self; Sumitomo Dainippon Pharma Co., Ltd.. Research Support; Self; Shionogi &amp; Co., Ltd.. Speaker's Bureau; Self; Shionogi &amp; Co., Ltd., Bayer Yakuhin, Ltd., Astellas Pharma US, Inc., AstraZeneca. Advisory Panel; Self; AstraZeneca, Teijin Pharma Limited.

Effects of Mindfulness on Psychological Distress and HbA1c in People with Diabetes

Type 2 diabetes mellitus (T2DM) is a prevalent chronic condition that is associated with a high degree of psychological distress. The aim of this study was to evaluate the effectiveness of a novel approach to delivering an intervention of mindfulness practice (IMP) to a patient population with a demonstrated need for psychological support. The novel approach utilised a self-directed audio compact disc (CD) recording of mindfulness practice. In this randomised controlled trial, 67 participants with T2DM (mean age = 59.4, standard deviation = 12.4), attending outpatient clinics, were randomised to an IMP (n = 31) or a control (n = 36) group. Participants completed written questionnaires at baseline and again at 8- and 12-week follow-ups. Primary outcome measures included depression, anxiety and stress (21-item Depression, Anxiety and Stress Scale) and diabetes-specific emotional problems (Problem Areas in Diabetes Survey (PAID)). Secondary outcome measures included diabetes self-management using the Summary of Diabetes Self-Care Activities Scale (SDSCA), systolic and diastolic blood pressure and HbA1c. Participants receiving the IMP reported significant reductions in depression (p = 0.02) and stress (p = 0.03) when compared with the control group. At the 12-week follow-up, there was an overall reduction in depression by 4.1 units and stress by 3.4 units in the IMP group relative to the control group. There was an overall improvement in blood glucose monitoring; however, this was not significant (p = 0.06). HbA1c measures decreased significantly over the 12-week follow-up by 0.48 units (time × group interaction: p = 0.02). The current study has shown that an easily accessible self-directed IMP was effective in improving psychological symptoms of depression and stress, blood glucose monitoring and HbA1c.

Clinical and Patient-Centered Outcomes in Obese Patients With Type 2 Diabetes 3 Years After Randomization to Roux-en-Y Gastric Bypass Surgery Versus Intensive Lifestyle Management: The SLIMM-T2D Study.

To compare the effect of Roux-en-Y gastric bypass (RYGB) surgery versus intensive medical diabetes and weight management (IMWM) on clinical and patient-reported outcomes in obese patients with type 2 diabetes. We prospectively randomized 38 obese patients with type 2 diabetes (15 male and 23 female, with mean ± SD weight 104 ± 16 kg, BMI 36.3 ± 3.4 kg/m2, age 52 ± 6 years, and HbA1c 8.5 ± 1.3% [69 ± 14 mmol/mol]) to laparoscopic RYGB (n = 19) or IMWM (n = 19). Changes in weight, HbA1c, cardiovascular risk factors (UKPDS risk engine), and self-reported health status (the 36-Item Short-Form [SF-36] survey, Impact of Weight on Quality of Life [IWQOL] instrument, and Problem Areas in Diabetes Survey [PAID]) were assessed. After 3 years, the RYGB group had greater weight loss (mean -24.9 kg [95% CI -29.5, -20.4] vs. -5.2 [-10.3, -0.2]; P < 0.001) and lowering of HbA1c (-1.79% [-2.38, -1.20] vs. -0.39% [-1.06, 0.28] [-19.6 mmol/mol {95% CI -26.0, -13.1} vs. -4.3 {-11.6, 3.1}]; P < 0.001) compared with the IMWM group. Changes in cardiometabolic risk for coronary heart disease and stroke were all more favorable in RYGB versus IMWM (P < 0.05 to P < 0.01). IWQOL improved more after RYGB (P < 0.001), primarily due to subscales of physical function, self-esteem, and work performance. SF-36 and PAID scores improved in both groups, with no difference between treatments. A structural equation model demonstrated that improvement in overall quality of life was more strongly associated with weight loss than with improved HbA1c and was manifest by greater improvements in IWQOL than with either SF-36 or PAID. Three years after randomization to RYGB versus IMWM, surgery produced greater weight loss, lower HbA1c, reduced cardiovascular risk, and improvements in obesity-related quality of life in obese patients with type 2 diabetes.

Factors related to sense of coherence in adult patients with Type 2 diabetes.

ABSTRACTThe influence of a diabetic person’s sense of burden and blood sugar control through sense of coherence (SOC) on self-management has yet to be sufficiently clarified. The purpose of this study was to examine the utility of salutogenesis, which has sense of coherence at its core, for the self-management of patients with type 2 diabetes. A total of 258 questionnaires were distributed to patients who were seen at one of three hospitals in an urban area in Japan, after obtaining consent from the patient. They were between 20 and 75 years old and regularly received care. Of the 185 responses, 177 were valid. The responses were analyzed by referring to the framework of salutogenesis, and the relationship between patient characteristics, SOC, the Problem Areas In Diabetes survey (PAID), and glycosylated hemoglobin (HbA1c) were studied with structural equation modeling (SEM). SOC had a main effect on PAID scores and an indirect effect on HbA1c. Moreover, age influenced SOC positively. The SOC of patients with type 2 diabetes in the present study was comparatively high. These observations suggest a direct effect of SOC on reducing the sense of burden from having diabetes and an indirect effect on decreasing HbA1c. This research suggested the possibility that diabetes can be controlled by improving SOC.

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.

Psychometric and screening properties of the WHO‐5 well‐being index in adult outpatients with Type 1 or Type 2 diabetes mellitus

The 5-item World Health Organization well-being index is a commonly used measure of emotional well-being, but research on psychometric properties in outpatients with diabetes is scarce. We examined psychometric and screening properties for depression of this index in a large sample of Dutch outpatients with diabetes. Patients with Type1 (n=384) and Type2 (n=549) diabetes from three outpatient clinics completed the WHO-5 index, the nine-item Patient Health Questionnaire, the Problem Areas in Diabetes survey and the Short Form-12 health survey. Internal consistency of the WHO-5 index was determined by Cronbach's alpha. The factor structure was tested by confirmatory factor analysis. Concurrent validity was assessed by correlations with the Patient Health Questionnaire, Problem Areas in Diabetes and the Short Form-12 mental component scores. Sensitivity and specificity of the WHO-5 index as depression screener were tested against two existing Patient Health Questionnaire cut-off scores for depression using receiver operating characteristic curves. A one-factor structure of the WHO-5 index was verified by confirmatory factor analysis for patients with Type1 and Type2 diabetes. Moderate to strong correlations were observed between the WHO-5 index and the Patient Health Questionnaire scores, the Problem Areas in Diabetes scores and the Short Form-12 mental component scores (r=0.55-0.69, P<0.001). Receiver operating characteristic curves showed that a WHO-5 index cut-off of <50 performed best as an indication for likely depression, with sensitivity compared with a Patient Health Questionnaire score ≥10 and ≥12 of 79% and 88%, respectively, and specificity of 88% and 76%, respectively. The WHO-5 index is a short, psychometrically sound measure of emotional well-being that appears suitable for use as screening test for likely depression in outpatients with Type1 and Type2 diabetes.

The association between Problem Areas in Diabetes Scale scores and glycemic control is modified by types of diabetes therapy: Diabetes Distress and Care Registry in Tenri (DDCRT 2)

AimTo evaluate the joint association of Problem Areas in Diabetes (PAID) Scale scores and glycemic control with diabetes therapy. MethodsWe used 3479 patients’ data with type 1 and type 2. Modified Poisson regression analysis was used to estimate relative risks (RRs) for poor glycemic control (HbA1c≥7.0%) across quartiles of PAID scores. ResultsCompared with the 1st quartile of PAID score, multivariable-adjusted RRs for poor glycemic control were 0.99 (95%CI, 0.87–1.11), 1.05 (95%CI, 0.93–1.18), and 1.12 (95%CI, 1.00–1.27), respectively, for 2nd to 4th quartiles, and we observed significant trend (p for trend=0.03). We observed significant interaction of PAID score and HbA1c with diabetes therapy (p=0.0469). In patients receiving diet only therapy, the RRs for poor glycemic control were 1.38 (95%CI, 0.93–2.05), 1.18 (95%CI, 0.51–5.13), and 1.81 (95%CI, 1.16–2.79), respectively for 2nd to 4th quartiles of PAID score compared with the 1st quartile (p for trend=0.025); while we did not observe significant association between PAID and poor glycemic control in patients receiving medication therapy. ConclusionsDiabetes distress measured by PAID survey was associated with poor glycemic control, and this association was modified by diabetes therapy.

Group Diabetes Education Administered Through Telemedicine: Tools Used and Lessons Learned

To describe the use of telemedicine for teaching group diabetes education classes to individuals with diabetes mellitus in a rural medically underserved area. Adults with diabetes from a rural area served by Oswego Hospital in upstate New York were asked to participate in this study. Volunteers received diabetes education through real-time teleconferencing (n=27) by joining age- and sex-matched patients from the Joslin Diabetes Center, Syracuse, NY, in our "Living with Diabetes Class" (n=39). The two 3-h sessions offered comprehensive diabetes education by a diabetes nurse educator, dietitian, and exercise physiologist. These sessions were followed in 3 months by a 3-h follow-up class. Each group receiving tele-education consisted of two or three patients with diabetes. The hemoglobin A1c test (a blood test that estimates the overall average glucose levels over the past 3 months) improved in the face-to-face and the telemedicine groups. There was no significant change in weight between groups. Each group had significant improvements in scores on the Problem Areas In Diabetes survey, which is a measure of emotional functioning in diabetes. Diabetes treatment satisfaction as measured in the Diabetes Treatment Satisfaction Questionnaire improved in the face-to-face group but not in the telemedicine group. Although the face-to-face group had significantly higher scores in the Diabetes Treatment Satisfaction Questionnaire, the telemedicine group was highly satisfied with the services provided. Telemedicine offers an effective alternative approach for providing group diabetes education to individuals with poor access to diabetes education programs.

Re‐examining a measure of diabetes‐related burden in parents of young people with Type 1 diabetes: the Problem Areas in Diabetes Survey – Parent Revised version (PAID‐PR)

In a pediatric patients, the burden of diabetes lies within the family. In the current era of intensive insulin therapy, perceived parental burden may affect the family's efforts at effective diabetes management. The aims of this study were to re-examine and revise a measure of perceived parental burden associated with caring for a child with diabetes in the current era. A geographically diverse population of young people (N = 376) with Type 1 diabetes and their parents included participants in the Juvenile Diabetes Research Foundation continuous glucose monitoring study and patients from the Joslin Diabetes Center. Participants provided data on demographics, diabetes management, diabetes-specific family conflict, and quality of life at baseline and after 6 months of follow-up. Young people were 12.9 ± 2.7 years old with diabetes duration of 6.3 ± 3.5 years. Mean HbA(1C) was 8.0 ± 1.2%(64 mmol/mol), 58% received insulin pump therapy, and young people monitored blood glucose 5.2 ± 2.3 times/day. Factor analysis yielded two factors, 'Immediate Burden' and 'Theoretical Burden'. The Problem Areas in Diabetes Survey - Parent Revised version (PAID-PR) demonstrated excellent internal consistency (Cronbach's α = 0.87; factor 1 α = 0.78; factor 2 α = 0.83). Greater parental burden was associated with more frequent blood glucose monitoring, higher HbA(1C) levels, greater diabetes-specific family conflict, and lower quality of life. Test-retest analysis was acceptable (r = 0.62). The PAID-PR demonstrated excellent internal consistency, good test-retest reliability, and associations with diabetes-specific family conflict and quality of life. This brief measure may have both clinical and research utility in the management of young people with Type 1 diabetes.

Limited effect of screening for depression with written feedback in outpatients with diabetes mellitus: a randomised controlled trial

Aims/hypothesisThe aim of this study was to test the effectiveness of a screening procedure for depression (SCR) vs care as usual (CAU) in outpatients with diabetes. The primary outcome measured was depression score and the secondary outcomes were mental healthcare consumption, diabetes-distress and HbA1c.Materials and methodsIn a multicentre parallel randomised controlled trial, 223 outpatients with diabetes, who had an elevated depression score, were randomly assigned to SCR (n = 116) or CAU (n = 107), using computer generated numbers. SCR-patients were invited for a Composite International Diagnostic Interview (CIDI) to diagnose depression and/or anxiety (interviewers were not blinded for group assignment). As part of the intervention, patients and their physicians were informed of the outcome of the CIDI in a letter and provided with treatment advice. At baseline and 6 month follow-up, depression and diabetes-distress were measured using the Centre for Epidemiologic Studies Depression Scale (CES-D) and the Problem Areas in Diabetes survey (PAID). HbA1c levels were obtained from medical charts.ResultsMean CES-D depression scores decreased from baseline to 6 months in both groups (24 ± 8 to 21 ± 8 [CAU] and 26 ± 7 to 22 ± 10 [SCR] respectively [p < 0.001]), with no significant differences between groups. Neither diabetes-distress nor HbA1c changed significantly within and between groups. The percentage of patients receiving mental healthcare increased in the SCR group from 20% to 28%, compared with 15% to 18% in the CAU group.Conclusions/interpretationDepression screening with written feedback to patient and physician does not improve depression scores and has a limited impact on mental healthcare utilisation, compared with CAU. It appears that more intensive depression management is required to improve depression outcomes in patients with diabetes.

Relation between psychosocial variables and the glycemic control of patients with type 2 diabetes: a cross-sectional and prospective study

BackgroundThis cross-sectional and prospective study used a variety of psychological inventories to evaluate the relationship between psychosocial factors and the glycemic control of patients with type 2 diabetes.MethodsParticipants were 304 patients with type 2 diabetes who were treated as outpatients at diabetes clinics. All participants were assessed for HbA1c and completed the following self-report psychological inventories: 1) Diabetes Treatment Satisfaction Questionnaire (DTSQ), 2) Problem Areas in Diabetes Survey (PAID), 3) Well-being Questionnaire 12 (W-BQ12), 4) Self-Esteem Scale (SES), 5) Social Support Scale, and 6) Self-Efficacy Scale. HbA1c was again measured one year later. The relationships between the psychosocial variables obtained by analysis of the psychological inventories and baseline or one-year follow-up HbA1c were determined.ResultsBaseline HbA1cwas significantly correlated with age, diet treatment regimen, number of microvascular complication of diabetes, and the total scores of DTSQ, W-BQ12, PAID, SES and the Self-Efficacy Scale. Hierarchical stepwise multiple regression revealed that significant predictors of baseline HbA1c were total DTSQ and PAID scores, along with age, diet treatment regimen, and number of microvascular complication of diabetes after adjustment for demographic, clinical and other psychosocial variables. Two hundred and ninety patients (95.4% of 304) were followed and assessed one year after baseline. Hierarchical stepwise multiple regression analysis showed the significant predictors of follow-up HbA1c to be total DTSQ and PAID scores, along with age and diet treatment regimen. However, the correlation between baseline and follow-up HbA1c was so high that the only other variable to retain significance was diet treatment regimen once baseline HbA1c was included in the regression of follow-up HbA1c.ConclusionThe DTSQ and the PAID predicted both current and future HbA1c to a similar and significant degree in patients with type 2 diabetes.