Regimen-related Distress Research Articles

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

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

Understanding Stress Among Adults Diagnosed with Type 2 Diabetes at a Younger Age

Objective: Little data exists regarding the emerging population of adults diagnosed with type 2 diabetes (T2DM) at a younger age. This study was conducted to gain insight related to diabetes distress and self-efficacy among adults diagnosed with T2DM between 18-40 years of age. Research Design and Methods: : Individuals diagnosed with T2DM between 18-40 years of age (n = 118) completed an online survey in either English or Spanish. The survey included two validated scales to understand levels of diabetes distress and self-efficacy. Independent samples t-tests were conducted to examine differences among gender, while Pearson correlation coefficients were conducted to examine the relationships of current age, age of diagnosis, duration of diabetes, HbA1c values, and insulin use with multiple domains of diabetes distress and self-efficacy. Results: Both regimen-related distress and interpersonal distress were reported at levels worthy of clinical attention. Overall diabetes-related distress, emotional-burden, and physician-related distress were slightly below the level of clinical significance. Bivariate analysis suggests strong positive relationships between HbA1c values and each domain of diabetes distress. Additionally, negative correlations were found between insulin use and overall diabetes distress, emotional-burden, physician-related distress, regimen-related distress, and interpersonal distress. Conclusions: Findings suggest adults diagnosed with T2DM at a younger age experience levels of diabetes distress worthy of clinical attention, particularly regarding regimen-related and interpersonal distress. T2DM programs should include psychosocial education and communication strategies for improving social support to enhance overall quality of life for this population.

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.

Regimen-Related Distress, Medication Adherence, and Glycemic Control in Rural African American Women With Type 2 Diabetes Mellitus.

Regimen-related emotional distress in patients with type 2 diabetes mellitus (T2DM) is associated with poor glycemic control, but the mediators of this relationship are not well described. This cross-sectional study at baseline examines these relationships, including the specific role of medication adherence in rural African American women. At baseline in the EMPOWER randomized trial, the investigators collected the following data: Regimen-Related Distress (RRD; subscale of the validated Diabetes Distress Scale), diabetes medications, medication adherence using the Morisky Medication Adherence Scale, and hemoglobin A1C (A1C). The study enrolled 189 rural African American women with T2DM (mean age = 53 ± 11 years, A1C = 9.1% ± 1.8%, body mass index = 37.7% ± 8.2%; 61% on insulin); 56% reported elevated RRD (mean ≥ 3.0), and this was associated with significantly lower medication adherence (4.4 vs 6.4, P < 0.001) and significantly higher A1C (9.5% vs 8.6%, P < 0.001). In multivariate modeling, both elevated RRD (exp β = 2.1; 95% CI = 1.1-4.2; P < 0.05) and lower medication adherence (exp β = 3.3; 95% CI = 1.1-9.6; P < 0.05) were independently associated with higher A1C values. In mediation analysis, medication adherence was a significant mediator of the effects of RRD on A1C. Among rural African American women with T2DM, elevated levels of RRD were common and were associated with higher A1C values, in part via effects on medication adherence. Complex treatment regimens accompanied by psychological distress may be associated with poorer glycemic control.

Association between psychological stress and metabolic control in patients with type 1 diabetes mellitus

An association between psychological stress and metabolic control can occur in patients with diabetes. To determine the longitudinal association between different psychological stress domains (emotional burden, physician-related distress, regimen-related distress, diabetes-related interpersonal distress) and metabolic control of adolescents with Type 1 diabetes. An intentional sample of 20 Type 1 diabetic adolescents aged 15 ± 4 years was followed-up for one year. Three HbA1c determinations were performed and a stress self-report was obtained with the Polonsky' Diabetes Distress Scale. Several analyses were conducted using growth curve modeling. The first model included the HbA1c measures, the time term (coded as 0, 1, 2) and several covariates (age, years living with type 1 diabetes mellitus, sex, and physical activity). An overall negative linear trend was found for HbA1c. Subsequent models added the stress domains finding that high levels of emotional burden and regimen related-distress were associated with higher HbA1c levels across all exams. A marginal association was found between diabetes-related interpersonal distress and HbA1c. Stress levels in type 1 diabetic adolescents deserve attention. Different psychological stress factors predicting metabolic control trajectories in type 1 diabetic adolescents were found.

Diabetes Distress among type 2 Diabetic Patients

A cross sectional study is carried out among 165 adult type 2 diabetes patients attending at the outpatient department of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) Dhaka. Sample is taken purposively. Data are collected through face to face interview and records review. Diabetes distress scale (DDS 17) was measured cut-off value of &lt;2 for little or no distress 2-2.9 for moderate distress and &gt;3 for high distress. It wes observed that 22.42% had high distress,26.1% moderate distress and rest of the 51.5% had little or no distress. The average score of total diabetes distress is 2.17 ± 0.75. The average score of each domain such as emotional burden physician related distress, regimen–related distress and interpersonal distress is (3.49± 1.52), (1.13±0.32), (2.12±0.85) .“Emotional Burden” is considered as the most important domain in measuring diabetes distress. The influence of age on level of diabetes distress is statically significant (p&lt;0.001). The distress scale gradually increase higher from 40 years and continue till 59. The influence of residential status on level of diabetes distress is also statically significant (p&lt;0.001). Respondents from sub-urban areas suffered more distressed symptoms than those from urban areas (53.3% vs.45.7%). The influence of smoking on level of diabetes distressed is statistically significant (p&lt;0.005). Respondents who were the members of the having ever smoker group had highest percentage of distressed symptoms (58.5%). The influence of BMI on level of diabetes distressed is statistically significant (p&lt;0.001). Respondents who were the members of the obese group had highest percent of distress symptoms (100%) they also the group of experience highest percentage of high distress (83.3%). There is a strong positive correlation between two variable [r=0.64,p&lt;0.001] ; diabetes distress score with duration of diabetes mellitus. The influence of duration since detection of diabetes mellitus on level of diabetes distress is statistically significant (p&lt;0.001). Respondents who were having diabetes of &gt;10 years had highest percentage of distressed symptoms. Diabetes distress showed significant relationship with glycemic status. Respondents who were the members of the insulin group had highest percentages of distressed symptoms. The influence of diabetic complication on level of diabetic distress is statistically significantly (p&lt;0.001). Respondents who were the members of having complications group had highest percentage of distressed symptoms.

Diabetes distress and neighborhood characteristics in people with type 2 diabetes

ObjectiveDiabetes-specific distress is an important psychological issue in people with diabetes. The neighborhood environment has the potential to be an important factor for diabetes distress. This study investigates the associations between neighborhood characteristics and diabetes distress in adults with type 2 diabetes. MethodsWe used cross-sectional data from a community-based sample of 578 adults with type 2 diabetes from Quebec, Canada. Information on perceived neighborhood characteristics and diabetes distress was collected from phone interviews. We used factor analysis to combine questionnaire items into neighborhood factors. Information on neighborhood deprivation was derived from census data. We performed linear regressions for diabetes distress and specific domains of diabetes distress (emotional, regimen-related, physician-related and interpersonal distress), adjusting for individual-level variables. ResultsFactorial analysis uncovered 3 important neighborhood constructs: perceived order (social and physical order), culture (social and cultural environment) and access (access to services and facilities). After adjusting for individual-level confounders, neighborhood order was significantly associated with diabetes distress and all specific domains of distress; neighborhood culture was specifically associated with regimen-related distress; and neighborhood access was specifically associated with physician-related distress. The objective measure of neighborhood material deprivation was associated with regimen-related distress. ConclusionsNeighborhood characteristics are associated with diabetes distress in people with type 2 diabetes. Clinicians should consider the neighborhood environment reported by their patients with diabetes when assessing and addressing diabetes-specific distress.

Diabetes and Mental Health

Diabetes and Mental Health

Psychological status and diabetes-related distress of Chinese type 1 diabetes patients in Jiangsu province, China

We sought to assess the psychological status and diabetes-related distress of Chinese type 1 diabetes patients in Jiangsu province, China. According to the World Health Organization criteria, 42 patients with type 1 diabetes were enrolled in the study and assessed with the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS) and Diabetes Distress Scale (DDS). All data were tabulated and statistical analyses were performed. The study summarized cases of 42 patients with type 1 diabetes, including 17 males and 25 females with a mean age of 23±12 years and a mean duration of diabetes of 7±6 years. Compared to the Chinese normative data, the SAS standard score was significantly higher, whereas SDS standard score had no statistical significance. The SAS standard score was most highly correlated with diabetes duration (γ = 0.547, P = 0.011). Additionally, 19.5% of the patients had moderate or even severe diabetes-related distress and 21.4% had moderate or even severe emotional burden while 26.2% had regimen-related distress. Multiple stepwise regression analysis showed that the mean correlation between DDS and the four domains was high, particularly the emotional burden domain (estimated β = 0.363, P < 0.001) and regimen-related distress domain (estimated β = 0.356, P < 0.001). The correlation between SAS and DDS was positive (estimated β = 0.039, P = 0.027). In conclusion, the results showed the importance of psychological aspects in Chinese individuals with type 1 diabetes. Screening and treatment of psychological aspects may result in better adherence and increased quality of life for patients with diabetes.

Patient reported outcomes in adults with type 2 diabetes on basal insulin randomized to addition of mealtime pramlintide or rapid-acting insulin analogs

Objective:To determine whether treatment satisfaction and quality of life were affected by adding mealtime pramlintide or rapid-acting insulin analogs (RAIAs) to basal insulin therapy for patients with inadequately controlled type 2 diabetes.Research design and methods:In this 24-week open-label, multicenter study of adults with type 2 diabetes, mealtime pramlintide (PRAM) (120 μg fixed dose; n = 56) or titrated RAIAs (n = 56) was added to basal insulin therapy with or without oral antidiabetic medications.Clinical trial registration:ClinicalTrials.Gov NCT00467649Main outcome measures:Quality of life (Diabetes Distress Scale – DDS, and Pittsburgh Sleep Quality Index – PSQI), and treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire – DTSQ, and Pramlintide Treatment Satisfaction Questionnaire – PRAM-TSQ) were assessed at baseline and week 24. Mixed-effect models estimated mean group changes from baseline to week 24 (adjusted for baseline scores) in patient reported outcomes.Results:PRAM patients experienced significant improvement in total diabetes distress, while RAIA patients did not; both groups experienced significant improvement in regimen-related distress and physician-related distress. Between-group differences in DDS measures were not significant. PRAM patients experienced significant improvement in sleep latency and daytime dysfunction, while RAIA patients did not; the difference between groups was significant for daytime dysfunction. Both treatment groups experienced significant improvement in most individual DTSQ items and total diabetes treatment satisfaction, while only PRAM patients experienced significant improvement in perceived hypoglycemia. Between-group differences in DTSQ measures were not significant. Both treatment groups experienced significant improvement in most individual PRAM-TSQ items and total treatment satisfaction; RAIA patients experienced increased eating flexibility and reduced perceived weight control. PRAM patients experienced significantly better perceived weight and appetite control than RAIA patients.Limitations:The sample size was relatively small and there were few non-white subjects. The schedule for implementation of change in therapy may have affected study outcomes.Conclusions:Adding pramlintide on a background of basal insulin improved some aspects of treatment satisfaction and quality of life relative to adding rapid-acting insulin analogs.

Advanced Insulin Management program reduces A1C levels and regimen-related distress without weight gain in patients with type 1 diabetes mellitus

Background: Despite the availability of effective treatments, many patients with diabetes have suboptimal glycemic control. Objective: This study was designed to determine whether the Advanced Insulin Management (AIM) program could help patients with type 1 diabetes mellitus (DM) reduce their A1C levels to ≤7.5% without weight gain, increased incidence of hypoglycemia, or increased diabetes-related distress. Methods: The AIM program, developed to intensify glycemic control in patients with type 1 DM, consisted of a screening visit and 3 to 6 interactive group sessions, depending on whether the patient elects multiple daily injections (MDIs) or an insulin pump. Patients who wanted to learn additional diabetes management skills were referred by their endocrinologist, and those with competent carbohydrate-counting skills and record-keeping practices were eligible to enroll. A nurse, dietitian, psychologist, and physician provided group instruction and supported individual goal setting. The program included depression screening, regimen adjustments, and problem-solving activities. Outcome measures, including blood glucose, A1C, weight, and diabetes-related distress, were tracked for 12 months. Results: The study included 113 adult patients with type 1 DM (59% female; mean age, 39 years). Twenty patients already had insulin pumps, 46 patients initiated pump therapy during the study, and 47 patients elected MDIs. Mean A1C declined by 0.5% (to 7.3%) after 12 months, without weight gain or increased hypoglycemia. A significant decrease in diabetes-related distress was observed. Conclusion: The AIM program was associated with important improvements in glycemic control in patients with type 1 DM, without weight gain or increased hypoglycemic episodes.

Assessing Psychosocial Distress in Diabetes

The purpose of this study was to describe the development of the Diabetes Distress Scale (DDS), a new instrument for the assessment of diabetes-related emotional distress, based on four independent patient samples. In consultation with patients and professionals from multiple disciplines, a preliminary scale of 28 items was developed, based a priori on four distress-related domains: emotional burden subscale, physician-related distress subscale, regimen-related distress subscale, and diabetes-related interpersonal distress. The new instrument was included in a larger battery of questionnaires used in diabetes studies at four diverse sites: waiting room at a primary care clinic (n = 200), waiting room at a diabetes specialty clinic (n = 179), a diabetes management study program (n = 167), and an ongoing diabetes management program (n = 158). Exploratory factor analyses revealed four factors consistent across sites (involving 17 of the 28 items) that matched the critical content domains identified earlier. The correlation between the 28-item and 17-item scales was very high (r = 0.99). The mean correlation between the 17-item total score (DDS) and the four subscales was high (r = 0.82), but the pattern of interscale correlations suggested that the subscales, although not totally independent, tapped into relatively different areas of diabetes-related distress. Internal reliability of the DDS and the four subscales was adequate (alpha > 0.87), and validity coefficients yielded significant linkages with the Center for Epidemiological Studies Depression Scale, meal planning, exercise, and total cholesterol. Insulin users evidenced the highest mean DDS total scores, whereas diet-controlled subjects displayed the lowest scores (P < 0.001). The DDS has a consistent, generalizable factor structure and good internal reliability and validity across four different clinical sites. The new instrument may serve as a valuable measure of diabetes-related emotional distress for use in research and clinical practice.