Examining Diabetes Distress, Medication Adherence, Diabetes Self-care Activities, Diabetes-specific Quality Of Life And Health-related Quality Of Life Among Type 2 Diabetes Mellitus Patients
Jump to Section Highlights Jump to Section Abstract Aims Health-Related Quality of Life (HRQoL) has been increasing attention in health outcome studies. Factors that individually influence HRQoL, diabetes self-care behaviors, and medication adherence have been widely investigated; however, most previous studies have not tested an integrated association between multiple health outcomes. The purpose of this study was to formulate a hypothetical structural equation model linking HRQoL, diabetes distress, diabetes self-care activities, medication adherence and diabetes-dependent QoL in patients with Type 2 Diabetes Mellitus (T2DM). Methods A cross-sectional study design was employed, and 497 patients with T2DM were recruited from outpatient clinics in three public hospitals and one government clinic. The patients completed a series of questionnaires. The hypothetical model was tested using Structural Equation Modeling (SEM) analysis. Results The values of the multiple fit indices indicated that the proposed model provided a good fit to the data. SEM results showed that medication adherence (MMAS) had a significant direct effect on diabetes distress (PAID) (Beta = −0.20). The self-care activities (SDSCA) construct was significantly related to PAID (Beta = −0.24). SDSCA was found to have a significant relationship with HRQoL (SF-36) (Beta = 0.11). Additionally, diabetes distress had a significant effect (Beta = −0.11) on HRQoL of patients. Finally, ADDQoL had a significant effect on HRQoL (Beta = 0.12). Conclusions The various health outcome indicators such as self-care behaviors, diabetes distress, medication adherence and diabetes-dependent QoL need to be considered in clinical practice for enhancing HRQoL in those patients. Jump to Section Introduction Diabetes Melli Continue reading >>
Understanding Stress Among Adults Diagnosed With Type 2 Diabetes At A Younger Age
Ashley N. Wingert L. Nicole Johnson, Dr.PH., M.P.H., M.A., Stephanie T. Melton, M.A., M.P.H. 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. Conclusion: 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 strate Continue reading >>
Reducing Diabetes Distress And Improving Self-management With Mindfulness
Stress associated with diabetes makes managing diabetes harder. We investigated whether mindfulness-based stress reduction (MBSR) could reduce diabetes distress and improve management. We recruited 38 participants to complete an MBSR program. Surveys and lab values were completed at baseline and post-intervention. Participants showed significant improvement in diabetes-related distress (Cohen’s d –.71, p < .002), psychosocial self-efficacy (Cohen’s d .80, p < .001), and glucose control (Cohen’s d –.79, p < .001). Significant improvements in depression, anxiety, stress, coping, self-compassion, and social support were also found. These results suggest that MBSR may offer an effective method for helping people better self-manage their diabetes and improve mental health. Continue reading >>
Short-form Measures Of Diabetes-related Emotional Distress: The Problem Areas In Diabetes Scale (paid)-5 And Paid-1.
Abstract AIMS/HYPOTHESIS: We wanted to identify a five-item short form of the Problem Areas in Diabetes Scale and a single-item measure for rapid screening of diabetes-related emotional distress. METHODS: Using an existing database of 1,153 patients with diabetes, we conducted a principal-components analysis to identify a set of five items and then conducted a reliability analysis and validity checks. From those five items, we identified the item with the strongest psychometric properties as a one-item screening tool. RESULTS: We identified a reliable and valid short version of the Problem Areas in Diabetes Scale (PAID) comprising five of the emotional-distress questions of the full PAID items (PAID-5, with items 3, 6, 12, 16, 19). The PAID-5 has satisfactory sensitivity (94%) and specificity (89%) for recognition of diabetes-related emotional distress. We also identified a one-item screening tool, the PAID-1 (Question 12: Worrying about the future and the possibility of serious complications), which has concurrent sensitivity and specificity of about 80% for the recognition of diabetes-related emotional distress. CONCLUSIONS/INTERPRETATION: The PAID-5 and PAID-1 appear to be psychometrically robust short-form measures of diabetes-related emotional distress. Continue reading >>
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Developing And Psychometric Testing Of A Short-form Problem Areas In Diabetes Scale In Chinese Patients
Hsu, Hui-Chun1; Chang, Yu-Hung2; Lee, Pei-Ju3; Chen, Shi-Yu4; Hsieh, Chang-Hsun5; Lee, Yau-Jiunn6; Wang, Ruey-Hsia7* Background: The 20-item Problem Areas in Diabetes (PAID) scale is widely used to measure diabetes-related emotional distress. The short-form PAID scale is helpful for the rapid screening of diabetes-related emotional distress in clinical settings. Purpose: This study developed and examined the psychometric properties of a short-form Chinese-version PAID (SF-PAID-C) scale. Methods: The Chinese-version 20-item PAID (PAID-C) scale was administered to 855 patients with type 2 diabetes mellitus. Item analysis, exploratory factor analysis, and confirmatoryfactoranalysis were then applied to develop the SF-PAID-C and evaluate its construct validity. The correlations between SF-PAID-C and the latest HbA1c close to the measurement of PAID-C (baseline HbA1c) 3 months and 12 months later were used to examine the concurrent and predictive validity of the SF-PAID-C. Receiver operating characteristic curve analysis was used to examine the sensitivity and specificity of the SF-PAID-C. Cronbach’s alpha was used to assess internal consistency. Test–retest on 24 patients was used to examine the stability of the SF-PAID-C. Results: An 8-item SF-PAID-C was developed. The SF-PAID-C significantly correlated with the PAID-C (r = .941, p < .001), baseline HbA1c (r = .148, p < .001), 3-month HbA1c (r = .147, p < .001), and 12-month HbA1c (r = .142, p < .001). The sensitivity and specificity of the SF-PAID-C were 93.2% and 94.2%, respectively. The Cronbach’s α and test–retest reliability of the SF-PAID-C were .85 and .93, respectively. Conclusions/Implications for Practice: The SF-PAID-C is a reliable and valid scale that can be used to screen for diabetes-related emotion Continue reading >>
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Impact Of "conversation Maps" On Diabetes Distress And Self-efficacy Of Chinese Adult Patients With Type 2 Diabetes: A Pilot Study
1Department of Health Education, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, Jiangsu, People’s Republic of China; 2Department of Endocrinology, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, Jiangsu, People’s Republic of China; 3Hangzhou 9th Middle School, Hangzhou, Zhejiang, People’s Republic of China; 4Department of Bioengineering, University of Washington, Seattle, WA, USA *These authors contributed equally to this work Abstract: The objective was to compare Diabetes Conversation Maps-based education and traditional education in Chinese patients with type 2 diabetes. A total of 53 outpatients were randomized to the intervention group (Diabetes Conversation Maps-based education) and control group (traditional education). In the intervention group, six 1-hour sessions covering diabetes overview, living with diabetes, risk factors and complications of diabetes, starting insulin treatment, foot care, and healthy eating and exercise were provided during 4 weeks. The participants had to attend at least four sessions, followed by a monthly follow-up telephone call in the subsequent 3 months. In the control group, six 1-hour diabetes classes covering similar topics as those in the intervention group were provided over 4 weeks. Each participant needed to attend at least four sessions. A1C was assessed at baseline, 3 months and 6 months after the last educational session/class. Psychosocial metrics and self-care activities were evaluated at baseline and 6 months after the last educational session/class. Forty-six participants finished the study. After 6 months, the total score of diabetes distress scale was significantly lower and total score of diabetes empowerment scale-short form was significan Continue reading >>
Impact Of Distress Reduction On Behavioral Correlates And A1c In African American Women With Uncontrolled Type 2 Diabetes: Results From Empower
Introduction The management of type 2 diabetes (T2D) involves adopting and maintaining a variety of lifestyle and self-care behaviors including dietary, physical activity, glucose monitoring, and medication adherence that may be new for patients.1 As glycemic control becomes more difficult with increasing duration of disease, treatment intensification involving additional medication, lifestyle changes, and monitoring is often recommended. These behavioral changes are inter-related and can result in ever-increasing complexity for the patient, potentially impacting quality of life. These complex behavioral changes may impact role functioning, a concern among African American women who often care for others in their family, often with limited social and financial support. Due to this increasing complexity and burden of self-care behaviors, many female patients experience increased emotional distress that has been reported in more than 40% of patients with T2D.2-5 This emotional distress related to diabetes has been associated with inadequate self-care behaviors, medication non-adherence, and poor glycemic control.2,3,6 Diabetes-related distress has also been associated with an increased risk for depression in a longitudinal study of patients with diabetes.7 Further, recent evidence from our prior work suggests that stress and depressive symptoms in patients with diabetes may be associated with a higher incidence of cardiovascular events and death, especially among African American women.8 While elevated levels of diabetes-related distress have been associated with inadequate self-care behaviors and adverse cardiovascular outcomes, it is unclear if improving adverse distress levels in at-risk African American women with T2D can result in improved glycemic outcomes. One stud Continue reading >>
The Problem Areas In Diabetes (paid) Scale: Psychometric Evaluation Survey In A Greek Sample With Type 2 Diabetes
Abstract Accessible summary Several instruments have been developed for the assessment of emotional distress in patients with diabetes. The Problem Areas in Diabetes Scale (PAID) is a brief self-report scale that evaluates diabetes-related distress. There is a lack of validated instruments for the evaluation of psychological aspects in patients with diabetes in Greek language. The current study was conducted to translate and adapt the PAID scale in Greek language and to evaluate the psychometric properties in two different study populations of patients with diabetes. Abstract The aim of this study was to translate the Problem Areas in Diabetes (PAID) scale into Greek, adapt it culturally to Greece and determine its psychometric properties. The translation process included two forward translations, reconciliation, backward translation and pre-testing steps. The validation incorporated the exploration of internal consistency (Cronbach's alpha), test–retest reliability (interclass correlation coefficient), construct validity (exploratory factor analysis) and responsiveness (Spearman correlation coefficient). Participants included 101 consecutive patients from a rural primary healthcare centre and 101 patients from an urban hospital. All patients completed the PAID scale and the Short Form-36 (SF-36) version 2. Internal consistency considered good (Cronbach's alpha = 0.948). Interclass correlation coefficient was 0.942 (95% CI 0.915–0.961). Factor analysis yielded three factors: ‘Diabetes-related emotional problems’ (51.79% variance, Cronbach's alpha = 0.910), ‘Food-related problems’ (9.55% variance, Cronbach's alpha = 0.824) and ‘Social support-related problems’ (5.96% variance, Cronbach's alpha = 0.704). Scree plot test and conceptual congruency of items s Continue reading >>
Translation And Adaptation Of The "diabetes Distress Scale - Dds" In Brazilian Culture
ORIGINAL ARTICLE Traducción y adaptación de la "Diabetes Distress Scale - DDS" en la cultura brasilera Raquel CurcioI; Neuza Maria Costa AlexandreII; Heloisa de Carvalho TorresIII; Maria Helena Melo LimaIV IMaster's in Nursing, State University of Campinas - UNICAMP - Campinas (SP), Brazil IIFull Professor, Associate Professor, Faculty Member at the Nursing Department, Faculty of Medical Science, State University of Campinas - UNICAMP - Campinas (SP), Brazil IIIPhD in Health Science. Adjunct Professor at Department of Applied Nursing at School of Nursing, Federal University of Minas Gerais - UFMG - Belo Horizonte (MG), Brazil IVProfessor at Nursing Department, Faculty of Medical Science, State University of Campinas - UNICAMP - Campinas (SP), Brazil ABSTRACT OBJECTIVE: To translate and adapt the Diabetes Distress Scale for the Brazilian culture. METHODS: The process followed international standards for adaptation of an instrument: translation, back translation and evaluation by a panel of judges, and pretest. RESULTS: The stages of translation and back translation were performed successfully, and the evaluation of the synthesis version by the expert panel resulted in modification of items, ensuring the equivalence between the original and translated versions. During the pretest, there were reformulations of some items, making them clearer and easier to understand. CONCLUSION: The Brazilian version of the Diabetes Distress Scale received satisfactory results with respect to the process of translation and cultural adaptation. Keywords: Diabetes mellitus; Quality of life; Validation studies; Translating RESUMEN OBJETIVO: Traducir y adaptar la Diabetes Distress Scale para la cultura brasilera. MÉTODOS: el proceso siguió las normas internacionales para la adaptación de Continue reading >>
Diabetes Attitude Scale: Validation In Type-2 Diabetes Patients In Multiple Centers In China
Abstract A prospective study was performed. The cultural equivalency and content validity of the Diabetes Attitude Scale were determined by panels of endocrinologists, physiologists, nurses and dieticians. An accurate and usable translation was obtained for each of five subscales examining attitudes on need for special training, the seriousness of type-2 diabetes, the need for controlling the condition, its psychosocial impact and the degree of autonomy given to patients in decision making. The validation was derived from 5961 patients with type-2 diabetes, recruited from 50 centers in 29 provinces throughout China between March 1st and September 30th, 2010. The modified Diabetes Attitude Scale showed an acceptable level of internal consistency. The strength of the inter-correlations among the domains of five subscales suggests that the instrument measures related but separate domains of patients' attitudes toward diabetes. Moreover, the test-retest intraclass correlation coefficients were high enough to support the stability of the Chinese version of the third version of the scale. The psychometric properties of the Chinese version of Diabetes Attitude Scale demonstrated satisfactory validity and reliability and appeared to effectively evaluate attitudes toward diabetes in patients with type-2 diabetes. Figures Citation: Lou Q, Chen Y, Guo X, Yuan L, Chen T, Wang C, et al. (2014) Diabetes Attitude Scale: Validation in Type-2 Diabetes Patients in Multiple Centers in China. PLoS ONE 9(5): e96473. Editor: Antony Bayer, Cardiff University, United Kingdom Received: November 7, 2013; Accepted: April 9, 2014; Published: May 6, 2014 Copyright: © 2014 Lou et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permit Continue reading >>
Md, Phd
Author information Cornelis A.J. van Beers, MD,1 Maartje de Wit, PhD,2 Susanne J. Kleijer, MD,1 Petronella H. Geelhoed-Duijvestijn, MD, PhD,3 J. Hans DeVries, MD, PhD,4 Mark H.H. Kramer, MD, PhD,1 Michaela Diamant, MD, PhD,1,† Erik H. Serné, MD, PhD,1 and Frank J. Snoek, PhD2,5 The aim of this study was to evaluate whether psychological distress modifies the effect of continuous glucose monitoring (CGM) in patients with type 1 diabetes (T1D) and impaired awareness of hypoglycemia. Fifty-two patients with T1D and impaired awareness of hypoglycemia participated in an earlier reported randomized crossover trial with two 16-week intervention periods comparing CGM with self-monitoring of blood glucose (SMBG). During the CGM phase, time spent in euglycemia (4–10 mmol/L), the primary outcome, was 9.6% higher compared with the SMBG phase (P < 0.0001). Psychological distress was operationalized as low emotional well-being (World Health Organization Well-being Index 5 [WHO-5] < 50), high diabetes-related distress (Problem Areas in Diabetes 5 [PAID-5] ≥ 8), and/or high fear of hypoglycemia (Hypoglycemia Fear Survey [HFS] Worry > mean HFS Worry score +1 standard deviation). Modifying effects were assessed by analyzing psychological distress score × intervention—interaction effects. Results showed that both the low emotional well-being group and normal emotional well-being group had equal glycemic outcomes during the CGM phase. High diabetes distress and elevated fear of hypoglycemia did not result in significant interaction effects for glycemic outcomes. This study demonstrated that CGM is equally effective in terms of glycemic improvements in high versus low distressed patients with T1D and impaired awareness of hypoglycemia. Continue reading >>
Original Research Report Putting Paid To Diabetes-related Distress: The Potential Utility Of The Problem Areas In Diabetes (paid) Scale In Patients With Diabetes
Introduction Distress and depression are commonly reported negative affects in people with diabetes (PWD), and may influence glycemic control. ‘Distress’ can be measured as general or diabetes-related. ‘Depression’ is considered through symptom severity or episodes of depressive disorder, both potentially derived by the Patient Health Questionnaire (PHQ-9). While current depressive disorder is found to affect the course of diabetes mellitus (DM), past depressive disorder may have a similar impact. Objectives To test the relationships between DM-distress (measured by the Problem Areas in Diabetes instrument [PAID]) and glycemic control, while considering the effects of general distress; depression severity; and both current and previous depressive disorder. In a diabetic service, 184 type 1 (n = 51) and type 2 (n = 133) PWD completed the PAID, PHQ-9 depression scale from the Patient Health Questionnaire, Kessler-10 psychological distress (K10), and Short-Form Survey (SF-12) instruments. Glycosylated hemoglobin (HbA1c) levels measured on the day of recruitment were recorded from the case notes. DM-related distress correlated positively with HbA1c, PHQ-9 depression, K10, and SF-12 MCS (mental component summary) scores, (all p < 0.01); and negatively with age (p < 0.01). Regression analysis revealed a significant association between PAID with PHQ-9 depression scores (p < 0.01) and with HbA1c (p < 0.01). PWD with past depressive disorder had higher PAID scores than those without (p < 0.05), and this was significant even after controlling for current depression scores (p < 0.05). Conclusions In PWD, DM-specific distress measured by the PAID correlated significantly with impaired glycemic control. Both past and current depressions are independently associated with DM-d Continue reading >>
The Importance Of Screening For Mild Depression In Adults With Diabetes
1School of Psychiatry, Faculty of Medicine and Black Dog Institute, University of New South Wales, Randwick, NSW, Australia 2St VincentâÂÂs Urban Mental Health Research Institute, St VincentâÂÂs Hospital, Sydney, NSW, Australia 3Consultation Liaison Psychiatry, St VincentâÂÂs Hospital, Sydney, NSW, Australia 4Diabetes Services, St VincentâÂÂs Hospital, Sydney, NSW, Australia 5School of Medicine, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia 6Department of Psychological and Addiction Medicine, Australian National University, Canberra ACT, Australia *Corresponding Author: Kay Wilhelm St VincentâÂÂs Urban Mental Health Research Institute St VincentâÂÂs Hospital, Sydney, NSW, Australia Tel: +61416143717 Fax: +61(02)83821402 E-mail: [email protected] Citation: Wilhelm K, Reddy J, Crawford J, et al. The Importance of Screening for Mild Depression in Adults with Diabetes. Transl Biomed. 2017, 8:1. doi:10.2167/2172-0479.1000101 Abstract Aim: While the impact of major depression on diabetes has gained increasing attention, the role of minor depression is less well investigated. This observational study compared three groups of adults with Type 1 (T1DM) or Type 2 (T2DM) diabetes mellitus: with me) no depressive symptoms (NODEP), ii) mild depressive symptoms (MILD) and iii) moderate-to-severe symptoms (MOD/SEVERE)-on diabetes distress, psychological distress, anxiety and somatic symptoms, quality of life and HbA1c levels. Methods: 245 outpatients attending two hospital diabetes services (27% with T1DM; 73% with T2DM) completed self-report measures including patient health questionnaire (PHQ), problem areas in diabetes (PAID) scale and short form health survey (SF12). Participants were interviewed by a psychiatrist Continue reading >>
What Is The Best Measure For Assessing Diabetes Distress? A Comparison Of The Problem Areas In Diabetes And Diabetes Distress Scale: Results From Diabetes Miles–australia
This study used Rasch analysis to examine the psychometric validity of the Diabetes Distress Scale and the Problem Areas in Diabetes scale to assess diabetes distress in 3338 adults with diabetes (1609 completed the Problem Areas in Diabetes scale (n = 675 type 1 diabetes; n = 934 type 2 diabetes) and 1705 completed the Diabetes Distress Scale (n = 693 type 1 diabetes; n = 1012 type 2 diabetes)). While criterion and convergent validity were good, Rasch analysis revealed suboptimal precision and targeting, and item misfit. Unresolvable multidimensionality within the Diabetes Distress Scale suggests a total score should be avoided, while suboptimal precision suggests that the Physician-related and Interpersonal distress subscales should be used cautiously. Bech, P (2004) Measuring the dimension of psychological general well-being by the WHO-5. Quality of Life Newsletter 32: 15–16. Google Scholar Bond, TG, Fox, CM (2001) Applying the Rasch Model: Fundamental Measurement in the Human Sciences. London: Lawrence Erlbaum Associates. Google Scholar Boone, W, Staver, J, Yale, M (2014) Rasch Analysis in the Human Sciences. Dordrecht: Springer. Google Scholar, Crossref Borsboom, D (2006) The attack of the psychometricians. Psychometrika 71: 425–440. Google Scholar, Crossref, Medline Cappelleri, JC, Jason Lundy, J, Hays, RD (2014) Overview of classical test theory and item response theory for the quantitative assessment of items in developing patient-reported outcomes measures. Clinical Therapeutics 36: 648–662. Google Scholar, Crossref, Medline Egede, LE, Zheng, D, Simpson, K (2002) Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. Diabetes Care 25: 464–470. Google Scholar, Crossref, Medline Fisher, L, Glasgow, Continue reading >>
Assessment Scale/forms Of Diabetes Self-management
3. BRFSS: module 30 – emotional support and life satisfaction 4. Diabetes specific version of the Perceived Medical-Condition Self-Management Scale (PMCSMS) a. It is difficult for me to find effective solutions for problems that occur with management my diabetes* b. I find efforts to change things I don’t like about my diabetes are ineffective* c. I handle myself well with respect to my diabetes d. I am able to manage things related to my diabetes as well as most other people e. I succeed in the projects I undertake to manage my diabetes f. Typically, my plans for managing my diabetes don’t work out well* g. No matter how hard I try, managing my diabetes doesn’t turn out the way I would like* h. I’m generally able to accomplish my goals with respect to managing my diabetes i. All items scored so that high score (1-5) equals high perceived self-management competence ii. *item needing to be reverse-scored (1=5, 2=4, 4=2, 5=1) iii. Wallston KA et al. Psychometric properties of the perceived diabetes self-management scale. J Behav Med 2007; 30:395-401 5. Diabetes management self-efficacy scale a. McDowell J, et al. Validation of the Australian/English version of the diabetes management self-efficacy scale. Int J Nursing Practice 2005; 11:177-184 6. The Summary of Diabetes Self-Care Activities a. Toobert DJ, et al. The summary of diabetes self-care activities measure. Diabetes Care 2000; 23:943-950 i. Appendix has a copy of the 11 core items of the revised SDSCA 7. The Diabetes Empowerment Scale (SF) a. Anderson RM, Fitzgerald JT, Gruppen LD, Funnell MM, Oh MS: The diabetes empowerment scale-short form (DES-SF). Diabetes Care 26:1641-1643, 2003 b. 8. Diabetes Self-Management Assessment Report Tool (D-SMART) a. The Diabetes Self-management A Continue reading >>
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