Assessment of diabetes acceptance can help identify patients with ineffective diabetes self‐care and poor diabetes control

Schmitt, Andreas; Reimer, André; Kulzer, Bernd; Haak, Thomas; Gahr, Annika; Hermanns, Norbert

doi:10.1111/dme.12553

Cited by 70 publications

(84 citation statements)

References 22 publications

(25 reference statements)

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“…Furthermore, we found this association only in men with type 2 diabetes, and not in women. Clinically, dealing with diabetes distress is important because it can present a psychological obstacle to effective selfmanagement behaviours and therefore to achieving good glycaemic control [18,19]. Several studies have evaluated the association between diabetes distress and glycaemic control or diabetes complications in individuals with diabetes.…”

Section: Discussionmentioning

confidence: 99%

Association between diabetes distress and all-cause mortality in Japanese individuals with type 2 diabetes: a prospective cohort study (Diabetes Distress and Care Registry in Tenri [DDCRT 18])

et al. 2018

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Aims/hypothesis The absence of data on the direct association between diabetes-specific distress and all-cause mortality in individuals with diabetes prompted us to examine the temporal association between Problem Areas in Diabetes (PAID) survey scores and the subsequent risk of all-cause mortality in a cohort of individuals with type 2 diabetes. Methods Longitudinal data from 3305 individuals with diabetes were obtained from a large Japanese diabetes registry. Independent correlations between quintiles of PAID total scores or PAID scores of ≥40 and all-cause mortality (median follow-up of 6.1 years) were examined using Cox proportional hazards models with adjustment for potential confounders.Results The study population included 1280 women and 2025 men with a mean age of 64.9 years, BMI of 24.6 kg/m 2 and HbA 1c level of 58.7 mmol/mol (7.5%). In the multivariable-adjusted model, compared with the first quintile of PAID scores, the multivariable-adjusted HRs (95% CIs) for all-cause mortality for the second to fifth quintiles were 1.11 (0.77, 1.60; p = 0.56), 0.87 (0.56, 1.35; p = 0.524), 0.95 (0.63, 1.46; p = 0.802) and 1.60 (1.09, 2.36; p = 0.016), respectively. Compared with a PAID score of <40, the multivariable-adjusted HR for all-cause mortality of those with a score of ≥10 was 1.56 (95% CI 1.17, 2.08; p = 0.002). In subgroup analyses, the association between PAID score and all-cause mortality was found in men (HR 1.76; 95% CI 1.26, 2.46) but not in women (HR 1.09; 95% CI 0.60, 2.00), with a significant interaction between diabetes distress and sex (p = 0.0336). Conclusions/interpretation We observed a significant positive association between high diabetes distress and all-cause mortality in men with diabetes.

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Section: Discussionmentioning

confidence: 99%

Association between diabetes distress and all-cause mortality in Japanese individuals with type 2 diabetes: a prospective cohort study (Diabetes Distress and Care Registry in Tenri [DDCRT 18])

et al. 2018

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“…The sixitem German version of the AADQ measures acceptance of diabetesrelated thoughts and feelings and the degree to which they interfere with valued action (10). A higher score indicates greater acceptance.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with diabetes and comorbid depression report a poorer quality of life (4), reduced well-being (5), higher levels of diabetes-related distress (6,7), lower satisfaction with diabetes treatment (8), reduced diabetes self-care (9), and higher nonacceptance of diabetes treatment measures (10). In the long term, depression in diabetes is associated with a poorer prognosis with regard to microvascular or macrovascular diabetes complications (11), disability (12), and early mortality (13,14).…”

mentioning

confidence: 99%

The Effect of a Diabetes-Specific Cognitive Behavioral Treatment Program (DIAMOS) for Patients With Diabetes and Subclinical Depression: Results of a Randomized Controlled Trial

et al. 2015

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OBJECTIVESubclinical depression is one of the most frequent mental comorbidities in patients with diabetes and is associated with a poorer long-term prognosis. Since there is a lack of specific intervention concepts for this patient group, a selfmanagement-oriented group program (DIAMOS [Diabetes Motivation Strengthening]) was newly developed and evaluated in a randomized trial. RESEARCH DESIGN AND METHODSDIAMOS is composed of cognitive behavioral interventions aiming at the reduction of diabetes distress. The active control group (CG) received diabetes education. The primary outcome was depressive symptoms. Secondary outcomes were diabetes distress, well-being, self-care behavior, diabetes acceptance, diabetes treatment satisfaction, HbA 1c , and subclinical inflammation. RESULTSTwo hundred fourteen participants (mean age 43.3 6 13.3 years, female sex 56.5%, type 2 diabetes 34.1%, mean diabetes duration 14.2 6 10.5 years, HbA 1c 8.9 6 1.8%, BMI 28.7 6 71 kg/m 2 ) were randomized. The 12-month follow-up revealed a significantly stronger reduction of depressive symptoms (Center for Epidemiologic Studies Depression Scale score) in the DIAMOS group compared with the CG (D3.9 [95% CI 0.6-7.3], P = 0.021). Of the secondary variables, the Patient Health Questionnaire-9 (D1.7 [95% CI 0.2-3.2], P = 0.023), Problem Areas in Diabetes scale (D8.2 [95% CI 3.1-13.3], P = 0.002), and Diabetes Distress Scale scores (D0.3 [95% CI 0.1-0.5], P = 0.012) displayed significant treatment effects. Moreover, the risk of incident major depression in the DIAMOS group was significantly reduced (odds ratio 0.63 [95% CI 0.42-0.96], P = 0.028). Inflammatory variables were not substantially affected. CONCLUSIONSDIAMOS is more effective in lowering depressive symptoms and diabetes-related distress in diabetic patients with subclinical depression. DIAMOS also has a preventive effect with respect to the incidence of major depression.

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“…However, a large part of the variance in such scales is not explained by depressive symptoms [18]. For example, a longitudinal study of 1567 individuals with diabetes found that 55% of those with diabetes distress did not have likely depression [19], while a factor analysis study reported that depression and distress symptoms could be segregated into two independent factors [20]. Clinically, diabetes distress is significant because it may be a greater psychological barrier to self-management, and therefore to optimising glycaemic control, than depressive symptoms [21,22] and it is potentially modifiable using psychological therapy [23].…”

Section: Introductionmentioning

confidence: 99%

The association of depressive symptoms and diabetes distress with glycaemic control and diabetes complications over 2 years in newly diagnosed type 2 diabetes: a prospective cohort study

et al. 2017

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Aims/hypothesis We examined the associations between depressive symptoms and diabetes distress with glycaemic control and diabetes complications over 2 years, after diagnosis of type 2 diabetes. Methods In a multi-ethnic, primary care cohort (n = 1735) of adults, all with recent (<6 months) diagnosis of type 2 diabetes, we measured the associations between depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score ≥10) and diabetes distress (Problem Areas in Diabetes [PAID] score ≥40), with change in 2 year HbA 1c as the primary outcome and with incident rates of diabetes complications as secondary outcomes. Multivariate models were used to account for potential confounders. Results Of the 1651 participants (95.2%) of the total primary care cohort with available baseline PHQ-9 and PAID scores, mean ± SD age was 56.2 ± 11.1 years, 55.1% were men and 49.1% were of non-white ethnicity; 232 (14.1%) and 111 (6.7%) had depressive symptoms and diabetes distress, respectively. After adjustment for confounders, depressive symptoms were not associated with worsening HbA 1c . After adjustment for age, sex, ethnicity, vascular risk factors and diabetes treatments, depressive symptoms were associated with increased risk of incident macrovascular complications (OR 2.78 [95% CI 1.19,6.49], p = 0.018) but not microvascular complications. This was attenuated (p = 0.09) after adjustment for IL-1 receptor antagonist concentration. Diabetes distress was not associated with worsening HbA 1c or incident complications. Conclusions/interpretation In the first 2 years of type 2 diabetes, the effect of depressive symptoms and diabetes distress on glycaemic control is minimal. There was, however, an association between depressive symptoms and incidence of macrovascular complications. Elevated innate inflammation may be common to both depression and macrovascular diabetes complications, but these findings require replication.

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Assessment of diabetes acceptance can help identify patients with ineffective diabetes self‐care and poor diabetes control

Cited by 70 publications

References 22 publications

Association between diabetes distress and all-cause mortality in Japanese individuals with type 2 diabetes: a prospective cohort study (Diabetes Distress and Care Registry in Tenri [DDCRT 18])

Association between diabetes distress and all-cause mortality in Japanese individuals with type 2 diabetes: a prospective cohort study (Diabetes Distress and Care Registry in Tenri [DDCRT 18])

The Effect of a Diabetes-Specific Cognitive Behavioral Treatment Program (DIAMOS) for Patients With Diabetes and Subclinical Depression: Results of a Randomized Controlled Trial

The association of depressive symptoms and diabetes distress with glycaemic control and diabetes complications over 2 years in newly diagnosed type 2 diabetes: a prospective cohort study

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