Overestimation of Risk and Increased Fear of Long-term Complications of Diabetes in People with Type 1 and 2 Diabetes

Abstract

Objective The quality report of the disease management programmes of North Rhine Westphalia 2016 showed prevalences for long-term complications (neuropathy, nephropathy, retinopathy) of less than 30% for people with diabetes type 1 (DM1) and type 2 (DM2). The aim of this study was to assess risk expectations and fear regarding long-term complications of diabetes in people with DM1 and DM2. Methods We assessed risk expectations and fear regarding diabetes complications in people with DM1 (n=110) and DM2 (n=143 without insulin, n=249 with insulin) visiting an University outpatient department of metabolic diseases. Fear of long-term complications was measured with the “Fear of Complications Questionnaire (FCQ)” (range 0–45 points, scores ≥30 suggest elevated fear). Participants were asked to estimate general and personal risks of long-term complications 10 years after developing diabetes in %. Results Elevated fear of complications (FCQ scores ≥30) was observed in 34.5, 25.9, and 43.0% of those with DM1, DM2 without insulin and DM2 with insulin, respectively. Participants estimated a mean general risk of diabetes-related complications after 10 years amounting to 45.9±15.8% (DM1), 49.7±15.4% (DM2 without insulin), and 52.5±16.4% (DM2 with insulin) and personal risk with 52.5±24.4% (DM1), 45.8±22.7% (DM2 without insulin), and 54.1±23.4% (DM2 with insulin), respectively. Higher risk expectations were associated with higher fear of complications (p<0.001). Conclusion Risk estimations regarding long-term complications were exaggerated in people with DM1 and DM2. About one third of the participants reported elevated fear of complications. Participants’ risk expectations and fear regarding diabetes complications appear excessive compared to population-based prevalence rates.

Perspectives of Persons With Type 2 Diabetes Toward Diabetes Self-Management: A Qualitative Study

“…Our study found that fear of health complications was a motivator for DSM. Past studies also reported patients’ fear of health complications as the main reason for managing their diabetes (Arend et al, 2019; Kuniss et al, 2019; Wukich et al, 2018). Patients feared not only health complications but also the impact of these complications or their death on their families’ fate.…”

Intention and Perceptions of Healthy Eating versus Actual Intake Among Patients with Type 1 and Type 2 Diabetes and the General Population

“…Health care providers should explore the reason for this with the patient. Is the patient actually eating healthily due to diabetes-related worries which are common in diabetes and can result in poor adherence to diabetes self-care in the long term, 21 , 22 or does the patient use the diagnosis as a personal driver for making healthy self-management decisions? 23 , 24 …”

“…Health care providers should explore the reason for this with the patient. Is the patient actually eating healthily due to diabetes-related worries which are common in diabetes and can result in poor adherence to diabetes self-care in the long term, 21,22 or does the patient use the diagnosis as a personal driver for making healthy self-management decisions? 23,24 We examined diet quality in relation to self-perceived diet healthiness and found that diet quality was higher among self-perceived healthy eaters compared with less healthy eaters based on higher intakes of vegetables, fruit, fish, fibre and protein both in T1D and T2D respectively, and additionally a lower sugar intake in the T1D group.…”

Assessing fear of complications in people with type 1 and type 2 diabetes with the Fear of Diabetes Complications Questionnaire.

“…Thus, about 20%–40% of PWD may experience clinically relevant FDC. Some studies suggest higher FDC levels in persons with established diabetes complications (Arend et al, 2019; Taylor et al, 2005), which would appear reasonable, but there are also inconsistent findings (Kuniss et al, 2019).…”