Psychosocial and quality of life correlates of glycemic control during intensive treatment of type 1 diabetes

To identify emotional and attitudinal barriers to improved glycemic control (HbA1c) during intensive diabetes treatment, 55 patients attending a 4-5 month intensive diabetes medical/education clinic were followed. Subjects completed a battery of psychological surveys, had HbA1c and body mass index measured, and rated their attitude toward weight gain and the extent of problems with specific self-management behaviors before and after the medical intervention. Although HbA1c improved on average, 29% had only modest improvement and 16% showed no improvement. The number of diabetes-related annoyances, worry about hypoglycemia, and diabetes-related emotional distress diminished. Only the satisfaction subscale of the Diabetes Quality of Life survey, diabetes-related emotional distress, and problems with self-management behaviors correlated with HbA1c. Treatment-related frustration and emotional distress may initially act as motivators to improve glycemia but can later become barriers to that goal. Interventions designed to help patients overcome attitudinal barriers should be incorporated into medical programs geared toward improving glycemia.     

Patient-reported use of collaborative goal setting and glycemic control among patients with diabetes

Objective

Little is known about how patient–clinician communication leads to better outcomes. Among patients with diabetes, we describe patient-reported use of collaborative goal setting and evaluate whether perceived competency and physician trust mediate the association between collaborative goal setting and glycemic control.

Methods

Data from a patient survey administered in 2008 to a cohort of insured patients aged 18+ years with diabetes who initiated oral mono-therapy between 2000 and 2005 were joined with pharmaceutical claims data for the prior 12 months and laboratory data for the prior and subsequent 12 months (N = 1065). A structural equation model (SEM) was used to test mediation models controlling for baseline HbA1c.

Results

The hypothesized mediation model was supported. Patient-reported use of more collaborative goal setting was associated with greater perceived self-management competency and increased level of trust in the physician (p < 0.05). In turn, both greater perceived competence and increased trust were associated with increased control (p < 0.05).

Conclusions

Findings indicate that engaging patients in collaborative goal setting during clinical encounters has potential to foster a trusting patient–clinician relationship as well as enhance patient perceived competence, thereby improving clinical control.

Practice implications

Fostering collaborative goal setting may yield payoffs in improved clinical outcomes among patients with diabetes.     

Exploring the relationship between diabetes self-efficacy,depressive symptoms,and glycemic control among men and women with type 2 diabetes

Depression and low self-efficacy are both associated with worse glycemic control in adults with diabetes, but the relationship between these variables is poorly understood. We conducted a cross-sectional study examining associations between depressive symptoms, self-efficacy, and glycemic control among men (n = 64) and women (n = 98) with type 2 diabetes to see if self-efficacy mediates the relationship between depression and glycemic control. Correlational and mediational analyses examined the relationship between these three variables for the sample as a whole and separately by sex. A significant association between depressive symptoms and glycemic control was found for men (0.34, P < 0.01) but not for women (0.05, P = 0.59). Path analysis suggested that, among men, self-efficacy mediates the relationship between depressive symptoms and glycemic control. We conclude that men with depressive symptoms and type 2 diabetes may need tailored interventions that improve their self-efficacy in order to achieve glycemic control.     

A follow-up study of adherence and glycemic control among Hong Kong youths with diabetes

OBJECTIVE: To extend longitudinally an earlier study of the pathway from symptoms of emotional distress (ED) through self-efficacy (SE) and adherence to glycemic control (GC) in youths with diabetes, and to examine the contribution of different specific adherence behaviors to changes in GC. METHODS: Fifty-six Hong Kong youths with diabetes received a follow-up evaluation 12-24 months after initial participation. ED, SE, self-reported adherence to medical regimen (SRA), and GC were assessed at both evaluations. RESULTS: The pathway from ED to SE to SRA to GC was replicated. Participants' SRA to regular checks on blood glucose levels, and taking steps to maintain levels in the recommended range, explained significant variance in changes in GC. CONCLUSIONS: The model offers strategies to enhance health care in youths with diabetes. Findings support the importance of adherence to the medical regimen but emphasize the complexity of the relationship between adherence behaviors and GC. Self-regulatory behaviors, rather than compliance with fixed instructions, appear to have the most impact on GC.     

Brief report: friendships of adolescents with and without diabetes

BACKGROUND: Friendships of adolescents with chronic illness have been rarely studied. OBJECTIVE: To compare the friendships of boys and girls with diabetes with those between healthy adolescents. METHODS: One hundred and thirty-eight adolescents were interviewed at summer camps. Participants indicated their number of close friends and rated friendships for support and conflict. Participants described aspects of their same-sex and other-sex friendships that they liked and disliked. RESULTS: Adolescents with diabetes have friendships that are similar to those between healthy adolescents, with a few exceptions. CONCLUSIONS: Emotional support may be especially valued by girls with diabetes, whereas differences among friends may be less valued among adolescents with diabetes.     

Relation of parent knowledge to glycemic control among emerging adults with type 1 diabetes: a mediational model

The study goal was to examine the links of parent knowledge of children’s behavior to diabetes outcomes and to test a mediational model that focused on psychological distress and self-care behavior. We recruited 132 adolescents (average age 12) and followed them to average age 23. At age 23 (n = 107), we conducted in-person interviews with these emerging adults to measure parent knowledge, psychological distress, self-care behavior and glycemic control. We used structural equation modeling to test our hypotheses with these cross-sectional data. Higher levels of parent knowledge were linked to better glycemic control, and this path was mediated by reduced psychological distress and enhanced self-care behavior. Parents remain an important influence in the lives of emerging adults with type 1 diabetes. When emerging adults have a relationship with their parents in which they share general information, psychological distress may be reduced which then facilitates self-care and, ultimately, glycemic control.     

Subjective quality of life of outpatients with diabetes: comparison with family caregivers' impressions and control group

BACKGROUND: There is a paucity of studies on comparison of quality of life (QOL) of type-1 and type-2 diabetes patients, and the impact of family caregivers' impressions on the QOL of patients. OBJECTIVES: To assess the subjective QOL of Sudanese diabetics using the WHOQOL-Bref, compared with a general population sample; examine caregiver-patient concordance; and assess the variables that impact on QOL. METHOD: The responses of 105 outpatients with type-1 diabetes and 136 with type-2 diabetes were compared with their family caregivers' impressions and 139 general population subjects. RESULTS: Patients were predominantly dissatisfied with their life circumstances. Type-1 diabetics had significantly lowest QOL scores, while the control group had highest scores. Having additional medical problems; having diminished sexual desire; and being young, unemployed and single were associated with poor QOL, but illness duration was not. Type-2 diabetics had lesser concordance with caregivers. The only predictor of patients' QOL was the caregivers' impression of patients' QOL. CONCLUSIONS: Caregivers' impression of patients' QOL impacted on outcome. Caregiver education is, therefore, important. The factors associated with QOL indicate a group that needs focused attention. The good QOL for type-2 and nonsignificance of illness duration encourage therapeutic optimism.     

Brief report: quality of life is impaired in pediatric burn survivors with posttraumatic stress disorder

Objective This study assessed health-related quality of life(HRQOL) and posttraumatic stress disorder (PTSD) in pediatricburn survivors and examined associations between PTSD and HRQOL.Methods Forty-three burn survivors, ages 7–16 years, wereinterviewed at an average of 4.4 years after their accidentusing the Clinician-Administered PTSD Scale for Children andAdolescents and the TNO-AZL Child Quality of Life Questionnaire.Results Eight children (18.6%) met DSM-IV criteria for currentPTSD. While most dimensions of HRQOL were within normal limits,social functioning was impaired. Severity of PTSD was significantlyassociated with physical, cognitive, and emotional dimensionsof HRQOL. Children with PTSD reported an impaired overall HRQOLand limited physical (e.g., more bodily complaints) and emotionalfunctioning (e.g., more feelings of sadness). Conclusions Thisstudy provides tentative evidence for a considerably high prevalenceof PTSD in pediatric burn survivors and for a negative associationbetween PTSD and HRQOL.     

Perceived control of asthma and quality of life among adults with asthma.

BACKGROUND: Perceived control of certain chronic conditions influences health status outcomes. OBJECTIVE: To explore the impact of perceived control of asthma on asthma-specific and generic health status outcomes among adults with asthma. Perceived control was defined as individuals' perceptions of their ability to deal with asthma and its exacerbations. METHODS: Data were drawn from the baseline and first two followups of a longitudinal study of adults with asthma surveyed by telephone at 18-month intervals. An 11-item questionnaire (Perceived Control of Asthma Questionnaire [PCAQ]) was developed and validated. RESULTS: The PCAQ demonstrated high internal consistency (Cronbach's alpha = 0.79). Greater perceived control was associated with less severe asthma, greater asthma self-efficacy, lower perceived asthma severity, lower perceived danger from asthma, and greater perceived usefulness of asthma medicines. Greater perceived control was significantly associated with better asthma-specific quality of life concurrently and 18 and 36 months later, after controlling for demographics, smoking, and severity of asthma. Greater perceived control as also significantly associated with generic mental health outcomes concurrently and 18 and 36 months later, after controlling for covariates. Perceived control was associated with physical function concurrently and 18 months later, but not 36 months later. CONCLUSIONS: The PCAQ is a reliable and valid measure of perceived control of asthma. Perceived control of asthma was associated with both asthma-specific and generic health status outcomes, concurrently and predictively. If perceived control could be modified, better outcomes, particularly better psychologic outcomes, might be achieved for individuals with asthma.     

Anger experiences among hepatitis C patients: relationship to depressive symptoms and health-related quality of life

The authors examined anger among hepatitis C (HCV) patients and its relationship to health-related quality of life (HRQL) and depression. Eighty-seven HCV patients who received pegylated interferon-alpha(2b) and ribavirin were included. Patients' mean age was 48 years; 42% were women, and 60% were white. Patients experienced moderate anger while undergoing HCV treatment. Angry feelings increased during treatment in some domains, specifically, Control Over Anger and Angry Reaction. Greater anger was associated with more depression and poorer HRQL. Findings point to the importance for physicians to screen for a wide range of neuropsychiatric side effects of interferon, including anger.     

Impact of family environment and support on adherence,metabolic control,and quality of life in adolescents with diabetes

Background: Diabetes is a common disease in pediatric populations. Family functioning has been related to child adaptation to diabetes. Purpose: To determine the impact of family factors on diabetes, particularly the influence of family support and family environment on adherence to treatment, quality of life, and metabolic control in Portuguese adolescents with type 1 diabetes, taking in consideration age, sex, duration of disease, and social class. Method: This study used a cross-sectional design. A sample of 157 Portuguese diabetic patients filled disease-specific measures on adherence and quality of life and family functioning measures. Hypotheses were that family support and an organized family environment (high cohesion and low conflict) would be positively associated with better adherence, metabolic control, and quality of life. Results: This study’s results confirmed that adherence was predicted by family support for females and lower-class patients while metabolic control was predicted by family conflict for upper-class patients. Quality of life was predicted by lack of family conflict and family social support for both males and females as well as lower-class patients. Conclusion: The results highlight the importance of studying family variables in adolescents’ diabetes care within the wider cultural factors affecting the patient.     

澳门特别行政区初三学生的睡眠质量、睡眠模式与抑郁、焦虑情绪

目的:了解澳门特别行政区初三年级学生的睡眠质量、模式与抑郁、焦虑情绪的关系。方法:抽取澳门535名初中三年级学生,用匹兹堡睡眠质量指数量表(PSQI)评估睡眠质量,爱泼沃斯思睡量表(ESS)以及清晨型和夜晚型量表(MEQ)调查白天思睡与睡眠模式,用贝克抑郁量表(BDI)、状态-特质焦虑量表(STAI)调查抑郁、焦虑状况。结果:PSQI和ESS得分分别为(5.2±2.6)和(8.4±4.7),女生PSQI[(5.5±2.5)vs.(4.8±2.6)]和ESS[(8.9±4.6)vs.(8.0±4.8)]得分高于男生(均P0.05)。MEQ平均得分(13.3±3.1),女生得分低于男生[(12.8±3.0)vs.(13.7±3.2),P0.01]。学生周末和假日的总睡眠时间长于平日总睡眠时间[(608±106)min,(605±109)min vs.(457±75)min],女生周末[(628±110)min vs.(590±97)min]和假期[(631±109)min vs.(581±103)min]平均睡眠时间长于男生(均P0.01)。BDI和STAI得分分别为(13.5±10.3)、(78.9±17)。睡眠质量差和白天思睡者MEQ得分、上学日睡眠时间低于睡眠质量好和无白天思睡者MEQ得分,而睡眠质量差和白天思睡者BDI得分高于睡眠质量好和无白天思睡者BDI得分(均P0.05)。PSQI分别与ESS、BDI,以及STAI中的TAI分呈正相关(r=0.27、0.37、0.12,均P0.05),而与M EQ和上学日总睡眠时间呈负相关(r=-0.30、-0.30,均P0.05)。结论:睡眠质量差和白天思睡在澳门初三学生中较为普遍,他们在上学日的平均睡眠时间不足,但在周末和假日则延长睡眠时间以作补充,其中女生更易出现上述睡眠模式。大部分学生有轻度抑郁,睡眠质量差可能与其抑郁、焦虑状况相关。     

Psychological factors account for variation in metabolic control and perceived quality of life among people with type 2 diabetes in New Zealand

Background: Many people with diabetes experience poor metabolic control and reduced quality of life (QoL). Purpose: This study investigates the relationships between psychological variables, metabolic control, and QoL among adults with type 2 diabetes. Method: Research participants (n = 615) were randomly selected from a medical database of people with type 2 diabetes held in Wellington, New Zealand. Self-report psychological data was collected using a mailed questionnaire survey. Clinical characteristics were obtained through a review of medical records with participants’ written consent. Results: Psychological perceptions of diabetes explain approximately 8% of differences in metabolic control and 16% of variability in quality of life, even when controlling for key clinical characteristics. Belief that diabetes is temporary, a perception that diabetes is difficult to control, strong negative emotional representation of diabetes, and agreement that diabetes has serious consequences were linked to poor illness outcomes. Conclusion: Psychological variables make a unique and statistically significant contribution to the explanation of differences in both physiological and emotional diabetes outcomes. Potentially, modification of personal views about diabetes could help promote positive health outcomes for people with type 2 diabetes. This study highlights specific illness perceptions that could be targeted in future interventions. The following organizations are acknowledged for their generous support of this research: Wellington Regional Diabetes Trust, Massey University, Palmerston North Medical Research Foundation, Foundation for Research, Science, and Technology, Novo Nordisk New Zealand.     

Coping and distress as predictors of glycemic control in diabetes

This study attempts to identify the relative contribution of coping styles (task-, emotion-oriented and avoidance) and anxiety and diabetes-related distress to glycemic control in IDDM (Insulin Dependent Diabetes Mellitus) patients. Recent research suggests that coping and distress may as well be determinants as consequences of certain characteristics of the illness and subject. This points to the need to control some of these variables in diabetic research. Ninety seven IDDM patients from an outpatient unit were included. Measures were self-report questionnaires (CISS, STAI-Y, PAID) and biological data (HbA1C i.e. metabolic control). When potential confounds were controlled for (current age, age at onset, gender, presence of complication), three main predictors of metabolic control could be isolated through hierarchical regression analysis: (1) presence of complications; (2) task-oriented coping style; and (3) diabetes-related distress. Three steps were included in predictors: illness and subject variables (step 1); coping styles (step 2); and negative emotions (step 3). Each step contributed to a significant increase in variance. Emotion-oriented coping style appeared as redundant with distress measures. Results suggest that the relations between psychological predictors and metabolic control would be closer in women. These results partly replicate other findings, and advocate for a better consideration of emotional factors in the prediction of blood glucose control in this disease.     

Relationships among quality of life, severity, and control measures in asthma: an evaluation using factor analysis

BACKGROUND: Validated psychometric tools measuring quality of life, asthma control, and asthma severity have been developed, but their relationships with each other and with other important patient-centered outcomes have not been rigorously assessed. OBJECTIVE: To use factor analysis to evaluate the relationships of these validated tools with each other and with other patient-centered outcomes. METHODS: Surveys were completed by a random sample of 2854 Health Maintenance Organization members age 18 to 56 years with persistent asthma. Surveys included demographic information; validated tools measuring generic (Short Form-12; SF-12) and asthma-specific (Juniper Mini Asthma Quality of Life Questionnaire; AQLQ) quality of life, asthma control (Asthma Therapy Assessment Questionnaire), and asthma symptom severity (Asthma Outcomes Monitoring System); self-described severity, control, and course over time; and history of acute exacerbations. RESULTS: Principal component analysis suggested a 5-factor model that accounted for approximately 59% of the variability. The most prominent rotated factor reflected asthma symptom frequency (19.4% of variability), was measured by the symptom subscale of the AQLQ, and was the only factor significantly related to the Asthma Therapy Assessment Questionnaire, Asthma Outcomes Monitoring System, or the self-reported assessments of severity, control, or course. Other factors included symptom bother (12.1% of variability), reflected by the environment and emotion AQLQ subscales; activity limitation (13.9% of variability), reflected by the activity AQLQ subscale and the SF-12 physical component scale; mental health (8.3% of variability), reflected by the SF-12 mental component scale; and acute exacerbations (5.0% of variability), not measured by any of the validated scales. CONCLUSION: Distinct components of patient-reported asthma health status can be identified by factor analysis. Distinct constructs of severity versus control cannot be identified by the use of these tools alone.