Addressing a Care Gap in Type 1 Diabetes Management: Using the Diabetes Distress Scale in a Community Care Setting to Address Diabetes-Related Treatment Challenges

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.

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Translation and cultural adaptation into Brazilian culture of type 1 diabetes distress scale

Diabetology & Metabolic Syndrome ◽

10.1186/s13098-017-0260-y ◽

2017 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

M. S. V. M. Silveira ◽

T. G. Bovi ◽

P. F. Oliveira ◽

E. J. Pavin ◽

L. Fisher

Keyword(s):

Type 1 Diabetes ◽

Cultural Adaptation ◽

Diabetes Distress ◽

Brazilian Culture ◽

Distress Scale ◽

Translation And Cultural Adaptation ◽

Diabetes Distress Scale

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Feasibility study of real-time online text-based CBT to support self-management for people with type 1 diabetes: the Diabetes On-line Therapy (DOT) Study

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001934 ◽

2021 ◽

Vol 9 (1) ◽

pp. e001934

Author(s):

Anne M Doherty ◽

Anne Herrmann-Werner ◽

Arann Rowe ◽

Jennie Brown ◽

Scott Weich ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Real Time ◽

Instant Messaging ◽

Controlled Trial ◽

Self Management ◽

Diabetes Distress ◽

The Mean ◽

Distress Scale

IntroductionThis study examines the feasibility of conducting diabetes-focused cognitive–behavioral therapy (CBT) via a secure online real-time instant messaging system intervention to support self-management and improve glycemic control in people with type 1 diabetes.Research design and methodsWe used a pre–post uncontrolled intervention design over 12 months. We recruited adults with type 1 diabetes and suboptimal glycemic control (HbA1c ≥69 mmol/mol (DCCT 8.5%) for 12 months) across four hospitals in London. The intervention comprised 10 sessions of diabetes-focused CBT delivered by diabetes specialist nurses. The primary outcomes were number of eligible patients, rates of recruitment and follow-up, number of sessions completed and SD of the main outcome measure, change in HbA1c over 12 months. We measured the feasibility of collecting secondary outcomes, that is, depression measured using Patient Health Questionnaire-9 (PHQ-9), anxiety measured Generalised Anxiety Disorder (GAD) and the Diabetes Distress Scale (DDS).ResultsWe screened 3177 patients, of whom 638 were potentially eligible, from whom 71 (11.1%) were recruited. The mean age was 28.1 (13.1) years, and the mean HbA1c was 84.6 mmol/mol (17.8), DCCT 9.9%. Forty-six (65%) patients had at least 1 session and 29 (41%) completed all sessions. There was a significant reduction in HbA1c over 12 months (mean difference −6.2 (2.3) mmol/mol, DCCT 0.6%, p=0.038). The change scores in PHQ-9, GAD and DDS also improved.ConclusionsIt would be feasible to conduct a full-scale text-based synchronized real-time diabetes-focused CBT as an efficacy randomized controlled trial.

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Home Telemedicine (CoYoT1 Clinic): A Novel Approach to Improve Psychosocial Outcomes in Young Adults With Diabetes

The Diabetes Educator ◽

10.1177/0145721719858080 ◽

2019 ◽

Vol 45 (4) ◽

pp. 420-430 ◽

Cited By ~ 14

Author(s):

Marwan Bakhach ◽

Mark W. Reid ◽

Elizabeth A. Pyatak ◽

Cari Berget ◽

Cindy Cain ◽

...

Keyword(s):

Type 1 Diabetes ◽

Young Adults ◽

Self Efficacy ◽

Group Home ◽

Depression Scale ◽

Diabetes Distress ◽

Control Group ◽

Distress Scale ◽

The Impact

Purpose To assess the impact of a home telemedicine clinic model (CoYoT1 Clinic) on psychosocial and behavioral outcomes designed for young adults (YAs) with type 1 diabetes (T1D). Methods YAs self-selected to participate in the CoYoT1 Clinic or serve as a usual care control. CoYoT1 Clinic visits consisted of an individual appointment with a provider and a group appointment with other YAs with T1D using home telemedicine. Psychosocial and behavioral functioning was assessed by 4 measures: Diabetes Distress Scale, Self-Efficacy for Diabetes Scale, Self-Management of Type 1 Diabetes in Adolescence Scale, and Center for Epidemiologic Studies Depression Scale. Results Forty-two patients participated in the CoYoT1 Clinic and 39 patients served as controls. CoYoT1 participants reported lower levels of distress ( P = .03), increased diabetes self-efficacy ( P = .01), and improved ability to communicate with others about diabetes ( P = .04) over the study period compared to controls. YA males in the control group reported increases in depressive symptoms ( P = .03) during the study period, but CoYoT1 participants showed no changes. Conclusion Group home telemedicine for YAs with T1D positively affects diabetes distress, self-efficacy, and diabetes-specific communication. These positive findings have the potential to also affect the YAs’ long-term diabetes outcomes. Further investigation of the model is needed.

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Challenges and Considerations for Reducing Diabetes Distress and Fear of Hypoglycemia in Parents of Youth With Type 1 Diabetes During the COVID-19 Pandemic (Preprint)

10.2196/preprints.25106 ◽

2020 ◽

Author(s):

Alexandra Monzon ◽

Nicole Kahhan ◽

Arwen Marker ◽

Susana Patton

Keyword(s):

Type 1 Diabetes ◽

Diabetes Management ◽

Diabetes Distress ◽

Treatment Needs ◽

Treatment Groups ◽

Manualized Treatment ◽

Fear Of Hypoglycemia ◽

Psychosocial Concerns ◽

P Type

UNSTRUCTURED Type 1 diabetes management can be challenging for children and their families. To address psychosocial concerns for parents of youth with type 1 diabetes, we developed two parent-focused interventions to reduce their diabetes distress and fear of hypoglycemia. Our team conducted several of these interventions during the early stages of the COVID-19 pandemic and recognized a need to make timely adjustments to our interventions. In this viewpoint article, we describe our experience conducting these manualized treatment groups during the pandemic, the range of challenges and concerns specific to COVID-19 that parents expressed, and how we adjusted our approach to better address parents’ treatment needs.

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An open trial of app-assisted acceptance and commitment therapy (iACT) for eating disorders in type 1 diabetes

Journal of Eating Disorders ◽

10.1186/s40337-020-00357-6 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Rhonda M. Merwin ◽

Ashley A. Moskovich ◽

Michael Babyak ◽

Mark Feinglos ◽

Lisa K. Honeycutt ◽

...

Keyword(s):

Eating Disorders ◽

Type 1 Diabetes ◽

Acceptance And Commitment Therapy ◽

Diabetes Management ◽

Personal Values ◽

Psychological Flexibility ◽

Open Trial ◽

Diabetes Distress ◽

Acceptance And Commitment

Abstract Background Eating disorders (EDs) among individuals with type 1 diabetes (T1D) increase the risk of early and severe diabetes-related medical complications and premature death. Conventional eating disorder (ED) treatments have been largely ineffective for T1D patients, indicating the need to tailor treatments to this patient population and the unique conditions under which ED symptoms emerge (in the context of a chronic illness with unrelenting demands to control blood glucose, diet and exercise). The current study was a pilot open trial of iACT, a novel intervention for EDs in T1D grounded in Acceptance and Commitment Therapy (ACT). iACT was based on the premise that ED symptoms emerge as individuals attempt to cope with T1D and related emotional distress. iACT taught acceptance and mindfulness as an alternative to maladaptive avoidance and control, and leveraged personal values to increase willingness to engage in T1D management, even when it was upsetting (e.g., after overeating). A tailored mobile application (“app”) was used in between sessions to facilitate the application of ACT skills in the moment that individuals are making decisions about their diabetes management. Methods Adults with T1D who met criteria for an ED completed 12 sessions of iACT (with three optional tapering sessions). In addition to examining whether treatment was acceptable and feasible (the primary aim of the study), the study also examined whether iACT was associated with increased psychological flexibility (i.e., the ability to have distressing thoughts/feelings about diabetes while pursuing personally meaningful values), and improvements in ED symptoms, diabetes management and diabetes distress. Results Treatment was acceptable to T1D patients with EDs and feasible to implement. Participants reported increased psychological flexibility with diabetes-related thoughts/feelings, and less obstruction and greater progress in pursuing personal values. There were large effects for change in ED symptoms, diabetes self-management and diabetes distress from baseline to end-of-treatment (Cohen’s d = .90–1.79). Hemoglobin A1c also improved, but the p-value did not reach statistical significance, p = .08. Conclusions Findings provide preliminary evidence for iACT to improve outcomes for T1D patients with EDs and support further evaluation of this approach in a controlled trial. Trial registration NCT02980627. Registered 8 July 2016.

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643 Rest Activity Rhythms, Symptom Burden, and Glucose Variability in Young Adults with Type 1 Diabetes

SLEEP ◽

10.1093/sleep/zsab072.641 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A252-A252

Author(s):

Stephanie Griggs ◽

Kingman Strohl ◽

Seunghee Margevicius ◽

Margaret Grey ◽

Ronald Hickman

Keyword(s):

Type 1 Diabetes ◽

Young Adults ◽

Daytime Sleepiness ◽

Activity Rhythm ◽

Symptom Burden ◽

Glucose Variability ◽

Diabetes Distress ◽

Distress Scale ◽

Rest Activity

Abstract Introduction Circadian alignment is an important element in individual health, and one behavioral marker, rest-activity rhythm (RAR), may influence disease management in young adults with type 1 diabetes (T1D). Thus, in this descriptive study, we examined whether circadian rhythm is correlated with symptoms (emotional and diabetes distress, and diabetes physical symptom burden) and glucose variability in young adults with T1D. Methods Using convenience sampling, young adults with T1D underwent concurrent actigraphy and continuous glucose monitoring for 6–14 days to generate the following RAR parameters: (MESOR, amplitude, acrophase, and circadian quotient) and glucose variability indices (coefficient of variation and time in range). Participants completed the 8-item Epworth Sleepiness Scale, 8-item PROMIS v1.0 Emotional Distress Scale, 17-item Diabetes Distress Scale, and 34-item Diabetes Symptom Checklist-Revised. Cosinor analysis was used to compute the RAR parameters and linear regression modeling procedures were performed to determine the associations among the study variables. Results The sample included 46 young adults (mean age 22.3±3.2; 32.6% male; 84.8% non-Hispanic White, A1C mean 7.2±1.1%, BMI 27.0±4.4 kg/m2). A more robust rhythm (higher amplitude) was associated with a lower diabetes symptom burden (ß=-0.31, p=.035). A higher circadian quotient was associated with less daytime sleepiness (ß=-0.41, p=.004). All associations between the RAR parameters and symptom measures remained statistically significant (p<.05) after adjustment for sex and BMI. The associations between the RAR parameters and glucose variability indices were not significant. Conclusion RAR was associated with daytime sleepiness, as well as symptom burden in young adults with T1D even after consideration of sex and BMI. Future investigators should clarify the causality of these associations and the potential for improving the strength and stability of RAR in the mitigation of daytime sleepiness and symptoms. Support (if any) This research is or was partially supported by grants from the American Academy of Sleep Medicine (220-BS-19), National Institute of Nursing Research (K99NR018886 & T32NR0008346), Sigma Theta Tau International, and Dexcom provided continuous glucose monitors (G4) free of charge for participants who did not have a device.

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