Screening for Anxiety and Depressive Symptoms in Type 2 Diabetes Using Patient-Reported Outcome Measures: Comparative Performance of the EQ-5D-5L and SF-12v2

Objective. To evaluate the performance of EQ-5D-5L (EuroQol Five-Dimension, Five-Level Questionnaire) and SF-12-v2 (12-item Medical Outcomes Health Survey–Short Form, Version 2) in screening for anxiety and depressive symptoms in adults with type 2 diabetes. Methods. Cross-sectional data from a population-based study of type 2 diabetes in Alberta, Canada, were used. Anxiety symptoms (using the 2-item Generalized Anxiety Disorder questionnaire) were categorized into absent (<3) versus present (≥3). Depressive symptoms (using the 8-item Patient Health Questionnaire) were categorized according to two severity cut-points: absent (<10) versus mild (≥10), and absent (<15) versus moderate-severe (≥15). The performance of the measures in screening for anxiety and depressive symptoms was evaluated using receiver operating curve (ROC) analysis. Results. Average age of participants ( N = 1,391) was 66.8 years (SD 10.2), and 47% were female. Seventeen percent of participants screened positive for mild and 5.9% for moderate-severe depressive symptoms, and 11.3% for anxiety symptoms. For comorbid symptoms, 8.6% screened positive for anxiety and any depressive symptoms, and 4.6% for anxiety and moderate-severe depressive symptoms. The EQ-5D-5L anxiety/depression dimension and the SF-12 mental composite summary score had the best performance in screening for anxiety (area under ROC: 0.89, 0.89, respectively), depressive symptoms (any: 0.88, 0.92; moderate-severe: 0.90, 0.90), and comorbid anxiety and depressive symptoms (any: 0.92, 0.91; moderate-severe: 0.92, 0.90). These were followed by SF-12 feeling downhearted/depressed item (range = 0.83–0.85), while the lowest performance was for the EQ-5D-5L index score (0.80–0.84) and the SF-12 mental health domain (0.81–0.82). Conclusion. The EQ-5D-5L and the SF-12 are suitable tools for screening for anxiety and depressive symptoms in adults with type 2 diabetes. These tools present a unique opportunity for a standardized approach for routine mental health screening within the context of routine outcome measurement initiatives, where screening is recommended.

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Psychometric evaluation of the DAILY EATS questionnaire in individuals living with obesity

Journal of Patient-Reported Outcomes ◽

10.1186/s41687-020-00259-w ◽

2020 ◽

Vol 4 (1) ◽

Author(s):

John Fastenau ◽

Heather Rozjabek ◽

Shanshan Qin ◽

Lori McLeod ◽

Lauren Nelson ◽

...

Keyword(s):

Type 2 Diabetes ◽

Severe Obesity ◽

Short Form ◽

Psychometric Evaluation ◽

Health Determinants ◽

Measurement Information ◽

Related Factors ◽

Patient Global Impression ◽

Patient Reported

Abstract Background Physiological and behavioral factors including hunger, satiety, food intake, and cravings are health determinants contributing to obesity. Patient-reported outcome (PRO) measures focused on eating-related factors provide insight into the relationships between food choice and quantity, weight change, and weight-loss treatment for individuals living with obesity. The DAILY EATS is a novel 5-item, patient-reported measure evaluating key eating-related factors (Worst and Average Hunger, Appetite, Cravings, and Satiety). Methods Psychometric analyses, consistent with regulatory standards, were conducted to evaluate the DAILY EATS using data from two randomized trials that included individuals with severe obesity without diabetes (NCT03486392) and with severe obesity and type 2 diabetes (NCT03586830). Additional measures included Patient Global Impression of Status (PGIS) and Patient Global Impression of Change items, Impact of Weight on Quality of Life-Lite, Ease of Weight Management, and Patient-Reported Outcomes Measurement Information System Physical Function Short Form 8b and 10a. The reliability, validity, and responsiveness of the DAILY EATS were assessed, and a scoring algorithm and thresholds to interpret meaningful score changes were developed. Results Item-level analyses of the DAILY EATS supported computation of an Eating Drivers Index (EDI), comprising the related items Worst Hunger, Appetite, and Cravings. Internal consistency (Cronbach’s coefficient alphas ≥0.80) and test-retest reliability (coefficients > 0.7) of the EDI were robust. Construct validity correlation patterns with other PRO measures were as hypothesized, with moderate to strong significant correlations between the EDI and PGIS-Hunger (0.30 ≤ r ≤ 0.68), PGIS-Cravings (0.33 ≤ r ≤ 0.77) and PGIS-Appetite (0.52 ≤ r ≤ 0.77). Anchor- and distribution-based analyses support reductions ranging from 1.6 to 2.1 as responder thresholds for the EDI, representing meaningful within-person improvement. Conclusions The DAILY EATS individual items and the composite EDI are reliable, sensitive, and valid in evaluating the concepts of hunger, appetite, and cravings for use in individuals with severe obesity with or without type 2 diabetes.

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Mental health comorbidity and youth onset type 2 diabetes: A systematic review of the literature

The International Journal of Psychiatry in Medicine ◽

10.1177/00912174211067335 ◽

2022 ◽

pp. 009121742110673

Author(s):

Molly McVoy ◽

Heather Hardin ◽

Erin Fulchiero ◽

Kate Caforio ◽

Farren Briggs ◽

...

Keyword(s):

Mental Health ◽

Type 2 Diabetes ◽

Depressive Symptoms ◽

Treatment Options ◽

Study Data ◽

Behavior Changes ◽

Previous Diagnosis ◽

Health Behavior Changes ◽

The Impact

Background Type 2 diabetes (T2D) is a burgeoning epidemic in children and adolescents. Adult T2D doubles the risk of depression and mental health comorbidity makes it more difficult to make the lifestyle, medication adherence and health behavior changes needed to optimize outcomes. There is limited research on the impact of depression and depressive symptoms on youth T2D. Methods A search of the literature in the last 10 years regarding youth with depression and T2D was conducted. Abstracts were screened by 2 randomly assigned authors for inclusion, and disagreement was resolved by a third author. Selected full-text articles were divided among all authors for review. Results 13 publications from 8 studies (N=2244, age 6–17) were included. 6 of 13 publications utilized Treatment Options for Type 2 Diabetes in Youth (TODAY) study data. While studies included evaluation of depressive symptoms, most did not formally assess for major depressive disorder (MDD) and excluded participants with a previous diagnosis of MDD. Depressive symptoms were common in this population and were associated with negative T2D outcomes. Conclusions While there is a growing body of adult literature highlighting the extensive relationship between T2D and mental health, there is a dearth of data in youth. Future studies are needed that include, 1.) youth with diagnosed MDD, 2.) treatment studies of both T2D and MDD, 3.) larger, more racially diverse samples of youth with T2D, and 4.) studies that evaluate the impact of social determinants of health, including mental health comorbidity on outcomes of T2D.

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A Web-Based Mental Health Intervention to Improve Social and Occupational Functioning in Adults With Type 2 Diabetes (The Springboard Trial): 12-Month Outcomes of a Randomized Controlled Trial (Preprint)

10.2196/preprints.16729 ◽

2019 ◽

Author(s):

Peter Andrew Baldwin ◽

Samineh Sanatkar ◽

Janine Clarke ◽

Susan Fletcher ◽

Jane Gunn ◽

...

Keyword(s):

Mental Health ◽

Type 2 Diabetes ◽

Depressive Symptoms ◽

Social Functioning ◽

Self Management ◽

Diabetes Distress ◽

Healthy Lifestyles ◽

Occupational Functioning ◽

Web Based

BACKGROUND People with type 2 diabetes mellitus (T2DM) often experience mental health symptoms that exacerbate illness and increase mortality risk. Access to psychological support is low in people with T2DM. Detection of depression is variable in primary care and can be further hampered by mental health stigma. Electronic mental health (eMH) programs may provide an accessible, private, nonstigmatizing mental health solution for this group. OBJECTIVE This study aims to evaluate the efficacy over 12 months of follow-up of an eMH program (myCompass) for improving social and occupational functioning in a community sample of people with T2DM and self-reported mild-to-moderate depressive symptoms. myCompass is a fully automated and self-guided web-based public health program for people with depression or anxiety. The effects of myCompass on depressive symptoms, diabetes-related distress, anxiety symptoms, and self-care behavior were also examined. METHODS Adults with T2DM and mild-to-moderate depressive symptoms (N=780) were recruited via online advertisements, community organizations, and general practices. Screening, consent, and self-report questionnaires were administered online. Eligible participants were randomized to receive either myCompass (n=391) or an attention control generic health literacy program (Healthy Lifestyles; n=379) for 8 weeks. At baseline and at 3, 6, and 12 months postintervention, participants completed the Work and Social Adjustment Scale, the Patient Health Questionnaire-9 item, the Diabetes Distress Scale, the Generalized Anxiety Disorder Questionnaire-7 item, and items from the Self-Management Profile for Type 2 Diabetes. Glycosylated hemoglobin measurements were obtained at baseline and 6 and 12 months postintervention. RESULTS A total of 38.9% (304/780) of the trial participants completed all postintervention assessments. myCompass users logged in on an average of 6 times and completed an average of 0.29 modules. Healthy Lifestyles users logged in on an average of 4 times and completed an average of 1.37 modules. At baseline, the mean scores on several outcome measures, including the primary outcome of work and social functioning, were close to the normal range, despite a varied and extensive recruitment process. Intention-to-treat analyses revealed slightly greater improvement at 12 months in work and social functioning for the Healthy Lifestyles group relative to the myCompass group. All participants reported equivalent improvements in depression anxiety, diabetes distress, diabetes self-management, and glycemic control across the trial. CONCLUSIONS The Healthy Lifestyles group reported higher ratings of social and occupational functioning than the myCompass group, but no differences were observed for any secondary outcome. Although these findings should be interpreted in light of the near-floor symptom scores at baseline, the trial yields important insights into how people with T2DM might be engaged in eMH programs and the challenges of focusing specifically on mental health. Several avenues emerge for continued investigation into how best to deal with the growing mental health burden in adults with T2DM. CLINICALTRIAL Australian New Zealand Clinical Trials Registry Number (ACTRN) 12615000931572; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368109&isReview=true

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The Association of Psychological Factors, Physical Activity, Neuropathy, and Quality of Life in Type 2 Diabetes

Biological Research For Nursing ◽

10.1177/1099800405285748 ◽

2006 ◽

Vol 7 (4) ◽

pp. 279-288 ◽

Cited By ~ 51

Author(s):

Deborah A. Chyun ◽

Gail D. Melkus ◽

Deborah M. Katten ◽

Wendie J. Price ◽

Janice A. Davey ◽

...

Keyword(s):

Quality Of Life ◽

Type 2 Diabetes ◽

Body Mass Index ◽

Depressive Symptoms ◽

Body Mass ◽

Psychological Factors ◽

Physical Inactivity ◽

Short Form

The objective of this study was to determine the relationship of sociodemographics; diabetes-related factors, including diabetes-related microvascular complications; cardiac risk factors; and psychological factors with quality of life (QOL). Participants enrolled at three sites in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study were invited to participate in this ancillary study. Questionnaires assessing psychological factors were completed by participants, and the remainder of the data was obtained as part of the DIAD study. Many participants had elevated levels of anxiety (n = 91; 82%), depressive symptoms (n = 16; 14%), anger (n = 38; 34%), and hostility (n = 17; 17%). Results of multivariate analyses conducted for each of the eight domains on the Medical Outcomes Study Short Form-36 and two Diabetes Quality of Life domains demonstrated that in the majority of models (42% to 68% of the variance explained), female sex, peripheral or autonomic neuropathy, physical inactivity, higher body mass index, and the presence of depressive symptoms and anxiety were associated with poorer QOL (p = .0001). These findings demonstrate that anxiety, depressive symptoms, and neuropathy are prevalent in older adults with type 2 diabetes. In addition, potentially important correlations were demonstrated between psychological factors, neuropathy, body mass index, and physical inactivity.

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Depressive symptoms and quality of life after screening for cognitive impairment in patients with type 2 diabetes: observations from the Cog-ID cohort study

BMJ Open ◽

10.1136/bmjopen-2018-024696 ◽

2019 ◽

Vol 9 (1) ◽

pp. e024696 ◽

Cited By ~ 3

Author(s):

Jolien Janssen ◽

Paula S Koekkoek ◽

Geert-Jan Biessels ◽

Jaap L Kappelle ◽

Guy E H M Rutten

Keyword(s):

Quality Of Life ◽

Type 2 Diabetes ◽

Cohort Study ◽

Cognitive Impairment ◽

Depressive Symptoms ◽

Short Form ◽

Depression Scale ◽

Analysis Of Covariance

ObjectivesTo assess changes in depressive symptoms and health-related quality of life (HRQOL) after screening for cognitive impairment in people with type 2 diabetes.DesignA prospective cohort study, part of the Cognitive Impairment in Diabetes (Cog-ID) study.SettingParticipants were screened for cognitive impairment in primary care. People suspected of cognitive impairment (screen positives) received a standardised evaluation at a memory clinic.ParticipantsParticipants ≥70 years with type 2 diabetes were included in Cog-ID between August 2012 and September 2014, the current study includes 179 patients; 39 screen positives with cognitive impairment, 56 screen positives without cognitive impairment and 84 participants not suspected of cognitive impairment during screening (screen negatives).Outcome measuresDepressive symptoms and HRQOL assessed with the Center for Epidemiologic Studies Depression Scale (CES-D), 36-Item Short-Form Health Survey, European Quality of Life-5 Dimensions questionnaire and the EuroQol Visual Analogue Scale. Outcomes were assessed before the screening, and 6 and 24 months after screening. An analysis of covariance model was fitted to assess differences in score changes among people diagnosed with cognitive impairment, screen negatives and screen positives without cognitive impairment using a factor group and baseline score as a covariate.ResultsOf all participants, 60.3% was male, mean age was 76.3±5.0 years, mean diabetes duration 13.0±8.5 years. At screening, participants diagnosed with cognitive impairment had significantly more depressive symptoms and a worse HRQOL than screen negatives. Scores of both groups remained stable over time. Screen positives without cognitive impairment scored between the other two groups at screening, but their depressive symptoms decreased significantly during follow-up (mean CES-D: −3.1 after 6 and −2.1 after 24 months); their HRQOL also tended to improve.ConclusionsDepressive symptoms are common in older people with type 2 diabetes. Screening for and a subsequent diagnosis of cognitive impairment will not increase depressive symptoms.

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The performance of the EQ-5D-3L in screening for anxiety and depressive symptoms in hospital and community settings

Health and Quality of Life Outcomes ◽

10.1186/s12955-021-01731-x ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Hilary Short ◽

Fatima Al Sayah ◽

Arto Ohinmaa ◽

Jeffrey A. Johnson

Keyword(s):

Depressive Symptoms ◽

Community Setting ◽

Anxiety Symptoms ◽

Self Report ◽

Screening Tools ◽

Receiver Operating Curve ◽

Community Settings ◽

Post Discharge ◽

Patient Reported ◽

Anxiety Depression

Abstract Background To examine the performance of the EQ-5D-3L in screening for anxiety and depressive symptoms in hospital and community settings compared to other patient-reported screening tools. Methods Data from a prospective cohort of patients discharged from general internal medicine wards from two hospitals in Edmonton, Alberta were used in this study. Two waves of measurements (discharge and 90-days post-discharge) were analyzed. The performance of the EQ-5D-3L was compared to other self-report screening tools: Generalized Anxiety Disorder 2-item questionnaire was used to categorize anxiety symptoms into absent (< 3) and present (≥ 3), and the Patient Health Questionnaire 9-items was used to categorize depressive symptoms by two severity cut-points: no (< 10) vs. mild (≥ 10), and no (< 15) vs. moderate-severe (≥ 15). Performance of EQ-5D-3L in screening for anxiety and depressive symptoms was evaluated using receiver operating curve (ROC) analysis. Results Average age of participants (n = 493) was 62.9 years (SD 18.6); 51% were female. At discharge, 30.0% screened positive for mild and 12.8% for moderate-severe depressive symptoms, while 27.6% screened positive for anxiety symptoms. For co-morbid symptoms, 17.1% screened positive for anxiety and any depressive symptoms, while 10.8% for anxiety and moderate-severe depressive symptoms. While the EQ-5D-3L had limited screening ability in hospital, the anxiety/depression dimension performed well in the community setting (90-days post-discharge) in screening for anxiety (area under ROC 0.79), depressive symptoms (any: 0.78, moderate-severe: 0.84), and a combination of both (any: 0.86; moderate-severe: 0.91). Conclusions The EQ-5D-3L anxiety/depression dimension could be a useful tool in screening for anxiety and depressive symptoms in community settings compared to other self-report screening tools. The usefulness of the EQ-5D-3L as a screening tool in other settings and populations is warranted.

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A Web-Based Cognitive Behavior Therapy Intervention to Improve Social and Occupational Functioning in Adults With Type 2 Diabetes (The SpringboarD Trial): Randomized Controlled Trial (Preprint)

10.2196/preprints.12246 ◽

2018 ◽

Author(s):

Janine Clarke ◽

Samineh Sanatkar ◽

Peter Andrew Baldwin ◽

Susan Fletcher ◽

Jane Gunn ◽

...

Keyword(s):

Mental Health ◽

Type 2 Diabetes ◽

Depressive Symptoms ◽

Primary Outcome ◽

The Self ◽

Diabetes Distress ◽

Occupational Functioning ◽

Web Based ◽

The Impact

BACKGROUND Depressive symptoms are common in people with type 2 diabetes mellitus (T2DM). Effective depression treatments exist; however, access to psychological support is characteristically low. Web-based cognitive behavioral therapy (CBT) is accessible, nonstigmatizing, and may help address substantial personal and public health impact of comorbid T2DM and depression. OBJECTIVE The aim of this study was to evaluate the Web-based CBT program, myCompass, for improving social and occupational functioning in adults with T2DM and mild-to-moderate depressive symptoms. myCompass is a fully automated, self-guided public health treatment program for common mental health problems. The impact of treatment on depressive symptoms, diabetes-related distress, anxiety symptoms, and self-care behavior was also examined. METHODS Participants with T2DM and mild-to-moderate depressive symptoms (N=780) were recruited online via Google and Facebook advertisements targeting adults with T2DM and via community and general practice settings. Screening, consent, and self-report scales were all self-administered online. Participants were randomized using double-blind computerized block randomization to either myCompass (n=391) for 8 weeks plus a 4-week tailing-off period or an active placebo intervention (n=379). At baseline and postintervention (3 months), participants completed the Work and Social Adjustment Scale, the primary outcome measure. Secondary outcome measures included the Patient Health Questionnaire-9 item, Diabetes Distress Scale, Generalized Anxiety Disorder Questionnaire-7 item, and items from the Self-Management Profile for Type 2 Diabetes. RESULTS myCompass users logged in an average of 6 times and completed an average of .29 modules. Healthy Lifestyles users logged in an average of 4 times and completed an average of 1.37 modules. At baseline, mean scores on several outcome measures, including the primary outcome of work and social functioning, were near to the normal range, despite an extensive recruitment process. Approximately 61.6% (473/780) of participants completed the postintervention assessment. Intention-to-treat analyses revealed improvement in functioning, depression, anxiety, diabetes distress, and healthy eating over time in both groups. Except for blood glucose monitoring and medication adherence, there were no specific between-group effects. Follow-up analyses suggested the outcomes did not depend on age, morbidity, or treatment engagement. CONCLUSIONS Improvement in social and occupational functioning and the secondary outcomes was generally no greater for myCompass users than for users of the control program at 3 months postintervention. These findings should be interpreted in light of near-normal mean baseline scores on several variables, the self-selected study sample, and sample attrition. Further attention to factors influencing uptake and engagement with mental health treatments by people with T2DM, and the impact of illness comorbidity on patient conceptualization and experience of mental health symptoms, is essential to reduce the burden of T2DM. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ACTRN12615000931572; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368109&isReview=true (Archived by WebCite at http://www.webcitation.org/7850eg8pi)

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Mindfulness in Relation to Diet Quality in Adults with Type 1 and Type 2 Diabetes: Results from Diabetes MILES-The Netherlands

Mindfulness ◽

10.1007/s12671-021-01754-x ◽

2021 ◽

Author(s):

Shengxin Liu ◽

Ivan Nyklíček ◽

Frans Pouwer ◽

Jane Speight ◽

Mariska Bot ◽

...

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Depressive Symptoms ◽

The Netherlands ◽

Diet Quality ◽

Anxiety Symptoms ◽

Dispositional Mindfulness ◽

Mediation Effects

Abstract Objectives The objectives of this study were to investigate the associations of dispositional mindfulness and its facets with diet quality in Dutch adults with type 1 diabetes and type 2 diabetes and to evaluate the potential mediating role of emotional distress in these associations. Methods This was a cross-sectional study using data from the Diabetes MILES-The Netherlands. In total, 296 adults with type 1 diabetes and 364 with type 2 diabetes completed questionnaires. We assessed dispositional mindfulness by the Five Facet Mindfulness Questionnaire-Short Form, including total mindfulness and five facets: observing, describing, acting with awareness, being non-judgmental, and being non-reactive, and diet quality by the Dutch Healthy Diet 2015-index. Linear regression models were used to estimate the association. Mediation effects of depressive symptoms, anxiety symptoms, and diabetes-related distress were evaluated using the PROCESS macro with bias-corrected bootstrapped confidence intervals. Results Higher scores on the total mindfulness (β = 0.14, p = 0.02) and the observing facet (β = 0.15, p = 0.01) were significantly associated with higher diet quality in people with type 1 diabetes only, after adjustment for demographic factors. These associations were not mediated by depressive symptoms, anxiety symptoms, or diabetes-related distress. In adults with type 1 diabetes (but not type 2), higher dispositional mindfulness levels were associated with more optimal diet quality. Conclusions Higher mindfulness in general and observing in particular were related to a healthier diet with higher quality in Dutch adults with type 1 diabetes. Further longitudinal studies are warranted to understand the temporal relationship between mindfulness and diet quality.

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Improved diabetes medication convenience and satisfaction in persons with type 2 diabetes after switching to insulin glargine 300 U/mL: results of the observational OPTIN-D study

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2018-000548 ◽

2018 ◽

Vol 6 (1) ◽

pp. e000548 ◽

Cited By ~ 4

Author(s):

Thomas H Wieringa ◽

Maartje de Wit ◽

Jos WR Twisk ◽

Frank J Snoek

Keyword(s):

Type 2 Diabetes ◽

Sleep Quality ◽

Insulin Glargine ◽

Mixed Model ◽

Short Form ◽

Well Being ◽

Diabetes Distress ◽

Diabetes Medication ◽

Patient Reported

ObjectiveInsulin glargine 300 (Gla-300) provides less hypoglycemia risk and more flexibility in injection time. The extent to which these effects translate into improved patient-reported outcomes (PROs) is unknown, and is the subject of this observational study.Research design and methodsAdults with type 2 diabetes treated with basal insulin for at least 6 months initiating Gla-300 were included. Data were collected at baseline (start Gla-300) and at 3-month and 6-month follow-up. Patients and physicians gave reasons for switching to Gla-300 at baseline and the extent to which Gla-300 fulfilled their expectations at 6 months. Mixed model analyses examined PRO changes over time, with emotional well-being (WHO-5 Well-Being Index) as the primary outcome. The secondary outcomes were hypoglycemia incidence, hemoglobin A1c (HbA1c), hypoglycemia worries (worry subscale of the Hypoglycemia Fear Survey), diabetes distress (short form of the Dutch version of the Problem Areas In Diabetes Scale), diabetes medication convenience (Diabetes Medication System Rating Questionnaire (DMSRQ)), sleep quality and duration (Pittsburgh Sleep Quality Index), and adherence (Summary of Diabetes Self-Care Activities).Results162 patients participated: 53.70% were men, the mean age was 65.54 years (9.05), baseline mean HbA1c was 7.87% (1.15) (62.48 mmol/mol (12.61)), and mean diabetes duration was 15.14 years (6.65). Mean WHO-5 Well-Being Index scores improved non-significantly from 61.94 (19.52) at baseline (T0) to 63.83 (19.67) at 6 months (T2). Mean DMSRQ scores improved significantly from 32.96 (9.02) (T0) to 36.70 (8.85) (T2) (p<0.001). Dose (less volume) was a switching reason in 69.60% of patients and 63% of physicians, and flexibility in 33.30% and 24.70%, respectively. Gla-300 fulfilled the expectations or even better than expected in 92.30% of patients and 88.90% of physicians.ConclusionIn a relatively well-controlled sample of adults with type 2 diabetes, switching to Gla-300 improves diabetes medication convenience.

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Anxiety and Depressive Symptoms in Juvenile Idiopathic Arthritis Correlate with Pain and Stress Using PROMIS Measures

The Journal of Rheumatology ◽

10.3899/jrheum.210101 ◽

2021 ◽

pp. jrheum.210101

Author(s):

Danielle C. Fair ◽

James J. Nocton ◽

Julie A. Panepinto ◽

Ke Yan ◽

Jian Zhang ◽

...

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Depressive Symptoms ◽

Disease Activity ◽

Disease Duration ◽

Outcome Measurement ◽

Reference Population ◽

Anxiety Symptoms ◽

Measurement Information ◽

Cross Sectional ◽

Patient Reported

Objective Describe anxiety and depressive symptoms in children with juvenile idiopathic arthritis (JIA) using Patient-Reported Outcome Measurement Information System (PROMIS) measures and evaluate potential correlations with disease manifestations. Methods We performed a cross-sectional study of children with JIA and a parent-proxy who completed PROMIS measures on depression, anxiety, stress, and pain. The Childhood Health Assessment Questionnaire (CHAQ) measured mobility, and the clinical juvenile arthritis disease activity score (cJADAS10) measured disease activity. Results 84 patients completed the study. Demographic median values included: age 14 years, disease duration 4.73 years, CHAQ score 0, total active joint count 0, and cJADAS10 score 2. Using cJADAS10, 57 patients (68%) had inactive or low disease activity. Mean PROMIS T-scores for depressive and anxiety symptoms were lower in children with JIA compared to the reference population (p<0.0001). Nineteen patients (23%) had moderate to severe symptoms of anxiety and/or depression. Age and CHAQ score (mobility) correlated with depressive symptoms (r=0.36, p=0.0008; r=0.32, p=0.0029, respectively) but not anxiety. Depressive and anxiety symptoms correlated with pain (r=0.64 and r=0.47 respectively; p<0.0001) and stress (r=0.79 and r=0.75 respectively; p<0.0001) but not with gender, JIA subtype, disease duration, or disease activity. Conclusion Approximately one-quarter of children with JIA reported moderate to severe symptoms of anxiety and depression. These symptoms are associated with pain and stress, but they are not associated with other disease manifestations. Understanding how mental health symptoms and JIA impact one another is necessary in order to improve patient outcomes and provide well-rounded care.

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