Veterans’ Interpretation of Diabetes Distress in Diabetes Self-Management: Findings From Cognitive Interviews

2021 ◽  
pp. 263501062110434
Author(s):  
Allison A. Lewinski ◽  
Abigail Shapiro ◽  
Hayden B. Bosworth ◽  
Matthew J. Crowley ◽  
Felicia McCant ◽  
...  
Keyword(s):  
Glycosylated Hemoglobin ◽  
Personal Characteristics ◽  
Self Management ◽  
Diabetes Distress ◽  
Cognitive Interviews ◽  
Sources Of Information ◽  
Management Interventions ◽  
Study Team ◽  
Physical Limitations ◽  
Distress Scale

Purpose The purpose of this project was to identify additional facets of diabetes distress (DD) in veterans that may be present due to the veteran’s military-related experience. Methods The study team completed cognitive interviews with veterans with type 2 diabetes mellitus (T2DM) to examine how they answered the Diabetes Distress Scale (DD Scale), a tool that assesses DD. The DD Scale was used because of its strong associations with self-management challenges, physician-related distress, and clinical outcomes. Results The veterans sample (n= 15) was 73% male, mean age of 61 (SD = 8.6), 53% Black, 53% with glycosylated hemoglobin level <9%, and 67% with prescribed insulin. The DD Scale is readily understood by veterans and interpreted. Thematic analysis indicated additional domains affecting DD and T2DM self-management, including access to care, comorbidities, disruptions in routine, fluctuations in emotions and behaviors, interactions with providers, lifelong nature of diabetes, mental health concerns, military as culture, personal characteristics, physical limitations, physical pain, sources of information and support, spirituality, and stigma. Conclusions This study describes how a veteran’s military experience may contribute to DD in the context of T2DM self-management. Findings indicate clinicians and researchers should account for additional domains when developing self-management interventions and discussing self-management behaviors with individuals with T2DM.

scholarly journals 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

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.

scholarly journals Investigating the Association Between Diabetes Distress and Self-Management Behaviors

2018 ◽  
Vol 12 (6) ◽  
pp. 1116-1124 ◽  
Author(s):  
Aneesah Khan ◽  
Pratik Choudhary
Keyword(s):  
Glycemic Control ◽  
Glucose Monitoring ◽  
Self Management ◽  
Diabetes Distress ◽  
Self Monitoring ◽  
High Distress ◽  
Future Work ◽  
Distress Scale ◽  
The Impact ◽  
Management Behaviors

Background: Diabetes distress has been linked with suboptimal glycemic control in patients with type 1 diabetes. We evaluated the effect of diabetes distress on self-management behaviors in patients using insulin pumps. Methods: We analyzed the impact of diabetes distress on self-management behaviors using pump downloads from 129 adults treated with continuous subcutaneous insulin infusion (CSII) at a single hospital clinic. Exclusion criteria were CSII treatment <6 months, pregnancy, hemoglobinopathy, and continuous glucose monitoring/sensor use. People were categorized into three groups based on the Diabetes Distress Scale-2 (DDS-2) score: < 2.5, 2.5-3.9, > 4. Results: Participants had a mean age of 45.2 ± 19.0 years; duration of diabetes 26.6 ± 16.2 years; duration of CSII 6.0 ± 3.5 years; HbA1c 8.0 ± 1.2%; and DDS-2 score 2.7 ± 1.3. Self-monitoring blood glucose (SMBG) frequency and bolus wizard usage was similar between groups. Patients with higher distress had higher HbA1c (7.7 ± 0.9 vs. 8.0 ± 0.9 vs. 8.7 ± 1.8; P = 0.004), lower frequency of set changes (4.7 ± 1.3vs. 4.8 ± 1.9 vs. 3.8 ± 1.1; P = .025), a greater number of appointments booked (5.8 ± 4.4 vs. 8.6 ± 4.8 vs. 8.1 ± 6.9; P = .021), and a greater number of appointments missed (1.9 ± 1.3 vs. 2.5 ± 1.5 vs. 3.8 ± 4.1; P = .004). Conclusions: Although in some patients, high distress may be caused by reduced self-management, in our highly trained, pump-using patients, high distress was associated with suboptimal biomedical outcomes despite appropriate self-management behaviors. Future work should further explore the relationships between diabetes distress, self-management, and glycemic control.

The impact of online self-management interventions on midlife adults with type 2 diabetes: a systematic review

2020 ◽  
Vol 29 (5) ◽  
pp. 266-272
Author(s):  
Aycan Celik ◽  
Rita Forde ◽  
Jackie Sturt
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Self Management ◽  
Diabetes Distress ◽  
Online Interventions ◽  
Management Interventions ◽  
Secondary Outcomes ◽  
Midlife Adults ◽  
The Impact

Background: Online self-management education programmes are now recommended for people with type 2 diabetes to improve self-management capacities. There is limited evidence to determine whether such programmes improve the health outcomes for midlife adults with diabetes. Aims: The purpose of this systematic review was to assess the impact of online self-management interventions with digital consulting on glycated haemoglobin (HbA1c), total cholesterol, blood pressure, diabetes distress, self-efficacy, and depression in midlife adults. Methods: A systematic review was undertaken searching Medline, Embase and CINAHL. Studies were appraised using the Cochrane Collaboration's tool. Results: Eight studies were included. Online interventions resulted in the improvement of HbA1c (pooled mean difference on HbA1c: -0.35%, 95% CI (-0.52, -0.18), P<0.001). A narrative synthesis was conducted for all secondary outcomes. No conclusions could be drawn on the impact of these outcomes. Conclusion: Online interventions improve HbA1c. Further research is needed for secondary outcomes.

Evaluating the Implementation of the Diabetes Self-Management Program in a Rural Population

2022 ◽  
Author(s):  
Kristin Pullyblank ◽  
Melissa Scribani ◽  
Lynae Wyckoff ◽  
Nicole Krupa ◽  
Jennifer Flynn ◽  
...  
Keyword(s):  
Rural Areas ◽  
Medical Records ◽  
Patient Activation ◽  
Management Program ◽  
Self Management ◽  
Diabetes Distress ◽  
Comprehensive Treatment ◽  
Post Intervention ◽  
Patient Reported ◽  
Distress Scale

The evidence-based Diabetes Self-Management Program (DSMP) has been shown to improve a variety of health-related outcomes, but the program has been challenging to implement in rural areas, and rural dissemination has been low. The purpose of this project was to evaluate the effect of implementing the DSMP on self-reported outcomes in a rural region. Through a collaboration with multiple partners, the Living Well program delivered 28 DSMP workshops from 2017 to 2019. Data were collected to determine whether there were post-intervention changes in patient-reported outcomes on measures of diabetes distress, self-management, and patient activation. In addition, secondary analysis of A1C was abstracted from the medical records of participants with type 2 diabetes who completed at least four sessions of a DSMP workshop between 2017 and 2019 and whose medical records had a A1C value in the year before the program and at least one A1C value &gt;3 months after the program. Statistically significant improvements were seen for the Diabetes Distress Scale (P = 0.0017), the Diabetes Self-Management Questionnaire (P &lt;0.0001) and the 10-item Patient Activation Measure (P &lt;0.0001). There was no evidence of change in A1C over time in analyses of all participants (P = 0.5875), but a consistent though nonsignificant (P = 0.1087) decline in A1C was seen for a subset of participants with a baseline A1C ≥8%. This evaluation provides preliminary support for implementing the DSMP as part of a comprehensive treatment and self-management plan for people living with diabetes in rural areas.

scholarly journals PILOT STUDI: MANAJEMEN DIRI PASIEN DIABETES MELITUS DI RUMAH SAKIT HL. MANAMBAI ABDULKADIR

2019 ◽  
Vol 5 (2) ◽  
pp. 107-113
Author(s):  
Satriya Pranata
Keyword(s):  
Diabetes Mellitus ◽  
Pilot Study ◽  
Self Efficacy ◽  
Public Awareness ◽  
Self Management ◽  
Diabetes Distress ◽  
P Value ◽  
Number Of Patients ◽  
Patients With Diabetes ◽  
Distress Scale

Background: The population of people with diabetes mellitus is increasing every year, furthermore included into number three of deadliest disease in Indonesia. The total number of patients with diabetes mellitus currently are 10.3 million, predicted in 2045, the population will increase to 16.7 million. The main cause population of people with diabetes mellitus are increasing due to public awareness regarding self-management is still less. No researcher has been conducted research about diabetes self-management in HL. Manambai Abdulkadir hospitals. Objectives of the Pilot Study: the main objective in this pilot study was to understand the self-management of people with diabetes mellitus in HL Manambai Abdulkadir hospitals. Methodology: The participants in this pilot study were people diabetes mellitus type 2 in HL Manambai Abdulkadir hospitals using cross sectional design by diabetes self-management, self-efficacy, diabetes self-management knowledge and diabetes distress scale questionnaire. Results: 60% of patients in HL Manambai Abdulkadir hospitals had lack of self-management. The result from measuring of distress scale, knowledge and self-efficacy of patients are related to self-management of patients with diabetes mellitus with P Value <0.05. Conclusion: further research is needed with additional interventions to overcome the lack of self-management to people who suffer diabetes mellitus in HL Manambai Abdulkadir Hospital.

scholarly journals ‘Diabetes is a gift from god’ a qualitative study coping with diabetes distress by Indonesian outpatients

2019 ◽  
Vol 29 (1) ◽  
pp. 109-125
Author(s):  
Bustanul Arifin ◽  
Ari Probandari ◽  
Abdul Khairul Rizki Purba ◽  
Dyah Aryani Perwitasari ◽  
Catharina C. M. Schuiling-Veninga ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Coping Strategies ◽  
Positive Attitude ◽  
Self Management ◽  
Diabetes Distress ◽  
Emotional Burden ◽  
Interpersonal Distress ◽  
And Coping ◽  
Distress Scale ◽  
Bahasa Indonesia

Abstract Background More than two-thirds of patients diagnosed with type 2 diabetes mellitus (T2DM) in Indonesia encounter medical-related problems connected to routine self-management of medication and the social stigma related to T2DM. The current study aims to explore distress and coping strategies in Indonesian T2DM outpatients in a Primary Healthcare Centre (PHC) in Surabaya, East Java, Indonesia. Methods We conducted a qualitative study using two different data collection methods: focus group discussions and in-depth interviews. The guideline of interviews and discussions were developed based on seventeen questions derived from the DDS17 Bahasa Indonesia (a Bahasa Indonesia version of the Diabetes Distress Scale questionnaire), which covered physician distress domain, emotional burden domain, regimen distress domain and interpersonal distress domain. Results The majority of the 43 participants were females and aged 50 or older. Our study discovered two main themes: internal and external diabetes distress and coping strategies. Internal diabetes distress consists of disease burden, fatigue due to T2DM, fatigue not due to T2DM, emotional burden (fear, anxiety, etc.) and lack of knowledge. Internal coping strategies comprised spirituality, positive attitude, acceptance and getting more information about T2DM. External diabetes distress was evoked by distress concerning healthcare services, diet, routine medication, monthly blood sugar checks, interpersonal distress (family) and financial concern. External coping strategies included healthcare support, traditional medicine, vigilance, self-management, social and family support and obtaining information about health insurance. Conclusion Our study shows that for Indonesian T2DM-patients, spirituality and acceptance are the most common coping mechanisms for reducing DD. Furthermore, our study revealed an overall positive attitude towards dealing with T2DM as well as a need for more information about T2DM and potential coping strategies. Finally, an important finding of ours relates to differences in DD between males and females, potential DD associated with health services provision and the specific challenges faced by housewives with T2DM.

scholarly journals Does Diabetes Distress Influence Clinical Response to an mHealth Diabetes Self-Management Education and Support Intervention?

2020 ◽  
Vol 46 (3) ◽  
pp. 289-296
Author(s):  
Taylor L. Clark ◽  
Linda Gallo ◽  
Johanna A. Euyoque ◽  
Athena Philis-Tsimikas ◽  
Addie Fortmann
Keyword(s):  
Usual Care ◽  
Management Education ◽  
Glycosylated Hemoglobin ◽  
Secondary Analysis ◽  
Glucose Monitoring ◽  
Text Messages ◽  
Blood Glucose Monitoring ◽  
Self Management ◽  
Diabetes Distress ◽  
Baseline Levels

Purpose The purpose of this study was to examine whether baseline levels of diabetes distress (DD) impacted clinical benefit from a mobile health (mHealth) diabetes self-management education and support (DSME/S) intervention (“Dulce Digital”). Methods This secondary analysis included the full sample of 126 Hispanic adults (mean age = 48.43 years, SD = 9.80) with type 2 diabetes and glycosylated hemoglobin A1C >7.5% enrolled from a Federally Qualified Health Center in a randomized, nonblinded clinical trial that compared Dulce Digital to usual care. Dulce Digital participants received educational/motivational, medication reminders, and blood glucose monitoring prompt text messages over 6 months. Results Baseline levels of DD prospectively moderated the effect of Dulce Digital (vs usual care) on glycemic control over 6 months, such that Dulce Digital participants with higher DD experienced relatively greater benefit from the intervention. The effect of the intervention on A1C change was 178% larger among individuals experiencing moderate/high versus no/low DD. Conclusions Although research has found DD to be associated with poorer self-management and clinical outcomes, individuals already distressed about their diabetes may benefit from a lower-burden mHealth DSME/S approach.

scholarly journals Alleviating diabetes distress and improving diabetes self-management through health coaching in a primary care setting

2021 ◽  
Vol 14 (4) ◽  
pp. e241759
Author(s):  
Charles C Chima ◽  
Brenna Swanson ◽  
Nnabuchi Anikpezie ◽  
Jason L Salemi
Keyword(s):  
Primary Care ◽  
American Woman ◽  
Health Coaching ◽  
Self Management ◽  
Diabetes Distress ◽  
Haemoglobin A1c ◽  
Point Reduction ◽  
Effective Interventions ◽  
Novel Approach ◽  
Distress Scale

Considering the rising global burden of diabetes and its complications, effective interventions for addressing barriers to diabetes self-management are needed. Diabetes distress, a psychological barrier to diabetes self-management, has become increasingly recognised in the literature, but effective and feasible ways of addressing it in routine primary care settings are not known. We present the case of a middle-aged non-Hispanic white American woman with poorly controlled diabetes (haemoglobin A1c (HbA1c): 13.9%) and elevated diabetes distress (baseline Diabetes Distress Scale Score: 2.53) who participated in a health coaching intervention. After the 5-month programme, which included eight 45 minute long sessions with a trained health coach, the patient achieved and sustained a 0.8-point reduction in diabetes distress, an improvement in insulin adherence and a 3.6-point reduction in HbA1c. This case demonstrates a novel approach to managing diabetes distress that entails providing patients a safe, nonjudgemental space to express their feelings and explore challenges with diabetes self-management.

Virtual Group Appointments Reduce Distress and Improve Care Management in Young Adults with Type 1 Diabetes

2021 ◽  
pp. 193229682110357
Author(s):  
Daniel I. Bisno ◽  
Mark W. Reid ◽  
Jennifer L. Fogel ◽  
Elizabeth A. Pyatak ◽  
Shideh Majidi ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Young Adults ◽  
Controlled Trial ◽  
Self Management ◽  
Diabetes Distress ◽  
Care Providers ◽  
Virtual Group ◽  
Distress Scale ◽  
The Impact

Purpose: The purpose of this study was to analyze the impact of virtual group appointments (VGA) on self-reported health-related outcomes and care activities for young adults (YA) with type 1 diabetes (T1D). Methods: Fifty-three YA (ages 18-25 years) with T1D participated in a randomized controlled trial (RCT) of the Colorado Young Adults with T1D (CoYoT1) Clinic intervention, encompassing telehealth (TH) with or without VGA. Both new patients ( n = 32) and those who participated in a pilot phase ( n = 26) were randomized to CoYoT1 Clinic (TH+VGA; n = 23) or TH-only ( n = 35) and followed for 1 year. YA completed the Diabetes Distress Scale (DDS), Diabetes Strengths and Resilience (D-STAR), Self-Efficacy in Diabetes (SED), Self-Management of Type 1 Diabetes in Adolescence (SMOD-A), Center for Epidemiologic Studies Depression (CES-D), and EuroQol (EQ-5D) scales at baseline and study end. Results: YA were 67% female, 84% white, 10% Latinx, and the mean age was 20.4 years old. At study end, participants in CoYoT1 Clinic reported significantly reduced diabetes distress compared to those in TH-only, who reported increased levels [Effect Size (ES) = −0.40, P = .02]. Specifically, CoYoT1 Clinic participants reported relative reductions in Physician (ES = −2.87, P = .02) and Regimen-related distress (ES = −0.35, P = .01). In addition, participants in CoYoT1 Clinic reported improved self-management of T1D-related problem solving (ES = 0.47, P = .051) and communication with care providers (ES = 0.39, P = .07). Conclusions: Virtual group attendance in CoYoT1 Clinic was associated with significant improvements in diabetes-related distress. Long-term exposure to VGA should be investigated in YA with T1D and other pediatric chronic conditions.

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