Reduction of HbA1c and diabetes-related distress after intervention in a diabetes day care clinic in people with type 2 diabetes but not with type 1 diabetes

Abstract

Objective The aim of this prospective, longitudinal study was to assess diabetes-related distress in people with diabetes mellitus type 1 (DM1) and type 2 (DM2) treated for diabetes-related problems and to evaluate, whether distress by diabetes are reduced after intervention in a diabetes day care clinic (DDC).

Methods Diabetes-related burden was assessed with the “Problem Area In Diabetes” (PAID) questionnaire before (T0), directly after (T1) and 6 months after intervention (T2) in the DDC in 72 people (18 DM1, 54 DM2) admitted with a diabetes-specific problem to a DDC in a University department for metabolic diseases. A PAID score of ≥40 was considered as high diabetes-related distress.

Results The PAID score in people with DM1 was not significantly different between T0, T1 and T2. Furthermore, neither HbA1c nor insulin dose did change at T2. In participants with DM2, the PAID score decreased significantly from T0 to T1 (18.4±15.9 vs. 15.4+± 13.0, p=0.042) and preserved the benefit at T2 (15.0±13.3). In addition, there was a significant reduction in HbA1c (−1.2%, p<0.001) and body weight (−1.3 kg, p=0.038) between T0 and T2. Insulin dose per day was 15.0 IU/day lower at T1 (p=0.006) and 9.0 IU/day lower at T2 (p=0.212) in comparison to T0.

Conclusions Diabetes-related distress was reduced after a problem-oriented intervention in a DDC in people with DM2 but not with DM1. Although, all participants at tertiary care level had serious diabetes-specific problems before intervention, mean PAID score was far under the threshold of 40 points thus distress was low.

Key words

diabetes day care clinic - diabetes-related distress - PAID questionnaire

• References

• 1 Hagen B, Groos S, Kretschmann J et al. Quality assurance report 2014 Disease-Management-Programmes in Northrhine 2015.
• 2 Kuniss N, Kramer G, Müller N. et al. Diabetes-related burden and distress is low in people with diabetes at outpatient tertiary care level. Exp Clin Endocrinol Diabetes. 2016; 124: 307-312
• 3 Schmitt A, Reimer A, Kulzer B. et al. Negative association between depression and diabetes control only when accompanied by diabetes-specific distress. Journal of Behavioral Medicine 2015; 38: 556-564
• 4 Jörgens V, Grüßer M, Kronsbein P. Strukturiertes Behandlungs- und Schulungsprogramm für Typ-2-Diabetes ohne Insulin. 29th ed. Deutscher Ärzte-Verlag; 2013
• 5 Grüßer M, Jörgens V. Strukturiertes Behandlungs- und Schulungsprogramm für Typ-2-Diabetiker mit Normalinsulin vor dem Essen Insulin. 2nd ed. Deutscher Ärzte-Verlag; 2012
• 6 Jörgens V, Grüßer M, Kronsbein P. Strukturiertes Behandlungs- und Schulungsprogramm für konventionelle Insulinbehandlung. 18th ed Deutscher Ärzte-Verlag; 2011
• 7 Grüßer M, Jörgens V. Strukturiertes Behandlungs- und Schulungsprogramm für intensivierte Insulintherapie. 5th ed. Deutscher Ärzte-Verlag; 2009
• 8 Welch GW, Jacobson AM, Polonsky WH. The Problem areas in diabetes scale. An evaluation of its clinical utility. Diabetes care 1997; 20: 760-766
• 9 Pouwer F, Skinner TC, Pibernik-Okanovic M. et al. Serious diabetes-specific emotional problems and depression in a Croatian-Dutch-English Survey from the European Depression in Diabetes [EDID] Research Consortium. Diabetes research and clinical practice 2005; 70: 166-173
• 10 Snoek FJ, Pouwer F, Welch GW. et al. Diabetes-related emotional distress in Dutch and U.S. diabetic patients: Cross-cultural validity of the problem areas in diabetes scale. Diabetes care 2000; 23: 1305-1309
• 11 Hermanns N, Kulzer B, Krichbaum M. et al. How to screen for depression and emotional problems in patients with diabetes: Comparison of screening characteristics of depression questionnaires, measurement of diabetes-specific emotional problems and standard clinical assessment. Diabetologia 2006; 49: 469-477
• 12 Bradley C, Todd C, Gorton T. et al. The development of an individualized questionnaire measure of perceived impact of diabetes on quality of life: the ADDQoL. Quality of life research: An international journal of quality of life aspects of treatment, care and rehabilitation 1999; 8: 79-91
• 13 World Health Organization. info package: Mastering depression in primary care. Frederiksborg: World Health Organization, Regional Office for Europe, Psychiatric Research Unit. 1998
• 14 Bradley C. (eds.) The diabetes treatment satisfaction questionnaire: DTSQ. Handbook of psychology and diabetes: A guide to psychological measurements in diabetes research and practice Chur. Switzerland: Harwood Academic Publishers; 1994
• 15 Dulon M, Bardehle D, Blettner M. Assessing social inequality in microcensus data and German national health examination survey. Gesundheitswesen 2003; 65: 629-635
• 16 Schumann M. Electronic Medical Information System for long-term documentation of chronic diseases (EMIL). 2013; http://cleverdoku.de (Last accessed 27.06.2017)
• 17 Seaquist ER, Anderson J, Childs B. et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care 2013; 36: 1384-1395
• 18 German Diabetes Association (DDG). Guidelines for recognition of a treatment institution – Certified Diabetes Center DDG (valid from 01.01.2015). 2015; http://www.deutsche-diabetes-gesellschaft.de/ fileadmin/Redakteur/Zertifizierung/Basisanerkennung/Richtlinie_Zert_Diabeteszentrum_DDG_2015.pdf (Last accessed 27.06.2017)
• 19 The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The diabetes control and complications trial research group. The New England journal of medicine 1993; 329: 977-986
• 20 Polonsky WH, Anderson BJ, Lohrer PA. et al. Assessment of diabetes-related distress. Diabetes care 1995; 18: 754-760
• 21 Petrak F, Kaltheuner M, Scheper N. et al. Psychische Belastungen und Therapieadhärenz von Patienten mit Diabetes in DSPen (Emotional stress and Treatment adherence in patients with diabetes in secondary care level). Diabetes Stoffwechsel und Herz 2011; 20: 7-14
• 22 Stoop CH, Nefs G, Pop VJ. et al. Diabetes-specific emotional distress in people with Type 2 diabetes: A comparison between primary and secondary care. Diabet Med 2014; 31: 1252-1259
• 23 Speight J, Holmes-Truscott E, Harvey DM. et al. Structured type 1 diabetes education delivered in routine care in Australia reduces diabetes-related emergencies and severe diabetes-related distress: The OzDAFNE program. Diabetes research and clinical practice 2016; 112: 65-72
• 24 Hermanns N, Schmitt A, Gahr A. et al. The effect of a Diabetes-Specific Cognitive Behavioral Treatment Program (DIAMOS) for patients with diabetes and subclinical depression: Results of a randomized controlled trial. Diabetes Care 2015; 38: 551-560
• 25 Pintaudi B, Lucisano G, Gentile S. BENCH-D Study Group . et al. Correlates of diabetes-related distress in type 2 diabetes: Findings from the benchmarking network for clinical and humanistic outcomes in diabetes (BENCH-D) study. J Psychosom Res. 2015; 79: 348-354
• 26 Kuniss N, Kramer G, Müller N. et al. History of mild hypoglycaemia does not affect the prevalence of diabetes-related distress in people with diabetes. Acta Diabetol. 2016; 53: 833-838
• 27 Kulzer BAC, Herpertz S, Kruse J et al. S2-Guideline „Psychosocial and Diabetes”. 2013; www.deutsche-diabetes-gesellschaft.de (Last accessed 27.06.2017)
• 28 Cooke D, Bond R, Lawton J. et al. Structured type 1 diabetes education delivered within routine care: impact on glycemic control and diabetes-specific quality of life. Diabetes Care 2013; 36: 270-272
• 29 Trento M, Merlo S, Durando O. et al. Self-management education and psychological support improve self-esteem in people with type 1 diabetes. Acta Diabetol 2017; 54: 415-416
• 30 Group DS . Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: Dose adjustment for normal eating (DAFNE) randomised controlled trial. BMJ 2002; 325: 746-749
• 31 Mühlhauser I, Bruckner I, Berger M. et al. Evaluation of an intensified insulin treatment and teaching programme as routine management of type 1 (insulin-dependent) diabetes. The Bucharest-Düsseldorf Study. Diabetologia 1987; 30: 681-690
• 32 Pieber TR, Brunner GA, Schnedl WJ. et al. Evaluation of a structured outpatient group education program for intensive insulin therapy. Diabetes Care 1995; 18: 625-630
• 33 Starostina EG, Antsiferov M, Galstyan GR. et al. Effectiveness and cost-benefit analysis of intensive treatment and teaching programmes for type 1 (insulin-dependent) diabetes mellitus in Moscow-blood glucose versus urine glucose self-monitoring. Diabetologia 1994; 37: 170-176
• 34 Müller UA, Mueller R, Starrach A. et al. Should insulin therapy in type 2 diabetic patients be started on an out- or inpatient basis? Results of a prospective controlled trial using the same treatment and teaching program in ambulatory care and a university hospital. Diabetes & Metabolism 1998; 24: 251-255
• 35 Grüsser M, Hartmann P, Schlottmann N. et al. Structured treatment and teaching program for type 2 diabetic patients on conventional insulin treatment: Evaluation of reimbursement policy. Patient Educ Couns. 1996; 29: 123-130
• 36 Kalfhaus J, Berger M. Insulin treatment with preprandial injections of regular Insulin in middle-aged type 2 diabetic patients. A two years observational study. Diabetes & metabolism 2000; 26: 197-201