Did You Know?
11 November 2013
Hypoglycaemia is the most common side effect of insulin use, and can cause significant worry and distress for people with diabetes and their families. Hypoglycaemia in type 1 diabetes has been an important area of investigation for many years. More recently, there has been an increased awareness of the experience and impact of hypoglycaemia for those with type 2 diabetes. A study reported in a recent edition of Diabetes Care sought to report the prevalence of severe hypoglycaemia (a hypoglycaemic episode during which someone else’s help is required) amongst adults with type 2 diabetes, and to describe the relationship between severe hypoglycaemia and HbA1c. A total of 9,094 adults with type 2 diabetes aged 30-77 years took part in the study, all of whom were using blood glucose lowering therapies (e.g. insulin or oral medication). Results indicated 10.8% of participants had experienced a severe hypoglycaemic episode in the past year. Risk of severe hypoglycaemia was highest for those with an HbA1c of <6% or >9%. Severe hypoglycaemia needs to be acknowledged as an acute complication of type 2 diabetes (for those using insulin or oral medications), particularly for those with a low or very high HbA1c.
Lipska, K. J., Warton, E. M., Huang, E. S., Moffet, H. H., Inzucchi, S. E., Krumholz, H. M., et al. (2013). HbA1c and risk of severe hypoglycemia in type 2 diabetes: The Diabetes and Aging Study. Diabetes Care, 36(11), 3535-3542.
9 October 2013
Living well with a chronic, long term condition such as diabetes, takes time, energy, effort and commitment. Self-management activities to reduce the likelihood of developing complications include: making healthy food choices and ensuring regular physical activity; maintaining strong and ongoing relationships both with personal support networks and a professional healthcare team; taking medications as recommended and self-monitoring blood glucose. A person’s ability to successfully manage and integrate all of these activities can be influenced heavily by their emotional health and psychological wellbeing. In addition to the relentless demands of self-management, people with diabetes are vulnerable to critical periods of psychological risk, such as those noted by Rubin and Peyrot in ‘Psychosocial care for people with diabetes’ (Hyman-Young, 2013). These periods include at time of initial diagnosis, first onset of complications and during changes to treatment regimen, such as initiation of insulin therapy.
Unfortunately, the demands of diabetes self-management can take their toll; people often report feeling worried about the future, anxious if diabetes management is not going to plan, and sometimes ‘burned out’. This distress is impairs their well-being and can, in turn, have a detrimental effect on their self-care. It is important both for people with diabetes to take care of their psychological and emotional health, and for members of their support networks, either personal or professional, to be able to recognize and address such problems as early as possible. Fortunately, there are many important resources and sources of advice available to people living with diabetes and to their support networks. Diabetes Australia – Victoria is an important first point of call for anyone seeking information. Their next ‘Living Well with Diabetes’ event will be held on 23 November at Melbourne Town Hall. The event is free for members and $10 for non-members if booked before November 1. Bookings can be made at 1300 136 588. Any enquiries should be directed to Claire Wytcherley. Friends, family and health professionals can also find helpful suggestions at the R U OK? Foundation website, which includes tips on starting a conversation about psychological wellbeing and links to crisis support and expert advice.
What positive steps do you take, to care for your emotional wellbeing? Take our poll here.
10 September 2013
In a study of 2419 Danish adults with type 1 diabetes (48% women), significant associations were found in both men and women between living without a partner and low diabetes empowerment and highHbA1c, following adjustments for age, diabetes duration, education and social support. Additionally, for women, living without a partner was significantly associated with higher diabetes distress, and for men, living without a partner was significantly associated with poorer quality of life. Women living without a partner were less likely to undertake self-care behaviours such as eating a healthy diet, exercising and taking prescribed medication than women living with a partner, after adjusting for age, diabetes duration and education, however this result was no longer significant once the model was adjusted for social support. Applying the same model to men showed no significant associations between self-care behaviours and living without a partner. This study highlights a need for assessment of cohabitation status and social support in routine clinical diabetes care to improve diabetes and psychological outcomes and diabetes self-care. Adults with type 1 diabetes living without a partner may benefit from referral to supplementary support services such as specialized peer support networks.
Reference: Joensen, Lene E., Thomas P. Almdal, and Ingrid Willaing. Type 1 diabetes and living without a partner: Psychological and social aspects, self-management behaviour, and glycaemic control. Diabetes Research and Clinical Practice (in press).
14 July 2013
13 May 2013
A recent systematic review published in Diabetic Medicine has identified factors that affect adherence to insulin therapy amongst people with type 1 or type 2 diabetes. 17 studies were reviewed. The percentage of people who self-reported using insulin therapy as recommended ranged from 43% - 86% across studies. Findings from the review indicate that factors associated with not using insulin as recommended fell into four categories: 1) predictive factors for adherence (e.g. older age), 2) patient-perceived barriers (e.g. feeling embarrassed about injecting in public), 3) device used to deliver insulin (e.g. insulin pen versus syringe), and 4) financial burden to patient (e.g. using insurance schemes which reduce out-of-pocket expenses for insulin and associated consumables). The authors conclude that the factors associated with ongoing use of insulin are different to those associated with initiation of insulin. These results should inform the use of strategies and interventions to facilitate safe and effective use of insulin therapy by people with type 1 or type 2 diabetes.
Davies, M. J., Gagliardino, J. J., Gray, L. J., Khunti, K., Mohan, V., & Hughes, R. (2013). Real-world factors affecting adherence to insulin therapy in patients with Type 1 or Type 2 diabetes mellitus: a systematic review. Diabetic Medicine, 30(5), 512-524.
10 April 2013
If you live with diabetes, how do you manage your medication regimen? Do you take only the medications prescribed by your clinician, or do you include complementary supplements, such as vitamins, minerals or fish oil? Previous research has raised the issue of the potential for adverse interactions between ingredients of medications and supplements, which may augment or antagonise the actions of the prescribed medication, yet few people keep the healthcare professionals fully informed of their self-care medication regimen. A recent online survey of over 5,000 Australians, conducted on behalf of the Australian Medicines Industry (AMI), found that 60% reported taking supplements, but that one-third of those either only informed their doctor "sometimes", or hadn't informed them at all. When focusing on people living with diabetes, the recent Australian Health Survey, from the Australian Bureau of Statistics, reported that 95% of people with diabetes took some form of medication in the past 2 weeks, including 45% of people who took supplements. With diabetes earning the ignominious title of Australia's fastest growing chronic disease, and development of diabetes medications continually increasing, it is important for people living with diabetes to keep their medical practitioners fully informed of all aspects of their self-care.
13 March 2013
A recent publication has aimed to clarify the association between self-reported medication-taking behaviours and glycaemic outcomes in people with type 2 diabetes in a primary care setting. This longitudinal study included 253 people, of whom 40% were using insulin in addition to tablets. Using the Morisky Medication Adherence Scale, the investigators found that 49% of the sample reported sub-optimal medication-taking behaviours, with the most frequently reported reason being 'forgetting to take medications' (39%). The baseline Morisky Scale total score was a significant predictor of future (6 month follow-up) HbA1c levels, even after controlling for demographic variables, baseline HbA1c and diabetes-related distress. Interestingly, the Morisky Scale total score could effectively be substituted for the 1 item question addressing forgetfulness, where an affirmative response to whether participants forget to take their medications was associated with a 4.7mmol/mol (or .43% unit) increase in Hba1c. The authors emphasise the need to implement strategies designed to directly reduce forgetfulness surrounding taking diabetes medications.
12 December 2012
Families carry a major burden of the diabetes pandemic. According to the first results to be released from the global DAWN2™ Study, the physical, financial and emotional burden of diabetes is carried by the entire family, not just the person with diabetes. DAWN2™ is the largest global study (across 17 countries and 4 continents) of its kind and for the first time included the opportunity for family members to be surveyed alongside people with diabetes and health professionals. The survey found:
- 63% of family members are anxious about the possibility that the person they live with will develop serious diabetes-related complications
- 66% of family members of people with insulin-treated diabetes fear that their loved one will have a hypoglycaemic episode during the night
- 34% of family members report a negative financial impact on themselves due to the diabetes of their loved one
- 20% of family members experience that their loved one is being discriminated against because of diabetes and that the community they live in is intolerant of diabetes
- 35% of people with diabetes report their family argues with them about how they manage their diabetes
- 75% of family members have not attended an education programme about diabetes, despite at least 70% of diabetes healthcare professionals believe that involvement of family members is a vital part of good diabetes care.
These initial findings, announced in a press release on 3 December, will soon to be made available on the DAWN Study website. Conducted in 2012, DAWN2™ expands on the original Diabetes Attitudes Wishes and Needs Study, conducted in 2001. Further results will be published in a series of articles and presented at a range of academic conferences in 2013.
7 November 2012
A recent publication based on data from the DAWN MIND study has highlighted the effects of routine monitoring of well-being for people with diabetes. 891 people with diabetes completed a questionnaire that included measures of diabetes-related distress, general psychological well-being and life events at 1-year follow-up. 28% had screened positive for depression and/or diabetes-related distress at baseline. Clinically relevant improvements in distress and general psychological well-being were observed over time in these cases. No change in HbA1c was observed. This method of routine monitoring of well-being was acceptable to both the healthcare professionals and patients involved.
Snoek FJ, Kersch NYA, Eldrup E, Harman-Boehm I, Hermanns N, Kokoszka A, et al. Monitoring of Individual Needs in Diabetes (MIND)-2: Follow-up data from the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) MIND study. Diabetes Care 2012; 35: 2128-32.
8 October 2012
Once considered a condition of older age, type 2 diabetes is now increasingly being diagnosed during young adulthood. This group face many medical and psychosocial challenges. Young-onset type 2 diabetes often progresses aggressively, with complications developing early. Young adults with type 2 diabetes also need to juggle the management of a chronic condition with other priorities and pressures that characterise this phase of life (such as work, relationships, and starting a family), and deal with public misconceptions and stigma about diabetes and other related health concerns. Furthermore, healthcare services for people with type 2 diabetes are often aimed at a much older age group.
Diabetes Australia – Vic recently launched Generation t2, a series of information sessions and events specifically for young adults with type 2 diabetes. The ACBRD’s Dr Jessica Browne spoke at the inaugural event in Melbourne in September, click here to check out a great write-up of the event. Find out more by contacting Generation t2 co-ordinator Angela Mallon or by using #gent2 on Twitter.
1 August 2012
22% of adults with diabetes reported experiencing severe diabetes-related distress in the Diabetes MILES – Australia 2011 survey. The top problem area for people with diabetes was worrying about the future and the possibility of serious complications.
11 July 2012
Psychosomatics published a review paper on positive emotional health and diabetes care. Over the last years increasing interest in positive psychology is starting to balance up with the huge amount of research on diabetes and depression or distress. The authors conceptualised positive emotional health into three aspects (well-being, positive affect, resilience).
A few of the key findings were that higher positive affect was associated with lower risk of all-cause mortality among people with diabetes, even after controlling for other significant predictors of mortality; people with higher levels of positive affect were 2-3 times more likely to exercise than those with lower levels of positive emotion; people with lower levels of resilience were more likely to have increased HbA1c levels and increased distress over time, and fewer self-care behaviours in the wake of rising distress.
The authors concluded that positive emotional health may facilitate self-management and improved health outcomes.
5 April 2012
According to a recently published article (reference and link below), people who use antidepressant medication may have a moderately elevated risk of developing type 2 diabetes compared to those who do not use these medications.
The association was examined in three cohorts of US adults primarilry made up of health care professionals with European ancestry. Overall, 29,776 men and 138,659 women who were free of diabetes, cardiovascular disease or cancer at baseline were followed for a time period between 1990 and 2008. 6,641 new cases of type 2 diabetes were documented. After controlling for age, diabetes risk factors and BMI antidepressant medication use was associated with a moderately elevated risk of type 2 diabetes across the sample.
Pan, A., Sun, Q., Okereke, O., Rexrode, K., Rubin, R., Lucas, M., . . . Hu, F. (2012). Use of antidepressant medication and risk of type 2 diabetes: results from three cohorts of US adults. Diabetologia, 55(1), 63-72.
27 Feb 2012
According to a recently published article (reference and link below), people with diabetes who have a 'diabetic foot ulcer' (DFU) and also present with a depressive disorder at diagnosis have an increased risk of mortality compared to those without a depressive disorder.
This is a 5-year follow-up of a cohort of 253 patients presenting with their first DFU. After 5 years almost half (45.1%) of those participants with depression had died, compared to around 1/3 of those without depression. Regardless of whether the participants had minor or major depressive disorders the mortality rate was persistently twofold of those without depression.
Winkley, K., Sallis, H., Kariyawasam, D., Leelarathna, L., Chalder, T., Edmonds, M., . . . Ismail, K. (2012). Five-year follow-up of a cohort of people with their first diabetic foot ulcer: the persistent effect of depression on mortality. Diabetologia, 55(2), 303-310.
1 Feb 2012
According to a recently published article (reference and link below), people with diabetes who discuss lifestyle changes with their primary care physicians are likely to achieve their health goals faster than those do so less frequently or not at all.
This retrospective study included more than 30,000 participants from a primary care setting. The article reports the association between the occurrence of lifestyle counselling from a primary care physician and participants meeting their health goals (e.g. lowering HbA1c to <7.0%, cholesterol to <100 mg/dL and blood pressure to <130/85 mmHg).
The authors inferred the occurrence of lifestyle counselling as instances when the primary care physician provided diet, exercise or weight counselling to the participant and it was likely that is was discussed, not simply recorded.
Participants who received once-monthly or more lifestyle counselling succeeded in meeting health goals in roughly one sixth of the time it took for those who had received lifestyle counselling less than once per 6 months from their primary care physician.
Morrison, F., Shubina, M., & Turchin, A. (2012). Lifestyle Counseling in Routine Care and Long-Term Glucose, Blood Pressure, and Cholesterol Control in Patients With Diabetes. Diabetes Care, 35(2), 334-341. doi: 10.2337/dc11-1635