Exp Clin Endocrinol Diabetes 2016; 124(05): 307-312
DOI: 10.1055/s-0042-103685
Article
© Georg Thieme Verlag KG Stuttgart · New York

Diabetes-Related Burden and Distress is Low in People with Diabetes at Outpatient Tertiary Care Level

N. Kuniss
1   Department of Internal Medicine III, Jena University Hospital, Jena, Germany
,
G. Kramer
1   Department of Internal Medicine III, Jena University Hospital, Jena, Germany
,
N. Müller
1   Department of Internal Medicine III, Jena University Hospital, Jena, Germany
,
C. Kloos
1   Department of Internal Medicine III, Jena University Hospital, Jena, Germany
,
T. Lehmann
2   Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany
,
S. Lorkowski
3   Institute of Nutrition, Friedrich Schiller University Jena, Germany
4   Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Halle-Jena-Leipzig, Germany
,
G. Wolf
1   Department of Internal Medicine III, Jena University Hospital, Jena, Germany
,
U. A. Müller
1   Department of Internal Medicine III, Jena University Hospital, Jena, Germany
› Author Affiliations
Further Information

Publication History

received 01 December 2015
first decision 09 February 2016

accepted 23 February 2016

Publication Date:
24 May 2016 (online)

Abstract

Objective: The importance of diabetes-related distress (DRD) for the treatment of diabetes is emphasized in national and international guidelines recommending routinely screening for psychosocial problems. To detect DRD, the PAID (Problem Area In Diabetes) questionnaire provides a valid and reliable instrument.

Research Design and Methods: 783 patients with diabetes mellitus type 1 (DM1, n=191, age 54.5 y, diabetes duration 22.5 y, HbA1c 7.2% (55 mmol/mol)) and type 2 (DM2, n=592, age 66.6 y, diabetes duration 15.6 y, HbA1c 7.0% (60.1 mmol/mol)) were interviewed with the PAID and WHO-5 questionnaire in a University outpatient department for endocrinology and metabolic diseases in 2012. A PAID score≥40 (range 0–100) was considered as high DRD.

Results: The mean PAID score was 17.1±15.1 in all participants. Only 8.9% of all responders showed high DRD (score≥40). The PAID score neither differed in people with DM1 and DM2, nor between participants with DM2 with or without insulin therapy. Females achieved significantly higher scores than men (19.0±16.6 vs. 15.6±13.7, p=0.003). A strong negative correlation existed between the PAID score and the WHO-5 Well-being Index (r=− 0.482, p<0.001). A 10 points higher WHO-5 Well-being Index was associated with 15.9 points lower PAID score in people with DM1 (p<0.001), and 9.2 points lower PAID score in DM2 (p<0.001), respectively. One percent higher HbA1c was associated with an increase of diabetes-related distress by 2.5 points in people with DM1 and by 2.0 points in people with DM2.

Conclusions: Less than 10% of our outpatients with diabetes showed high diabetes-related distress.

 
  • References

  • 1 American Diabetes Association . Standards of medical care in diabetes – 2015. Diabetes care 2015; 38: -
  • 2 International Diabetes Federation Guideline Development G . Global guideline for type 2 diabetes. Diabetes research and clinical practice 2014; 104: 1-52
  • 3 Kulzer BAC, Herpertz S, Kruse J et al. S2-Guideline „Psychosocial and Diabetes”. 2013. www.deutsche-diabetes-gesellschaft.de (Last accessed 02.09.2015)
  • 4 Welch GW, Jacobson AM, Polonsky WH. The Problem Areas in Diabetes Scale. An evaluation of its clinical utility. Diabetes care 1997; 20: 760-766
  • 5 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
  • 6 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
  • 7 Nicolucci A, Kovacs Burns K, Holt RI et al. Diabetes Attitudes, Wishes and Needs second study (DAWN2): cross-national benchmarking of diabetes-related psychosocial outcomes for people with diabetes. Diabetic medicine 2013; 30: 767-777
  • 8 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
  • 9 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
  • 10 Petrak FRRA, 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
  • 11 Joensen LE, Almdal TP, Willaing I. Type 1 diabetes and living without a partner: psychological and social aspects, self-management behaviour, and glycaemic control. Diabetes research and clinical practice 2013; 101: 278-285
  • 12 Fisher L, Skaff MM, Mullan JT et al. A longitudinal study of affective and anxiety disorders, depressive affect and diabetes distress in adults with Type 2 diabetes. Diabetic medicine 2008; 25: 1096-1101
  • 13 Wardian J, Sun F. Factors associated with diabetes-related distress: implications for diabetes self-management. Social work in health care 2014; 53: 364-381
  • 14 Reddy J, Wilhelm K, Campbell L. Putting PAID to diabetes-related distress: the potential utility of the problem areas in diabetes (PAID) scale in patients with diabetes. Psychosomatics 2013; 54: 44-51
  • 15 Gonzalez JS, Shreck E, Psaros C et al. Distress and type 2 diabetes-treatment adherence: A mediating role for perceived control. Health psychology 2015; 34: 505-513
  • 16 World Health Organization info package. Mastering depression in primary care. Frederiksborg: World Health Organization, Regional Office for Europe, Psychiatric Research Unit; 1998
  • 17 Schumann M. Electronic Medical Information System for long-term documentation of chronic diseases (EMIL). 2013 http://cleverdoku.de (Last accessed 02.09.2015)
  • 18 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
  • 19 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 02.09.2015)
  • 20 Dulon M, Bardehle D, Blettner M. Assessing social inequality in microcensus data and German national health examination survey. Gesundheitswesen 2003; 65: 629-635
  • 21 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
  • 22 Polonsky WH, Anderson BJ, Lohrer PA et al. Assessment of diabetes-related distress. Diabetes care 1995; 18: 754-760
  • 23 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
  • 24 Hagen BAL, Groos S, Kretschmann J et al. Quality Assurance Report 2012 Disease-Management-Programmes in Northrhine. 2012
  • 25 Hermanns N, Kulzer B, Ehrmann D et al. The effect of a diabetes education programme (PRIMAS) for people with type 1 diabetes: Results of a randomized trial. Diabetes Research and Clinical Practice 2013; 102: 149-157
  • 26 Pouwer F, Snoek FJ. Association between symptoms of depression and glycaemic control may be unstable across gender. Diabetic Medicine 2001; 18: 595-598
  • 27 Lustman PJ, Anderson RJ, Freedland KE et al. Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care 2000; 23: 934-942
  • 28 Busch MA, Maske UE, Ryl L et al. Prevalence of depressive symptoms and diagnosed depression among adults in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1). Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz 2013; 56: 733-739
  • 29 Busse R. Disease management programs in Germanyʼs statutory health insurance system. Health affairs 2004; 23: 56-67
  • 30 Bäz L, Müller N, Beluchin E et al. Differences in the quality of diabetes care caused by social inequalities disappear after treatment and education in a tertiary care centre. Diabetic medicine 2012; 29: 640-645