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Aim: To examine associations of metabolic parameters (mean 30 years' time‐weighted HbA1c and low‐density lipoprotein‐cholesterol [LDL‐c], current methionine sulfoxide [MetSO], advanced glycation end products [AGEs], inflammatory markers and hypoglycaemia) with pain, fatigue, depression and quality of life (QoL) in people with long‐term type 1 diabetes. Methods: A total of 104 persons with type 1 diabetes ≥45 years duration were included. Participants completed questionnaires measuring bodily pain (RAND‐36 bodily pain domain with lower scores indicate higher levels of bodily pain), fatigue (Fatigue Questionnaire), depression (Patient Health Questionnaire), overall QoL (World Health Organization Quality of Life—BREF) and diabetes‐related QoL (Audit of Diabetes‐Dependent Quality of Life). In this observational study, mean time‐weighted HbA1c and LDL‐c were calculated based on longitudinal measures obtained from medical records of up to 34 years, while current HbA1c, LDL‐c and inflammatory markers were analysed in blood samples and collagen MetSO and AGEs in skin biopsies. History of hypoglycaemia was self reported. Associations between metabolic parameters and questionnaire scores were analysed using linear regression analyses and are reported as standardized regression coefficients (beta). Results: Of the metabolic variables, higher mean time‐weighted HbA1c was associated with higher levels of bodily pain and total fatigue (beta [p‐value]) −0.3 (<0.001) and 0.2 (0.001). Conclusions: Long‐term chronic hyperglycaemia may have a negative influence on pain and fatigue in people with type 1 diabetes. These results may assist health care workers in emphasizing the importance of strict glycaemic control in people with diabetes and identifying and treating type 1 diabetes‐related pain and fatigue. [ABSTRACT FROM AUTHOR]

Aims: To select a core list of standard outcomes for diabetes to be routinely applied internationally, including patient‐reported outcomes. Methods: We conducted a structured systematic review of outcome measures, focusing on adults with either type 1 or type 2 diabetes. This process was followed by a consensus‐driven modified Delphi panel, including a multidisciplinary group of academics, health professionals and people with diabetes. External feedback to validate the set of outcome measures was sought from people with diabetes and health professionals. Results: The panel identified an essential set of clinical outcomes related to diabetes control, acute events, chronic complications, health service utilisation, and survival that can be measured using routine administrative data and/or clinical records. Three instruments were recommended for annual measurement of patient‐reported outcome measures: the WHO Well‐Being Index for psychological well‐being; the depression module of the Patient Health Questionnaire for depression; and the Problem Areas in Diabetes scale for diabetes distress. A range of factors related to demographic, diagnostic profile, lifestyle, social support and treatment of diabetes were also identified for case‐mix adjustment. Conclusions: We recommend the standard set identified in this study for use in routine practice to monitor, benchmark and improve diabetes care. The inclusion of patient‐reported outcomes enables people living with diabetes to report directly on their condition in a structured way. What's new?: Standardized monitoring of diabetes care can improve quality through routine audit and benchmarking. Inconsistencies between measures adopted in different countries hamper this process and undermine international comparisons.This study was the first multinational effort to recommend a standard list of outcomes that matter most to people with diabetes, and that can be used in routine clinical practice to monitor, benchmark and improve diabetes care.The essential outcomes relate to diabetes control, acute events, chronic complications, health service utilisation and survival, measured using routine administrative data and/or clinical records. Three instruments were recommended for annual measurement of patient‐reported outcome measures (PROMs): the WHO Well‐Being Index for psychological well‐being; the depression module of the Patient Health Questionnaire for depression; and the Problem Areas in Diabetes scale for diabetes distress. [ABSTRACT FROM AUTHOR]

To conduct a systematic review and meta‐analysis of longitudinal studies assessing the bi‐directional association between depression and diabetes macrovascular and microvascular complications. Embase, Medline and PsycINFO databases were searched from inception through 27 November 2017. A total of 4592 abstracts were screened for eligibility. Meta‐analyses used multilevel random/mixed‐effects models. Quality was assessed using the Newcastle‐Ottawa scale. Twenty‐two studies were included in the systematic review. Sixteen studies examined the relationship between baseline depression and incident diabetes complications, of which nine studies involving over one million participants were suitable for meta‐analysis. Depression was associated with an increased risk of incident macrovascular (HR = 1.38; 95% CI: 1.30–1.47) and microvascular disease (HR = 1.33; 95% CI: 1.25–1.41). Six studies examined the association between baseline diabetes complications and subsequent depression, of which two studies involving over 230 000 participants were suitable for meta‐analysis. The results showed that diabetes complications increased the risk of incident depressive disorder (HR = 1.14; 95% CI: 1.07–1.21). The quality analysis showed increased risk of bias notably in the representativeness of selected cohorts and ascertainment of exposure and outcome. Depression in people with diabetes is associated with an increased risk of incident macrovascular and microvascular complications. The relationship between depression and diabetes complications appears bi‐directional. However, the risk of developing diabetes complications in depressed people is higher than the risk of developing depression in people with diabetes complications. The underlying mechanisms warrant further research. What's new?: Numerous studies have examined the longitudinal relationship between depression and diabetes complications but comprehensive evidence about the magnitude and direction is unavailable.The current study shows that the relationship between depression and diabetes complications appears bi‐directional with depression being associated with an increased risk of developing incident macrovascular and microvascular complications, and diabetes complications increasing the risk of subsequent depression.The increase in risk of developing diabetes complications in depressed people (by 38 and 33% for macrovascular and microvascular complications, respectively) is higher than the increase in risk of developing depression (by 9 and 24% for macrovascular and microvascular complications, respectively) in people with diabetes complications. [ABSTRACT FROM AUTHOR]

Aims: To determine the prevalence of diabetes among older people receiving care at home, and to explore differences in sociodemographic and clinical characteristics, symptoms, health status, quality of life and psychological well‐being between diabetes categories defined as HbA1c ≥ 48 mmol/mol (6.5%) and/or self‐report. Methods: A community‐based sample of 377 people receiving care at home in Western Norway participated in a cross‐sectional survey. Instruments included the MMSE‐NR, Symptom Check‐List, WHO Quality of Life‐BREF (WHOQOL‐BREF, global items), EuroQol EQ‐5D‐5L/EQ‐5D‐VAS and WHO‐Five Well‐Being Index (WHO‐5). Participants were grouped into four categories: no diabetes, self‐report only, HbA1c ≥ 48 mmol/mol (6.5%) and self‐report, and HbA1c ≥ 48 mmol/mol (6.5%) only. Results: Median age (IQR) was 86 (81–91) years and 34% of the sample were men. We identified 92 people (24%) with diabetes. Diabetes was more prevalent in men than women (34% vs. 20%, age‐adjusted P = 0.005). Among people with diabetes, 14% were unaware of their diagnosis. There were significant differences in symptoms between the diabetes categories, with more symptoms (abnormal thirst, polyuria, genital itching, nausea, excessive hunger, perspiring, cold hands/feet, daytime sleepiness) among the groups with elevated HbA1c. Significant differences in WHO‐5, WHOQOL‐BREF and EQ‐5D‐5L between diabetes categories were identified, with the poorest scores in the group with undiagnosed diabetes. Conclusions: A high percentage of people with diabetes receiving care at home are unaware of their diagnosis. Diabetes deserves increased case‐finding efforts and allocation of resources towards those receiving care at home to alleviate symptoms and the burden of inadequate diabetes care. What's new?: Knowledge on the prevalence of diabetes among older persons receiving care at home is scarce.The prevalence of diabetes was 24%, and among those with diabetes, 14% were unaware of their diagnosis and reported significantly poorer health status than those with known diabetes.Diabetes deserves increased case‐finding efforts and allocation of resources to alleviate symptoms and burden of inadequate diabetes care at home. [ABSTRACT FROM AUTHOR]

Aims To assess the ways in which healthcare professionals address psychological problems of adults with diabetes in the second Diabetes Attitudes, Wishes and Needs ( DAWN2™) study. Methods Approximately 120 primary care physicians, 80 diabetes specialists and 80 nurses and dietitians providing diabetes care participated in each of 17 countries ( N=4785). Multiple regression analyses were used to evaluate independent statistically significant associations of respondent attributes concerning psychological care strategies, including assessment of diabetes impact on the patient's life, assessment of depression, provision of psychological assessment and support, and coordination with mental health professionals. Results Psychological care strategies were positively associated with each other but differed by healthcare practice site and discipline; nurses and dietitians were less likely to assess depression than other healthcare professionals, while primary care physicians were less likely to coordinate with mental health specialists or ask patients how diabetes affects their lives. Psychological care was positively associated with healthcare professionals' beliefs that patients need help dealing with emotional issues and that clinical success depends on doing so, and also with level of psychological care training, multidisciplinary team membership and availability of resources for psychological care. There were significant between-country variations in psychological care strategies, before and after adjustment for individual-level factors, and significant country-by-covariate interactions for almost all individual-level factors investigated. Conclusions Improvements in training and resources, recognition and assessment of psychological problems, and increased belief in the efficacy of psychological support may enhance healthcare professionals' efforts to address psychological problems in adults with diabetes. [ABSTRACT FROM AUTHOR]

Aims To conduct a second Diabetes Attitudes, Wishes and Needs ( DAWN2™) study, examining the experiences of family members caring for adults with diabetes in order to identify correlates of family member psychological outcomes (generic psychological well-being, perceived quality of life, and diabetes-related burden, impact and distress). Methods A total of 2057 family members living with a person with diabetes and involved in their care participated in an online, telephone or in-person survey. Samples of 120 respondents were recruited in each of 17 countries. Significant ( P < 0.05) correlates of psychological outcomes were identified by multi-level multiple regression. Results Outcomes were worse for family members not working because of diabetes or those who had other competing obligations. Outcomes were worse if the person with diabetes was not a partner or parent, used injected diabetes medication, or had more frequent hypoglycaemia. Outcomes were worse for family members who believed that diabetes was more severe, were more involved in diabetes care, had more conflict over diabetes care or were frustrated about not knowing how to help the person with diabetes. Outcomes were better for those who had greater support from others and felt they found good ways to help the person with diabetes. There were significant differences in outcomes among countries before and after adjustment for individual characteristics, and correlates of outcomes varied by country. Conclusions Several modifiable risk and protective factors for family member psychological outcomes were identified in this study. Diabetes education and social support were associated with improved outcomes, especially if they were helpful in supporting people with diabetes. [ABSTRACT FROM AUTHOR]

Aims To assess country- and individual-level correlates of psychological outcomes, and differences among countries in the associations of individual characteristics with psychological outcomes among adults with diabetes. Methods The second Diabetes Attitudes, Wishes and Needs ( DAWN2™) study assessed self-reported characteristics of people with diabetes in 17 countries, including 1368 adults with Type 1 diabetes and 7228 with Type 2 diabetes. In each country, a sample of 500 adults, stratified by diabetes type and treatment, completed a questionnaire incorporating the validated WHO-5 wellbeing index, the WHOQOL- BREF, and the five-item Problem Areas in Diabetes Scale, as well as the newly developed Diabetes Impact on Life Dimensions that assessed impact ranging from very positive to very negative, with no impact as the midpoint. Multilevel regression analyses identified significant ( P < 0.05) independent correlates of psychological outcomes. Results There were significant variations in all outcomes across countries before adjustment for individual-level factors; adjustment reduced between-country disparities. Worse psychological outcomes were associated with more complications, incidence of hypoglycaemia, hypoglycaemic medication, perceived burden of diabetes, family conflict and experience of discrimination. Better psychological outcomes were associated with higher self-rated health, greater access to diabetes education and healthcare, and more psychosocial support from others. The associations of many factors with the outcomes were mediated by modifiable factors. The association of all factors with the outcomes varied across (interacted with) countries, highlighting the need for country-specific analyses. Conclusions Improvements in modifiable risk factors (reductions in burden and increases in support) may lead to better psychological outcomes in adults with diabetes. [ABSTRACT FROM AUTHOR]

Aim To examine whether diabetes-specific emotional distress was related to follow-up glycaemic control in adults with Type 1 diabetes mellitus. Methods Adults with Type 1 diabetes mellitus completed the Diabetes Distress Scale and reported sociodemographic information when attending a clinical consultation at a university endocrinology unit. Blood samples to determine baseline HbA1c were taken during consultations. All respondents' HbA1c measurements registered from January 2009 to December 2011 were collected from medical records. The relationship between baseline diabetes-specific emotional distress and HbA1c was examined with linear mixed-effects models in 175 patients with complete data. Results After controlling for confounders, baseline diabetes-specific emotional distress and glycaemic control were significantly associated (fixed-effect coefficient 0.40, P < 0.001) and the regimen-related distress subscale had the strongest association with glycaemic control (fixed-effect coefficient 0.47, P < 0.001). The two-item measure of diabetes-specific distress had a weaker but still significant association with glycaemic control (fixed-effect coefficient 0.31, P < 0.001). None of these relationships was significant after adjusting for the baseline HbA1c. Conclusions People with elevated baseline diabetes-specific emotional distress are at risk of prolonged suboptimum glycaemic control; therefore, elevated diabetes-specific emotional distress, especially regimen-related distress, might be an important marker for prolonged suboptimum glycaemic control, and might indicate a need for special attention regarding patient self-management. [ABSTRACT FROM AUTHOR]

Aim To identify insulin delivery system perceptions that contributed to improvements in overall satisfaction with insulin therapy (treatment satisfaction) that were larger in those using sensor-augmented pump therapy than those using multiple daily injections with self monitoring of blood glucose. Methods The Sensor-Augmented Pump Therapy for A1C Reduction 3 ( STAR 3), a randomized 12-month clinical trial, compared sensor-augmented pump therapy to multiple daily injections + self monitoring of blood glucose in adult and paediatric patients. The Insulin Delivery System Rating Questionnaire measured perceptions of convenience, problems, interference with daily activities, blood glucose monitoring burden, social burden, clinical efficacy, diabetes worries and psychological well-being, as well as treatment satisfaction. We conducted separate multiple regression analyses for the 334 adult patients and 147 paediatric patients and their caregivers to assess the independent associations ( P < 0.05) between change from baseline to follow-up in user perceptions and treatment satisfaction. Results Increased convenience was associated with improved treatment satisfaction in all user groups. Reduced interference with daily activities (caregivers), reduced social burden (adults) and increased efficacy (both) also were associated with improved treatment satisfaction. Conclusions Treatment satisfaction among children was primarily a function of convenience, while perceived clinical efficacy was also a primary determinant among adults, reflecting different emphases on the treatment process itself vs. treatment consequences. Among adult patients and caregivers, improved treatment satisfaction was also a function of reductions in social burden and interference with daily activities (respectively), reflecting concern with the broader psychosocial impact of sensor-augmented pump therapy on their lives. [ABSTRACT FROM AUTHOR]