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Purpose Of Review: This study aims to examine the operationalisation of 'psychological insulin resistance' (PIR) among people with type 2 diabetes and to identify and critique relevant measures.Recent Findings: PIR has been operationalised as (1) the assessment of attitudes or beliefs about insulin therapy and (2) hypothetical or actual resistance, or unwillingness, to use to insulin. Five validated PIR questionnaires were identified. None was fully comprehensive of all aspects of PIR, and the rigour and reporting of questionnaire development and psychometric validation varied considerably between measures. Assessment of PIR should focus on the identification of negative and positive attitudes towards insulin use. Actual or hypothetical insulin refusal may be better conceptualised as a potential consequence of PIR, as its assessment overlooks the attitudes that may prevent insulin use. This paper provides guidance on the selection of questionnaires for clinical or research purpose and the development of new, or improvement of existing, questionnaires. [ABSTRACT FROM AUTHOR]

Background: Excercise self-efficacy is believed to influence physical activity bahavior. Purpose: The purpose of this study is to assess the psychometric aspects of the Exercise Self-efficacy Scale (ESS) in a type 2 diabetes Dutch Primary care sample. Method: Type 2 diabetes patients ( n = 322; <80 years old) filled in the ESS and the short questionnaire to assess health enhancing physical activity (SQUASH). The structural validity of the ESS was assessed by means of principal axis factor analyses and confirmatory factor analysis. In addition, reliability and concurrent validity with the SQUASH outcomes 'total' and 'leisure time minutes/week of moderate to vigorous intensity physical activity' were evaluated. T tests and ANOVAs were used to examine ESS scores in subgroups. In addition, a 13-item version of the ESS was developed. Results: Analyses were performed on complete cases ( n = 255). Exploratory factor analysis suggested one underlying factor (total explained variance 54 %), with good internal consistency ( α = 0.95). Confirmatory factor analysis showed a poor fit, as did a three-factor model suggested in an earlier research. Therefore, a 13-item ESS was developed with one underlying factor (total explained variance 59 %) and good internal consistency ( α = 0.95). Both the 18-item and 13-item ESS correlated significantly with total and leisure time physical activity. ESS scores differed significantly between categories of education level and physical activity level. Conclusion: The 13-item ESS had sound psychometric properties in a large sample of primary care type 2 diabetes patients. The 13-item ESS could be useful in (intervention) research on physical activity in type 2 diabetes patients. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to assess the difference in explained variance of Health-Related Quality of Life (HRQoL) between comorbidity, sociodemographic characteristics and cancer characteristics. This association was assessed among thyroid cancer, colorectal cancer, and (non-)Hodgkin's lymphoma patients. Methods: Data from three large population-based surveys on survivors of thyroid cancer, colorectal cancer, and (non-)Hodgkin's lymphoma were used. Cancer-specific HRQoL was assessed with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) of which physical function, emotional function, fatigue, and pain were included in the analyses. Comorbidity was assessed using the Self-reported Comorbidity Questionnaire. The association between comorbidity and HRQoL was assessed with multivariate linear regression models. Semi-partial R2 was reported to assess the amount of variance in HRQoL explained by comorbidity in comparison with sociodemographic and cancer characteristics. Results: In total, 3,792 cancer survivors were included in this analysis. The variance in HRQoL subscales explained by comorbidity was higher compared with sociodemographic and cancer characteristics for physical function (11–17 vs. 2–4 and 1–2 %, respectively) and emotional function (7–17 vs. 1–3 and 1–3 %, respectively), regardless of cancer type. In addition, comorbidity explained 7–20 and 11–13 % of the variance in pain and fatigue, respectively, compared to 0–4 % for both sociodemographic and cancer characteristics. Osteoarthritis and back pain were strongly associated with physical function and pain, while depression was strongly associated with emotional function. Depression and back pain were strongly associated with fatigue. Conclusions: This study showed that comorbidity explained more variance in physical and emotional function, pain, and fatigue in comparison with sociodemographic and cancer characteristics in cancer survivors, regardless of cancer type. Our findings emphasize the importance of adjusting for the presence of comorbid diseases when assessing HRQoL in cancer survivors. Implication for cancer survivors: Cancer survivors suffering from comorbid diseases experience lower levels of health-related quality of life. Clinicians should become more aware of the impact of comorbidity on HRQoL and provide necessary psychological support to assist self-management of comorbid diseases. [ABSTRACT FROM AUTHOR]

Aims/hypothesis: Psychological problems are relatively common in people with type 2 diabetes. It is unclear whether exercise training exerts an effect on quality of life, symptoms of depression, symptoms of anxiety and emotional well-being in people with type 2 diabetes. The aim of this study was to conduct a systematic review to assess the effects of exercise training on these outcomes in people with type 2 diabetes. Methods: MEDLINE, PsycINFO, Embase and ClinicalTrials.gov databases were searched. The review included randomised controlled trials (RCTs) of at least 4 weeks' duration in people with type 2 diabetes that evaluated the effect of exercise training on quality of life, symptoms of depression, symptoms of anxiety and/or emotional well-being compared with usual care. Results: Of 1,261 retrieved articles, 20 RCTs were included with a total of 1,719 participants. Quality of life was assessed in 16 studies. Between-group comparisons showed no significant results for aerobic training with the exception of one study, and mixed results for resistance and combined training. Symptoms of depression were assessed in four studies. In only one study did the intervention decrease symptoms of depression. Emotional well-being was evaluated in four studies, which also showed conflicting results. Symptoms of anxiety were evaluated in one study, which showed a significant improvement. Conclusions/interpretation: The effects of exercise training on psychological outcomes in people with type 2 diabetes are conflicting. Therefore, there is a need for further high-quality RCTs in order to gain greater insight into the role of exercise training in people with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Purpose: To test whether improvement in glycosylated haemoglobin (HbA) as a marker of glycaemic control, following intensifying insulin therapy, is associated with improvements in HRQoL. Methods: Dutch sub-optimally controlled (HbA > 7%) type 2 diabetes patients (N = 447, mean age 59 ± 11) initiated insulin glargine therapy. Data were collected at baseline, 3 and 6 months, and included HbA and measures of HRQoL: diabetes symptom distress (Diabetes Symptom Checklist-revised; DSC-r), fear of hypoglycaemia (Hypoglycaemia Fear Survey; HFS-w) and emotional well-being (WHO-5 wellbeing index). Results: HbA decreased from 8.8 ± 1.4% to 8.0 ± 1.2% and 7.7 ± 1.3% at 3 and 6 months follow-up, respectively ( P < 0.001), DSC-r score improved from 17.7 ± 14.7 to 14.3 ± 13.3 and 13.6 ± 13.3 ( P < 0.001). HFS-w score did not significantly change. WHO-5 score increased from 56 ± 23 to 62 ± 23 and 65 ± 22 P < 0.001). A modest, significant association was found between HbA and WHO-5 score (B = −1.8, 95% CI: −2.7 to −0.8) and HbA1c and DSC-r score (B = 1.0, 95% CI: 0.4 to 1.6). No such association was found for HFS-w score. Conclusions: An association between improvement in HbA by means of optimising insulin therapy and improvement in HRQoL in type 2 diabetes patients has been observed. A weak, yet significant longitudinal association was found between improved HbA and emotional well-being and diabetes symptom distress. [ABSTRACT FROM AUTHOR]

Aims/hypothesis: The aim of the study was to examine the course (incidence, recurrence/persistence) of depressive symptoms in primary care patients with type 2 diabetes and to identify significant predictors of these different course patterns. Methods: A cohort of 2,460 primary care patients with type 2 diabetes was assessed for demographic, clinical and psychological factors in 2005 and followed-up in 2007 and 2008. Depression was defined as a score of ≥12 on the Edinburgh Depression Scale. Multivariate logistic regression analyses were used to determine whether several depression-course patterns could be predicted by means of demographics, medical co-morbidities and psychological factors. Results: A total of 630 patients (26%) met the criterion for depression at one or more assessments. In the subgroup with no baseline depression, incident depression at follow-up was present in 14% ( n = 310), while recurrence/persistence in those with baseline depression was found in 66% ( n = 212).The presence of any depression was associated with being female, low education, non-cardiovascular chronic diseases, stressful life events and a self-reported history of depression. Incident depression was predicted by female sex, low education and depression history, while patients with a history of depression had a 2.5-fold increased odds of recurrent/persistent depression. Conclusions/interpretation: Depression is common in primary care patients with type 2 diabetes, with one in seven patients reporting incident depression during a 2.5 year period. Once present, depression often becomes a chronic/recurrent condition in this group. In order to identify patients who are vulnerable to depression, clinicians can use questionnaire data and/or information about the history of depression. [ABSTRACT FROM AUTHOR]

ims/hypothesis: The aim of this study was to test the effectiveness of a screening procedure for depression (SCR) vs care as usual (CAU) in outpatients with diabetes. The primary outcome measured was depression score and the secondary outcomes were mental healthcare consumption, diabetes-distress and HbA. Materials and methods: In a multicentre parallel randomised controlled trial, 223 outpatients with diabetes, who had an elevated depression score, were randomly assigned to SCR ( n = 116) or CAU ( n = 107), using computer generated numbers. SCR-patients were invited for a Composite International Diagnostic Interview (CIDI) to diagnose depression and/or anxiety (interviewers were not blinded for group assignment). As part of the intervention, patients and their physicians were informed of the outcome of the CIDI in a letter and provided with treatment advice. At baseline and 6 month follow-up, depression and diabetes-distress were measured using the Centre for Epidemiologic Studies Depression Scale (CES-D) and the Problem Areas in Diabetes survey (PAID). HbA levels were obtained from medical charts. Results: Mean CES-D depression scores decreased from baseline to 6 months in both groups (24 ± 8 to 21 ± 8 [CAU] and 26 ± 7 to 22 ± 10 [SCR] respectively [ p < 0.001]), with no significant differences between groups. Neither diabetes-distress nor HbA changed significantly within and between groups. The percentage of patients receiving mental healthcare increased in the SCR group from 20% to 28%, compared with 15% to 18% in the CAU group. Conclusions/interpretation: Depression screening with written feedback to patient and physician does not improve depression scores and has a limited impact on mental healthcare utilisation, compared with CAU. It appears that more intensive depression management is required to improve depression outcomes in patients with diabetes. [ABSTRACT FROM AUTHOR]

ims/hypothesis: An earlier meta-analysis showed that diabetes is a risk factor for the development and/or recurrence of depression. Yet whether this risk is different for studies using questionnaires than for those relying on diagnostic criteria for depression has not been examined. This study examined the association of diabetes and the onset of depression by reviewing the literature and conducting a meta-analysis of longitudinal studies on this topic. Methods: EMBASE, MEDLINE and PsycInfo were searched for articles published up to September 2009. All studies that examined the relationship between type 2 diabetes and the onset of depression were included. Pooled relative risks were calculated using fixed and random effects models. Results: Eleven studies met our inclusion criteria for this meta-analysis. Based on the pooled data, including 48,808 cases of type 2 diabetes without depression at baseline, the pooled relative risk was 1.24 (95% CI 1.09-1.40) for the random effects model. This risk was significantly higher for studies relying on diagnostic criteria of depression than for studies using questionnaires. However, this difference was no longer significant when controlled for year of publication. Conclusions/interpretation: Compared with non-diabetic controls, people with type 2 diabetes have a 24% increased risk of developing depression. The mechanisms underlying this relationship are still unclear and warrant further research. [ABSTRACT FROM AUTHOR]

The aim of the study was to determine the prevalence of depression in insulin-naive diabetes patients and to investigate the associations between different forms of vascular co-morbidity and depression. Cross-sectional data were used from a primary-care sample of 1,269 insulin-naive (i.e. not using insulin therapy) diabetes patients participating in the DIAZOB Primary Care Diabetes study. Demographics, vascular co-morbidities, clinical and lifestyle characteristics, and psychosocial factors were assessed. Depression symptoms were measured with the Edinburgh Depression Scale, with a score >11 defined as depression. The χ2 and Student’s t tests were used to compare groups with and without vascular co-morbidities. Rates and odds ratios of depression were calculated for each vascular co-morbidity, with diabetes only as the reference group, correcting for age and sex. Single and multiple logistic regression analyses were performed to test a more comprehensive model regarding the likelihood of depression in diabetes. The prevalence of depression was 11% in the total sample with little difference between the groups with and without any vascular co-morbidity (11.2% vs 10.0%). Single vascular co-morbidities were not associated with increased rates of depression. The final model predicting depression included: having multiple vascular co-morbidities compared with none; having less social support; having experienced a recent stressful life event; female sex; and being a smoker. Rates of depression in those with one additional vascular co-morbidity did not differ from patients with diabetes only. Vascular co-morbidities were only associated with higher depression scores in case of multiple co-morbidities. [ABSTRACT FROM AUTHOR]

Psychosocial interventions in diabetic patients Diabetes treatment largely consists of self-care. On a daily basis, and probably life-long, diabetic patients need to balance their medication, diet and exercise. They constantly need to be aware for signs of deregulation of blood glucose levels or emerging complications. Diabetes is regarded a disease with a huge emotional impact. As a result, psychological problems, ranging from adaptation problems to depression and anxiety disorders, are common in diabetic patients. A large diversity of psychological interventions has been developed for patients with diabetes. In this paper, we will subdivide these interventions in interventions embedded in regular care, additional outpatient psychological care and interventions for diabetes-related psychopathology. Most intervention studies concern additional outpatient psychological programmes. Research shows no effects to moderate effects of these programmes in improving blood glucose, whereas moderate effects are reported in psychological well-being. Increasing intensity, specificity of the target group for treatment and a sound theoretical underpinning increase the efficacy of these interventions. Most interventions use some form of cognitive behavioural therapy. Limited research focuses on psychological intervention embedded in regular care, but the few publications report positive effects. There is ample research on incidence and aetiology of psychopathology in diabetic patients, but little is known about the efficacy of treatment in this group of patients. In general, both standard medication and psychotherapeutic interventions seem effective, although it is essential that therapists have knowledge in the field of diabetes. The large majority of studies primarily focus on the efficacy of the interventions, disregarding other aspects like the impact in clinical practice. For example, it is mostly unknown whether the target group is reached and whether the intervention is performed as intended. We notice main caveats in research on psychological interventions in regular diabetes care and in effect studies on treatment for psychopathology in diabetic patients. Currently, psychological problems are increasingly screened for in clinical practice, which is an important first step for psychological care. [ABSTRACT FROM AUTHOR]

The association between depression and insulin resistance has been investigated in only a few studies, with contradictory results reported. The aim of this study was to determine whether the association between symptoms of depression and insulin resistance varies across glucose tolerance status and between men and women. Cross-sectional data from a population-based cohort study in Hoorn, a medium-sized town in the Netherlands, were analysed. The study sample consisted of 541 men and women aged 55–75 years, of whom 260 had NGT, 164 had IGT and 117 had established type 2 diabetes mellitus. Main outcome measures were insulin resistance defined by the homeostasis model assessment for insulin resistance (HOMA-IR) and symptoms of depression using the Centre for Epidemiologic Studies Depression Scale (CES-D). In the total sample, we found a weak positive correlation between the depressive symptoms CED-D scores and HOMA-IR scores ( r s = 0.156, p < 0.001). Even weaker associations were found in subjects with NGT ( r s = 0.041, p=0.509), in subjects with IGT ( r s = 0.112, p = 0.160) and in subjects with type 2 diabetes ( r s = 0.007, p = 0.942). The association between depressive symptoms and insulin resistance was similar for men and women. We found only weak associations between depressive symptoms and insulin resistance, which did not differ among different glucose metabolism subgroups or between men and women. [ABSTRACT FROM AUTHOR]

Aims/hypothesis: Evidence strongly suggests that depression and type 2 diabetes are associated, but the direction of the association is still unclear. Depression may occur as a consequence of having diabetes, but may also be a risk factor for the onset of type 2 diabetes. This study examined the latter association by reviewing the literature and conducting a meta-analysis of longitudinal studies on this topic. Methods: Medline and PsycInfo were searched for articles published up to January 2005. All studies that examined the relationship between depression and the onset of type 2 diabetes were included. Pooled relative risks were calculated using fixed and random effects models. To explore sources of heterogeneity between studies, subgroup analyses and meta-regression analyses were performed. Results: Nine studies met our inclusion criteria for this meta-analysis. The pooled relative risk was 1.26 (1.13–1.39) using the fixed effects model and 1.37 (1.14–1.63) using the random effects model. Heterogeneity between studies could not be explained by (1) whether studies controlled for undetected diabetes at baseline; (2) the method of diabetes assessment at followup; (3) the baseline overall risk of diabetes in the study population; and (4) follow-up duration. Conclusions/interpretation: Depressed adults have a 37% increased risk of developing type 2 diabetes mellitus. The pathophysiological mechanisms underlying this relationship are still unclear and warrant further research. A randomised controlled study is needed to test whether effective prevention or treatment of depression can reduce the incidence of type 2 diabetes and its health consequences. [ABSTRACT FROM AUTHOR]

Aims/hypothesis. There is accumulating evidence that depression is common in people with Type 2 diabetes. However, most prevalence-studies are uncontrolled and could also be inaccurate from selection-bias, as they are conducted in specialized treatment settings. We studied the prevalence and risk factors of co-morbid depression in a community-based sample of older adults, comparing Type 2 diabetic patients with healthy control subjects. Methods. A large (n=3107) community-based study in Dutch adults (55–85 years of age) was conducted. Pervasive depression was defined as a CES-D score greater than 15. Diagnosis of Type 2 diabetes was obtained from self-reports and data from general practitioners. Results. A number of 216 patients (7%) were identified as having Type 2 diabetes. The prevalence of pervasive depression was increased in people with Type 2 diabetes and co-morbid chronic disease (20%) but not in patients with Type 2 diabetes only (8%), compared with the healthy control subjects (9%). Regression analyses in diabetic patients yielded that being single, being female, having functional limitations, receiving instrumental support and having an external locus of control were associated with higher levels of depression. Conclusions/interpretation. The Results suggest that the prevalence of pervasive depression is increased in patients with Type 2 diabetes and co-morbid disease(s), but not in patients with Type 2 diabetes only. Functional limitations that often accompany co-morbid chronic disease could play an essential role in the development of depression in Type 2 diabetes. These findings can enable clinicians and researchers to identify high-risk groups and set up prevention and treatment programs. [ABSTRACT FROM AUTHOR]

The Disability and Impact Profile (DIP) is used for the measurement of quality of life in multiple sclerosis (MS) patients. Data from 211 persons with definite MS from Belgium, Denmark and the Netherlands were used to address three questions. To what extent do the impairment ratings and their complementary weighted scores share common variance? What is the factor structure of the weighted scores? To what extent do disease-related information and information from psychological questionnaires offer concurrent validity for the factors? Correlations between impairment ratings and the weighted item scores were high; for most items the complementary ratings of impact do not supplement information provided by impairment ratings. The DIP weighted scores can be represented to some extent by three independent dimensions: a motor (skeletal movement) or displacement ability factor, a factor relating to sensory–cognitive intactness and a psychological well-being factor. A two-factor solution provides a first factor identical to that of the three-factor solution and a second factor representing psychological well-being. The two factors correlate well with instruments measuring disability and with satisfaction versus emotional distress. Provisional scales based on the factors were constructed. [ABSTRACT FROM AUTHOR]

In the present study, the equivalence of paper and pencil assessment versus computer assessment of two self-administered questionnaires was investigated by means of a randomized cross-over design. Therefore, 105 out-patients with diabetes were invited to participate; 76 patients completed both the computer and the paper and pencil version of the Well-being Questionnaire (WBQ) and the Diabetes Treatment Satisfaction Questionnaire (DTSQ) in a randomized order, with a mean interval of 7 days. The scales showed high test-retest correlations and the means, dispersions, kurtosis and skewness were found to be approximately the same in both versions. In both modes of assessment, the depression and the energy scale proved to be sensitive for carry-over effects, resulting in better well-being scores at the second measurement. Almost all subjects reported that using the personal computer in the realization of a questionnaire was easy. It is concluded that the paper and pencil and the computerized versions of the WBQ and DTSQ can be considered equivalent. Therefore, the norms and cut-off scores obtained from paper and pencil assessments can be used in computerized versions of the WBQ and DTSQ and vice versa. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor regarding health-related quality of life in Type 2 diabetes published in the February 5, 2003 issue of "Diabetologia."