Partners’ representations of diabetes as mediators between patients’ representations and adherence to self-care behaviors,in type 2 diabetes

The purpose of this study was to analyze partners’ representations of diabetes as mediators between patients’ illness representations and adherence to all self-care behaviors, in recently diagnosed type 2 diabetes (T2DM) patients. The sample included 340 patients and their respective partners. The instruments used were: Revised Summary of Diabetes Self-Care Activities (RSDSCA); Medication Adherence Report Scale (MARS); and the Brief Illness Perception Questionnaire (Brief-IPQ). A mediational effect of partners’ representation of diabetes consequences was found between the same patients’ representations and exercise, foot care, and self-monitoring of blood glucose. Partners’ representations of personal and treatment control, were mediators between the same partners’ representations and self-monitoring of blood glucose. No partners’ representations mediated patients’ representation and adherence to medication or diet . This study emphasized partners’ representations on patient’s adherence to exercise, foot care and monitoring of blood glucose, in recent diagnosed T2DM patients. Interventions to promote adherence in T2DM should promote convergence between patients and partners’ diabetes representations. This study provides some evidence for the need to treat T2DM within the dyad to improve adherence, starting after the diagnosis.     

Father-absent adolescents with insulin-dependent diabetes mellitus: A population at risk?

This study evaluated whether family structure is associated with the psychosocial functioning and physical health of adolescents with insulin-dependent diabetes mellitus (IDDM). Subjects were 30 intact families and 30 father-absent families. Adolescents and their mothers completed several self-report and observational instruments that assessed adolescent adherence to treatment, adolescents' and mothers' perceptions of maternal support and nonsupport of treatment, mothers' parental competence, and adolescent social competence. Metabolic control was determined by averaging the adolescent's hemoglobin A1c levels during the previous year. A 2 × 2 (Family Structure × Gender) analysis of variance was conducted on each dependent measure. The results showed that father-absent adolescents had better adherence to the IDDM treatment regimen, despite the fact that adolescents from intact families reported significantly more maternal support for treatment. In addition, single mothers reported relatively high parental competence; and statistical interaction effects indicated that single mothers of girls were more involved in the daily treatment of IDDM, consisting of both positive and negative interactions, than single mothers of boys. There were no between-groups differences for adolescents' metabolic control or social competence. Together, these findings suggested that the father-absent adolescents have adjusted very well to living with one parent and a chronic illness.     

Representing diabetes: ‘Brightside’ and ‘chaos’ in autobiography

This paper examines six autobiographical sources written by people with type 1 diabetes. In seeking to improve the understanding of diabetic lifeworlds; some of the autobiographies present heroic stories of ‘overcoming’ diabetes while others present a more ‘chaotic’ narrative. Regardless of their form, all the autobiographies highlight how the everyday problems and concerns associated with diabetes can be hidden and silenced. Therefore, I ask the question of how to use autobiographies as sources of evidence, being aware of the power constructs that may have directed their form. Despite this question, I argue that autobiographies remain crucial sources for exploring the experience of everyday life and much of the silencing in the texts reflects spatial and emotional challenges faced by the authors. I also consider the limitations of representation in the autobiographies calling for an understanding that the experience of diabetes carries with it feelings, emotions and affects that are non-representable and so never entirely knowable. Thus, this paper builds on recent geographical research on emotion and ‘contested’ illnesses, especially those that are not obviously visible or are easily hidden.     

How patients’ representations of cystic fibrosis-related diabetes inform their health behaviours

Background: Although diabetes is a frequent complication of cystic fibrosis (CF), patients’ behaviours tend not to comply with best practice recommendations. Using Leventhal’s Common-Sense Model, we address this issue by exploring patients’ representations of CF-related diabetes (CFRD) to better understand the discrepancy between patients’ expected and observed health behaviours.

Methods: Semi-structured individual interviews were conducted with patients (n = 39) in six CF clinics in Quebec, Canada. These interviews were part of a larger research project on screening and management practices for CFRD.

Results: Illness representations differed between two groups of interviewed patients: (1) one group had either CF without dysglycemia or CF with impaired glucose tolerance; and (2) the other group had CFRD. Both representations were internally consistent and encompassed Leventhal’s five dimensions of illness representation: illness identity, cause, timeline, consequences and control.

Conclusions: Patients require specific information on CFRD. The screening phase could be a crucial time to help patients adjust their representations to fit the reality of CFRD.     

Do mental disorders moderate the association between diabetes status and alcohol consumption?

Although heavy alcohol consumption is associated with diabetes-related complications, little is known about patterns of alcohol use among people with diabetes. Moreover, heavy drinking is more common among individuals with major depressive disorder (MDD), bipolar disorder (BD), and generalized anxiety disorder (GAD) than in the general population, and these disorders are often comorbid with diabetes. The present study tested the hypothesis that mental disorders moderate the association between diabetes status and alcohol consumption. A total of 14,302 adult participants aged 40-79 were included from the cross-sectional 2012 Canadian Community Health Survey-Mental Health (1,698 with diabetes). Data were analyzed using hierarchical linear regression models. MDD and BD, but not GAD, significantly moderated the association between diabetes status and alcohol quantity, such that the presence of diabetes was strongly and negatively associated with alcohol quantity if individuals had MDD or BD. There was no interaction between diabetes status and any of the mental disorders and alcohol frequency. This study suggests that among individuals with diabetes, those with comorbid MDD or BD drink less than those without MDD or BD. Further investigation of this association is needed and could help inform future alcohol-related interventions among individuals with diabetes.     

Life stories managing chronic illness: Young adults’ lived experiences with type 1 diabetes

This study aimed to characterise diabetes management experiences of South African young adults living with well-controlled type 1 diabetes (n = 8, female = 5, male = 3, age range = 20–25). The young adults told life stories managing their type 1 diabetes. Thematic analysis revealed the young adults to construct personal identities as people living with type 1 diabetes, to mostly utilise emotion-focused management strategies and social support for successful living with type 1 diabetes. Behavioural health strategies appear important for living well with this chronic insulin deficiency condition.     

Job Demand–Control–Support and diabetes risk: The moderating role of self-efficacy

Work-related stressors, including high demands and low control, play a significant role in the aetiology of diabetes. Nevertheless, most studies focus on main effects, and few consider individual differences that may moderate the stress–health association. Drawing from the Job Demands–Control-–Support (JDC-S) model, this study addresses this gap by testing how baseline levels of JDC-S affect an increase in two risk factors for diabetes—glycated haemoglobin (HbA1C) and fasting plasma glucose (FPG)—and by investigating the moderating role of self-efficacy. Participants (N = 1618) were Israeli employees who attended two consecutive routine health examinations. All were free of diabetes at baseline. JDC-S and self-efficacy were assessed at baseline (T1), and HbA1C and FPG were assessed at T1 and T2. Data were analysed with logistic and linear regressions, controlling for well-established diabetes risk factors. High demands and low support predicted an increase in HbA1C and FPG. In addition, high self-efficacy interacted with high demands and with low control in the prediction of an increase in HbA1C and FPG. Although employees with high self-efficacy might function well at work, overloading them may harm their physical health. Similarly, incongruence between employees’ sense of ability and the control given to them at work may result in physical impairment.     

Is spousal support always helpful to patients with asthma or diabetes? A prospective study

The current study examined effects of three ways of providing spousal support (active engagement, protective buffering, and overprotection) on self-efficacy and physical and mental health in patients with diseases imposing a high demand on self-management routines (36 asthma patients and 21 diabetic patients). Employing a nine-month prospective design, we hypothesized that active engagement would be positively related to health and self-efficacy, that overprotection would have a negative impact, and that the impact of protective buffering would depend on symptom level at baseline. Results confirmed the latter hypothesis while either positive or negative effects of active engagement and overprotection were absent. These findings are discussed with respect to the role of spousal support in diseases requiring self-management behaviour.     

Clinical staff’s attributions about diabetes: Scale-development and staff vs. patient comparisons

Clinical staff’s attributions about diabetes management were measured using newly developed scales. Eighty-five physicians and nurses provided data to investigate the psychometric properties of the scales and to examine the patterns of attributions made. Alpha coefficients for the 7 six-item scales were satisfactory, ranging from .51 to .73. A comparison between attributions for positive and negative outcomes of diabetes management produced examples of self-serving bias. Comparisons were made with data from 286 insulin-dependent diabetes patients. Staff tended to rate patients as having less personal control over positive outcomes (t=2.94;df=338;p<.01) and tended to emphasize chance to a greater extent than did the patients (t=?4.32;df=338;p<.001). There was a tendency for staff to rate negative outcomes as being more foreseeable by the patients than the patients did themselves (t=?3.11;df=346;p<.01). Both patients and staff demonstrated bias towards dispositional attributions. The implications of between and within group differences in attribution patterns are discussed.     

Are exercise social-cognitive factors and behaviours different for adults with diabetes? A randomized community sample

Exercise plays a key role in the prevention and delay of the onset of Type 2 diabetes and in the management of this disorder. To determine if there are differences in key social-cognitive determinants of exercise and self-reported physical activity levels between adults with diabetes and those without the condition, a random selected sample of adults was surveyed. A telephone interview assessed physical activity behaviour and key social-cognitive constructs from major health behaviour change theories/models. The mean energy expenditure was not significantly different between the diabetes (n?=?46) and the non-diabetes (n?=?1556) groups. The diabetes group reported significantly lower scores for self-efficacy and perceived behavioural control, but higher for fear of, and vulnerability to, general health and cardiovascular disease threat. The data suggest that it may not be necessary to promote health threat messages, as threat is already high for this diabetes population and studies have shown that excess threat does not promote recommended exercise and health behaviours. Instead, the low levels of self-efficacy and perceived behavioural control among those with diabetes emphasize the importance of designing specific strategies (e.g., skills, incremental success) to increase their self-confidence in undertaking physical activity.     

Foot care, ‘spousal’ support and type 2 diabetes: an exploratory qualitative study

Objectives: People with type 2 diabetes (T2DM) should check their feet and protect them against harm, but few do. Living with a spouse contributes to good foot care behaviour. This study explores awareness, perceived susceptibility of, and concern about, foot problems, and reported foot care behaviour, and ways in which a spouse may or may not contribute to foot care in T2DM.

Methods: 1:1 interviews were conducted with 6 individuals with T2DM. Half had a spouse half did not. There was one person at low, medium and high risk in each sample. Each spouse participated in a separate interview, and the dyads were interviewed together. Interviews were analysed using Applied Thematic Analysis.

Results: All participants knew that diabetes was associated with foot problems. Not all people with T2DM thought that they were susceptible; spouses perceived greater susceptibility for the patient. This was unrelated to risk level. Most people with T2DM and all spouses engaged in behaviour to identify problems or protect feet, but rarely both. Spouses’ attitude and behaviour did influence the patients’ own behaviour. At times spouse support was perceived positively, and at times negatively.

Conclusion: Engaging spouses in foot care education may improve foot care behaviour.     

Does diabetes protect or provoke Alzheimer's disease? Insights into the pathobiology and future treatment of Alzheimer's disease

Diabetes mellitus has long been considered a risk factor for the development of vascular dementia. Epidemiologic evidence has suggested that diabetes mellitus significantly increases risk for the development of Alzheimer's disease, independent of vascular risk factors. As insulin's role as a neuromodulator in the brain has been described, its significance for AD has also emerged. Insulin dysregulation may contribute to AD pathology through several mechanisms including decreased cortical glucose utilization particularly in the hippocampus and entorhinal cortex; increased oxidative stress through the formation of advanced glycation end-products; increased Tau phosphorylation and neurofibrillary tangle formation; increased b-amyloid aggregation through inhibition of insulin-degrading enzyme. Future treatment of AD might involve pharmacologic and dietary manipulations of insulin and glucose regulation.     

Can the onset of type 2 diabetes be delayed by a group-based lifestyle intervention? A randomised control trial

This study was a randomised control trial with a waiting control group. It was designed to evaluate the effectiveness of a 6-month, group-based diabetes prevention programme, The Healthy Living Course and assess whether participation in the programme led to changes in modifiable risk factors for type 2 diabetes among an already at-risk pre-diabetic population. Individuals designated at risk for diabetes by their general practitioners (GPs) were screened using an Oral Glucose Tolerance Test. Volunteers (N = 307) with pre-diabetes were assigned to an intervention or wait-control group in the ratio of approximately 2 : 1. The sample was pre-tested on biochemical, anthropometric and self-report behavioural, cognitive and mood variables and post-tested either at the end of the educational/support-based lifestyle programme or the end of the wait period. The intervention group significantly improved their diabetes knowledge, motivation to change, positive affect, healthy eating and activity levels and showed significantly greater reductions in weight, body mass index, waist circumference, diastolic blood pressure and fasting plasma glucose in comparison with controls. The intervention group also changed their diagnostic status from pre-diabetes to non-diabetes at a greater rate than the wait group (43% vs. 26%) who received standard care from their GPs.     

Can the onset of type 2 diabetes be delayed by a group-based lifestyle intervention? A randomised control trial

This study was a randomised control trial with a waiting control group. It was designed to evaluate the effectiveness of a 6-month, group-based diabetes prevention programme, The Healthy Living Course and assess whether participation in the programme led to changes in modifiable risk factors for type 2 diabetes among an already at-risk pre-diabetic population. Individuals designated at risk for diabetes by their general practitioners (GPs) were screened using an Oral Glucose Tolerance Test. Volunteers (N?=?307) with pre-diabetes were assigned to an intervention or wait-control group in the ratio of approximately 2?:?1. The sample was pre-tested on biochemical, anthropometric and self-report behavioural, cognitive and mood variables and post-tested either at the end of the educational/support-based lifestyle programme or the end of the wait period. The intervention group significantly improved their diabetes knowledge, motivation to change, positive affect, healthy eating and activity levels and showed significantly greater reductions in weight, body mass index, waist circumference, diastolic blood pressure and fasting plasma glucose in comparison with controls. The intervention group also changed their diagnostic status from pre-diabetes to non-diabetes at a greater rate than the wait group (43% vs. 26%) who received standard care from their GPs.     

Association between quality of life of adolescents with type 1 diabetes and parents’ illness perception as evaluated by adolescents

Children and adolescents account for half of all cases of type 1 diabetes, which is one of the most common pediatric chronic diseases. The disease’s effects and the treatment/disease-management protocols patients must follow can lead to a marked deterioration in quality of life, especially for adolescents. Patients’ illness perceptions have been shown to impact their quality of life, but do other people’s illness perceptions also have an effect? The present study addressed this question by investigating possible links between the quality of life of adolescent patients with type 1 diabetes and illness perceptions, measured in terms of the adolescents’ self-perceptions, parents’ self-perceptions, and the adolescents’ evaluations of their parents’ perceptions. We asked 41 adolescents (M = 13.9 years; SD = 1.9) who had been undergoing treatment for type 1 diabetes for at least a year (M = 6.6 years; SD = 3.7) to complete the Diabetes Quality of Life for Youth Questionnaire-Short Form (DQOLY-SF) and the Illness Perception Questionnaire-Revised (IPQ-R). They completed the IPQ-R twice, once to state their own opinions (self-report) and once to give their evaluations of their parents’ perceptions. At the same time, but in a different room, their parents (N = 47) completed the IPQ-R (self-report). Quality of life was predicted by gender (p < .05) and by the parents’ emotional representations (p < .01) and perceptions of consequences (p < .01) as evaluated by the adolescents. This new approach provides new insights into the impact of parents’ perceptions on the quality of life of adolescents with type 1 diabetes.     

Parent–adolescent conflict,treatment adherence and glycemic control in Type 1 diabetes: The importance of adolescent externalising symptoms

Parent–adolescent conflict has been demonstrated to relate to treatment adherence and glycemic control in adolescents with Type 1 diabetes. The present longitudinal study investigated how these variables were interrelated over time, and examined whether externalising and internalising symptoms function as mediating variables. A total of 109 adolescents with diabetes participated at four annual time points and completed measures on conflict with parents, internalising and externalising symptoms. Information on treatment non-adherence and glycemic control was obtained from treating physicians. Cross-lagged analyses from a structural equation modelling approach indicated that father–adolescent but not mother–adolescent conflict positively influenced treatment non-adherence over time, which, in turn, was associated with higher glycosylated haemoglobin-values. Further, externalising but not internalising symptoms were found to mediate the pathway from father–adolescent conflict to treatment adherence over time. Finally, mother–adolescent conflict was found to relate indirectly to treatment non-adherence through its relationship with externalising symptoms. Hence, the present longitudinal study provides evidence that externalising symptoms represent an important mechanism through which earlier experiences of parent–adolescent conflict may influence later treatment non-adherence and poorer glycemic control. Implications and suggestions for future research are outlined.