Testing mediator variables in a physical activity intervention for women with type 2 diabetes

ObjectivesA limited understanding of the mechanisms of behavior change has hindered the development of more effective interventions. The aim of this study was to identify potential mediators of objectively measured physical activity (PA) behavior change in women with type 2 diabetes (T2DM).DesignMediation test of a randomized controlled trial.MethodWomen with T2DM (n = 93) from the control group (standard PA materials, n = 44) and the full intervention group (control + stage-matched printed material and telephone counseling, n = 49) of a larger PA intervention trial were included. PA outcomes were minutes of MET weighted moderate and vigorous PA/week (self-report) and steps/3-days (objective) recorded at baseline and 12-months. Social-cognitive constructs were measured and tested in a mediating variable framework.ResultsPerceived behavioral control and barrier self-efficacy mediated intervention effects on objective PA (proportion of intervention effect mediated = 18% and 24% respectively). Intention was a mediator of objective PA (23%).ConclusionPerceived behavior control, barrier self-efficacy, and intention are effective mechanisms of PA behavior change in women with T2DM.     

Diabetes distress,illness perceptions and glycaemic control in adults with type 2 diabetes

The emotional distress associated with adjusting to and living with diabetes has been termed diabetes distress. Diabetes distress is associated with glycaemic control but interventions to reduce diabetes distress have failed to consistently improve diabetes control. Various illness perceptions have previously been linked with both diabetes distress and glycaemic control but interrelationships between these features have not been previously investigated. We hypothesised that illness perceptions mediate the relationship between diabetes distress and glycaemia. Participants with type 2 diabetes attending diabetes outpatient clinics (n = 84) provided demographic and clinical information and completed the Diabetes Distress Scale-17 and the Brief Illness Perceptions Questionnaire. Using regression analysis we demonstrated that the illness perceptions of personal control, regimen-related distress, socioeconomic status and insulin use were significant contributors in the final model predicting HbA_1c. Higher levels of personal control were associated with better glycaemic control. Conversely, regimen-related distress was associated with hyperglycaemia. Mediation analyses showed that the relationship between regimen-related distress and HbA_1c was mediated by personal control. Our work suggests that psychological interventions designed to reduce diabetes distress may be more efficacious in improving glycaemic control if they address an individual’s perception of personal control.     

Illness perception clusters and relationship quality are associated with diabetes distress in adults with Type 2 diabetes

This report aims to augment what is already known about emotional distress in Type 2 diabetes, by assessing the predictive value of illness perception clusters and relationship quality on four subcategories of Diabetes Distress.162 individuals with Type 2 diabetes responded to a postal questionnaire assessing demographics, depression, diabetes distress, illness perceptions and relationship quality. Long-term blood glucose was retrieved from participants’ General Practitioner. Three illness perception clusters emerged from the data, capturing three subgroups of participants sharing similar illness perception schemas. Regression analyses were performed across each diabetes distress subscale, with demographics, illness perception clusters, and relationship variables entered into three blocks. Covariates explained 51.1% of the variance in emotional burden, 41% of the variance in regimen-related distress, 20% of the variance in interpersonal distress, and 8.6% of the variance in physician-related distress. Cluster membership was strongly associated with emotional burden, regimen-related distress, and to a lesser degree interpersonal distress, but was not associated with physician-related distress. Relationship quality most strongly predicted regimen-related distress. Illness perception schemas and interpersonal issues influence emotional adjustment in diabetes. This study provides direction for the content of a novel approach to identifying and reducing diabetes distress in people with Type 2 diabetes.     

Associations between type of treatment and illness-specific locus of control in type 1 diabetes patients

Abstract

This study examined differences in diabetes-specific locus of control beliefs of 82 insulin-treated Type I diabetes patients undergoing either conventional therapy (CT), intensified conventional therapy (ICT) or continuous subcutaneous insulin infusion (CSII). Compared to CT with its adherence to a strict regimen, ICT and CSII allow a much greater flexibility in timing of meals and daily activities. On the other hand, such flexibility requires a much more active role of the patient. The hypotheses of higher internality and lower powerful others locus of control beliefs in ICT and CSII patients than in CT patients could be supported for powerful others locus of control only. A one-year follow-up replicated this finding. Furthermore, high powerful others locus of control was associated with low diabetes-related knowledge and poor glycaemic control. The relevance of the patients' experience with the respective treatment is examined in view of the results and implications for studies on the feasibility of diabetes regimens are discussed.     

Text‐message reminders plus incentives increase adherence to antidiabetic medication in adults with type 2 diabetes

Some adults with Type 2 diabetes mellitus have difficulty adhering to their oral medication regimens. The current study used a multiple baseline design with 3 adults with Type 2 diabetes. Medication taking was monitored remotely in real time via an electronic pill bottle. During the intervention, monetary incentives were delivered contingent on evidence of adherence to taking medication at specified times. Text‐message reminders were also sent if medication was not taken. Adherence increased for all participants. Future studies should separate the relative contributions of text‐message and incentive components of the intervention.     

Effect of a behavioral intervention on dimensions of self-regulation and physical activity among overweight and obese adults with type 2 diabetes: a pilot study

The purpose of this pilot study was to determine the preliminary effect of a behavioral intervention on the use of self-regulation strategies and moderate-to-vigorous physical activity (MVPA) in overweight and obese adults with type 2 diabetes. 23 individuals recruited from ResearchMatc.org and campus advertisements were randomized into an intervention (n = 12) and control (n = 11) group. The intervention group received a behavioral intervention that used goal setting, time management, and self-monitoring to target dimensions of self-regulation and MVPA. The control received information regarding their PA habits. MVPA was measured via BodyMedia Armbands at pre- and post-test. The use of self-regulatory strategies for MVPA was assessed at pretest and posttest using the Self-Regulation for Exercise Scale. Cohen’s d effect sizes were calculated to determine the practical impact of the intervention. The intervention had a large effect on all dimensions of self-regulation across time: including total self-regulation (3.15), self-monitoring (4.63), goal setting (3.17), social support (1.29), self-reward (1.98), time management (4.41), and overcoming barriers (2.25). The intervention had no impact on dimensions of MVPA across time. This pilot study demonstrated the ability of a behavioral intervention to improve the use of self-regulation strategies for MVPA in a sample of adults with type 2 diabetes. These findings can further inform the development of health promotion programs to promote self-regulation. Future research should focus on determining ability of improvements in self-regulation to stimulate behavior change.     

Self-efficacy and planning strategies can improve physical activity levels in women with a recent history of gestational diabetes mellitus

Introduction: Regular physical activity can reduce the risk of developing diabetes in high risk populations including in women with gestational diabetes mellitus (GDM). This study applied the Health Action Process Approach (HAPA) to determine the motivational and volitional factors important in increasing physical activity among women with previous GDM.

Methods: Women with GDM receiving obstetric care at a teaching hospital in Sri Lanka were invited to participate in a survey 6–36 months post-delivery. At baseline and 8 weeks later, 152 women completed postal and telephone surveys that collected socio-cognitive and physical activity data. The study hypotheses were tested using structural equation modelling.

Results: The modified model fit the data well (CFI = .95, TLI = .94, RMSEA = .057) and explained 11% of the variance in behaviour. Action self-efficacy was the only important predictor of intention to be physically active. Intention as well as maintenance self-efficacy predicted planning, which, in turn, predicted physical activity. Planning mediated the effect of intention and self-efficacy (maintenance and recovery) on physical activity.

Conclusion: This study has identified predictors of physical activity among women with previous GDM that can inform intervention studies. Interventions targeting this population need to include planning strategies and enhance self-efficacy.     

The effect of diabetes knowledge and attitudes on self-management and quality of life among people with type 2 diabetes

We examined the effect of diabetes knowledge and attitudes on self-management and quality of life (QoL) of people with type 2 diabetes mellitus (T2DM). We employed a cross-sectional study design. A total of 137 female and 129 male participants with T2DM completed the diabetes knowledge scale (DKN), Diabetes Integration Scale-19 (ATT19), Summary of Diabetes Self-care Activities (SDSCA) scale, and Diabetes Quality of Life (DQoL) scale, measuring diabetes knowledge, attitudes, self-management, and QoL respectively. The SDSCA scale measures diet, exercise, blood glucose monitoring, and foot care. The DQoL scale measures satisfaction and impact of QoL. An initial path model that tested the inter-relationships of the study variables was first identified based on previous research. Then, the path model was tested using Mplus 7.3. In the final model, diabetes knowledge was a significant predictor of attitudes and self-management in terms of blood glucose monitoring and foot care. Attitudes was a significant predictor of impact of QoL. Self-management in terms of blood glucose monitoring was a significant predictor of impact of QoL and diet was a significant predictor of satisfaction and impact of QoL. Exercise and foot care aspects of Self-management were significant predictors of satisfaction and impact of QoL respectively. The final model showed a good fit to the data: RMSEA = .045 (90% CI: .009, .071; Clfit = .601), CFI = .950, SRMR = .058. The findings suggest a theoretical basis to direct the development of appropriate health programs and interventions for improving QoL in people with T2DM and warrant replication in diverse samples.     

Diabetes and psychological co-morbidity in children with a family history of early-onset type 2 diabetes

The present study was conducted to evaluate for depressive symptoms and undiagnosed diabetes in children with familial history of early-onset type 2 diabetes. Studies have shown that diabetes doubles the risk for depression and that the duration of diabetes is related to the severity of the depression. Individuals with depression are also said to be at greater risk for developing diabetes. In many cases diabetes is detected whilst screening for depression. Fifty-three children aged between 6 and 17 years were screened for diabetes and assessed for depressive symptoms using the Children Depression Rating Scale, revised version (CDRS-R). Thirty-six (68.0 %) of the children with a family history of early-onset type 2 diabetes had CDRS-R scores consistent with likely or very likely major depressive disorders. Depressive symptoms score was predicted best by the number of generations of diabetes in the family, with an associated r = .65 and adjusted R(2) = .41. As the generations of diabetes increased, the more likely it was for a child to have diabetes (r = .38, p = .005). Four (7.5%) of the children were diagnosed with diabetes. The findings suggest that depressive symptoms are common in children with a family history of early onset type 2 diabetes and may co-exist with diabetes. The independent variable that reliably predicted the child depressive symptoms score was the number of generations of diabetes in the family.     

The effectiveness of cognitive behavioral group intervention on depression and anxiety in patients with type II diabetes

IntroductionDepression and anxiety are important risk factors for diabetes and high blood pressure.ObjectiveThis study investigated the effectiveness of the Cognitive-Behavioral Group Intervention for Diabetes Disease (CBGI-DD) in reducing depression and anxiety in female patients with type 2 diabetes (T2D).MethodThe CBGI-DD program includes 12 weekly 2.5 h sessions, spread weekly over the course of 3 months. The present study was semi-experimental and controlled, with assessments at pre-test and post-test. It included diagnostic criteria for the diagnosis of T2D in the patient's medical records by a diabetes specialist. Participants (62 female volunteers aged 25 to 75 years) were randomly allocated to a control or test group. Both groups responded to the Second edition of the Beck Depression Inventory (BDI-II) and the Beck Anxiety Inventory (BAI) before (pretest) and immediately after the intervention (posttest). Participants in the test group received CBGI-DD (from April up to the end of September 2018) at Mashhad Diabetes Center. The control group received only medical care during this period.ResultsAn analysis of covariance showed that compared to the control group, the test group had a significant reduction in anxiety and depression from pre-test to post-test (p < 0.05). It was compared post-test scores between the two groups, controlling for pre-test scores.ConclusionThe CBGI-DD program seems to be effective in reducing anxiety and depression in female patients with T2D. However, further research exploring the potential for long-term improvements in depression and anxiety is needed.     

Relationship beliefs and illness appraisals are differentially associated with specific ways of coping in spouses of patients with type 2 diabetes

Using data from 117 spouses of patients diagnosed with type 2 diabetes and multiple-group path analysis, the current study explored the association of four relationship beliefs (satisfaction, sacrifice, confidence and instability) and four diabetes appraisals (consequences, distress, control and efficacy) with illness-specific coping behaviour: active engagement, protective buffering and overprotection. The potential moderating effect of gender was also tested. Results indicated gender did moderate the associations among the variables in the model, with the association of relationship satisfaction and active engagement being significantly stronger for men, while diabetes control was more strongly related to protective buffering for women. The only variables associated with active engagement were three relationship-specific cognitions: higher levels of relationship satisfaction (for men only), satisfaction with sacrifice and relationship confidence were all related to higher active engagement. The diabetes appraisals were the only variables associated with protective buffering and overprotection. Higher diabetes distress and diabetes control (for women only) and lower diabetes efficacy were predictive of greater protective buffering. Lower diabetes efficacy and higher diabetes control were associated with greater overprotection. Implications for theory, research and practice are discussed.