What are disease perceptions and subjective treatment goals of insulin treated diabetic patients? (original) (raw)
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The DIAB.&TE.S Project: how patients perceive diabetes and diabetes therapy
Acta bio-medica : Atenei Parmensis, 2004
Assessment of quality of life (QoL) in diabetic patients is increasingly retained as a crucial parameter to take into account before concluding on the efficacy of new therapies. Indeed, the trend is to adopt treatments providing a genuine clinical benefit associated with a positive impact on QoL. In this context, DIAB.&TE.S Project aimed at analyzing patient's perception of psychological well-being, quality of treatment and their correlation with glyco-metabolic values control. A total of 1918 diabetic patients, mostly from southern Italy, were enrolled in this observational study. DIAB.&TE.S included a wide range of patients taking insulin monotherapy, OHA (oral hypoglycemic agents) monotherapy or combined therapy (insulin + OHA). Internationally recognized instruments such as the Well-Being Questionnaire (WBQ) and Diabetes Treatment Satisfaction Questionnaire (DTSQ) were used to assess general well-being and diabetes treatment satisfaction. Combined therapy was not highly effi...
Patient perceptions of diabetes and diabetes therapy: assessing quality of life
Diabetes/Metabolism Research and Reviews, 2002
Efforts to prevent complications of diabetes often overlook the impact of the condition and its treatment on current quality of life (QoL). The Diabetes Treatment Satisfaction Questionnaire (DTSQ) has proved valuable for understanding and measuring patients' treatment satisfaction in assessments of new treatments and strategies. For example, the DTSQ has demonstrated improved patient satisfaction with fast-acting insulin lispro versus standard soluble insulin and with long-acting insulin glargine versus NPH insulin. However, improvements in treatment satisfaction are often inferred to be improvements in overall QoL without recognizing the limited scope of the satisfaction measure. It is necessary to evaluate not only satisfaction with treatment per se but also the impact of diabetes and its treatment on a broad range of life domains in order to assess the impact on QoL. The Audit of Diabetes-Dependent Quality of Life (ADDQoL) measure is a diabetes-specific instrument that assesses the impact of diabetes on 18 life domains. Use of the ADDQoL with people with type 1 or type 2 diabetes has shown, on average, almost universally negative impact of diabetes on all domains. Significant differences have also been shown in the magnitude of effect between insulintreated and non-insulin-treated patients and patients with and without complications. The negative impact of diabetes on QoL has been observed despite high levels of treatment satisfaction (as measured by the DTSQ). The greatest negative impact was observed for the domain 'Freedom to eat as I wish', indicating the strong influence of dietary restrictions on QoL. Studies to assess the outcomes of treatment approaches designed to improve dietary flexibility are under way.
Eastern Mediterranean Health Journal
Background: Proper glycaemic control can slow progression of diabetes complications. One of the main causes of poor glycaemic control is delayed initiation of insulin therapy. Aims: To explain the reasons for delayed insulin initiation based on a behavioural model using patients' innate psychological needs. Methods: We enrolled 151 patients with type 2 diabetes who had indications for insulin therapy. Thirty general practitioners (GPs) were included as care providers. Patients were studied by questionnaires evaluating components of self determination theory, such as competency, relatedness and autonomy. We also evaluated patients' attitudes towards insulin therapy using the Insulin Treatment Appraisal Scale questionnaire. GPs' attitudes towards insulin therapy were assessed with a different questionnaire. Results: Competency of patients was scored as acceptable (14.44/20). Relatedness score was low at around 15.63/30. The findings suggested that the patients' intrinsic motivation was less than their extrinsic motivation (8.41/15 vs 15.03/20). The main barrier to insulin therapy on the patients' side was rejection of severity of illness (67.5%). According to GPs, low compliance (96.7%) was the main cause of delayed insulin prescription. Conclusions: We observed that patients do not have a proper understanding about their illness. Due to the low score of relatedness as a representative of patients and care providers' relationship, we highlight the importance of educating both about insulin therapy and how they can have the most effective relationship in this process.
Variation of patients’ views on Type 2 diabetes management over time
Diabetic Medicine, 2007
The aim of the study was to examine the relationship between participants' views about their role in diabetes treatment and their glycaemic control 3-7 years after having entered an educational intervention, and to investigate whether people's attitudes towards diabetes management change over an extended period of time. The present study is a long-term follow-up analysis of data collected from 193 persons with Type 2 diabetes. A qualitative content analysis of three open-ended questions about participants' self-perceived role in diabetes treatment was used. The related outcome measure was haemoglobin A(1c) (HbA(1c)). The way people viewed their role in diabetes management affected glycaemic control. Individuals in the Disease Manager or Compliant categories had significantly lower HbA(1c) compared with those in the Disheartened category. Furthermore, in people whose attitudes towards diabetes treatment was variable, weight and age influenced why participants changed their views and thus switched categories. Paradoxically, when people changed their views, this change did not produce a change in blood glucose control, which would have been expected. From the health-care provider's perspective, it is important to know how the person with diabetes perceives his/her role in disease management and to determine if a change in perception would be followed by intervention to adjust glycaemic control. Consequently, individuals' perception of disease management should be incorporated in patient education programmes and routine diabetes care to enable customized care and prevent stagnation in negative roles.
How diabetes and insulin therapy affects the lives of people with type 1 diabetes
European Diabetes Nursing, 2006
Background: Management of type 1 diabetes places a considerable burden upon patients in terms of frequent insulin injections and blood glucose monitoring. Aims: Patients' fears and thoughts concerning diabetes and treatment were explored in two focus groups. The features of insulin therapy most likely to influence treatment preferences of type 1 patients were investigated. These features would then be used to inform a quantitative patient preference study using a discrete choice experiment. Method: This qualitative study utilised two focus groups, guided by a detailed discussion script based upon clinician input and literature review. Six main topics related to diabetes and insulin therapy were discussed; impact on patient's lifestyle, hypoglycaemic events, predictability and ability to maintain blood glucose levels within recommended targets, injection devices, and negative effects of insulin therapies. In addition, the value people would place on improved insulin therapy measured in terms of their willingness to pay for new therapies, was discussed. Participants were recruited using a screener based upon clinician input. A total of 11 participants attended the two sessions. Transcripts were analysed using content analysis. Results: Participants reported that all six areas were of significant importance in diabetes management. Diabetes and insulin therapy had a huge impact on lifestyle in terms of activity and diet. Fear and experience of hypoglycaemic events were reported as significant concerns. Participants described predicting variation in glucose levels as the key to better management. Participants were willing to pay from £0.70 to £5.00 a day for a better insulin therapy. Conclusion: Diabetes and insulin therapy affects many areas of a patient's life. These data may help understand patients' motivations and treatment preferences, and shape future management and improve diabetic care.
Therapeutic Innovation Regulatory Science, 2014
This study aims to assess diabetic patients' knowledge of their disease, therapeutic goals, self-management, and its association with goal attainment at a hospital in Ethiopia. Methods: A prospective cross-sectional study was conducted from February to March 2012 at the diabetic follow-up clinic of Dessie Referral Hospital. Diabetic patients who came for their diabetic follow-up were included consecutively until a calculated sample size of 303 was obtained. Data were collected by face-to-face interview through a pretested structured questionnaire and by medical record review. Binary logistic regression analysis was used to determine predictors of fasting glycemic control. Results: Ninety-nine patients (32.7%) had poor knowledge about their disease. The average fasting blood glucose was 226.57 + 85.86 mg/dL, and only 61 patients (20.1%) achieved the recommended fasting glycemic goal (70-130 mg/dL). Diabetic patients who had poor knowledge were 5.53 times (95% confidence interval [CI]: 1.85, 16.49) more likely to not attain fasting glycemic goal compared to those who had good knowledge. Patients who did not practice self-monitoring of blood glucose were 3.09 times (95% CI: 1.33, 7.21) more likely to not attain fasting glycemic goal than those who practiced. Failure to achieve fasting glycemic goal was 2.43 times (95% CI: 1.15, 5.13) more common among patients who did not regularly exercise as compared to those who did. Patients who did not adhere to their medication were 3.72 times (95% CI: 1.69, 8.20) more likely to fail to achieve fasting glycemic goal compared to those who adhered to their medication. Conclusions: Fasting glycemic control was below the recommended standard among the study participants. Glycemic control was poor among patients who had poor knowledge, did not practice self-monitoring of blood glucose, did not participate in regular exercise, and were nonadherent to their medication. This study population had poor knowledge about their disease.
Validation of a Structured Interview for the Assessment of Diabetes Self-Management.
Diabetes …, 2000
OBJECTIVE -The authors developed and validated a semi-structured interview, the Diabetes Self-Management Profile (DSMP), to measure self-management of type 1 diabetes. The DSMP includes the following regimen components: exercise, management of hypoglycemia, diet, blood glucose testing, and insulin administration and dose adjustment.
Health and Quality of Life Outcomes, 2007
Background Although insulin therapy is well-accepted by symptomatic diabetic patients, it is still often delayed in less severe patients, in whom injectable insulin remains under-used. A better understanding of patients' perception of insulin would eventually help physicians to adopt the most appropriate dialogue when having to motivate patients to initiate or to intensify insulin injection. Methods The 'Studying the Hurdles of Insulin Prescription' (SHIP) questionnaire was developed based on a list of concepts derived from three diabetic patients' focus groups, and was included into two cross-sectional studies with similar design: SHIP Oral study and SHIP Premix study. Diabetic patients treated with oral hypoglycaemic agents (OHA; n = 1,494) and patients already treated with insulin (n = 1,150) completed the questionnaire at baseline, 6- and 12 months. Psychometric properties were assessed: 1) structure analysis by Principal Component Analysis (PCA) with Varimax rotation, 2) internal consistency reliability (Cronbach's alpha), and 3) concurrent validity (Spearman correlation coefficients with the Fear of Self-Injecting (FSI) score of the Diabetes Fear of Injecting and Self-testing Questionnaire. Reluctance/motivation towards insulin was assessed. Scores' ability to predict patients' insulin injection reluctance/motivation and initiation/intensification was evaluated with the Area Under the Receiver Operating Characteristic (ROC) Curve (AUC). Results PCA analysis confirmed the structure of the 14 items grouped into 3 dimensions: 'acceptance and motivation', 'fear and constraints', and 'restraints and barriers' towards insulin injection. Internal consistency reliability was excellent (Cronbach's alpha > 0.70); concurrent validity was good. The three scores were significantly predictive of patients' reluctance/motivation towards insulin injection initiation, as they were of patients' actual switch, except for the 'restraints and barriers' dimension. 'Acceptance and motivation' and 'fears and constraints' dimensions were also significantly predictive of patients' reluctance/motivation towards insulin intensification. By the end of the 12-month study, 179 of the initially OHA-treated patients had started insulin injections; 186 of the patients already treated with insulin had increased their injections. Conclusion The SHIP questionnaire provides reliable and valid assessment of diabetic patients' attitude towards insulin and injections. The predictive power of scores for patients' reluctance/motivation and actual treatment decisions demonstrates encouraging potential for further application in clinical practice.
Diabetes & Metabolism, 2009
Aim.-The main purpose of this survey was to describe type 2 diabetes (T2DM) from the patient's standpoint in a representative French panel in 2008. Methods.-Fourteen thousand two hundred and one individuals from the general population aged 45 or older completed a self-questionnaire exploring knowledge about diabetes; 1092 replies were from patients with T2DM. Results.-The prevalence of T2DM in this population was 7.7%, with demographics as follows: 60% men; mean age: 66 years; mean age at diagnosis: 55 years; mean BMI: 29 kg/m 2. Eighty-five percent of T2DM patients reported that they wanted more information about at least one aspect of the disease at diagnosis; they reported feeling anxious (30%), frightened (13%), angry (4%) or that the disease was unfair (12%). Half of the patients had modified their dietary habits but 71% found it difficult to engage in regular physical activity. Most patients (90%) were treated with drugs: 81% with oral antidiabetic drugs (OAD) (44% in monotherapy) while 19% received insulin (alone or in combination with OAD). Twenty-three percent complained of weight gain since start of current therapy (average gain of 7.3 kg). Insulin initiation represented a turning point for patients who became more aware of the disease severity, more willing to follow advice and to take greater control over their disease management. The mean time from diagnosis to insulin initiation was 13.8 years. Half of the patients perceived their disease as severe especially women, patients who initially reacted with anxiety, insulin-treated patients and those actively involved in their disease management. Some gender differences emerged: women took the disease more seriously, were more engaged in self-management, and reported a higher impact on daily life. Conclusions.-DIABASIS provides important information for diabetes care by highlighting patients' views of the disease, such as distress at diagnosis, lack of adequate information to cope with this distress and the important supportive role played by the family. A deeper understanding of patients' perception of the disease would help optimize customized care.