Diabetes Distress During COVID-19: Three Brief ‘Snapshot’ Surveys of Adults With Diabetes Calling the Australian National Diabetes Services Scheme Helpline

The aim of this study was to take ‘snapshots’ of how people with diabetes are feeling emotionally during the coronavirus disease 2019 (COVID-19) pandemic. Three ‘snapshot’ surveys were conducted during May 2020, August 2020 and April 2021, each over a two-week period. Adults (≥18 years) with diabetes calling the Australian Government’s National Diabetes Services Scheme Helpline (NDSS) were invited to participate. Those who accepted were asked three questions sourced/adapted from the Problem Areas in Diabetes scale. Responses were recorded on a 5-point scale (0=’not a problem’, 4=’serious problem’). Of interest were scores ≥2, indicating this was at least a ‘moderate problem’. The survey was administered by NDSS Helpline staff via telephone. Basic demographic and clinical data were collected. In total, 1,278 surveys were completed over the three ‘snapshots’ (1st N=449; 2nd N=414; 3rd N=415). Participants were aged (median[IQR]) 62[47,72] years, 56% were women, and 57% had type 2 diabetes. At the 3rd ‘snapshot’, 21% had received a COVID-19 vaccine. Our findings show that feeling at least moderately ‘burned out’ by the constant effort needed to manage diabetes is salient, and consistently experienced by adults with diabetes calling the NDSS Helpline at three timepoints during the coronavirus pandemic. Those who participated in the 3rd ‘snapshot’ survey were less likely to report that feeling ‘alone with their diabetes’ or ‘worrying about their diabetes because of the COVID-19 pandemic’ were moderate or serious problems for them. Except for younger adults, findings indicate that the easing of restrictions may mitigate some of the effects of the pandemic on diabetes-specific emotional problems, including feeling ‘burned out’, ‘alone’ with diabetes, and/or worried about diabetes due to COVID-19. Prospective data are needed to improve our understanding of the emotional impact of COVID-19 on people with diabetes and to inform when and how to target support for those who need it most

The Social and Emotional Well-being of Indigenous Peoples Living With Diabetes: A Systematic Review Protocol

IntroductionGlobally, Indigenous people have a greater incidence and earlier onset of diabetes than the general population and have higher documented rates of emotional distress and mental illness. This systematic review will provide a synthesis and critical appraisal of the evidence focused on the social and emotional well-being of Indigenous peoples living with diabetes, including prevalence, impact, moderators, and the efficacy of interventions.MethodsWe will search MEDLINE Complete, EMBASE, APA PsycINFO, and CINAHL Complete from inception until late April 2021. Search strategies will include keywords related to Indigenous peoples, diabetes, and social and emotional well-being. All abstracts will be rated independently by two researchers against specified inclusion criteria. Eligible studies will report social and emotional well-being data for Indigenous people with diabetes, and/or report on the efficacy of interventions designed to address social and emotional well-being in this population. For each eligible study, quality will be rated using standard checklists to appraise each study’s internal validity, to be determined based on study type. Any discrepancies will be resolved through discussions and consultation with other investigators as needed. We expect to present a narrative synthesis of the evidence.DiscussionThe findings of the systematic review will enable greater understanding of the impact of relationships between diabetes and emotional well-being among Indigenous peoples to inform research, policy and practice. The findings will be accessible to Indigenous people affected by diabetes through a summary published in plain language on our research centre’s website.Systematic Review RegistrationPROSPERO registration number: CRD42021246560

Development and Feasibility of mHAT: A Smartphone App to Improve Awareness of Hypoglycemia

Development and Feasibility of mHAT: A Smartphone App to Improve Awareness of Hypoglycemi

Exploring engagement patterns within a mobile health intervention for women at risk of gestational diabetes.

Exploring engagement patterns within a mobile health intervention for women at risk of gestational diabetes

Psychosocial Outcomes among Users and Nonusers of Open-Source Automated Insulin Delivery Systems: Findings from an International Survey of Adults with Type 1 Diabetes

Background: Use of open-source automated insulin delivery (AID) is associated with improved psychosocial outcomes among people with type 1 diabetes (T1D) . However, research to date has been qualitative or used study-specific single items. There is a need for quantitative research using validated measures in larger samples. Method: We conducted an international online survey to examine the psychosocial outcomes of open-source AID users and non-users. Validated questionnaires assessed diabetes-specific quality of life (QoL) , impact of the COVID-pandemic on diabetes-specific QoL, diabetes specific-positive well-being, diabetes treatment satisfaction, diabetes distress, fear of hypoglycaemia, general emotional well-being, and subjective sleep quality. Results: 587 participants completed at least one questionnaire, including 447 adults using open-source AID (mean age 43, 42% women) and 140 non-users (mean age 40, 64% women) . Table 1 shows significant between-group differences for all questionnaire scores. Discussion: Adults with T1D using open-source AID report significantly better psychosocial outcomes than non-users. Due to the cross-sectional design of this study, we cannot make any causal inferences about the use of these devices. Further research is needed to examine the reasons for these differences. Disclosure J.Schipp: None. T.C.Skinner: None. J.Speight: Advisory Panel; Insulet Corporation, Research Support; Novo Nordisk, Sanofi. C.Hendrieckx: None. K.Braune: None. S.O'donnell: None. H.Ballhausen: None. B.Cleal: None. M.Wäldchen: None. C.Knoll: None. K.A.Gajewska: None. Funding European Commission Horizon 2020 (823902

Diabetes distress and sleep impairment in type 2 diabetes: A population‐based cross‐sectional study—The HUNT Study, Norway

AbstractAimsTo examine associations between sleep impairments and diabetes distress in men and women with type 2 diabetes (T2D) by using cross‐sectional data from the Trøndelag Health Study (HUNT).MethodsThis population‐based cross‐sectional study consists of individuals ≥20 years with T2D participating in the HUNT4 survey (2017–2019; n = 1954). Sleep impairments (snoring, sleep apnoea, troubles falling asleep, wake up during the night, early wakening, difficulties coping during the daytime due to sleep problems and restless legs) were measured by the sleeping HUNT‐Questionnaire, along with a separate question on the number of hours of sleep at night. Diabetes distress was measured using the Problem Areas in Diabetes (PAID‐5) questionnaire. Diabetes distress prevalence, grouped by sleep impairment, was estimated with 95% confidence intervals. Multivariable linear regression models with distress as outcome and adjusted for demographic, clinical and mental health factors were used to examine associations with sleep.ResultsOverall, sleep impairment was associated with increased diabetes distress. Regression coefficients B (95% CI) for higher distress score were 0.6 (95% CI 0.2, 0.9) for ≤7 h of sleep, 0.6 (95% CI 0.1–1.1) for snoring, 1.4 (95% CI 0.8–2.2) for troubles falling asleep, 1.1 (95% CI 0.6–1.6) for waking up during the night, 1.2 (95% CI 0.7–1.8) for early wakening, 2.6 (95% CI 1.7–3.6) for troubles coping during daytime due to sleep problems and 0.8 (95% CI 0.2–1.3) for restless legs.ConclusionMultiple components of sleep impairment were significantly associated with high diabetes distress in individuals with T2D

Psychosocial Outcomes Among Users and Nonusers of Open-Source Automated Insulin Delivery Systems: Multinational Survey of Adults With Type 1 Diabetes

Background Emerging research suggests that open-source automated insulin delivery (AID) may reduce diabetes burden and improve sleep quality and quality of life (QoL). However, the evidence is mostly qualitative or uses unvalidated, study-specific, single items. Validated person-reported outcome measures (PROMs) have demonstrated the benefits of other diabetes technologies. The relative lack of research investigating open-source AID using PROMs has been considered a missed opportunity. Objective This study aimed to examine the psychosocial outcomes of adults with type 1 diabetes using and not using open-source AID systems using a comprehensive set of validated PROMs in a real-world, multinational, cross-sectional study. Methods Adults with type 1 diabetes completed 8 validated measures of general emotional well-being (5-item World Health Organization Well-Being Index), sleep quality (Pittsburgh Sleep Quality Index), diabetes-specific QoL (modified DAWN Impact of Diabetes Profile), diabetes-specific positive well-being (4-item subscale of the 28-item Well-Being Questionnaire), diabetes treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire), diabetes distress (20-item Problem Areas in Diabetes scale), fear of hypoglycemia (short form of the Hypoglycemia Fear Survey II), and a measure of the impact of COVID-19 on QoL. Independent groups 2-tailed t tests and Mann-Whitney U tests compared PROM scores between adults with type 1 diabetes using and not using open-source AID. An analysis of covariance was used to adjust for potentially confounding variables, including all sociodemographic and clinical characteristics that differed by use of open-source AID. Results In total, 592 participants were eligible (attempting at least 1 questionnaire), including 451 using open-source AID (mean age 43, SD 13 years; n=189, 41.9% women) and 141 nonusers (mean age 40, SD 13 years; n=90, 63.8% women). Adults using open-source AID reported significantly better general emotional well-being and subjective sleep quality, as well as better diabetes-specific QoL, positive well-being, and treatment satisfaction. They also reported significantly less diabetes distress, fear of hypoglycemia, and perceived less impact of the COVID-19 pandemic on their QoL. All were medium-to-large effects (Cohen d=0.5-1.5). The differences between groups remained significant after adjusting for sociodemographic and clinical characteristics. Conclusions Adults with type 1 diabetes using open-source AID report significantly better psychosocial outcomes than those not using these systems, after adjusting for sociodemographic and clinical characteristics. Using validated, quantitative measures, this real-world study corroborates the beneficial psychosocial outcomes described previously in qualitative studies or using unvalidated study-specific items

Implementing a complex mHealth coaching intervention to prevent overweight, obesity and diabetes in high-risk women in antenatal care: an implementation protocol (Preprint)

Implementing a complex mHealth coaching intervention to prevent overweight, obesity and diabetes in high-risk women in antenatal care: an implementation protocol (Preprint

Six early CPAP-usage behavioural patterns determine peak CPAP adherence and permit tailored intervention, in patients with obstructive sleep apnoea

BackgroundHigh rates of non-adherence to continuous positive airway pressure (CPAP) in obstructive sleep apnoea hamper good clinical outcomes. Current recommendations assumes two behaviours (adherence and non-adherence) and days 7–90 follow-up post-CPAP initiation mitigates against non-adherence.ObjectivesTo investigate associations between early CPAP-usage behaviours and (1) CPAP adherence at month 3 of treatment and (2) sleep centres’ treatment pathways (the procedures patients undergo that may affect barriers or facilitators of CPAP adherence).MethodsWe conducted growth mixture modelling (GMM) on retrospective data from 1000 patients at 5 UK sleep centres. Night 1 to month 3 telemonitored CPAP-usage data were downloaded from 200 patients per centre who started CPAP in 2019 (100) or 2020 (100). Adherence was defined using accepted criteria (mean CPAP-usage ≥4 hours/night for ≥70% of nights).ResultsGMM identified six distinct CPAP-usage behaviour patterns over month 1. In four (54% of patients), CPAP-usage increased or decreased, in two (remaining 46%), CPAP-usage/non-usage was consistent. 62% of the cohort were non-adherent by month 3, despite pathways following current recommendations. 98% of patients who were non-adherent by month 3 were already non-adherent by month 1. Regression analysis with a separate dataset demonstrated that early CPAP-usage behaviour explained 86% of the variance in CPAP non-adherence at month 3.ConclusionsThese data, supported by previous work, indicate that recommended day 30–90 follow-up is too late to prevent CPAP non-adherence. Determining CPAP-usage behavioural pattern in week 2 identifies risk of CPAP non-adherence at month 3 and permits the possibility of tailored interventions

Bringing an end to diabetes stigma and discrimination: an international consensus statement on evidence and recommendations

To accelerate an end to diabetes stigma and discrimination, an international multi-disciplinary expert panel (N=51 members, 18 countries) conducted rapid reviews and participated in a three-round Delphi survey process. They achieved Consensus on 25 Statements of Evidence and 24 Statements of Recommendations. The Consensus is that diabetes stigma is driven primarily by blame, perceptions of burden/sickness, (in)visibility, and fear/disgust. People with diabetes often encounter stigma (negative social judgments, stereotypes, prejudice), which can adversely affect emotional, mental, and physical health, self-care, access to optimal healthcare, and social and professional opportunities. Up to one-in-three experience discrimination (unfair and prejudicial treatment) due to diabetes, e.g., in healthcare, education and employment. Diabetes stigma and discrimination are harmful, unacceptable, unethical, and counterproductive. Collective leadership is needed to pro-actively challenge, and bring an end to, diabetes stigma and discrimination. Consequently, the panel achieved unanimous consensus on a pledge to end diabetes stigma and discrimination.</p