Status psicologico, autoefficacia e controllo glicemico nel diabete tipo 2: studio trasversale e studio randomizzato controllato per valutare l\u2019efficacia di un intervento psicologico nel migliorare il controllo glicemico

PROGETTO I \u2013 STUDIO TRASVERSALE Distress psicologico, autoefficacia e controllo glicemico in soggetti con diabete tipo 2 Premesse e scopo dello studio: Depressione e bassa percezione di autoefficacia sono associati con scarso controllo glicemico in soggetti con diabete. Una scarsa aderenza al programma terapeutico potrebbe determinare un abbassamento del senso di efficacia incrementando la probabilit\ue0 di sintomi depressivi. E\u2019 stato condotto uno studio allo scopo di indagare la relazione tra distress psicologico, compenso metabolico e senso di autoefficacia in soggetti con diabete tipo 2 (DM2). Soggetti e Metodi: Sono stati analizzati 172 soggetti (104 M; 68 F) affetti da DM2 afferenti presso il Servizio di Diabetologia dell\u2019AOUI di Verona. A tutti i soggetti sono stati somministrati 4 questionari: la Beck Depression Inventory (BDI-II) per la rilevazione del tono dell\u2019umore, la Beck Anxiety Inventory (BAI) per la rilevazione dei livelli di ansia, la Binge Eating Scale (BES) per la rilevazione della severit\ue0 dei comportamenti Binge e il Multidimensional Diabetes Questionnaire che valuta, attraverso 3 sottoscale, lo stress legato al diabete, il supporto relazionale e l\u2019autoefficacia percepita. Risultati: I soggetti arruolati avevano un\u2019et\ue0 media (\ub1SD) di 62.6\ub17.5 anni, durata di diabete pari a 10.9\ub18.4 anni, body mass index (BMI) 31.4\ub14.0 Kg/m2, emoglobina glicosilata (HbA1c) % 7.5\ub11.2. Nel complesso, il 14.5% e il 18.6% dei soggetti analizzati presentava, rispettivamente, sintomi di ansia e depressione clinicamente rilevante. In analisi univariata la percezione di autoefficacia mostrava una correlazione negativa con il distress psicologico espresso in termini di depressione (r=-0.37, p<0.001), ansia (r=-0.28, p<0.001) e comportamenti binge (r=-0.48, p<0.001) e con gli indici di compenso metabolico, HbA1c (r=-0.21, p=0.005) e BMI (r=-0.25, p=0.001). All'aumentare di HbA1c aumentava la percezione di compromissione (r=0.33, p<0.001) e di gravit\ue0 (r=0.24, p=0.001) associata al diabete. Non \ue8 stata invece rilevata un'associazione tra HbA1c e distress psicologico (depressione: r= 0.019, p=0.80; ansia: r=0.10, p=0.15; comportamenti binge: r=0.14, p=0.07). Conclusioni: In un ampio campione di pazienti italiani affetti da DM2 si \ue8 riscontrata una elevata prevalenza di distress psicologico, ma questo non si associava significativamente con il controllo glicemico. Un peggiore compenso glicemico, maggiore adiposit\ue0 e una pi\uf9 elevata prevalenza di sintomi depressivi e ansiosi erano significativamente associati ad uno scarso senso di autoefficacia nei confronti della gestione del DM2. Questi risultati sottolineano il ruolo chiave della autoefficacia nella gestione del DM2 e suggeriscono che interventi mirati psicologici focalizzati su questo costrutto possano favorire un miglioramento degli outcome clinici e psicologici associati al diabete. PROGETTO II \u2013 STUDIO CLINICO RANDOMIZZATO CONTROLLATO Efficacia di un intervento psicologico nel migliorare il controllo glicemico e ridurre il distress psicologico in soggetti con diabete tipo 2 Premesse e scopo dello studio: Disturbi psicopatologici e disagio psicologico sono fattori individuali che giocano un ruolo importante nell'insorgenza e nel peggioramento del diabete. E\u2019 stato dimostrato che soggetti con DM hanno una probabilit\ue0 doppia di incorrere in un episodio depressivo nel corso della loro vita rispetto a soggetti non diabetici. Inoltre, in soggetti con diabete la depressione tende ad associarsi con scarsa aderenza al regime terapeutico, pi\uf9 complicanze e pi\uf9 alti tassi di ospedalizzazione. Ad oggi \ue8 poco chiaro il meccanismo sottostante la relazione tra distress psicologico e peggioramento degli outcome clinici associati al diabete. Il principale scopo di questa ricerca \ue8 stato valutare l'efficacia di un intervento psicologico in soggetti con diabete tipo 2 in non ottimale compenso glicemico Materiali e Metodi: 55 soggetti, 25 donne e 30 maschi di et\ue0 compresa tra 36 e 73 anni sono stati randomizzati a gruppo di controllo (cure standard) o a gruppo d'intervento (cure standard+intervento convenzionale). A tutti i soggetti che hanno accettato di partecipare allo studio sono stati somministrati una serie di test e questionari alla fine dell'intervento (T26) e a 12 settimane di Follow-up (T38). Risultati: Nei soggetti che hanno finora completato lo studio (N=44), si \ue8 osservato un significativo miglioramento del compenso glicemico (p=0.02) e una significativa riduzione del valore di BMI (p=0.005) dei soggetti del gruppo di intervento rispetto ai soggetti del gruppo di controllo. Analogamente, il gruppo di intervento presentava rispetto al gruppo di controllo una netta riduzione dello stato ansioso (p=0.027) e depressivo (p<0.001) e della severit\ue0 dei comportamenti binge (p=0.006). Infine, si \ue8 anche osservato un significativo aumento della percezione di autoefficacia nel gestire la malattia nel gruppo intervento (p<0.001) rispetto al gruppo di controllo. Nei soggetti che avevano completato il follow-up (N=38) si \ue8 osservato che gruppo intervento e gruppo di controllo non mostravano variazioni statisticamente significative relativamente al compenso glicemico (p=0.84) e al valore di BMI (p=0.47) durante l'arco temporale complessivo dello studio da T0 a T38. Per quanto riguarda la variabili psicologiche, al follow-up si confermava un significativa riduzione dello stato ansioso (p=0.019) e della sintomatologia depressiva (p=0.035). Non si \ue8 confermata invece la riduzione della gravit\ue0 dei comportamenti binge (p=0.12), mentre si manteneva significativamente aumentata la percezione dell' autoefficacia (p<0.001). Conclusioni: Il presente studio mostra l'efficacia di un intervento psicologico nel ridurre il distress psicologico e nel migliorare il controllo glicemico. Il maggior cambiamento si \ue8 rilevato nel corso del trattamento e tende a rimanere stabile al follow-up per le variabili psicologiche ma non per quelle metaboliche.PROJECT I \u2013 CROSS-SECTIONAL STUDY Psychological distress, self-efficacy and glycemic control in type 2 diabetes. Background: Psychological distress and poorer glycemic control are strongly associated together in people affected by diabetes mellitus. Higher diabetes-related self-efficacy is associated with both better glycemic control and increased engagement in self-care behaviors. Poor behavioral adherence to diabetic regimen (diet and physical activity) may lower self-efficacy, which would lead, in turn, to a higher likelihood of depressive symptoms. This study aimed to investigate the association among psychological distress, glycemic control and self-efficacy in type 2 diabetes (T2D). Subjects and Methods: One-hundred seventy-two subjects with T2D were consecutively recruited from the Verona Diabetes Center. Standard biochemical parameters and the following survey batteries were assessed in all study participants: the Beck Depression Inventory (BDI-II) to assess the severity of depression; the Beck Anxiety Inventory (BAI) to assess the level of anxiety; the Binge Eting Scale (BES) to assess the severity of binge eating; the Multidimensional Diabetes Questionanire to assess the psychosocial adjustment of patients to diabetes. Results: Age, body-mass index (BMI) and glucose control (HbA1c) were (mean\ub1SD) 62.6\ub17.5 years, 31.4\ub14.0 Kg/m\ub2, 7.5\ub11.2% respectively. Prevalence of clinically detectable anxiety and depression was 14.5% and 18.6%, respectively. Self-efficacy was inversely correlated with HbA1c (r=-0.21, p=0.005), BMI (r=-0.25, p=0.001) and with psychological distress, a composite endpoint comprised of depression (r=-0.37, p<0.001), anxiety (r=-0.28, p<0.001) and binge eating (r=-0.48, p<0.001). HbA1c was positively correlated with perceived interference (r=0.33, p<0.001) and perceived severity of diabetes (r=-0.14, p=0.001). No correlation was found between HbA1c and psychological distress (depression: r=0.019, p=0.80; anxiety: r=0.10 p=0.15; binge eating: r=0.14, p=0.07). Conclusions: Psychological distress was highly prevalent in a sample of T2D Italian patients. Despite psychological distress and glycemic control were not related to each other, we found that a lower sense of self-efficacy was significantly related to a poorer glycemic control, increased adiposity and a higher prevalence of depression and anxiety. Our data highlight the key role of self-efficacy in the management of T2D and suggest that interventions focused on improvement of self-efficacy may favorably impact both clinical and psychological diabetes outcomes. Project II \u2013 Randomized Clinical Trial Effects of psychological intervention on glycemic control and psychological distress in type 2 diabetic patients Background: Increasing evidence suggests that psychological disorders play an important role in the development and worsening of type 2 diabetes (T2D). Among the spectrum of psychological disorders, there is a wide literature about the association between depression and T2D and current data show an approximately two-fold prevalence of depression in adults affected by diabetes compared to un-affected subjects. Moreover, depression in diabetic patients is associated with higher blood glucose levels, poorer adherence to therapeutic regimens (whether pharmacological or therapeutic lifestyle changes), more medical complications, and higher hospitalization rates. Nevertheless, at the best of our knowledge, the mechanism underlying the association between depression and adverse diabetes-related outcomes is currently unresolved. Aim of this project is to assess the efficacy of a psychological treatment for diabetic patients with suboptimal level of Hemoglobin A1c. Subjects and Methods: 55 subjects, 25 females and 30 males were randomized to two treatment arms standard diabetes care or 24 individual sessions of psychological intervention. Those who agreed to take part in the study completed survey batteries at the end of the study (T26) and at 12-week follow-up (T38). Results: Among those who completed the 24-week study evaluation the intervention group showed lower HbA1c (p=0.02) and BMI (p=0.005)), markedly reduced anxiety e depression and higher perceived self-efficacy ) (p<0.001) compared to the control group at the end of the study. Among those subjects who completed the follow-up evaluation (N=38) there were not significant differences on measures of glycemic control (p=0.84) and BMI (p=0.47) from baseline (T0) to follow-up (T38). About psychological measures, at follow-up it was confirmed a significant decrease of anxiety (p=0.019) and depression (p=0.035) but not of binge eating (p=0.12), while it was confirmed a significant increase of diabetes self-efficacy (p<0.001). Conclusion: The data showed a significant decrease of psychological distress among type 2 diabetic patients after 24 weeks of psychological intervention added to standard medical care

Assessing attitudes towards insulin pump therapy in adults with type 1 diabetes: Italian validation of the Insulin Pump Attitudes Questionnaire (IT-IPA questionnaire)

Aims: The aim of the study was to adapt the German version of the insulin pump therapy (IPA) questionnaire to Italian (IT-IPA) and to evaluate its psychometric properties in adults with type 1 diabetes. Methods: We conducted a cross-sectional study, data were collected through an online survey. In addition to IT-IPA, questionnaires evaluating depression, anxiety, diabetes distress, self-efficacy, and treatment satisfaction were administered. The six factors identified in the IPA German version were assessed using confirmatory factor analysis; psychometric testing included construct validity and internal consistency. Results: The online survey was compiled by 182 individuals with type 1 diabetes: 45.6% continuous subcutaneous insulin infusion (CSII) users and 54.4% multiple daily insulin injection users. The six-factor model had a very good fit in our sample. The internal consistency was acceptable (Cronbach's α = 0.75; 95% IC [0.65-0.81]). Diabetes treatment satisfaction was positively correlated with a positive attitude towards CSII therapy (Spearman's rho = 0.31; p &lt; 0.01), less Technology Dependency, higher Ease of Use, and less Impaired Body Image. Furthermore, less Technology Dependency was associated with lower diabetes distress and depressive symptoms. Conclusions: The IT-IPA is a valid and reliable questionnaire evaluating attitudes towards insulin pump therapy. The questionnaire can be used for clinical practice during consultations for shared decision-making to CSII therapy

Technological devices utilization and its effect on psychological health status and glycemic control in emerging adults with type 1 diabetes: a 3-years prospective study

Aims: Various studies have investigated the relationship between depressive symptoms, diabetes distress, low adherence and glycemic control in adolescents with type 1 diabetes. Less is known about the impact of technological devices on diabetes management in young adults and its relationship with psychological well-being. The aim of the study is to investigate psychological health status and glycemic control during a three years period in a population of emerging adults (18-25 years) with type 1 diabetes. The relationship between technology utilization and psychological health status and glycemic control will be then investigated. Design: This is an observational, prospective (3 years) and multi-centric national study. Experimental sites: University of Padova, University of Bologna and University of Verona. Methods: Participant recruitment will be face to face or online. We aim to recruit at least 200 participants. Emerging adults will be recruited in Diabetology Units or in University Faculties. The study will be advertised via social media and posters. Socio-demographic and clinical data will be asked to participants. Glycemic control will be detected with HbA1c test (mmol/mol). Psychological health status will be assessed with generic and diabetes specific self-administered questionnaires, evaluating: depressive symptoms (PHQ-9), anxiety (GAD-7), adult attachment style (ECRR), sleep quality (PSQI), diabetes distress (PAID), self-efficacy in diabetes management (IT-DMSES), fear of hypoglicaemia (HFS-II), and treatment satisfaction (DTSQ). In patients using Continuous Subcutaneous Insulin Infusion (CSII), beneficial and barriers related to technology utilization will be investigated using the Insulin Pump Attitudes questionnaire (IPA) recently developed in Germany. The questionnaire will be firstly translated and adapted from German to Italian and, then, administered with the other questionnaires. With their permission, participants will be contacted after 12, 24 and 36 months to repeat the evaluation with the questionnaires previously used. Planned analysis: Primary endpoint: Descriptive statistics will examine participants\u2019 clinical characteristics at baseline. To analyze the trend of glycemic control and psychological health status over time (T0=baseline, T1=12 months, T2=24 months and T3=36 months), repeated measures mixed models will be used. These models are suitable in the presence of missing data. The effects that will be investigated in these analyses are: the mean effect of technological devices utilization (yes vs. no); the time trend of scores regardless of the technological devices utilization; and the time trend in each group. Secondary endpoint: Psychometric testing included construct validity (principal component analysis), internal consistency (Cronbach\u2019s \u3b1 coefficient) and convergent/discriminant validity (Spearman\u2019s correlation coefficient) will be performed for the Italian validation of the IPA questionnaire. Expected outcomes: \uf0d8 IPA Questionnaire will be validated in the Italian language in a population of emerging adults with type 1 diabetes. \uf0d8 Prevalence data on psychological health status of emerging adults with type 1 diabetes. \uf0d8 Longitudinal data (3 years) on psychological health status of emerging adults with type 1 diabetes. \uf0d8 Longitudinal data on the relationship between the use of technological device, glycemic control, and psychological health status in emerging adults with type 1 diabetes. Problems/Questions: 1) To include only patients who use technology devices or all patients with type 1 diabetes 2) Would be appropriate to build a questionnaire ad hoc to investigate the prevalence of use of proximal technology such as apps? PSA

Depressive symptoms and glycaemic control in adults with type 1 diabetes: an exploratory study on the role of family functioning

Psychological distress and family functioning have a considerable impact on diabetes self-management and glycaemic control in individuals with type 1 diabetes (T1D). However, the influence of both individual and family factors on glycaemic control has not been adequately investigated yet. This study aimed at examining the relationship between perceived family functioning and depressive symptoms with the frequency of capillary self-monitoring of blood glucose (SMBG) and glycaemic control (HbA1c) in a large sample of adults with T1D

Psychological distress, Self-Efficacy and Glycemic Control in Type 2 Diabetes

Aim \u2013 To investigate the association of glycemic control with depression, anxiety, self-efficacy and other diabetes-specific psychological measures in a cohort of adult patients with type 2 diabetes (T2D) free of severe chronic diabetes-related complications. Methods \u2013 In 172 T2D outpatients consecutively recruited at the Diabetes Center of Verona City Hospital, we performed a standard medical assessment and completed the Beck Depression Inventory-II (BDI-II), the Beck Anxiety Inventory (BAI) and the Multidimensional Diabetes Questionnaire (MDQ). Results \u2013 Age, body mass index (BMI) and glycosylated hemoglobin (HbA1c) were (median [IQR]): 64.0 [58.0-69.0] years, 31.0 [28.0-34.4] kg/m\ub2, and 7.3 [6.7-8.0] %, respectively. The overall prevalence of anxiety and depression was 14.5% and 18.6%, respectively. Higher levels of HbA1c were significantly (p<0.001) associated with a number of MDQ dimensions, such as higher perceived interference with daily activities (Spearman\u2019s rho coefficient=0.33), higher perceived diabetes severity (rho=0.28) and lower self-efficacy (rho=-0.27), but not with depression or anxiety. These three variables were also independent predictors of higher HbA1c levels, when entered in a multivariable stepwise-forward regression model that also included age, BMI, diabetes duration and diabetes-specific social support as covariates. Conclusion \u2013 Lower self-efficacy and higher diabetes distress were closely associated with poorer glycemic control. No direct association between HbA1c and clinical psychological symptoms was detected. These results highlight that a number of diabetes-specific psychological variables may play a role amidst psychological distress and glycemic control. Further studies are needed to elucidate the relevance of diabetes distress and self-efficacy to the achievement of individual glycemic targets

Sex differences in the association of psychological status with measures of physical activity and sedentary behaviour in adults with type 2 diabetes

Aim To assess the association of psychological variables on leisure-time physical activity and sedentary time in men and women with type 2 diabetes mellitus (T2D). Methods In this cross-sectional study, we evaluated 163 patients with T2D, consecutively recruited at the Diabetes Centre of the Verona General Hospital. Scores on depression and anxiety symptoms, psychosocial factors (including self-efficacy, perceived interference, perceived severity, social support, misguided support behaviour, spouse’s positive behaviour), physical activity and time spent sitting were ascertained using questionnaires responses to the Beck Depression Inventory-II, Beck Anxiety Inventory, Multidimensional Diabetes Questionnaire, International Physical Activity Questionnaire. Results Physical activity was significantly associated with higher social support in women and with increased self-efficacy in men. Sedentary time was significantly associated with higher perceived interference, anxiety and depressive symptoms, and with reduced diabetes self-efficacy in women, while it was associated solely with anxiety in men. Depressive symptoms and self-efficacy in women and anxiety symptoms in men were independent predictors of sedentary time when entered in a multivariable regression model also including age, BMI, haemoglobin A1c, diabetes duration, perceived interference and self-efficacy as covariates. Conclusions Lower self-efficacy and higher symptoms of depression were closely associated with increased sedentary time in women, but not in men, with T2D. It is possible that individualized behavioural interventions designed to reduce depressive symptoms and to improve diabetes self-efficacy would ultimately reduce sedentary behaviours, particularly in women with T2D

Growing up with type 1 diabetes mellitus: Data from the Verona Diabetes Transition Project

Aim Transition from paediatric to adult care is a critical step in life of emerging adults with type 1 diabetes. We assessed, according to indicators established by panel of experts, clinical, socio-demographic and psychosocial factors in young adults with type 1 diabetes throughout structured transition to investigate the associations, if any, with HbA(1c) value at time of transition. Methods The "Verona Diabetes Transition Project" started in January 2009: a structured transition program, shared between paediatric and adult clinic, was organised with a multi-disciplinary team. All young adults underwent a semi-structured interview by a psychologist, before transition. Minimum age for transition was 18 years. Results 222 (M/F = 113/109) young adults moved to adult care from January 2009 to March 2020. The mean time between the last paediatric visit and the first adult visit ranged from 13.6 +/- 6.1 months at the beginning of the project to 3.6 +/- 11.5 months over the following years. At first adult clinic attendance, women showed higher HbA(1c) values (70 +/- 11 mmol/mol vs. 65 +/- 7 mmol/mol or 8.57% +/- 1.51% vs. 8.14% +/- 0.98%, p = 0.01), higher frequency of disorders of eating behaviours (15.6% vs. 0%, p &lt; 0.001) and poor diabetes acceptance (23.9% vs. 9.7%, p &lt; 0.001) than men. Mediation analyses showed a significant mediating role of glucose control 2 years before transition in the relationship between poor diabetes acceptance and glucose control at transition. Conclusions This study demonstrated a delay reduction in establishing care with an adult provider and suggested the potential role of low diabetes acceptance on glycemic control at transition. Further studies are needed to confirm and expand these data

Programa de Sensibilización y Capacitación. Lengua y Escritura 3°. Actividad de Simulación. TERCE 2013

Este cuadernillo les acerca actividades que se asemejan a las que serán evaluadas y que pueden diferir de las que se utilizan habitualmente en la escuela

Programa de Sensibilización y Capacitación. Módulo Común para las Áreas Evaluadas. TERCE 2013

Presentar las características y el alcance del Estudio TERCE, como así también, las consideraciones más relevantes de los criterios de evaluación. Brindar información anticipada sobre las capacidades cognitivas y contenidos implicados en la resolución de los ítems o actividades de las evaluaciones TERCE

Programa de Sensibilización y Capacitación. Ciencias 6°. Actividad de Simulación. TERCE 2013

Este cuadernillo les acerca actividades que se asemejan a las que serán evaluadas y que pueden diferir de las que se utilizan habitualmente en la escuela