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Polonsky W.H.,University of California at San Diego | Polonsky W.H.,Behavioral Diabetes Institute | Hajos T.R.S.,VU University Amsterdam | Dain M.-P.,Sanofi S.A. | Snoek F.J.,VU University Amsterdam
Current Medical Research and Opinion | Year: 2011

Objective: To examine the scope and underpinnings of psychological insulin resistance (PIR) across eight Western nations, with special attention to the potential influence of beliefs about insulin and broader patient beliefs regarding medications and diabetes. Methods: A total of 1400 subjects with insulin-naïve, type 2 diabetes across eight nations completed an online survey. The survey assessed willingness to start insulin, beliefs about insulin and current medications, and diabetes-related emotional distress. Results: The majority of respondents were male (59.3%), mean age was 51.6 years and mean diabetes duration was 6.1 years. A total of 17.2% reported they would be unwilling to start insulin (the PIR group), while 34.7% were ambivalent and 48.1% indicated they would be willing to do so. Marked differences by country were apparent, with PIR ranging from 5.9% (Spain) to 37.3% (Italy). Both unwilling and ambivalent patients reported significantly more negative (p<0.001; p<0.05) and fewer positive beliefs (p<0.001; p<0.01) about starting insulin, more negative feelings about their current medications (p<0.01, p<0.001), and more diabetes-related distress (p<0.001; p<0.05) than willing patients. Unwilling patients also reported significantly more negative (p<0.05) and fewer positive beliefs (p<0.001) about starting insulin than ambivalent patients. Conclusion: These are the first data demonstrating the prevalence of PIR across Western nations. PIR is strongly linked to positive and negative insulin beliefs, and may also reflect a broader discomfort with medications and with diabetes in general. Of note, however, PIR is a marker of behavioral intent only; it is not known whether this predicts actual behavior at the time when insulin is prescribed. When addressing patients who are reluctant to initiate insulin therapy, clinicians may find it valuable to inquire about their beliefs about insulin and their current medications. © 2011 Informa UK Ltd. Source

Fisher L.,University of California at San Francisco | Gonzalez J.S.,Yeshiva University | Polonsky W.H.,University of California at San Diego | Polonsky W.H.,Behavioral Diabetes Institute
Diabetic Medicine | Year: 2014

Studies have identified significant linkages between depression and diabetes, with depression associated with poor self-management behaviour, poor clinical outcomes and high rates of mortality. However, findings are not consistent across studies, yielding confusing and contradictory results about these relationships. We suggest that there has been a failure to define and measure 'depression' in a consistent manner. Because the diagnosis of depression is symptom-based only, without reference to source or content, the context of diabetes is not considered when addressing the emotional distress experienced by individuals struggling with diabetes. To reduce this confusion, we suggest that an underlying construct of 'emotional distress' be considered as a core construct to link diabetes-related distress, subclinical depression, elevated depression symptoms and major depressive disorder (MDD). We view emotional distress as a single, continuous dimension that has two primary characteristics: content and severity; that the primary content of emotional distress among these individuals include diabetes and its management, other life stresses and other contributors; and that both the content and severity of distress be addressed directly in clinical care. We suggest further that all patients, even those whose emotional distress rises to the level of MDD or anxiety disorders, can benefit from consideration of the content of distress to direct care effectively, and we suggest strategies for integrating the emotional side of diabetes into regular diabetes care. This approach can reduce confusion between depression and distress so that appropriate and targeted patient-centred interventions can occur. © 2014 Diabetes UK. Source

Polonsky W.H.,University of California at San Diego | Polonsky W.H.,Behavioral Diabetes Institute | Hessler D.,University of California at San Francisco
Diabetes Technology and Therapeutics | Year: 2013

Background: How does real-time (RT) continuous glucose monitoring (CGM) affect quality of life (QOL)? We explored the types and frequencies of diabetes-specific QOL changes resulting from RT-CGM as reported by current users and investigated what patient-reported factors predict these changes. Subjects and Methods: Current RT-CGM users (n=877) completed an online questionnaire investigating perceived QOL benefits/losses since RT-CGM initiation and RT-CGM attitudes and behavior. Exploratory factor analysis (EFA) examined the 16 QOL benefit/loss items to identify underlying factors. Regression analyses examined associations between demographics and RT-CGM attitudes and behavior with the QOL factors emerging from the EFA. Results: Three major QOL factors emerged: Perceived Control over Diabetes, Hypoglycemic Safety, and Interpersonal Support. QOL improvement was common for Perceived Control over Diabetes and Hypoglycemic Safety (86% and 85% of respondents, respectively), although less common for Interpersonal Support (37%). Consistent independent predictors of perceived benefits were greater confidence in using RT-CGM data (P<0.001), satisfaction with device accuracy (P≤0.05) and usability (P<0.01), older age (P<0.01), more frequent receiver screen views (P<0.05), and use of multiple daily injections (Hypoglycemic Safety and Interpersonal Support, P≤0.05). Conclusions: Diabetes-specific QOL benefits resulting from RT-CGM were common. Major predictors of QOL benefits were satisfaction with device accuracy and usability and trust in one's ability to use RT-CGM data, suggesting that "perceived efficacy," for both device and self, are key QOL determinants. Psychoeducational strategies to boost confidence in using RT-CGM data and provide reasonable device expectations might enhance QOL benefits. © Mary Ann Liebert, Inc. Source

Hajos T.R.S.,VU University Amsterdam | Polonsky W.H.,Behavioral Diabetes Institute | Pouwer F.,University of Tilburg | Gonder-Frederick L.,University of Virginia | Snoek F.J.,VU University Amsterdam
Diabetes Care | Year: 2014

Objective To determine a cutoff score for clinicallymeaningful fear of hypoglycemia (FoH) on the Hypoglycemia Fear Survey Worry subscale (HFS-W). Research Design And Methods Data on the HFS-W, history of hypoglycemia, emotional well-being (World Health Organization-5 well-being index), and distress about diabetes symptoms (Diabetes Symptom Checklist-Revised) were available from Dutch patients with type 2 diabeteswhowere treated with oral medication or insulin (n = 1,530). Four criteria were applied to define a threshold for clinically meaningful FoH: 1) modal score distribution (MD criterion), 2) scores 2 SDs above the mean (SD criterion), 3) concurrent validity with severe hypoglycemia and suboptimal well-being (CV criterion), and 4) an elevated score (‡3) on more than one HFS-Witem(elevated item endorsement [EI criterion]). Associations between the outcomes of these approaches and a history of severe hypoglycemia and suboptimal well-being were studied. Results Of the 1,530 patients, 19% had a HFS-Wscore of 0 (MD criterion), and 5% reported elevated FoH (HFS-W ‡ mean 1 2 SD; SD criterion). Patients with severe hypoglycemia reported higher HFS-W scores than those without (25 6 20 vs. 15 6 17; P 0.001). Patients with suboptimal well-being reported higher HFS-W scores than those with satisfactory well-being (20 6 18 vs. 13 6 15; P 0.001, CV criterion). Elevated FoH (defined by the EI criterion) was seen in 26% of patients. The SD and EI criteria were the strongest associated with history of severe hypoglycemia. The EI criterion was the strongest associated with suboptimal well-being. Conclusions Although no definite cutoff score has been determined, the EI criterion may be most indicative of clinically relevant FoH in this exploratory study. Further testing of the clinical relevance of this criterion is needed. © 2014 by the American Diabetes Association. Source

Polonsky W.H.,University of California at San Diego | Polonsky W.H.,Behavioral Diabetes Institute | Fisher L.,University of California at San Francisco | Hessler D.,University of California at San Francisco | And 2 more authors.
Diabetes, Obesity and Metabolism | Year: 2010

Aim: To examine patient beliefs, preferences and concerns regarding a once-weekly (QW) glucose-lowering medication option. Methods: A total of 1516 adults with type 2 diabetes drawn from a national Chronic Illness Panel completed an anonymous online survey that assessed perceived attributes of QW therapy, willingness to take an injectable QW medication and patient characteristics that might influence their willingness, such as current perceived glycaemic control and diabetes quality of life (DQOL). Results: Positive attitudes regarding QW medication were common, with current injection users significantly more likely than non-injection users to view beneficial aspects: greater convenience, better medication adherence, improved quality of life (QOL) and a less overwhelming sense of treatment (in all cases, p < 0.001). In all, 46.8% reported that they would likely take an injectable QW medication if recommended by their physician, with current injection users more than twice as likely as non-injection users (73.1 vs. 31.5%; p < 0.001). Greater willingness to take QW medications was associated with poorer DQOL [injection users only; odds ratio (OR) = 1.37, p < 0.01] and poorer perceived glycaemic control (non-injection users only; OR = 1.24, p < 0.05). Concerns arose about consistency of dosage over time, potential forgetfulness and cost. Conclusions: QW glucose-lowering medications are viewed positively by patients with type 2 diabetes, especially if they are current injection users or are dissatisfied with their current treatments or outcomes. Greater convenience, better medication adherence and improved QOL are commonly endorsed attributes. Clinicians may need to review both the positive attributes of QW medications as well as common patient concerns, when considering this option. © 2010 Blackwell Publishing Ltd. Source

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