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Peyrot M.,Loyola University Maryland | Burns K.K.,University of Alberta | Davies M.,University of Leicester | Forbes A.,Kings College London | And 8 more authors.
Diabetes Research and Clinical Practice | Year: 2013

Aims: The Diabetes Attitudes Wishes and Needs 2 (DAWN2) study aims to provide a holistic assessment of diabetes care and management among people with diabetes (PWD), family members (FM), and healthcare professionals (HCPs) and explores potential drivers leading to active management. Methods: DAWN2 survey over 16,000 individuals (∼9000 PWD, ∼2000 FM of PWD, and ∼5000 HCPs) in 17 countries across 4 continents. Respondents complete a group-specific questionnaire; items are designed to allow cross-group comparisons on common topics. The questionnaires comprise elements from the original DAWN study (2001), as well as psychometrically validated instruments and novel questions developed for this study to assess self-management, attitudes/beliefs, disease impact/burden, psychosocial distress, health-related quality of life, healthcare provision/receipt, social support and priorities for improvement in the future. The questionnaires are completed predominantly online or by telephone interview, supplemented by face-to-face interviews in countries with low internet access. In each country, recruitment ensures representation of the diabetes population in terms of geographical distribution, age, gender, education and disease status. Discussion: DAWN2 aims to build on the original DAWN study to identify new avenues for improving diabetes care. This paper describes the study rationale, goals and methodology. © 2012 Elsevier Ireland Ltd. Source

Schmitt A.,Research Institute of the Diabetes Academy Mergentheim FIDAM | Gahr A.,Research Institute of the Diabetes Academy Mergentheim FIDAM | Hermanns N.,Research Institute of the Diabetes Academy Mergentheim FIDAM | Kulzer B.,Research Institute of the Diabetes Academy Mergentheim FIDAM | And 2 more authors.
Health and Quality of Life Outcomes | Year: 2013

Background: Though several questionnaires on self-care and regimen adherence have been introduced, the evaluations do not always report consistent and substantial correlations with measures of glycaemic control. Small ability to explain variance in HbA1c constitutes a significant limitation of an instrument's use for scientific purposes as well as clinical practice. In order to assess self-care activities which can predict glycaemic control, the Diabetes Self-Management Questionnaire (DSMQ) was designed.Methods: A 16 item questionnaire to assess self-care activities associated with glycaemic control was developed, based on theoretical considerations and a process of empirical improvements. Four subscales, 'Glucose Management' (GM), 'Dietary Control' (DC), 'Physical Activity' (PA), and 'Health-Care Use' (HU), as well as a 'Sum Scale' (SS) as a global measure of self-care were derived. To evaluate its psychometric quality, 261 patients with type 1 or 2 diabetes were assessed with the DSMQ and an established analogous scale, the Summary of Diabetes Self-Care Activities Measure (SDSCA). The DSMQ's item and scale characteristics as well as factorial and convergent validity were analysed, and its convergence with HbA1c was compared to the SDSCA.Results: The items showed appropriate characteristics (mean item-total-correlation: 0.46 ± 0.12; mean correlation with HbA1c: -0.23 ± 0.09). Overall internal consistency (Cronbach's alpha) was good (0.84), consistencies of the subscales were acceptable (GM: 0.77; DC: 0.77; PA: 0.76; HU: 0.60). Principal component analysis indicated a four factor structure and confirmed the designed scale structure. Confirmatory factor analysis indicated appropriate fit of the four factor model. The DSMQ scales showed significant convergent correlations with their parallel SDSCA scales (GM: 0.57; DC: 0.52; PA: 0.58; HU: n/a; SS: 0.57) and HbA1c (GM: -0.39; DC: -0.30; PA: -0.15; HU: -0.22; SS: -0.40). All correlations with HbA1c were significantly stronger than those obtained with the SDSCA.Conclusions: This study provides preliminary evidence that the DSMQ is a reliable and valid instrument and enables an efficient assessment of self-care behaviours associated with glycaemic control. The questionnaire should be valuable for scientific analyses as well as clinical use in both type 1 and type 2 diabetes patients. © 2013 Schmitt et al.; licensee BioMed Central Ltd. Source

Ehrmann D.,Research Institute of the Diabetes Academy Mergentheim FIDAM | Kulzer B.,Research Institute of the Diabetes Academy Mergentheim FIDAM | Kulzer B.,Diabetes Center Mergentheim | Haak T.,Research Institute of the Diabetes Academy Mergentheim FIDAM | And 3 more authors.
Diabetic Medicine | Year: 2015

Aim: To investigate the longitudinal bi-directionality of diabetes-related distress and depressive symptoms. Methods: A total of 509 patients receiving intensified insulin therapy completed the Centre for Epidemiological Studies Depression scale questionnaire for the assessment of depressive symptoms as well as the Problem Areas in Diabetes questionnaire for the assessment of diabetes-related distress at baseline and at 6-month follow-up. Separate logistic and linear regression analyses for incidence and persistence were performed with demographic (age, gender, BMI) and medical (diabetes type, HbA1c, diabetes duration, late complications) control variables. Results: Diabetes-related distress at baseline increased the risk of the incidence of elevated depressive symptoms by 2.56-fold (odds ratio 2.56; 95% CI 1.15-5.72; P=0.02) when controlling for demographic and medical variables. In addition, diabetes-related distress at baseline doubled the chance of the persistence of elevated depressive symptoms (odds ratio 2.04, 95% CI 1.04-3.99; P=0.04) when controlling for demographic and medical variables. The chance of having persistent elevated diabetes-related distress was increased 5.94-fold (odds ratio 5.94, 95% CI 2.60-13.59; P<0.0001) when elevated depressive symptoms were present at baseline. None of the medical variables had an influence on incidence or persistence. Conclusions: Diabetes-related distress was identified as a risk factor for the incidence and persistence of depressive symptoms. Reducing diabetes-related distress could help to prevent the development of elevated depressive symptoms. Furthermore, depressive symptoms were identified as an amplifier for diabetes-related distress. Diabetes-related distress and depressive symptoms were independent risk factors for each other and should be monitored in routine care to disentangle their influence. © 2015 Diabetes UK. Source

Schmitt A.,Research Institute of the Diabetes Academy Mergentheim FIDAM | Schmitt A.,German Center for Diabetes Research | Reimer A.,Research Institute of the Diabetes Academy Mergentheim FIDAM | Reimer A.,German Center for Diabetes Research | And 9 more authors.
PLoS ONE | Year: 2016

Aim To appraise the Diabetes Self-Management Questionnaire (DSMQ)?s measurement of diabetes self-management as a statistical predictor of glycaemic control relative to the widely used SDSCA. Methods 248 patients with type 1 diabetes and 182 patients with type 2 diabetes were cross-sectionally assessed using the two self-report measures of diabetes self-management DSMQ and SDSCA; the scales were used as competing predictors of HbA1c. We developed a structural equation model of self-management as measured by the DSMQ and analysed the amount of variation explained in HbA1c; an analogue model was developed for the SDSCA. Results The structural equation models of self-management and glycaemic control showed very good fit to the data. The DSMQ?s measurement of self-management showed associations with HbA1c of ?0.53 for type 1 and ?0.46 for type 2 diabetes (both P < 0.001), explaining 21% and 28% of variation in glycaemic control, respectively. The SDSCA?s measurement showed associations with HbA1c of 0.14 (P = 0.030) for type 1 and 0.31 (P = 0.003) for type 2 diabetes, explaining 2% and 10% of glycaemic variation. Predictive power for glycaemic control was significantly higher for the DSMQ (P < 0.001). Conclusions This study supports the DSMQ as the preferred tool when analysing self-reported behavioural problems related to reduced glycaemic control. The scale may be useful for clinical assessments of patients with suboptimal diabetes outcomes or research on factors affecting associations between self-management behaviours and glycaemic control. © 2016 Schmitt et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Source

Hermanns N.,Research Institute of the Diabetes Academy Mergentheim FIDAM | Kulzer B.,Research Institute of the Diabetes Academy Mergentheim FIDAM | Maier B.,Research Institute of the Diabetes Academy Mergentheim FIDAM | Mahr M.,Research Institute of the Diabetes Academy Mergentheim FIDAM | Haak T.,Research Institute of the Diabetes Academy Mergentheim FIDAM
Patient Education and Counseling | Year: 2012

Objective: In a randomized, multi-centre trial, the effect of an education programme (MEDIAS 2 ICT) involving intensive insulin treatment for people with type 2 diabetes was compared with an established education programme as an active comparator condition (ACC). Methods: We investigated whether MEDIAS 2 ICT was non-inferior to ACC in overall glycaemic control. Secondary outcomes were the diabetes-related distress, diabetes knowledge, quality of life, self-care behavior, lipids, blood pressure and weight. Results: 186 subjects were randomized. After a six month follow-up the mean HbA1c decrease was 0.37% (from 8.2 ± 1.1% to 7.8 ± 1.5%) in the ACC and 0.63% (from 8.5 ± 1.5% to 7.9 ± 1.2%) in MEDIAS 2 ICT. The mean difference between both groups was -0.26% (95% CI -0.63 to -0.14) in favor of MEDIAS 2 ICT. This result was within the predefined limit for non-inferiority. Diabetes-related distress was significantly more reduced in MEDIAS 2 ICT (-3.4 ± 7.1) than in ACC (0.4 ± 9.0; p = 0.31). Conclusion: MEDIAS 2 ICT is as effective in lowering HbA1c as previously established education programmes, but showed superiority in reducing diabetes-related distress. Practical implications: MEDIAS 2 ICT provides an alternative for education of people with type 2 diabetes treated by multiple injection therapy. © 2011 Elsevier Ireland Ltd. Source

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