Low empowerment and diabetes regimen distress are related to HbA1c in low income type 1 diabetes patients in a Brazilian tertiary public hospital
Abstract Background Adults with type 1 diabetes (T1D) have a high risk of developing depressive symptoms and diabetes-related distress (DD). Low socioeconomic level is associated with increased risk of poor self-management, treatment difficulties and psychological distress. The goals of this study w...
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| Format: | Article |
| Language: | English |
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BMC
2019-01-01
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| Series: | Diabetology & Metabolic Syndrome |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13098-019-0404-3 |
| _version_ | 1811293395477331968 |
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| author | M. S. V. M. Silveira A. Moura Neto A. C. Sposito L. Siminerio E. J. Pavin |
| author_facet | M. S. V. M. Silveira A. Moura Neto A. C. Sposito L. Siminerio E. J. Pavin |
| author_sort | M. S. V. M. Silveira |
| collection | DOAJ |
| description | Abstract Background Adults with type 1 diabetes (T1D) have a high risk of developing depressive symptoms and diabetes-related distress (DD). Low socioeconomic level is associated with increased risk of poor self-management, treatment difficulties and psychological distress. The goals of this study were to document the frequency of major depressive disorder (MDD), high depressive symptoms and high DD, to assess levels of empowerment and to determine the association with each of these measures and glycemic control in a low-income Brazilian sample of adults with T1D. Methods In a cross-sectional study, inclusion criteria were age > 18 years and diagnosis of T1D > 6 months. Exclusion criteria were cognitive impairment, history of major psychiatric disorders, severe diabetes-related complications and pregnancy. Diagnoses of MDD were made using interview-based DSM-5 criteria. Depressive symptoms were evaluated by the depression subscale of the Hospital Anxiety and Depression Scale (HAD-D). The Diabetes Distress Scale (DDS) assessed DD. Empowerment levels were evaluated by the Diabetes Empowerment Scale short form (DES-SF). Glycemic control was measured by HbA1c. The latest lipid panel results were recorded. Number of complications was obtained from medical records. Results Of the 63 T1D patients recruited, 36.5% were male, mean age was 31.5 (± 8.9), mean number of complications was 1 (± 1.1), and mean HbA1c was 10.0% (± 2). Frequency of MDD was 34.9% and 34.9% reported high depressive symptoms. Fifty-seven percent reported clinically meaningful DD. High diabetes regimen distress and low empowerment were associated to HbA1c (p = 0.003; p = 0.01, respectively). In multivariate analyses, lower empowerment levels were associated to higher HbA1c (beta − 1.11; r-partial 0.09; p value 0.0126). MDD and depressive symptoms were not significantly correlated with HbA1c in this expected direction (p = 0.72; p = 0.97, respectively). Conclusions This study showed high rates of MDD, high depressive symptoms and high DD and low levels of empowerment in this low income population. Empowerment and diabetes regimen distress were linked to glycemic control. The results emphasize the need to incorporate the psychological and psychosocial side of diabetes into strategies of care and education for T1D patients. |
| first_indexed | 2024-04-13T05:00:47Z |
| format | Article |
| id | doaj.art-9206766f1d694b3294294360e47f09d3 |
| institution | Directory Open Access Journal |
| issn | 1758-5996 |
| language | English |
| last_indexed | 2024-04-13T05:00:47Z |
| publishDate | 2019-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Diabetology & Metabolic Syndrome |
| spelling | doaj.art-9206766f1d694b3294294360e47f09d32022-12-22T03:01:21ZengBMCDiabetology & Metabolic Syndrome1758-59962019-01-011111810.1186/s13098-019-0404-3Low empowerment and diabetes regimen distress are related to HbA1c in low income type 1 diabetes patients in a Brazilian tertiary public hospitalM. S. V. M. Silveira0A. Moura Neto1A. C. Sposito2L. Siminerio3E. J. Pavin4Internal Medicine Postgraduate Program, Faculty of Medical Sciences, State University of CampinasEndocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences, State University of CampinasCardiology Division, Department of Internal Medicine, Faculty of Medical Sciences, State University of CampinasDiabetes Division, University of PittsburghEndocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences, State University of CampinasAbstract Background Adults with type 1 diabetes (T1D) have a high risk of developing depressive symptoms and diabetes-related distress (DD). Low socioeconomic level is associated with increased risk of poor self-management, treatment difficulties and psychological distress. The goals of this study were to document the frequency of major depressive disorder (MDD), high depressive symptoms and high DD, to assess levels of empowerment and to determine the association with each of these measures and glycemic control in a low-income Brazilian sample of adults with T1D. Methods In a cross-sectional study, inclusion criteria were age > 18 years and diagnosis of T1D > 6 months. Exclusion criteria were cognitive impairment, history of major psychiatric disorders, severe diabetes-related complications and pregnancy. Diagnoses of MDD were made using interview-based DSM-5 criteria. Depressive symptoms were evaluated by the depression subscale of the Hospital Anxiety and Depression Scale (HAD-D). The Diabetes Distress Scale (DDS) assessed DD. Empowerment levels were evaluated by the Diabetes Empowerment Scale short form (DES-SF). Glycemic control was measured by HbA1c. The latest lipid panel results were recorded. Number of complications was obtained from medical records. Results Of the 63 T1D patients recruited, 36.5% were male, mean age was 31.5 (± 8.9), mean number of complications was 1 (± 1.1), and mean HbA1c was 10.0% (± 2). Frequency of MDD was 34.9% and 34.9% reported high depressive symptoms. Fifty-seven percent reported clinically meaningful DD. High diabetes regimen distress and low empowerment were associated to HbA1c (p = 0.003; p = 0.01, respectively). In multivariate analyses, lower empowerment levels were associated to higher HbA1c (beta − 1.11; r-partial 0.09; p value 0.0126). MDD and depressive symptoms were not significantly correlated with HbA1c in this expected direction (p = 0.72; p = 0.97, respectively). Conclusions This study showed high rates of MDD, high depressive symptoms and high DD and low levels of empowerment in this low income population. Empowerment and diabetes regimen distress were linked to glycemic control. The results emphasize the need to incorporate the psychological and psychosocial side of diabetes into strategies of care and education for T1D patients.http://link.springer.com/article/10.1186/s13098-019-0404-3Diabetes mellitusType 1DepressionEmotional distressEmpowermentPatient |
| spellingShingle | M. S. V. M. Silveira A. Moura Neto A. C. Sposito L. Siminerio E. J. Pavin Low empowerment and diabetes regimen distress are related to HbA1c in low income type 1 diabetes patients in a Brazilian tertiary public hospital Diabetology & Metabolic Syndrome Diabetes mellitus Type 1 Depression Emotional distress Empowerment Patient |
| title | Low empowerment and diabetes regimen distress are related to HbA1c in low income type 1 diabetes patients in a Brazilian tertiary public hospital |
| title_full | Low empowerment and diabetes regimen distress are related to HbA1c in low income type 1 diabetes patients in a Brazilian tertiary public hospital |
| title_fullStr | Low empowerment and diabetes regimen distress are related to HbA1c in low income type 1 diabetes patients in a Brazilian tertiary public hospital |
| title_full_unstemmed | Low empowerment and diabetes regimen distress are related to HbA1c in low income type 1 diabetes patients in a Brazilian tertiary public hospital |
| title_short | Low empowerment and diabetes regimen distress are related to HbA1c in low income type 1 diabetes patients in a Brazilian tertiary public hospital |
| title_sort | low empowerment and diabetes regimen distress are related to hba1c in low income type 1 diabetes patients in a brazilian tertiary public hospital |
| topic | Diabetes mellitus Type 1 Depression Emotional distress Empowerment Patient |
| url | http://link.springer.com/article/10.1186/s13098-019-0404-3 |
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