Background
Living with diabetes
The Diabetes MILES Study International Collaborative
Diabetes self-care
Additional themes
Subtypes of depression
Type D “distressed” personality
Mindfulness
Sleep
Sexual functioning
Research questions
-
Is the Diabetes Self-Care Inventory - Revised a valid self-report measure of the frequency, perceived importance, and burden of diabetes self-care activities in people with diabetes?
-
Are different subtypes of emotional distress (melancholic versus atypical depressive symptoms, mixed depression/anxiety, anhedonia, manic symptoms) differentially associated with diabetes self-care activities and healthcare consumption?
-
Are people with Type D personality, compared to those without Type D personality (a) less likely to engage in adequate self-care activities in terms of diet, physical activity, medication use, disease monitoring, smoking and alcohol consumption; and (b) less likely to attend medical appointments or to consult their physician or nurse in case of symptoms or problems with diabetes self-care?
-
Is a higher level of mindfulness associated with greater engagement in self-care activities and better emotional well-being in people with diabetes?
-
Which factors are associated with sleep quality and quantity in people with diabetes? Is there a relationship between sleep problems and diabetes self-care?
-
What are the correlates of sexual dysfunction in people with diabetes?
Methods/design
Study design
Participants
Procedure
Measures
Concept | Measure or variable * | Survey version |
---|---|---|
Demographics | Sex†‡, age†‡, marital status†‡, ethnicity†, education†‡, current employment†‡, shift work | All participants |
Diabetes (clinical) | Diabetes type†‡, diabetes duration†‡, current treatment regimen†‡, current blood glucose level, most recent HbA1c†‡, HbA1c target level, number of severe hypos/hypers in past year, main diabetes health professional, membership of patient organisation†‡ | All participants |
General health | Height†‡, weight†‡, waist circumference†‡, hip circumference, presence of and medication for co-morbid conditions (including diabetes complications)†‡, number of hospitalisations in past year | All participants |
Health consultations | Number of contacts with health professionals† in past year, cancelled appointments in past year, consultation behaviour (10 items) | All participants |
Self-care behaviours | Diabetes Self-Care Inventory Revised (unpublished) plus Diabetes MILES – Australia smoking items†‡ | All participants |
Medication taking | ASK-12: Adherence Starts with Knowledge 12-item version [61] | All participants |
Physical Activity | IPAQ: International Physical Activity Questionnaire (Short Form)[62], questions about sedentary behaviour adapted from Diabetes MILES - Australia | All participants |
Eating behaviour | 38-item food frequency questionnaire | All participants |
Disordered eating | 6 items†‡ plus 2 items with respect to insulin adapted from Diabetes MILES – Australia | All participants |
Alcohol consumption | 1 item: number of units per week | All participants |
Diabetes-related distress | PAID: Problem Areas In Diabetes scale [63]†‡ | All participants |
Depression | PHQ-9: Patient Health Questionnaire 9-item scale [64]†‡ | All participants |
Anxiety | GAD-7: Generalized Anxiety Disorder 7-item scale [65]†‡ | All participants |
Type D personality | DS14: Type D Scale-14 [38] | All participants |
Stressful life event(s) | 1 item: stressful life event(s) in past year | All participants |
Loneliness | 1 item: loneliness in past year | All participants |
Psychological insulin resistance | ITAS: Insulin Treatment Appraisal Scale [66]†‡ | Module 1 |
Fear of hypoglycaemia | HFS-II: Hypoglycaemia Fear Survey-II [67] | Module 1 |
Diabetes-specific avoidance | 6 items | Module 1 |
Eating style | DEBQ: Dutch Eating Behavior Questionnaire [68] | Module 1,3 |
Beliefs about diabetes | BIPQ: Brief Illness Perception Questionnaire (diabetes version) [69]†‡ | Module 1,3 |
Anhedonia | 4-item anhedonia subscale HADS: Hospital Anxiety and Depression Scale [70] | Module 2 |
Manic symptoms | MDQ-NL: Mood Disorder Questionnaire [71] | Module 2 |
Subtypes of depression | IDS-SR: Inventory of Depressive Symptomatology – self reported [72] | Module 2 |
Mindfulness | FFMQ-NL: Five Facet Mindfulness Questionnaire – Dutch version [73] | Module 3 |
Neuropathic pain | NeuroQoL: Neuropathy and foot ulcer-specific Quality of Life questionnaire (physical symptom measures only) [74] | Module 3,4 |
Positive mental health | MHC-SF: Mental Health Continuum - Short Form (emotional and psychological subscales only) [75] | Module 3 |
Sleep | PSQI: Pittsburgh Sleep Quality Index [76] | Module 4 |
Fatigue | FAS: Fatigue Assessment Scale [77] | Module 4 |
Daytime sleepiness | ESS: Epworth Sleepiness Scale [78] | Module 4 |
Social support | MSPSS: Multidimensional Scale of Perceived Social Support [79] | Module 5 |
Relationship adjustment | DAS: Dyadic Adjustment Scale [80] | Module 5 |
Sexual problems | SSFS: Short Sexual Functioning Scale – male and female version (Enzlin et al., unpublished) | Module 5 |
Ethical principles
Statistical analyses
Sample characteristics
All | Type 1 diabetes | Type 2 diabetes | |
---|---|---|---|
(n=3,960) | (n=1,573) | (n=2,108) | |
Demographics
| |||
Women | 54% (2,133/3,925) | 61% (958/1,572) | 48% (1,020/2,108) ‡ |
Age in years | 55 ± 14 | 47 ± 15 | 62 ± 10 ‡ |
Ethnic minority | 3% (104/3,884) | 2% (34/1,573) | 3% (58/2,108) |
Educational level | |||
Low | 27% (1,040/3,870) | 19% (293/1,571) | 33% (684/2,101) |
Middle | 34% (1,313/3,870) | 35% (546/1,571) | 34% (704/2,101) |
High | 39% (1,517/3,870) | 47% (732/1,571) | 34% (713/2,101) ‡ |
Having a partner | 80% (3,107/3,889) | 80% (1,260/1,573) | 80% (1,682/2,108) |
Paid employment | 48% (1,838/3,873) | 63% (992/1,571) | 36% (763/2,104) ‡ |
Clinical characteristics
| |||
Duration of diabetes in years | 16 ± 13 | 23 ± 15 | 11 ± 8 ‡ |
Diabetes treatment | |||
Insulin pump | 24% (910/3,786) | 48% (761/1,572) | 6% (125/2,102) ‡ |
Insulin injections | 50% (1,891/3,786) | 53% (830/1,572) | 47% (995/2,102) † |
Glucagon-like peptide-1 (GLP-1) agonist injections | 2% (62/3,786) | 0.1% (2/1,572) | 3% (59/2,102) ‡ |
Blood glucose lowering tablets | 44% (1,627/3,664) | 7% (111/1,566) | 74% (1,474/1,987) ‡ |
Lifestyle only | 3% (99/3,726) | 0% (0/1,572) | 5% (95/2,042) ‡ |
Most recent HbA1c (mmol/mol) | 56 ± 12 | 58 ± 12 | 54 ± 12 ‡ |
Body Mass Index (kg/m2) | 28 ± 6 | 25 ± 5 | 30 ± 6 ‡ |
Macro-vascular disease and/or micro-vascular complications * | |||
None | 69% (2,544/3,691) | 70% (1,077/1,539) | 68% (1,383/2,041) |
One | 20% (729/3,691) | 18% (276/1,539) | 21% (436/2,041) |
Two or more | 11% (418/3,691) | 12% (186/1,539) | 11% (222/2,041) † |