Journal of diabetes science and technology, Nov 17, 2022
People with Alzheimer’s disease or related dementias and diabetes mellitus (ADRD-DM) are at high ... more People with Alzheimer’s disease or related dementias and diabetes mellitus (ADRD-DM) are at high risk for hypoglycemic events. Their cognitive impairment and psychosocial situation often hinder detection of hypoglycemia. Extending use and benefits of continuous glucose monitoring (CGM) to people with ADRD-DM could improve hypoglycemia detection, inform care, and reduce adverse events. However, cognitive impairment associated with ADRD presents unique challenges for CGM use. This commentary proposes applying the human-centered design process to CGM, investigating design solutions or interventions needed to integrate CGM into the health care of patients with ADRD-DM. With this process, we can identify and inform CGM designs for people with ADRD-DM, broadening CGM access, increasing detection and treatment of the silent threat posed by hypoglycemia.
Objective Data derived from the electronic health record (EHR) are commonly reused for quality im... more Objective Data derived from the electronic health record (EHR) are commonly reused for quality improvement, clinical decision-making, and empirical research despite having data quality challenges. Research highlighting EHR data quality concerns has largely been examined and identified during traditional in-person visits. To understand variations in data quality among patients managing type 2 diabetes mellitus (T2DM) with and without a history of telehealth visits, we examined three EHR data quality dimensions: timeliness, completeness, and information density. Methods We used EHR data (2016–2021) from a local enterprise data warehouse to quantify timeliness, completeness, and information density for diagnostic and laboratory test data. Means and chi-squared significance tests were computed to compare data quality dimensions between patients with and without a history of telehealth use. Results Mean timeliness or T2DM measurement age for the study sample was 77.8 days (95% confidence interval [CI], 39.6–116.4). Mean completeness for the sample was 0.891 (95% CI, 0.868–0.914). The mean information density score was 0.787 (95% CI, 0.747–0.827). EHR data for patients managing T2DM with a history of telehealth use were timelier (73.3 vs. 79.8 days), and measurements were more uniform across visits (0.795 vs. 0.784) based on information density scores, compared with patients with no history of telehealth use. Conclusion Overall, EHR data for patients managing T2DM with a history of telehealth visits were generally timelier and measurements were more uniform across visits than for patients with no history of telehealth visits. Chronic disease care relies on comprehensive patient data collected via hybrid care delivery models and includes important domains for continued data quality assessments prior to secondary reuse purposes.
OBJECTIVE: To determine whether interventions that slow or prevent the development of type 2 d... more OBJECTIVE: To determine whether interventions that slow or prevent the development of type 2 diabetes mellitus in those at risk reduce the subsequent prevalence of diabetic retinopathy. RESEARCH DESIGN AND METHODS: The Diabetes Prevention Program (DPP) randomized subjects at risk for developing type 2 diabetes because of overweight/obesity and dysglycemia to either metformin (MET), intensive lifestyle intervention (ILS) or placebo (PLB) to assess the prevention of diabetes. During the DPP and DPP Outcome Study (DPPOS), we performed fundus photography over time on study participants, regardless of their diabetes status. Fundus photographs were graded using the ETDRS grading system with diabetic retinopathy defined as typical lesions of diabetic retinopathy (microaneurysms, exudates or hemorrhage, or worse) in either eye. RESULTS: Despite reduced progression to diabetes in the ILS and MET groups compared to PLB, there was no difference in the prevalence of diabetic retinopathy b...
Past cross-sectional studies have suggested that young adults with insulin-dependent (Type 1) dia... more Past cross-sectional studies have suggested that young adults with insulin-dependent (Type 1) diabetes mellitus (IDDM) may experience problems in their close peer relationships. For 10 years, we have followed an onset cohort of children and adolescents with IDDM (n = 57) and an age-matched group who were originally recruited after an acute illness, accident, or injury (n = 54). Now aged 19-26 years, these two groups were compared in terms of their friendship patterns, dating and love experiences, and sense of loneliness. All subjects in both groups had at least one friend. However, the IDDM group reported fewer friendships overall. The difference was accounted for by the number of less intimate friends. The two groups had similar frequencies of current romantic partners (IDDM = 63%; comparison group = 64%). While dating attitude and dating assertiveness did not differ between groups, some differences were found in terms of experiences of a primary love relationship. IDDM patients experienced less trust and sense of intimate friendship in these love relationships. No differences in loneliness were found. The preponderance of our findings indicate that the two groups had similar patterns and experiences of close peer relationships. Thus, the study does not suggest that IDDM leads to serious problems in forming social relationships for these patients during the transition to young adulthood. On the other hand, the IDDM patients' lower level of trust and intimacy within love relationships are consistent with other findings from this study suggesting specific areas of lowered self-worth that appear in social relationships.
This study describes the mental health of US adults with (PWD) and without (ND) diabetes during t... more This study describes the mental health of US adults with (PWD) and without (ND) diabetes during the COVID-19 pandemic. A 24-month web-based survey was administered from May 2020 (baseline, n=2,176) to June 2022 (24MO; n=1,172; 5 time points). Demographics, pandemic experiences, diabetes distress (DDS-17), depression (PHQ-8) and anxiety (GAD-7) symptoms, perceived stress (PSS-10), and resilience (BRS) were collected. On average, 24MO completers (53.1%) were 53 years (SD=16.4), primarily female (80.9%) and White (91.3%), highly educated (45.0% post-master’s degree), homeowners (72.7%), with an annual household income of ≥ $60,000 (62.2%). They were less likely to have a diagnosis of depression compared to non-completers (all p<0.05). Mental health score means (SD) were DDS= 2.2 (1.0; moderate), PHQ=4.9 (5.0; mild), GAD=4.0 (4.7), PSS=13.3 (8.0). At 24MO, type 2 diabetes (TD2) prevalence was 14% (167), prediabetes 7% (82), and type 1 4% (52; T1D). PWD showed higher levels of financi...
Purpose: The purpose of this study was to assess the feasibility of delivering the Diabetes Tune-... more Purpose: The purpose of this study was to assess the feasibility of delivering the Diabetes Tune-Up Group (DTU), a cognitive-behavioral-therapy-based (CBT) multidisciplinary intervention for adults with diabetes distress and elevated A1C using a group in-person delivery format. Methods: The DTU intervention consisted of 6 weekly group sessions (90 minutes in duration per session). The groups were cofacilitated by a diabetes care and education specialist (DCES) and a master’s-level clinical psychology trainee. The intervention integrated CBT with patient-centered diabetes education. Using a pre/post study design, participants completed assessments at baseline, post-intervention, and 3 months following the intervention. Results: The sample consisted of 29 adults with type 1 diabetes (N = 8) or type 2 diabetes (N = 21) who were predominantly female (79%), White (59%), and educated (56% with a college degree or greater). Participants attended 131 total sessions out of 174 possible sessi...
RESULTS — A total of 24 studies satisfied the inclusion and exclusion criteria for the metaanalys... more RESULTS — A total of 24 studies satisfied the inclusion and exclusion criteria for the metaanalysis. Depression was significantly associated with hyperglycemia (Z = 5.4, P � 0.0001). The standardized ES was in the small-to-moderate range (0.17) and was consistent, as the 95% CI was narrow (0.13‐0.21). The ES was similar in studies of either type 1 or type 2 diabetes (ES 0.19 vs. 0.16) and larger when standardized interviews and diagnostic criteria rather than selfreport questionnaires were used to assess depression (ES 0.28 vs. 0.15). CONCLUSIONS — Depression is associated with hyperglycemia in patients with type 1 or type 2 diabetes. Additional studies are needed to establish the directional nature of this relationship and to determine the effects of depression treatment on glycemic control and the longterm course of diabetes. Diabetes Care 23:934‐942, 2000
Purpose: To test the association of autonomic nervous system (ANS) dysregulation symptoms and dia... more Purpose: To test the association of autonomic nervous system (ANS) dysregulation symptoms and diabetes distress (DD) in adults with type 2 diabetes (T2D). US adults (n=299) with self-identified type 2 diabetes completed a web-based survey in October 2022, including demographics, ANS reactivity symptoms (Body Perception Questionnaire; BPQ), diabetes-related distress (Diabetes Distress Scale-17; DDS-17), depressive symptoms (PHQ-8) and anxiety (GAD-7). Mean age was 60.2 years (S.D. = 13.6), 58.7% female, 82.9% White, with a median annual household income of $40,000-$60,000. Mean self-reported A1c was 7.0% (S.D. 1.2%). Self-reported medications: oral hypoglycemic agents (51.8%), oral medications and injectable insulin or other medications (26.7%), and diet and exercise alone (8.4%). Mean glucose checks was 1.5 times/day (S.D. = 4.9). The sample reported high levels of comorbid hypertension (65.4%), dyslipidemia (55.8%), sleep apnea (33.9%) and depression (36.2%). Mean DDS-17 score was ...
This study describes the mental health of US adults with and without diabetes (ND) over an 18-mon... more This study describes the mental health of US adults with and without diabetes (ND) over an 18-month period of the COVID-pandemic. A 12-month web-based survey was administered in May 2020 (N = 2,176) to June 2021 and November 2021 (18MO; N = 1,192) including demographics, pandemic experiences, depression (PHQ-8) and anxiety (GAD-7) symptoms, perceived stress (PSS) , and resilience (BRS) . Mean age of 18MO Completers (55%) was 53 years (SD = 16.4) , primarily female (80%) , White (91%) , with an annual household income of ≥ $60,000 (58%) . 165 had type 2 diabetes (T2D; 14%) , 83 had prediabetes (7%) , and 56 had type 1 (T1D; 5%) . Completers were more likely to be White, educated (45% post-master’s degree) , and homeowners with fewer medical and emotional comorbidities at baseline than non-completers (all p<.05) . At 18MO, mean PHQ-8 score was 5.2 (SD = 5.3; mild) , GAD-7 was 4.1 (SD = 4.8) , PSS was 13.2 (SD = 5.5) . All improved from baseline (p<.001) . Ages 18-30 had the high...
Journal of diabetes science and technology, Nov 17, 2022
People with Alzheimer’s disease or related dementias and diabetes mellitus (ADRD-DM) are at high ... more People with Alzheimer’s disease or related dementias and diabetes mellitus (ADRD-DM) are at high risk for hypoglycemic events. Their cognitive impairment and psychosocial situation often hinder detection of hypoglycemia. Extending use and benefits of continuous glucose monitoring (CGM) to people with ADRD-DM could improve hypoglycemia detection, inform care, and reduce adverse events. However, cognitive impairment associated with ADRD presents unique challenges for CGM use. This commentary proposes applying the human-centered design process to CGM, investigating design solutions or interventions needed to integrate CGM into the health care of patients with ADRD-DM. With this process, we can identify and inform CGM designs for people with ADRD-DM, broadening CGM access, increasing detection and treatment of the silent threat posed by hypoglycemia.
Objective Data derived from the electronic health record (EHR) are commonly reused for quality im... more Objective Data derived from the electronic health record (EHR) are commonly reused for quality improvement, clinical decision-making, and empirical research despite having data quality challenges. Research highlighting EHR data quality concerns has largely been examined and identified during traditional in-person visits. To understand variations in data quality among patients managing type 2 diabetes mellitus (T2DM) with and without a history of telehealth visits, we examined three EHR data quality dimensions: timeliness, completeness, and information density. Methods We used EHR data (2016–2021) from a local enterprise data warehouse to quantify timeliness, completeness, and information density for diagnostic and laboratory test data. Means and chi-squared significance tests were computed to compare data quality dimensions between patients with and without a history of telehealth use. Results Mean timeliness or T2DM measurement age for the study sample was 77.8 days (95% confidence interval [CI], 39.6–116.4). Mean completeness for the sample was 0.891 (95% CI, 0.868–0.914). The mean information density score was 0.787 (95% CI, 0.747–0.827). EHR data for patients managing T2DM with a history of telehealth use were timelier (73.3 vs. 79.8 days), and measurements were more uniform across visits (0.795 vs. 0.784) based on information density scores, compared with patients with no history of telehealth use. Conclusion Overall, EHR data for patients managing T2DM with a history of telehealth visits were generally timelier and measurements were more uniform across visits than for patients with no history of telehealth visits. Chronic disease care relies on comprehensive patient data collected via hybrid care delivery models and includes important domains for continued data quality assessments prior to secondary reuse purposes.
OBJECTIVE: To determine whether interventions that slow or prevent the development of type 2 d... more OBJECTIVE: To determine whether interventions that slow or prevent the development of type 2 diabetes mellitus in those at risk reduce the subsequent prevalence of diabetic retinopathy. RESEARCH DESIGN AND METHODS: The Diabetes Prevention Program (DPP) randomized subjects at risk for developing type 2 diabetes because of overweight/obesity and dysglycemia to either metformin (MET), intensive lifestyle intervention (ILS) or placebo (PLB) to assess the prevention of diabetes. During the DPP and DPP Outcome Study (DPPOS), we performed fundus photography over time on study participants, regardless of their diabetes status. Fundus photographs were graded using the ETDRS grading system with diabetic retinopathy defined as typical lesions of diabetic retinopathy (microaneurysms, exudates or hemorrhage, or worse) in either eye. RESULTS: Despite reduced progression to diabetes in the ILS and MET groups compared to PLB, there was no difference in the prevalence of diabetic retinopathy b...
Past cross-sectional studies have suggested that young adults with insulin-dependent (Type 1) dia... more Past cross-sectional studies have suggested that young adults with insulin-dependent (Type 1) diabetes mellitus (IDDM) may experience problems in their close peer relationships. For 10 years, we have followed an onset cohort of children and adolescents with IDDM (n = 57) and an age-matched group who were originally recruited after an acute illness, accident, or injury (n = 54). Now aged 19-26 years, these two groups were compared in terms of their friendship patterns, dating and love experiences, and sense of loneliness. All subjects in both groups had at least one friend. However, the IDDM group reported fewer friendships overall. The difference was accounted for by the number of less intimate friends. The two groups had similar frequencies of current romantic partners (IDDM = 63%; comparison group = 64%). While dating attitude and dating assertiveness did not differ between groups, some differences were found in terms of experiences of a primary love relationship. IDDM patients experienced less trust and sense of intimate friendship in these love relationships. No differences in loneliness were found. The preponderance of our findings indicate that the two groups had similar patterns and experiences of close peer relationships. Thus, the study does not suggest that IDDM leads to serious problems in forming social relationships for these patients during the transition to young adulthood. On the other hand, the IDDM patients&#39; lower level of trust and intimacy within love relationships are consistent with other findings from this study suggesting specific areas of lowered self-worth that appear in social relationships.
This study describes the mental health of US adults with (PWD) and without (ND) diabetes during t... more This study describes the mental health of US adults with (PWD) and without (ND) diabetes during the COVID-19 pandemic. A 24-month web-based survey was administered from May 2020 (baseline, n=2,176) to June 2022 (24MO; n=1,172; 5 time points). Demographics, pandemic experiences, diabetes distress (DDS-17), depression (PHQ-8) and anxiety (GAD-7) symptoms, perceived stress (PSS-10), and resilience (BRS) were collected. On average, 24MO completers (53.1%) were 53 years (SD=16.4), primarily female (80.9%) and White (91.3%), highly educated (45.0% post-master’s degree), homeowners (72.7%), with an annual household income of ≥ $60,000 (62.2%). They were less likely to have a diagnosis of depression compared to non-completers (all p<0.05). Mental health score means (SD) were DDS= 2.2 (1.0; moderate), PHQ=4.9 (5.0; mild), GAD=4.0 (4.7), PSS=13.3 (8.0). At 24MO, type 2 diabetes (TD2) prevalence was 14% (167), prediabetes 7% (82), and type 1 4% (52; T1D). PWD showed higher levels of financi...
Purpose: The purpose of this study was to assess the feasibility of delivering the Diabetes Tune-... more Purpose: The purpose of this study was to assess the feasibility of delivering the Diabetes Tune-Up Group (DTU), a cognitive-behavioral-therapy-based (CBT) multidisciplinary intervention for adults with diabetes distress and elevated A1C using a group in-person delivery format. Methods: The DTU intervention consisted of 6 weekly group sessions (90 minutes in duration per session). The groups were cofacilitated by a diabetes care and education specialist (DCES) and a master’s-level clinical psychology trainee. The intervention integrated CBT with patient-centered diabetes education. Using a pre/post study design, participants completed assessments at baseline, post-intervention, and 3 months following the intervention. Results: The sample consisted of 29 adults with type 1 diabetes (N = 8) or type 2 diabetes (N = 21) who were predominantly female (79%), White (59%), and educated (56% with a college degree or greater). Participants attended 131 total sessions out of 174 possible sessi...
RESULTS — A total of 24 studies satisfied the inclusion and exclusion criteria for the metaanalys... more RESULTS — A total of 24 studies satisfied the inclusion and exclusion criteria for the metaanalysis. Depression was significantly associated with hyperglycemia (Z = 5.4, P � 0.0001). The standardized ES was in the small-to-moderate range (0.17) and was consistent, as the 95% CI was narrow (0.13‐0.21). The ES was similar in studies of either type 1 or type 2 diabetes (ES 0.19 vs. 0.16) and larger when standardized interviews and diagnostic criteria rather than selfreport questionnaires were used to assess depression (ES 0.28 vs. 0.15). CONCLUSIONS — Depression is associated with hyperglycemia in patients with type 1 or type 2 diabetes. Additional studies are needed to establish the directional nature of this relationship and to determine the effects of depression treatment on glycemic control and the longterm course of diabetes. Diabetes Care 23:934‐942, 2000
Purpose: To test the association of autonomic nervous system (ANS) dysregulation symptoms and dia... more Purpose: To test the association of autonomic nervous system (ANS) dysregulation symptoms and diabetes distress (DD) in adults with type 2 diabetes (T2D). US adults (n=299) with self-identified type 2 diabetes completed a web-based survey in October 2022, including demographics, ANS reactivity symptoms (Body Perception Questionnaire; BPQ), diabetes-related distress (Diabetes Distress Scale-17; DDS-17), depressive symptoms (PHQ-8) and anxiety (GAD-7). Mean age was 60.2 years (S.D. = 13.6), 58.7% female, 82.9% White, with a median annual household income of $40,000-$60,000. Mean self-reported A1c was 7.0% (S.D. 1.2%). Self-reported medications: oral hypoglycemic agents (51.8%), oral medications and injectable insulin or other medications (26.7%), and diet and exercise alone (8.4%). Mean glucose checks was 1.5 times/day (S.D. = 4.9). The sample reported high levels of comorbid hypertension (65.4%), dyslipidemia (55.8%), sleep apnea (33.9%) and depression (36.2%). Mean DDS-17 score was ...
This study describes the mental health of US adults with and without diabetes (ND) over an 18-mon... more This study describes the mental health of US adults with and without diabetes (ND) over an 18-month period of the COVID-pandemic. A 12-month web-based survey was administered in May 2020 (N = 2,176) to June 2021 and November 2021 (18MO; N = 1,192) including demographics, pandemic experiences, depression (PHQ-8) and anxiety (GAD-7) symptoms, perceived stress (PSS) , and resilience (BRS) . Mean age of 18MO Completers (55%) was 53 years (SD = 16.4) , primarily female (80%) , White (91%) , with an annual household income of ≥ $60,000 (58%) . 165 had type 2 diabetes (T2D; 14%) , 83 had prediabetes (7%) , and 56 had type 1 (T1D; 5%) . Completers were more likely to be White, educated (45% post-master’s degree) , and homeowners with fewer medical and emotional comorbidities at baseline than non-completers (all p<.05) . At 18MO, mean PHQ-8 score was 5.2 (SD = 5.3; mild) , GAD-7 was 4.1 (SD = 4.8) , PSS was 13.2 (SD = 5.5) . All improved from baseline (p<.001) . Ages 18-30 had the high...
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Papers by Mary De Groot