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 assess in participants in the Diabetes Prevention Program and Diabetes Prevention Pr... more Objective-To assess in participants in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study (DPP/DPPOS) whether diagnosis of diabetes predicted: elevated depressive symptoms (DS) or antidepressant medicine (ADM) use after diagnosis; diabetes status or duration had significant effect on DS or ADM use; and associations between A1C, fasting plasma glucose (FPG), normalization of FPG and DS or ADM use post diagnosis. Methods-DPP participants in 3 treatment arms [intensive lifestyle (ILS), metformin (MET), placebo (PLC)] were assessed semiannually or annually for diabetes, glucose control, ADM use, and DS. DS was measured using Beck Depression Inventory (BDI) questionnaire. Among the total 3234 enrolled participants, 1285 developed diabetes whose levels of depression were measured before and after their diabetes diagnosis. Results-Neither DS nor ADM use increased significantly following diabetes diagnosis. After diabetes diagnosis, higher FPG was associated with greater ADM use in the ILS arm independent of potential confounders; a 10 mg/dl higher in FPG is associated with 8.8% more odds of ADM use. Higher FPG, and higher A1C were associated with higher BDI scores in all three arms. On average, a participant with 10 mg/dl higher rise in FPG had a 0.07 increase in BDI score.
Purpose-The purpose of this study is to assess if diagnosis of type 2 diabetes affected healthrel... more Purpose-The purpose of this study is to assess if diagnosis of type 2 diabetes affected healthrelated quality of life (HRQoL) among participants in the Diabetes Prevention Program/Diabetes Prevention Program Outcome Study and changes with treatment or diabetes duration.
Objective-Antidepressant medication use (ADM) has been shown to predict diabetes. This paper asse... more Objective-Antidepressant medication use (ADM) has been shown to predict diabetes. This paper assessed the role of inflammatory markers in this relationship within the Diabetes Prevention Program (DPP). Methods-DPP participants randomized to Metformin (MET), Lifestyle Intervention (ILS) or placebo (PLB) were assessed for depression (BDI; Beck Depression Inventory) annually; ADM use semi-annually; serum inflammatory markers (CRP, IL-6) at baseline and Year 1; and diagnosis of T2DM semi-annually (over 3.2 years). Results-At baseline (N=3,187), mean BMI was 34 kg/m 2 (S.D. 6) and the median BDI score was 3 [interquartile range: 1-7]. 181 (5.7%) reported ADM use and 328 (10%) had BDI scores of ≥11. CRP and IL-6 levels did not differ by treatment group. Baseline ADM, but not BDI score, was associated with higher levels of baseline CRP adjusted for demographic, anthropometric variables, and other medications (20% higher, p=0.01). Year 1 CRP decreased for non-ADM users in the MET (−13.2%) and ILS (−34%) groups and ADM users in the ILS group (−29%). No associations were found with IL-6. CRP and continuous use of ADM predicted incident T2DM in the PLB group. In the ILS group, continuous and intermittent ADM, but not CRP, predicted T2DM. In the MET group, CRP predicted incident T2DM. CRP did not mediate the risk of T2DM with ADM use in any group.
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...
States have the latitude to mandate coverage of diabetes self-management education (DSME) service... more States have the latitude to mandate coverage of diabetes self-management education (DSME) services for privately insured and Medicaid patients. The impact of these mandates on the supply of DSME resources is unknown. This study compared changes in the supply of DSME programs and program sites accredited by the American Association for Diabetes Educators (AADE) and certified diabetes educators (CDE) between states that did and did not mandate benefits for DSME. Using a unique combination of legal and programmatic data sources, the authors employed fixed effects regression models with clustered robust standard errors to compare changes in the supply of AADE-accredited DSME programs, program sites, and CDEs in states that mandated benefits with states that did not. Given the variation in state mandates, models also estimated the impact of ''flexible'' reimbursement provisions on the supply of resources among adopting states. The supply of DSME resources has increased over time, but results indicate that mandated benefits were not a significant driver of these changes in the supply. The impact of flexible reimbursement provisions varied. Interestingly, provisions of the Affordable Care Act were associated with an increased supply of resources. Results suggest that extending benefits to previously insured patients does not increase the supply of DSME resources, but a rapid increase in patients entering the health system does encourage growth.
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.
Purpose-The purpose of this study is to assess if diagnosis of type 2 diabetes affected healthrel... more Purpose-The purpose of this study is to assess if diagnosis of type 2 diabetes affected healthrelated quality of life (HRQoL) among participants in the Diabetes Prevention Program/Diabetes Prevention Program Outcome Study and changes with treatment or diabetes duration.
Depression in patients with type 2 diabetes (T2D) is associated with long-term complications, dis... more Depression in patients with type 2 diabetes (T2D) is associated with long-term complications, disability, and early mortality. No studies have systematically examined the length of episodes and remission in adults with major depressive disorder (MDD) and T2D. This study examined the course of depressive disorders in patients with T2D and MDD. RESEARCH DESIGN AND METHODS Participants (N = 50) enrolled in a behavioral intervention for adults with T2D and MDD were interviewed using the Structured Clinical Interview for DSM-IV-TR to assess history of depressive disorders at baseline (lifetime history), postintervention, and 3-month follow-up. Onset and remission dates were recorded for all Axis I depressive disorders from birth to final interview. RESULTS Average number of MDD episodes was 1.8 with a mean duration of 23.4 months (SD 31.9; range 0.5-231.3). Over the life course, mean exposure to MDD was 43.1 months (SD 46.5; range 0.5-231.3). Kaplan-Meier survival curve analysis indicated median episode duration decreased with subsequent episodes (14 months, first episode; 9 months, second episode; P < 0.002). In patients with multiple depressive episodes, recovery time was shorter with each subsequent episode (P = 0.002). No differences in length of episode or remission were observed based on chronology of T2D diagnosis. CONCLUSIONS The overall exposure to depression in this sample of adults with T2D represents a substantial period of time that can contribute to negative medical and psychiatric outcomes. Recurrent episodes decrease in duration as do recovery periods, resulting in a waxing and waning pattern. Findings from this study underscore the need to effectively diagnose and treat depression in patients with T2D to minimize risk of future depressive episodes. Type 2 diabetes (T2D) affects more than 29.1 million Americans and was the seventh leading cause of death in the U.S. in 2010 (1). Additionally, T2D contributes significantly to overall health care expenditures, accounting for $245 billion in total expenses in 2012 alone (1). Depression is comorbid with T2D. One in four patients with T2D report elevated depressive symptoms, and 11% have been diagnosed with a clinical depressive disorder (2,3). Depressive symptoms and disorders are significantly associated with worsened glycemic control (4), greater severity of diabetes complications (5,6), poorer adherence to diabetes self-care (7-9), decreased quality of life (10),
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
Obesity and type 2 diabetes disproportionately impact U.S. racial and ethnic minority communities... more Obesity and type 2 diabetes disproportionately impact U.S. racial and ethnic minority communities and low-income populations. Improvements in implementing efficacious interventions to reduce the incidence of type 2 diabetes are underway (i.e., National Diabetes Prevention Program), but challenges in effectively scaling-up successful interventions and reaching at-risk populations remain.
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...
Comorbid diabetes and depression are a major clinical challenge as the outcomes of each condition... more Comorbid diabetes and depression are a major clinical challenge as the outcomes of each condition are worsened by the other. This article is based on the presentations and discussions during an international meeting on diabetes and depression convened by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) in collaboration with the National Institute of Mental Health and the Dialogue on Diabetes and Depression. While the psychological burden of diabetes may contribute to depression in some cases, this explanation does not sufficiently explain the relationship between these two conditions. Shared biological and behavioral mechanisms, such as hypothalamic-pituitary-adrenal axis activation, inflammation, autonomic dysfunction, sleep disturbance, inactive lifestyle, poor dietary habits, and environmental and cultural risk factors, are important to consider in understanding the link between depression and diabetes. Both individual psychological and pharmacological depression treatments are effective in people with diabetes, but the current range of treatment options is limited and has shown mixed effects on glycemic outcomes. More research is needed to understand what factors contribute to individual differences in vulnerability, treatment response, and resilience to depression and metabolic disorders across the life course and how best to provide care for people with comorbid diabetes and depression in different health care settings. Training programs are needed to create a cross-disciplinary workforce that can work in different models of care for comorbid conditions. Co morbid diabetes and depression represent a major clinical challenge as the outcomes of each condition are worsened by the presence of the other (1). In October 2012, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH), in collaboration with the National Institute of Mental Health and the Dialogue on Diabetes and Depression (2), convened a meeting of experts from 15 countries for two primary purposes. First, there was an opportunity to present and summarize the current state of the science on the association between depression and diabetes in the areas of basic, clinical, behavioral, and public health research. The second aim was to identify and highlight gaps in current scientific knowledge to inform the direction of future research and training (3). This article is not a review article but rather summarizes the evidence-based presentations and discussions during the meeting and synthesizes the scientific content and future research recommendations. Although no conference could include
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 assess in participants in the Diabetes Prevention Program and Diabetes Prevention Pr... more Objective-To assess in participants in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study (DPP/DPPOS) whether diagnosis of diabetes predicted: elevated depressive symptoms (DS) or antidepressant medicine (ADM) use after diagnosis; diabetes status or duration had significant effect on DS or ADM use; and associations between A1C, fasting plasma glucose (FPG), normalization of FPG and DS or ADM use post diagnosis. Methods-DPP participants in 3 treatment arms [intensive lifestyle (ILS), metformin (MET), placebo (PLC)] were assessed semiannually or annually for diabetes, glucose control, ADM use, and DS. DS was measured using Beck Depression Inventory (BDI) questionnaire. Among the total 3234 enrolled participants, 1285 developed diabetes whose levels of depression were measured before and after their diabetes diagnosis. Results-Neither DS nor ADM use increased significantly following diabetes diagnosis. After diabetes diagnosis, higher FPG was associated with greater ADM use in the ILS arm independent of potential confounders; a 10 mg/dl higher in FPG is associated with 8.8% more odds of ADM use. Higher FPG, and higher A1C were associated with higher BDI scores in all three arms. On average, a participant with 10 mg/dl higher rise in FPG had a 0.07 increase in BDI score.
Purpose-The purpose of this study is to assess if diagnosis of type 2 diabetes affected healthrel... more Purpose-The purpose of this study is to assess if diagnosis of type 2 diabetes affected healthrelated quality of life (HRQoL) among participants in the Diabetes Prevention Program/Diabetes Prevention Program Outcome Study and changes with treatment or diabetes duration.
Objective-Antidepressant medication use (ADM) has been shown to predict diabetes. This paper asse... more Objective-Antidepressant medication use (ADM) has been shown to predict diabetes. This paper assessed the role of inflammatory markers in this relationship within the Diabetes Prevention Program (DPP). Methods-DPP participants randomized to Metformin (MET), Lifestyle Intervention (ILS) or placebo (PLB) were assessed for depression (BDI; Beck Depression Inventory) annually; ADM use semi-annually; serum inflammatory markers (CRP, IL-6) at baseline and Year 1; and diagnosis of T2DM semi-annually (over 3.2 years). Results-At baseline (N=3,187), mean BMI was 34 kg/m 2 (S.D. 6) and the median BDI score was 3 [interquartile range: 1-7]. 181 (5.7%) reported ADM use and 328 (10%) had BDI scores of ≥11. CRP and IL-6 levels did not differ by treatment group. Baseline ADM, but not BDI score, was associated with higher levels of baseline CRP adjusted for demographic, anthropometric variables, and other medications (20% higher, p=0.01). Year 1 CRP decreased for non-ADM users in the MET (−13.2%) and ILS (−34%) groups and ADM users in the ILS group (−29%). No associations were found with IL-6. CRP and continuous use of ADM predicted incident T2DM in the PLB group. In the ILS group, continuous and intermittent ADM, but not CRP, predicted T2DM. In the MET group, CRP predicted incident T2DM. CRP did not mediate the risk of T2DM with ADM use in any group.
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...
States have the latitude to mandate coverage of diabetes self-management education (DSME) service... more States have the latitude to mandate coverage of diabetes self-management education (DSME) services for privately insured and Medicaid patients. The impact of these mandates on the supply of DSME resources is unknown. This study compared changes in the supply of DSME programs and program sites accredited by the American Association for Diabetes Educators (AADE) and certified diabetes educators (CDE) between states that did and did not mandate benefits for DSME. Using a unique combination of legal and programmatic data sources, the authors employed fixed effects regression models with clustered robust standard errors to compare changes in the supply of AADE-accredited DSME programs, program sites, and CDEs in states that mandated benefits with states that did not. Given the variation in state mandates, models also estimated the impact of ''flexible'' reimbursement provisions on the supply of resources among adopting states. The supply of DSME resources has increased over time, but results indicate that mandated benefits were not a significant driver of these changes in the supply. The impact of flexible reimbursement provisions varied. Interestingly, provisions of the Affordable Care Act were associated with an increased supply of resources. Results suggest that extending benefits to previously insured patients does not increase the supply of DSME resources, but a rapid increase in patients entering the health system does encourage growth.
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.
Purpose-The purpose of this study is to assess if diagnosis of type 2 diabetes affected healthrel... more Purpose-The purpose of this study is to assess if diagnosis of type 2 diabetes affected healthrelated quality of life (HRQoL) among participants in the Diabetes Prevention Program/Diabetes Prevention Program Outcome Study and changes with treatment or diabetes duration.
Depression in patients with type 2 diabetes (T2D) is associated with long-term complications, dis... more Depression in patients with type 2 diabetes (T2D) is associated with long-term complications, disability, and early mortality. No studies have systematically examined the length of episodes and remission in adults with major depressive disorder (MDD) and T2D. This study examined the course of depressive disorders in patients with T2D and MDD. RESEARCH DESIGN AND METHODS Participants (N = 50) enrolled in a behavioral intervention for adults with T2D and MDD were interviewed using the Structured Clinical Interview for DSM-IV-TR to assess history of depressive disorders at baseline (lifetime history), postintervention, and 3-month follow-up. Onset and remission dates were recorded for all Axis I depressive disorders from birth to final interview. RESULTS Average number of MDD episodes was 1.8 with a mean duration of 23.4 months (SD 31.9; range 0.5-231.3). Over the life course, mean exposure to MDD was 43.1 months (SD 46.5; range 0.5-231.3). Kaplan-Meier survival curve analysis indicated median episode duration decreased with subsequent episodes (14 months, first episode; 9 months, second episode; P < 0.002). In patients with multiple depressive episodes, recovery time was shorter with each subsequent episode (P = 0.002). No differences in length of episode or remission were observed based on chronology of T2D diagnosis. CONCLUSIONS The overall exposure to depression in this sample of adults with T2D represents a substantial period of time that can contribute to negative medical and psychiatric outcomes. Recurrent episodes decrease in duration as do recovery periods, resulting in a waxing and waning pattern. Findings from this study underscore the need to effectively diagnose and treat depression in patients with T2D to minimize risk of future depressive episodes. Type 2 diabetes (T2D) affects more than 29.1 million Americans and was the seventh leading cause of death in the U.S. in 2010 (1). Additionally, T2D contributes significantly to overall health care expenditures, accounting for $245 billion in total expenses in 2012 alone (1). Depression is comorbid with T2D. One in four patients with T2D report elevated depressive symptoms, and 11% have been diagnosed with a clinical depressive disorder (2,3). Depressive symptoms and disorders are significantly associated with worsened glycemic control (4), greater severity of diabetes complications (5,6), poorer adherence to diabetes self-care (7-9), decreased quality of life (10),
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
Obesity and type 2 diabetes disproportionately impact U.S. racial and ethnic minority communities... more Obesity and type 2 diabetes disproportionately impact U.S. racial and ethnic minority communities and low-income populations. Improvements in implementing efficacious interventions to reduce the incidence of type 2 diabetes are underway (i.e., National Diabetes Prevention Program), but challenges in effectively scaling-up successful interventions and reaching at-risk populations remain.
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...
Comorbid diabetes and depression are a major clinical challenge as the outcomes of each condition... more Comorbid diabetes and depression are a major clinical challenge as the outcomes of each condition are worsened by the other. This article is based on the presentations and discussions during an international meeting on diabetes and depression convened by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) in collaboration with the National Institute of Mental Health and the Dialogue on Diabetes and Depression. While the psychological burden of diabetes may contribute to depression in some cases, this explanation does not sufficiently explain the relationship between these two conditions. Shared biological and behavioral mechanisms, such as hypothalamic-pituitary-adrenal axis activation, inflammation, autonomic dysfunction, sleep disturbance, inactive lifestyle, poor dietary habits, and environmental and cultural risk factors, are important to consider in understanding the link between depression and diabetes. Both individual psychological and pharmacological depression treatments are effective in people with diabetes, but the current range of treatment options is limited and has shown mixed effects on glycemic outcomes. More research is needed to understand what factors contribute to individual differences in vulnerability, treatment response, and resilience to depression and metabolic disorders across the life course and how best to provide care for people with comorbid diabetes and depression in different health care settings. Training programs are needed to create a cross-disciplinary workforce that can work in different models of care for comorbid conditions. Co morbid diabetes and depression represent a major clinical challenge as the outcomes of each condition are worsened by the presence of the other (1). In October 2012, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH), in collaboration with the National Institute of Mental Health and the Dialogue on Diabetes and Depression (2), convened a meeting of experts from 15 countries for two primary purposes. First, there was an opportunity to present and summarize the current state of the science on the association between depression and diabetes in the areas of basic, clinical, behavioral, and public health research. The second aim was to identify and highlight gaps in current scientific knowledge to inform the direction of future research and training (3). This article is not a review article but rather summarizes the evidence-based presentations and discussions during the meeting and synthesizes the scientific content and future research recommendations. Although no conference could include
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Papers by Mary De Groot