Emotional and quality-of-life aspects of diabetes management
- William H. Polonsky PhD, CDE
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Patients with diabetes commonly feel overwhelmed, frustrated, or “burned out” by the daily hassles of disease management and by the unending, often burdensome self-care demands. Many report feeling angry, guilty, or frightened about the disease, and often are unmotivated to complete diabetes self-care tasks. The toll of short- and long-term complications can make the disease even more burdensome. Not surprisingly, it is a consistent finding across studies that diabetes is associated with impaired health-related quality of life (HRQOL), measured in a variety of different ways. Importantly, the relationship between HRQOL and diabetes appears to be bidirectional. Both medical and psychosocial aspects of diabetes may negatively affect HRQOL; in turn, impaired HRQOL may negatively influence diabetes self-management. Unfortunately, the concept of HRQOL in diabetes remains unclear, making precise evaluation and intervention difficult.
There is growing agreement that the focus of HRQOL assessment should be on the subjective burden of symptoms, not merely on the presence of objectively identifiable problems. Proper evaluation should include both generic and diabetes-specific elements of HRQOL. In this article, a comprehensive multidimensional model of HRQOL in diabetes involving six major components is introduced and described. Representative self-report questionnaires that may be valuable in assessing these components are also presented. Once the patient's most important HRQOL issues have been identified and prioritized, appropriate intervention becomes possible. The good news is that there are now a growing number of research-based interventions available for addressing almost all of the HRQOL impairments that may occur.
- Glasgow RE, Ruggiero L, Eakin EG, et al.: Quality of life and associated characteristics in a large national sample of adults with diabetes. Diabetes Care 1997, 20:562–567. CrossRef
- Anderson RJ, Freedland KE, Clouse RE, Lustman PJ: The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 2001, 24:1069–1078. Examines 42 eligible studies and concludes that individuals with diabetes are at double the risk for depression compared to nondiabetic populations. Aggregate estimates point to the widespread nature of depression in diabetes. Major depressive disorder is present in 11% of diabetes patients, whereas elevated depression symptoms are apparent in 31% of diabetes patients. CrossRef
- Jacobson AM, de Groot M, Samson JA: The evaluation of two measures of quality of life in patients with type 1 and type 2 diabetes. Diabetes Care 1994, 17:267–274. CrossRef
- Polonsky WH, Anderson BJ, Lohrer PA, et al.: Assessment of diabetes-specific distress. Diabetes Care 1995, 18:754–760. CrossRef
- Delamater AM, Jacobson AJ, Anderson B, et al.: Psychosocial therapies in diabetes. Diabetes Care 2001, 24:1286–1292. CrossRef
- Polonsky WH, Welch G: Listening to our patients' concerns: understanding and addressing diabetes-specific emotional distress. Diabetes Spectrum 1996, 9:8–11.
- Freeman J, Loewe R: Barriers to communication about diabetes mellitus. Patients' and physicians' different view of the disease. J Fam Pract 2000, 49:513–542.
- Gill TM, Feinstein AR: A critical appraisal of the quality of quality-of-life measurements. JAMA 1994, 272:619–626. CrossRef
- Wood-Dauphinee S: Assessing quality of life in clinical research: from where have we come and where are we going? J Clin Epidemiol 1999, 52:355–363. CrossRef
- Anderson RM, Fitzgerald JT, Wisom K, et al.: A comparison of global versus disease-specific quality-of-life measures in patients with NIDDM. Diabetes Care 1997, 20:299–305. CrossRef
- Polonsky WH: Understanding and assessing diabetes-specific quality of life. Diabetes Spectrum 2000, 13:36–41.
- Bradley C: Measuring quality of life in diabetes. Diabetes Annu 1996, 10:207–224.
- Bradley C: Importance of differentiating health status from quality of life. Lancet 2001, 357:7–8. CrossRef
- Wulsin LR, Jacobson AM, Rand LI: Psychosocial aspects of diabetic retinopathy. Diabetes Care 1987, 10:367–373. CrossRef
- Hampton JK: Long-term effects of hemodialysis in diabetic patients with end stage renal disease. ANNA J 1992, 19:455–456.
- Van der Does FE, De Neeling JN, Snoek FJ, et al.: Symptoms and well-being in relation to glycemic control in type II diabetes. Diabetes Care 1996, 19:204–210. CrossRef
- Cryer PE: Hypoglycemia is the limiting factor in the management of diabetes. Diabetes Metab Res Rev 1999, 15:42–46. CrossRef
- Polonsky WH: Understanding and treating patients with diabetes burnout. In Practical Psychology for Diabetes Clinicians. Edited by Anderson BJ, Rubin RR. Alexandria, VA: American Diabetes Association; 1996:183–192.
- Lustman PJ, Anderson RJ, Freedland KE, et al.: Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care 2000, 23:934–942. CrossRef
- Lustman PJ: Anxiety disorders in adults with diabetes mellitus. Psychiatr Clin North Am 1988, 11:419–432.
- Eaton WW, Armenian H, Gallo J, et al.: Depression and risk for onset of type II diabetes: a prospective population-based study. Diabetes Care 1996, 19:1097–1020. CrossRef
- Kawakami N, Takatsuka N, Shimizu H, Ishibashi H: Depressive symptoms and occurrence of type 2 diabetes among Japanese men. Diabetes Care 1999, 22:1071–1076. CrossRef
- Nichols GA, Brown JB: Does depression cause diabetes, or diabetes cause depression? Diabetes 2000, 49(suppl 1):A63.
- Fisher L, Chesla CA, Mullan JT, et al.: Contributors to depression in Latino and European-American patients with type 2 diabetes. Diabetes Care 2001, 24:1751–1757. CrossRef
- Rydall AC, Rodin GM, Olmsted MP, et al.: Disordered eating behavior and microvascular complications in young women with insulin-dependent diabetes mellitus. N Engl J Med 1997, 336:1849–1854. CrossRef
- Peyrot M, McMurray JF, Kruger DF: A biopsychosocial model of glycemic control in diabetes: stress, coping and regimen adherence. J Health Soc Behav 1999, 40:141–158. A good review of the literature concerning stress, coping, adherence to diabetes self-care behaviors and metabolic control, followed by the presentation of a clear and comprehensive model that describes how these factors are intertwined. CrossRef
- Gonder-Frederick LA, Clarke WL, Cox DJ: The emotional, social and behavioral implications of insulin-induced hypoglycemia. Semin Clin Neuropsychiatry 1997, 2:57–65.
- Anderson BJ: Involving family members in diabetes treatment. In Practical Psychology for Diabetes Clinicians. Edited by Anderson BJ, Rubin RR. Alexandria, VA: American Diabetes Association; 1996:43–50.
- Glasgow RE, Toobert DJ: Social environment and regimen adherence among type 2 diabetic patients. Diabetes Care 1988, 11:377–386. CrossRef
- Boehm S, Schlenk EA, Funnell MM, et al.: Predictors of adherence to nutrition recommendations in people with non-insulin-dependent diabetes mellitus. Diabetes Educ 1997, 23:157–165. CrossRef
- Warner JP: Quality of life and social issues in older depressed patients. Int Clin Psychopharmacol 1998, 13(suppl 5): S19-S24. CrossRef
- Jacobson AM, Hauser ST, Lavori, P, et al.: Family environment and glycemic control: a four-year prospective study of children and adolescents with insulin-dependent diabetes mellitus. Psychosom Med 1994, 56:401–409.
- Fisher L, Chesla CA, Skaff MM, et al.: The family and disease management in Hispanic and European-American patients with type 2 diabetes. Diabetes Care 2000, 23:267–272. CrossRef
- Samuel-Hodge CD, Headen SW, Skelly AH, et al.: Influences on day-to-day self-management of type 2 diabetes among African-American women: spirituality, the multicaregiver role, and other social context factors. Diabetes Care 2000, 23:928–933. CrossRef
- Grootenhuis PA, Snoek FJ, Heine RJ, Bouter LM: Development of a type 2 diabetes symptom checklist: a measure of symptom severity. Diabet Med 1994, 11:253–261. CrossRef
- Bradley C, Todd C, Gorton T, et al.: The development of an individualized questionnaire measure of perceived impact of diabetes on quality of life: The ADDQoL. Qual Life Res 1999, 8:79–91. CrossRef
- Welch G, Jacobson AM, Polonsky WH: The problem areas in diabetes scale: an evaluation of its clinical utility. Diabetes Care 1995, 20:760–766. CrossRef
- Welch G, Weinger K, Polonsky W, Anderson B: Responsiveness to change in diabetes-related emotional distress: does the Problem Areas in Diabetes (PAID) questionnaire measure up? Diabet Med 2001, in press.
- Ware JH, Sherbourne CD: The MOS 36-item Short Form Health survey (SF-36) I: conceptual framework and item selection. Med Care 1992, 30:473–483. CrossRef
- Meijer JW, Trip J, Jaegers SM, et al.: Quality of life in patients with diabetic foot ulcers. Disabil Rehabil 2001, 23:336–340. CrossRef
- Sinclair AJ, Bayer AJ, Girling AJ, Woodhouse KW: Older adults, diabetes mellitus and visual acuity: a community-based case-control study. Age Ageing 2000, 29: 335–339. CrossRef
- Backonja M, Beydoun A, Edwards KR, et al.: Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomized controlled trial. JAMA 1998, 280:1831–1836. CrossRef
- Davies S, Gibby O, Phillips C, et al.: The health status of diabetes patients receiving orthotic therapy. Qual Life Res 2000, 9:233–240. CrossRef
- Radloff LS: The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Measures 1977, 1:385–401. CrossRef
- Lustman PJ, Griffith LS, Clouse RE, et al.: Effects of nortryptiline on depression and glycemic control in diabetes: results of a double-blind, placebo-controlled trial. Psychosom Med 1997, 59:241–250.
- Lustman PJ, Griffith LS, Freedland KE, et al.: Cognitive behavior therapy for depression in type 2 diabetes mellitus. A randomized, controlled trial. Ann Intern Med 1998,129:613–621.
- Lustman PJ, Freedland KE, Griffith LS, Clouse RE: Fluoxetine for depression in diabetes: a randomized double-blind placebo-controlled trial. Diabetes Care 2000, 23:618–623. CrossRef
- Cox DJ, Gonder-Frederick L, Polonsky W, et al.: Blood glucose awareness training (BGAT-2): long-term benefits. Diabetes Care 2001, 24:637–642. CrossRef
- Anderson RM, Funnell MM, Butler PM, et al.: Patient empowerment: results of a randomized controlled trial. Diabetes Care 1995, 18:943–949. CrossRef
- Snoek FJ, van der Ven NCW, Lubach C: Cognitive behavioral group training for poorly controlled type 1 patients: a psychoeducational approach. Diabetes Spectrum 1999, 12:147–152. One of the first published attempts to develop a comprehensive intervention for patients with poor glycemic control by targeting diabetes-related emotional distress. Only the most preliminary data for this first pilot study is presented, but the results seem promising.
- Weinger K, Jacobson AM: Psychosocial and quality of life correlates of glycemic control during intensive treatment of type 1 diabetes. Patient Educ Counseling 2001, 42:123–131. CrossRef
- Anderson BJ, Brackett J, Ho J, Laffel LM: An office-based intervention to maintain parent-adolescent teamwork in diabetes management. Impact on parental involvement, family conflict, and subsequent glycemic control. Diabetes Care 1999, 22:713–721. CrossRef
- Testa MA, Simonson DC: Health economic benefits and quality of life during improved glycemic control in patients with type 2 diabetes mellitus: a randomized, controlled, double-blind trial. JAMA 1998, 280:1490–1496. This was the first study to demonstrate that improving glycemic control, within the constraints of a multicenter, double-blind, randomized control trial of an oral hypoglycemic agent, could positively impact on generic HRQOL in a relatively short period of time. Over 12 weeks, significant improvements were reported in general perceived health, symptom distress, and cognitive functioning. CrossRef
- Emotional and quality-of-life aspects of diabetes management
Current Diabetes Reports
Volume 2, Issue 2 , pp 153-159
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