Norbert Hermanns

• Professor, PhD
• Research Director at Diabetes Center Mergentheim, Bad Mergentheim, Germany

Inflammation is a probable biological pathway underlying the relationship between diabetes and depression, but data on differences between diabetes types and symptom clusters of depression are scarce. Therefore, this cross-sectional study aimed to compare associations of a multimarker panel of biomarkers of inflammation with depressive symptoms and...

Despite recommendations in scientific guidelines, person-reported outcomes (PROs) have rarely been collected in clinical practice or for quality assurance purposes. There are now several consensus recommendations on which instruments should be used in diabetes and experiences from other countries on how to successfully implement them in practice. I...

Aim To analyse the potential drivers (glucose level, complications, diabetes type, gender, age and mental health) of diabetes symptoms using continuous glucose monitoring (CGM) and ecological momentary assessment. Materials and Methods Participants used a smartphone application to rate 25 diabetes symptoms in their daily lives over 8 days. These s...

Zusammenfassung Hintergrund Obwohl die Insulinpumpentherapie (CSII) derzeit im Vergleich zur Insulininjektionstherapie eine deutlich physiologischere Methode der Insulinsubstitution darstellt, wenden in Deutschland im Vergleich zu anderen Ländern weniger Menschen mit einem Typ-1-Diabetes diese Therapieform an. Eine Bedeutung könnten hierbei psychol...

Background Conclusive evidence on the benefits of automated insulin delivery (AID) systems on person-reported outcomes (PROs) is missing. Methods In this systematic review and meta-analysis, four databases (PubMed, PsycINFO, Cochrane, and GoogleScholar) were searched from inception up to August 7th, 2024. All types of studies were included if studi...

Aims Diabetes distress is common among people with type 1 diabetes (T1D), negatively affecting quality of life, self management, and diabetes outcomes. E‐health‐based interventions could be an effective and low‐cost way to improve the psychological care for people with T1D experiencing diabetes distress. The MyREMEDY study aims to test the effectiv...

Background Extended glucose predictions are novel in diabetes management. Currently, there is no solution widely available. People with diabetes mellitus (DM) are offered features like trend arrows and limited predictions linked to predefined situations. Thus, the impact of extended glucose predictions on the burden of diabetes and person-reported...

Aims/hypothesis Diabetes distress is one of the most frequent mental health issues identified in people with type 1 and type 2 diabetes. Little is known about the role of glucose control as a potential contributor to diabetes distress and whether the subjective perception of glucose control or the objective glycaemic parameters are more important f...

People with diabetes report relevant impairments of quality of life and mental health more frequently. However, the individual mental concerns and disorders may be varied and diverse, and the interactions with diabetes and glucose vary between individuals. Therefore, a precision medicine approach for mental health is required for optimal mental hea...

Major limitations of current automated insulin delivery (AID) systems are the subcutaneous insulin route and the need to wear devices on the body. The EU project “FORGETDIABETES” (supported by H2020-FETPROACT, n.951933) will develop a fully implantable AID systems to overcome these barriers. To assess attitudes and barriers to such an implantable s...

AID systems are becoming increasingly popular among people with type 1 diabetes (pwt1d). As part of the Diabetes Report, we asked Pwt1d (n=1920) and parents of children with type 1 diabetes (n=210) in three countries (Germany, Austria and Switzerland) about the expected consequences of the increased use of AID systems. On a 5-point Likert scale (1=...

This review highlights the role of patient-reported outcomes (PROs) and patient-reported experiences (PREs) in improving diabetes care, increasing patient involvement, and fostering collaboration between healthcare professionals and patients. It covers the definition and management of PROs and PREs and their relevance for person-centered care, incl...

Fragestellung: Die PRO-MENTAL-Studie implementiert einen Precision Monitoring-Ansatz für mentale Gesundheit bei Menschen mit Diabetes. Mentale Gesundheitsaspekte werden über zwei Jahre halbjährlich monitoriert mithilfe von Fragebögen, Smartphone-basiertem Ecological Momentary Assessment sowie CGM-Glukosedaten. Die Initialuntersuchung beinhaltet ein...

Background In a randomized controlled trial, the efficacy of a digital diabetes diary regarding a reduction of diabetes distress was evaluated. Methods A randomized controlled trial with a 12-week follow-up was conducted in 41 study sites across Germany. Key eligibility criteria were a diagnosis of type 1, type 2, or gestational diabetes and regul...

Aims Psychological care is recognised as an integral part of quality diabetes care. We set out to describe the roles and competencies of the clinical psychologist as a member of the multidisciplinary adult diabetes care team, focused on secondary care. Methods The authors are clinically experienced psychologists involved in adult diabetes care, fr...

In this review, we aim to show how person‐reported outcomes (PROs) and person‐reported experiences (PREs) can significantly contribute to the way diabetes care is delivered, the involvement of people with diabetes in diabetes care, and the collaboration between health care professionals and people with diabetes. This review focuses on the definitio...

Little is known about mental load in people with diabetes and associations with demographic, clinical, and treatment characteristics, such as the use of diabetes technologies. To explore perceived mental load, 503 adults with diabetes answered the one-item survey "How much time (in minutes) would you spontaneously estimate that you spend each day t...

The associations of continuous glucose monitoring (CGM)-specific diabetes education with real-world utilisation of glucose alerts and alarms were assessed in current CGM-users with type 1 or type 2 diabetes. A cross-sectional online survey was conducted in Germany assessing utilisation (use & responses) of different alerts and alarms. Ordinal logis...

Aims To analyze if midterm improvement in diabetes distress can be explained by resilience, diabetes acceptance, and patient characteristics. Methods N = 179 adults with type 1 diabetes were enrolled during their stay at a tertiary diabetes center (monocentric enrolment) and followed up over three months in a prospective, observational study (‘DIA...

Objective: Fear of diabetes complications (FDC) is a common source of emotional distress in people with diabetes across types and treatments and may affect health outcomes. To assess FDC, the Fear of Diabetes Complications Questionnaire (FDCQ) was developed. This study evaluates the FDCQ's German version in people with type 1 diabetes (T1D) and ty...

Background The majority of people with type 2 diabetes who require insulin therapy use only basal insulin in combination with other anti-diabetic agents. We tested whether using a smartphone application to titrate insulin could improve glycaemic control in people with type 2 diabetes who use basal insulin. Methods This was a 12-week, multicentre,...

Current CGM algorithms allow a glucose prediction up to 30 minutes. To elaborate on the potential to improve current CGM systems, we investigated if a possible increase in this prediction window to up to 2 hours would be perceived as a significant benefit. People with type 1 and type 2 diabetes currently using a CGM system were invited to participa...

Smart insulin pens have the potential to fulfill some of the unmet needs of people with diabetes through the accurate administration of bolus doses, the simplification of documentation relating to diabetes therapy, the improvement of communication and the quality of advice given to patients. 305 (2021) and 336 diabetologists in Germany (2022; 38% f...

A multicenter RCT in people with type 2 diabetes has shown that the use of a basal insulin titration app (myDose Coach) reduced A1c levels by 0.35 percentage points compared to titration without an app. Is the use of such a titration app associated with safety issues? We used negative binomial regressions to analyze the occurrence of adverse and se...

A randomized controlled trial (RCT) has demonstrated the efficacy of a digital diabetes logbook (mySugr) in reducing diabetes distress compared to a control group without such an app. In a sub-group analysis, we analyzed whether those who have paired their glucose meter (glucose values were directly imported into the app) benefit differently than t...

Background: The correct injection technique is crucial for people with insulin therapy. However, barriers to insulin injections exist, which can lead to problems with injections. In addition, injection behavior may deviate from recommendations leading to lower adherence to the correct injection technique. We developed two scales to assess barriers...

Aims Several instruments are used to identify depression among patients with diabetes and have been compared for their test criteria, but, not for the overlaps and differences, for example, in the sociodemographic and clinical characteristics of the individuals identified with different instruments. Methods We conducted a cross-sectional survey am...

Depressive disorders are among the most common mental disorders in diabetes, and evidence suggests an unfavourable prognosis. It is thus important to be able to identify and diagnose patients with diabetes and comorbid depression and provide optimal treatment recommendations. The article imparts skills for clinical practice and explains guideline-b...

Depressive disorders are among the most common mental disorders. In people with diabetes, the prevalence rate is increased. Affected persons experience impaired quality of life and may have problems of performing self-management tasks optimally. This can lead to adverse health outcomes: Long-term complications, cardiovascular events and somatic as...

Aims: People with type 1 diabetes have a higher risk for cardiovascular disease (CVD). Reduced heart rate variability (HRV) is a clinical marker for CVD. In this observational study using continuous HRV measurement across 26 days, we investigated whether psychological stressors (diabetes distress, depressive symptoms) and glycaemic parameters (hyp...

Background Optimal insulin titration is essential in helping people with type 2 diabetes mellitus (T2DM) to achieve adequate glycemic control. Barriers of people with diabetes to implementation of titration include lack of self-efficiency and self-management skills, increased diabetes-related distress, low treatment satisfaction, poor well-being, a...

Background Diabetes-related distress (DRD) can affect diabetes management adversely. In lack of population-based data, the frequency and determinants of DRD among adults with diabetes in Germany remain controversial. Methods This study included 1367 adults with diabetes who participated in a nationwide health telephone survey conducted among Germa...

Introduction Living with diabetes can be burdensome and lead to serious emotional distress and impaired mental health. Acceptance and commitment therapy (ACT) can support people facing the challenges of living with diabetes. This trial aims to evaluate the effectiveness and cost-effectiveness of the internet-based and mobile-based intervention (IMI...

Aims: More and more people with diabetes (PwD) are paying attention to the waste associated with new technologies and want more sustainable concepts for waste prevention and a positive ecological footprint. So far, there are little results on the importance people with diabetes attach to the issue of sustainability and environmental compatibility....

The EU project “FORGETDIABETES” will develop a fully implantable automated insulin delivery (AID) system. It will consist of an intraperitoneal pump and an implantable CGM sensor. It aims at providing fully automated diabetes management with minimal user interaction. Semi-structured interviews to explore human factors of the bionic invisible pancre...

A fully implantable automated insulin delivery system consisting of an intraperitoneal pump and an implantable CGM sensor (Bionic Invisible Pancreas - BIP) is under development. The occurrence of potential benefits or barriers to the use of the BIP was assessed in people with diabetes under different treatment regimens (MDI, CSII, CSII and CGM) . T...

Aims: Are there differences in the attitudes of physicians, parents and people with diabetes (PwD) towards digitalization and new technologies in diabetes and how do these change from 20- 2021? Methods: In 20 and 2021, PwD and diabetologists in Germany were asked via online surveys about their attitudes and assessment of digitalization and new tech...

Aims: How do physicians assess AID-Systems in terms of their current and future importance for diabetes care? Methods: In 2021 3diabetologists in Germany (48% female, average age 53.7 years) were asked via online surveys about their current and future assessment of AID-Systems.The results were compared with the 20survey, in which 337 diabetologists...

Aims Psychological distress due to living with diabetes, demanding self-management tasks, impacts on life, and risks of complications is common among people living with diabetes. COVID-19 could pose a new additional risk factor for psychological distress in this group. This study aimed to analyze levels of COVID-19-related burdens and fears, variab...

Aim: The TheraKey Diabetes 3.0 app supports people with diabetes (PwD) during diabetes diagnosis and in the further course of the disease by providing personalized content (e.g., information, graphics, educational videos, testimonials, worksheets, interactive elements) , knowledge and skills for better self-management and coping with the diabetes d...

OBJECTIVE To estimate time with diabetes distress using ecological momentary assessment (EMA) in people with type 1 diabetes and analyze its associations with glycemic management based on continuous glucose monitoring (CGM). RESEARCH DESIGN AND METHODS We used EMA to assess diabetes distress in a sample of recently hospitalized adults with type 1...

Objective: We combined data from two landmark trials (DIAMOND and HypoDE) to examine the diagnostic performance of low glucose measurements derived from open and masked continuous glucose monitoring (CGM) to predict the occurrence of future severe hypoglycemia (SH). Methods: We analyzed hypoglycemia parameters (Low Blood Glucose Index [LBGI], %...

Background Diabetes self-management is a mainstay of diabetes care, but the implementation of self-management regimens into daily life is complex and often results in discouragement and distress. Modern approaches such as smartphone-based self-management applications are therefore needed to support people with diabetes. Since reimbursability would...

Monitoring of glucose plays an essential role in the management of diabetes. However, to fully understand and meaningfully interpret glucose levels, additional information on context is necessary. Important contextual factors include data on behaviours such as eating, exercise, medication-taking and sleep, as well as data on mental health aspects s...

Objective This randomized cross-over study aimed to compare different algorithms for calculating prandial insulin considering the fat and protein content of a standardized meal in type 1 diabetes patients using insulin pump therapy (CSII). Methods Twenty-six patients received a standardized evening meal for three consecutive days using different al...

Background: Many people with diabetes have permanently elevated blood sugar concentrations and a high level of diabetes-related psychological stress, also called "diabetes distress." In clinical practice, diabetes distress is often an impediment to successful self-management. psy- PAD is a psychodynamically oriented short-term therapy program whos...

AimsMeasurement tools to evaluate self-management behavior are useful for diabetes research and clinical practice. The Diabetes Self-Management Questionnaire (DSMQ) was introduced in 2013 and has become a widely used tool. This article presents a revised and updated version, DSMQ-R, and evaluates its properties in assessing self-management practice...

Introduction: Depression is a common and serious complication of diabetes. Treatment approaches addressing the specific demands of affected patients are scarce. Objective: The aim of this work was to test whether a stepped care approach for patients with diabetes and depression and/or diabetes distress yields greater depression reduction than tr...

Zusammenfassung Die Prognose der Diabeteserkrankung wird entscheidend vom Selbstbehandlungsverhalten der Betroffenen beeinflusst. Psychosoziale Aspekte wie krankheitsspezifische Belastungen, subklinische oder klinische psychische Störungen stellen eine wesentliche Barriere für eine erfolgreiche Diabetestherapie dar. Deshalb ist ein Screening auf mö...

Objective: Hypoglycaemic episodes and fear of hypoglycaemia can be burdensome for adults with type 1 diabetes. This study explored unmet support needs relating to hypoglycaemia among adults with type 1 diabetes living in Denmark, Germany, the Netherlands, or the United Kingdom. Research design and methods: Respondents participated in a web-based...

Introduction Achieving glycemic targets and optimizing quality of life (QoL) are important goals of type 1 diabetes care. Hypoglycemia is a common barrier to achieving targets and can be associated with significant distress. However, the impact of hypoglycemia on QoL is not fully understood. The aim of this study was to explore how adults with type...

Aim To determine the 10-year cumulative incidence of high depressive symptoms in people with diagnosed and, in particular, previously undetected diabetes compared to those without diabetes in a population-based cohort study in Germany. Materials and Methods We included 2813 participants (52.9% men, mean age (SD) 58.9 (7.7) years, 7.1% diagnosed di...

Time in glucose ranges is increasingly relevant for research and clinical practice. Whereas the clinical validity of these metrics has been demonstrated with regard to long-term complications, their associations with patient-reported outcomes such as well-being, diabetes distress, and fear of hypoglycemia remain an open research question. This arti...

Introduction Studies have shown beneficial effects of real-time continuous glucose monitoring (rtCGM) usage on clinical outcomes. The objective of this analysis was to identify which therapy adjustments were made by people with type 1 diabetes with impaired hypoglycemia awareness during rtCGM usage enabling reductions in the number of low glucose e...

Despite the demonstrated benefits of using insulin, nearly a third of the patients with type 2 diabetes (T2D) are initially reluctant to initiate insulin therapy when it is first recommended by their healthcare provider (HCP). Several studies have documented the reasons for this phenomenon known as psychological insulin resistance (PIR) and also id...

Objective: Increased health care use and costs have been reported in individuals with diabetes with comorbid depression. Knowledge regarding cost differences between individuals with diabetes alone and those with diabetes and diagnosed/undiagnosed depression is, however, scarce. We therefore compared use and costs for patients with diabetes and no...

Das Essverhalten ist ein wichtiger Faktor bei Entstehung, Verlauf und Prognose eines Diabetes mellitus. Es wird wie jedes andere menschliche Verhalten durch Zusammenwirken sozialer, psychischer und biologischer Faktoren bedingt. In der Auffassung von den Grenzen "normalen Essens" und der Körperform spiegeln sich gesellschaftliche Normen und Körperi...

Objective: To analyze the independent associations of depression and diabetes distress with self-management and glycemic outcome in Type I (T1DM) and Type 2 diabetes (T2DM). Method: Six hundred six people with T1DM or T2DM participated in a cross-sectional survey including measures of depression (PHQ-9), diabetes distress (PAID-5), self-manageme...