Emotional and quality-of-life aspects of diabetes management
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.
Available from: Mia Berglund
- "Studies have shown that important aspects of treatment are achieving patientcentred interaction and sharing patients' personal understanding of living with diabetes (Boströ m, Isaksson, Lundman, Graneheim, & Hö rnsten, 2014; Hörnsten, Sandströ m, & Lundman, 2004). Medical advances have made possible active selfcare and control, as well as influence over treatment (Polonsky, 2002). Experience of balancing biomarkers in relation to the quality of life in the long term has been described by people with type 2 diabetes in the study (Frost, Garside, Cooper, & Britten, 2014). "
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ABSTRACT: Research shows that people with diabetes want their lives to proceed as normally as possible, but some patients experience difficulty in reaching their desired goals with treatment. The learning process is a complex phenomenon interwoven into every facet of life. Patients and healthcare providers often have different perspectives in care which gives different expectations on what the patients need to learn and cope with. The aim of this study, therefore, is to describe the experience of learning to live with diabetes. Interviews were conducted with 12 patients afflicted with type 1 or type 2 diabetes. The interviews were then analysed with reference to the reflective lifeworld research approach. The analysis shows that when the afflicted realize that their bodies undergo changes and that blood sugar levels are not always balanced as earlier in life, they can adjust to their new conditions early. The afflicted must take responsibility for balancing their blood sugar levels and incorporating the illness into their lives. Achieving such goals necessitates knowledge. The search for knowledge and sensitivity to changes are constant requirements for people with diabetes. Learning is driven by the tension caused by the need for and dependence on safe blood sugar control, the fear of losing such control, and the fear of future complications. The most important responsibilities for these patients are aspiring to understand their bodies as lived bodies, ensuring safety and security, and acquiring the knowledge essential to making conscious choices.
Available from: sciencedirect.com
- "For patients with diabetes mellitus (DM), the physical burden, emotional consequences, and daily self-care requirements  lead to large and well-documented deficits in HRQOL compared with the general population . Low HRQOL may erode the capacity for self-care of patients with diabetes, increasing their risk of complications and comorbidities . "
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ABSTRACT: To estimate clinical and social benchmarks for interpretation of score differences on the Short-Form 36 Health Survey, and apply these benchmarks to populations with diabetes mellitus (DM).
Using survival and logistic regression models, we reanalyzed data from three US cohorts: the Medical Outcomes Study (N = 3,445; 541 patients with DM), the Medicare Health Outcomes Survey (N = 78,183; 16,388 patients with DM), and the QualityMetric 2009 Norming Study (N = 4,040; 580 patients with DM). Outcome variables were mortality, hospitalization, current inability to work, and loss of ability to work.
Benchmarks were robust across disease groups, but varied according to age and score level. A 1-point lower score on the Physical Function, General Health, and Physical Component Summary scales was associated with a 1.05 to 1.09 relative risk (RR) of mortality for the typical patient with DM, with stronger associations in the younger age groups. For several scales (Physical Function, Role Physical, Bodily Pain, General Health, Vitality, Social Function, and Role Emotional), the associations with mortality also depended on score level, with stronger associations in the lower score ranges (i.e., patients in worse health). A 1-point lower score on the Physical Function, Role Physical, Bodily Pain, General Health, Vitality, Social Function, and Physical Component Summary scales implied a 1.02 to 1.04 RR of hospitalization, a 1.07 to 1.12 RR of being unable to work, and a 1.04 to 1.07 RR of losing the ability to work.
A 1-point lower score on selected Short-Form 36 Health Survey scales is associated with an excess risk of up to 9% for mortality and 12% for inability to work.
Available from: William D Johnson
- "Physical activity interventions have been shown to improve glycemic control (7,8). Given that poor glycemic control is a potential mediator between diabetes and QOL (9) changes in hemoglobin A1c (HbA1c) occurring as a result of an exercise intervention may lead to improvements in QOL. To date, limited data exist regarding the effects of exercise training on QOL in sedentary adults with type 2 diabetes. "
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To establish whether exercise improves quality of living (QOL) in individuals with type 2 diabetes and which exercise modalities are involved.RESEARCH DESIGN AND METHODS
Health benefits of aerobic and resistance training in individuals with type 2 diabetes (HART-D; n = 262) was a 9-month exercise study comparing the effects of aerobic training, resistance training, or a combination of resistance and aerobic training versus a nonexercise control group on hemoglobin A1C (HbA(1C)) in sedentary individuals with type 2 diabetes. This study is an ancillary analysis that examined changes in QOL after exercise training using the Short Form-36 Health Survey questionnaire compared across treatment groups and with U.S. national norms.RESULTSThe ancillary sample (n = 173) had high baseline QOL compared with U.S. national norms. The QOL physical component subscale (PCS) and the general health (GH) subscale were improved by all three exercise training conditions compared with the control group condition (resistance: PCS, P = 0.005; GH, P = 0.003; aerobic: PCS, P = 0.001; GH, P = 0.024; combined: PCS, P = 0.015; GH, P = 0.024). The resistance training group had the most beneficial changes in bodily pain (P = 0.026), whereas physical functioning was most improved in the aerobic and combined condition groups (P = 0.025 and P = 0.03, respectively). The changes in the mental component score did not differ between the control group and any of the exercise groups (all P >0.05). The combined training condition group had greater gains than the aerobic training condition group in the mental component score (P = 0.004), vitality (P = 0.031), and mental health (P = 0.008), and greater gains in vitality compared with the control group (P = 0.021).CONCLUSIONS
Exercise improves QOL in individuals with type 2 diabetes. Combined aerobic/resistance exercise produces greater benefit in some QOL domains.
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