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Psychosocial care in diabetes


Quality of life

Physical activity in youth with type 1 diabetes: A review

This review article covers the recent literature on physical activity in children with type 1 diabetes with particular focus on young children, discusses the limitations of the current body of research and provides recommendations for objectively measured physical activity.

Summary points
  • Objective measures of physical activity are expensive and labor-intensive both to collect and to analyze, but subjective self- or parental report of child/adolescent physical activity may not be very reliable.
  • The American Academy of Pediatrics (AAP) recommends that all youth engage in 60–90 minutes of physical activity daily.
  • In healthy children, physical activity provides small but significant benefits in reducing depression, anxiety, psychological distress and emotional disturbance. Such activity may be particularly important for youths with type 1 diabetes, as this population is at an increased risk of depression and the association between depressive symptoms, poor glycemic control and diabetes-related health outcomes.
  • In a cross-sectional pilot study of young children with type 1 diabetes (n=10; age range; 3–7 years), those who engaged in moderate physical activity throughout the day trended to spend less time in blood glucose excursions than children who concentrated their physical activity at only one time of day.
  • Studies focusing on the physical activity of young children with type 1 diabetes are rare, with only six included in this review; three studies found no difference in glycemic control between the physical activity intervention group and controls, while in one other study, a 30-minute vigorous exercise program three times a week for 12 weeks improved their glycemic control and aerobic capacity.
  • Facilitators of physical activity in young children include preference for activity, positive modeling, environmental access to activities and social connectedness.
  • Barriers to physical activity include: safety concerns related to sun exposure and neighborhood, parental fear of hypoglycemia, time and financial constraints and family values prioritizing different activities such as education.
  • A review of relevant literature indicates that physical activity benefits physical health among youths with type 1 diabetes.
  • Healthcare providers should focus on promoting physical activity engagement in youths with type 1 diabetes.

Tully C et al. Curr Diab Rep 2016; 16: 85. doi: 10.1007/s11892-016-0779-6

The complex interplay between clinical and person-centered diabetes outcomes in the two genders

This secondary analysis of the data collected during the BENCH-D study (Benchmarking Network for Clinical and Humanistic Outcomes in Diabetes) assessed gender differences in diabetes-related distress, physical and psychological well-being, empowerment, perceived social support and other measures of satisfaction with treatment and care in people with type 2 diabetes.

Summary points
  • Data from the Annals of Associazione Medici Diabetologi has been used to suggest that, compared with men, the likelihood of reaching positive clinical outcomes is systematically lower for women with type 2 diabetes, especially in metabolic control (i.e. HbA1c > =8.0%).
  • A random sample of 2,335 patients with type 2 diabetes (men: 59.7%; women: 40.3%) was selected by from 26 diabetes outpatient clinics in Italy between January 2010 and July 2011.
  • Clinical data, including HbA1c, lipid profile, blood pressure and BMI, were extracted from electronic databases of these clinics; information on socio-demographic characteristics, quality of life, satisfaction and self-care behaviors and attitudes was collected using an ad hoc self-administered questionnaire that included 10 validated instruments.
  • Smaller proportions of women reached HbA1c levels of ≤7.0% (23.2% vs 27.8%; p=0.03), LDL-cholesterol <100 mg/dl (48.3 vs 57.8%; p=0.0005) and BMI <27 Kg/m2 (27.2 vs 31.6%; p=0.04) than men.
  • Compared with men, women scored significantly lower on:
    • Physical functioning;
    • Psychological well-being;
    • Self-care activities dedicated to physical activities;
    • Empowerment;
    • Diabetes-related distress;
    • Satisfaction with treatment;
    • Barriers to medication taking;
    • Satisfaction with access to chronic care and healthcare communication;
    • Perceived social support.
  • Moreover, 24.8% of women and 8.8% of men had WHO-5 score of ≤28 (likely depression) (p<0.0001), and 67.7% of women and 55.1% of men had PAID-5 score of > 40 (high levels of diabetes-related distress) (p<0.0001).
  • Multivariate analysis showed that the factors associated with an increased likelihood of having elevated HbA1c levels (≥8.0%) were different in men and women:
    • In men but not in women, the likelihood of having HbA1c ≥ 8.0% decreased as age increased (−3% for each additional 5 years) and was associated with the level of school education;
    • In women but not in men, high levels of diabetes related distress were associated with a higher likelihood of poor metabolic control.
  • Women with type 2 diabetes achieve poorer clinical and psychosocial outcomes than men.
  • Diabetes-related distress plays a role as a correlate of metabolic control in women but not in men.

Rossi MC et al. Health Qual Life Outcomes 2017; 15: 41. doi: 10.1186/s12955-017-0613-0

Contents

Back to collection

  1. Editorial
  2. Overview
  3. Adherence
  4. Diabetes distress and psychological comorbidities
  5. Disordered eating
  6. Quality of life
  7. Pyschosocial interventions
  8. Self management strategies

  9. Supplementary resource