Bluetooth Technology, Smart Phone Application and Remote Diabetes Management in Reduction of Hba1c in Type 2 Diabetes Mellitus Patients on Intensive Insulin Regimen (Cloud-Dm Study)

Background and Aims: The burden of uncontrolled DM amongst insulin users in Malaysia is great. Structured Self- Monitoring of Blood Glucose (SMBG) that are stored in cloud, simplified into visual charts, graphs coupled with a diabetes management system (DMS) that allows remote insulin titration can lead to improvement of glycemic control. Method(s): 124 Type 2 DM outpatients with HbA1C > 8% on intensive insulin therapy were recruited in this 26 weeks, multicenter, double arm, randomized controlled study. The patients were randomized to control arm which used traditional logbook and intervention arm which received remote insulin titration with a Bluetooth glucometer coupled with a DMS. The primary objective was to compare reduction of HbA1C and the secondary objective was to compare the change in Diabetes Distress Scale (DDS) between the control and intervention arm. Result(s): There was significantly higher mean reduction of HbA1C in the intervention group ;-2.016+/-1.60 versus - 1.326+/-1.51 in the control group (p = 0.027) by week 14 and was maintained till Week 26. There was no significant difference between the reduction of DDS between both groups. The mean frequency of SMBG in the intervention group was significantly higher than the control group;339.656+/-171.14 (intervention) versus 216.716+/-96.40 (control) [p < 0.001]. Conclusion(s): Remote insulin titration has been proven effective especially during COVID-19 whereby there was imminent need for reduction of physical visits to the hospital. This has led to improvement of glycemic control but could translate to lesser waiting time and reduction of cost in the long term.

Diabetes Distress During COVID-19: Three Brief 'Snapshot' Surveys of Adults With Diabetes Calling the Australian National Diabetes Services Scheme Helpline.

The aim of this study was to take 'snapshots' of how people with diabetes are feeling emotionally during the coronavirus disease 2019 (COVID-19) pandemic. Three 'snapshot' surveys were conducted during May 2020, August 2020 and April 2021, each over a two-week period. Adults (≥18 years) with diabetes calling the Australian Government's National Diabetes Services Scheme Helpline (NDSS) were invited to participate. Those who accepted were asked three questions sourced/adapted from the Problem Areas in Diabetes scale. Responses were recorded on a 5-point scale (0='not a problem', 4='serious problem'). Of interest were scores ≥2, indicating this was at least a 'moderate problem'. The survey was administered by NDSS Helpline staff via telephone. Basic demographic and clinical data were collected. In total, 1,278 surveys were completed over the three 'snapshots' (1st N=449; 2nd N=414; 3rd N=415). Participants were aged (median[IQR]) 62[47,72] years, 56% were women, and 57% had type 2 diabetes. At the 3rd 'snapshot', 21% had received a COVID-19 vaccine. Our findings show that feeling at least moderately 'burned out' by the constant effort needed to manage diabetes is salient, and consistently experienced by adults with diabetes calling the NDSS Helpline at three timepoints during the coronavirus pandemic. Those who participated in the 3rd 'snapshot' survey were less likely to report that feeling 'alone with their diabetes' or 'worrying about their diabetes because of the COVID-19 pandemic' were moderate or serious problems for them. Except for younger adults, findings indicate that the easing of restrictions may mitigate some of the effects of the pandemic on diabetes-specific emotional problems, including feeling 'burned out', 'alone' with diabetes, and/or worried about diabetes due to COVID-19. Prospective data are needed to improve our understanding of the emotional impact of COVID-19 on people with diabetes and to inform when and how to target support for those who need it most.

How has the COVID-19 Pandemic Affected Diabetes Self-Management in People With Diabetes? - A One-Year Follow-Up Study.

Background and Aim: In Denmark, the COVID-19 pandemic resulted in two lockdowns, one from March to May 2020 and another from December 2020 to April 2021, which had severe impact on everyday life. The aim of this study was to explore changes in diabetes self-management behaviors during the pandemic and to examine how specific population characteristics were associated with changes in diabetes management. Methods and Participants: In a cohort study from March 2020 to April 2021, two online questionnaires were collected from a total of 760 people with diabetes. Descriptive statistics were used to assess the proportion of participants experiencing improvements, deterioration, and status quo in diabetes self-management during the pandemic. Using logistic regressions, baseline characteristics were explored as potential predictors of change. Results: Approximately half of the participants reported that they experienced lower physical activity in April 2021 compared to before the pandemic, approximately one fifth reported diabetes self-management to be more difficult than prior to the pandemic, and one fifth reported eating more unhealthily than before the pandemic. Some participants reported higher frequency of high blood glucose levels (28%), low blood glucose levels (13%) and more frequent blood glucose variability (33%) compared to before. Easier diabetes self-management was reported by relatively few participants, however, 15% reported eating more healthily, and 20% reported being more physically active. We were largely unable to identify predictors of change in exercise activities. The few baseline characteristics identified as predictors of difficulties in diabetes self-management and adverse blood glucose levels due to the pandemic were sub-optimal psychological health, including high diabetes distress levels. Conclusion: Findings indicate that many people with diabetes changed diabetes self-management behaviors during the pandemic, mostly in a negative direction. Particularly high diabetes distress levels in the beginning of the pandemic was a predictor of both positive and negative change in diabetes self-management, indicating that people with high diabetes distress levels could potentially benefit from increased support in diabetes care during a period of crisis.

Psychosocial Impact of the COVID-19 Pandemic on People With Type 1 Diabetes: Results of an Ecological Momentary Assessment Study.

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, variables explaining these levels, and associations with the concurrent 7-day COVID-19 incidence in people with type 1 diabetes (T1D). Methods: A total of 113 people with T1D (58% women; age: 42.3 ± 9.9 years) participated in an ecological momentary assessment (EMA) study between December 2020 and March 2021. The participants reported daily levels of COVID-19-related burdens and fears over 10 consecutive days. Global ratings of COVID-19-related burdens and fears were assessed using questionnaires, as were current and previous levels of diabetes distress (PAID), acceptance (DAS), fear of complications (FCQ), depressive symptoms (CES-D), and diabetes self-management (DSMQ). Current levels of diabetes distress and depressive symptoms were compared with pre-pandemic ratings gained during an earlier study phase. Associations between burdens and fears, psychosocial and somatic aspects, and the concurrent 7-day incidence rate were analyzed using multilevel regression. Results: Diabetes distress and depressive symptoms reported during the pandemic were comparable to pre-pandemic levels (PAID: p = .89; CES-D: p = .38). Daily EMA ratings reflected relatively low mean COVID-19-related burdens and fears in everyday life. However, there was substantial day-to-day variation per person indicating higher burdens on specific days. Multilevel analyses showed that daily COVID-19-related burdens and fears were significantly predicted by pre-pandemic levels of diabetes distress and diabetes acceptance but were not associated with the concurrent 7-day incidence rate nor with demographic and medical variables. Conclusions: This study observed no increase in diabetes distress and depressive symptoms during the pandemic in people with T1D. The participants reported low to moderate levels of COVID-19-related burdens. COVID-19-related burdens and fears could be explained by pre-pandemic levels of diabetes distress and acceptance but not by demographic and clinical risk variables. The findings suggest that mental factors may constitute stronger predictors of COVID-19-related burdens and fears than objective somatic conditions and risks in middle-aged adults with T1D.

Greater Telehealth Use Results in Increased Visit Frequency and Lower Physician Related-Distress in Adolescents and Young Adults With Type 1 Diabetes.

BACKGROUND: Type one diabetes (T1D) management is challenging for adolescents and young adults (AYAs) due to physiological changes, psychosocial challenges, and increasing independence, resulting in increased diabetes distress and hemoglobin A1c (HbA1c). Alternative care models that engage AYAs and improve diabetes-related health outcomes are needed. METHODS: A 15-month study evaluated an adaptation of the Colorado Young Adults with T1D (CoYoT1) Care model. CoYoT1 Care includes person-centered care, virtual peer groups, and physician training delivered via telehealth. AYAs (aged 16-25 years) were partially randomized to CoYoT1 or standard care, delivered via telehealth or in-person. As the study was ending, the COVID-19 pandemic forced all AYAs to transition to primarily telehealth appointments. This secondary analysis compares changes in clinic attendance, T1D-related distress, HbA1c, and device use between those who attended more than 50% of diabetes clinic visits via telehealth and those who attended more sessions in-person throughout the course of the study. RESULTS: Out of 68 AYA participants, individuals (n = 39, 57%) who attended most (>50%) study visits by telehealth completed more diabetes care visits (3.3 visits) than those (n = 29, 43%) who primarily attended visits in-person (2.5 visits; P = .007). AYAs who primarily attended visits via telehealth maintained stable physician-related distress, while those who attended more in-person visits reported increases in physician-related distress (P = .03). CONCLUSIONS: Greater usage of telehealth improved AYA engagement with their care, resulting in increased clinic attendance and reduced physician-related diabetes distress. A person-centered care model delivered via telehealth effectively meets the needs of AYAs with T1D.

Physical Activity Behavior During the COVID-19 Outbreak in Individuals with Type 2 Diabetes: Role of Social Support and Other Covariates.

Objectives: This study was performed to investigate whether social support and other psychological predictors were associated with physical activity during the prolonged social isolation due to the coronavirus disease 2019 outbreak in Iran. Methods: This cross-sectional study was performed on 494 individuals with type 2 diabetes (T2D) in a diabetes specialty clinic. The questionnaire package comprised five parts, including sociodemographic and clinical characteristics, physical activity level, diabetes-specific social support, feelings of isolation, and diabetes-related distress. Clinical and hemoglobin A1c data were obtained from electronic medical records. Descriptive statistics, Pearson's chi-square test, and multivariable logistic regressions were conducted to analyze the data. Results: Approximately 71% of the participants participated in low/insufficient levels of physical activity. The participants who received support from family/friends (odds ratio [OR] = 1.77; 95% confidence interval [CI]: 1.47 - 2.74), diabetes care team (OR = 1.42; 95% CI: 1.15 - 1.77), and neighbors (OR = 1.53; 95% CI: 1.20 - 2.08) were more likely to have sufficient physical activity than those who did not receive these supports. There was also an association between physical activity behavior with feelings of isolation and diabetes distress. Conclusions: This study points to the importance of social support as an amplifier mechanism for the maintenance of physical activity behavior in individuals with T2D during critical times.

Prevalence and Associated Factors of Diabetes Distress, Depression and Anxiety Among Primary Care Patients With Type 2 Diabetes During the COVID-19 Pandemic in Egypt: A Cross-Sectional Study.

The prevalence of type 2 diabetes mellitus (T2DM) is growing worldwide. T2DM is often complicated by a range of psychological disorders that interfere with glycemic control and self-care. Previous studies have reported diabetes distress, depression, and anxiety among patients with T2DM; however; little is known about the burden of these comorbid mental disorders in primary care patients with T2DM treated in Egypt during the COVID-19 era. Participants were selected by convenient sampling from eight rural primary healthcare facilities from Ismailia in Egypt. Symptoms of diabetes distress, depression and anxiety were assessed by using the Arabic version of the 20-item Problem Areas in Diabetes (PAID), Patient Health Questionnaire 9, and Generalized Anxiety Disorder Scales, respectively. Multiple hierarchical logistic regression models were used to estimate the significant factors associated with diabetes distress, depression, and anxiety. A total of 403 individuals with T2DM were interviewed. The prevalence of severe diabetes distress was 13.4% (95% CI: 10.1-16.7), while prevalence of depressive and anxiety symptoms was 9.2% (95% CI: 6.4-12.0%), and 4.0% (95% CI: 2.1-5.9), respectively. In a series of hierarchical logistic regression models, significant predictors for diabetes distress were being married, illiterate, not-working, living with insufficient income, and having multi-comorbidities. Likewise, the significant predictors for depression and anxiety were elevated glycated hemoglobin level and the higher PAID total score, while having multi-comorbidities was a significant predictor for anxiety only. Diabetes distress was more prevalent than depressive and anxiety symptoms in this study population. Several sociodemographic and clinical characteristics were identified to be related with psychological problems among patients with T2DM, which necessitate a multidisciplinary team-based approach for optimal screening and management.

Relationship between depression and psychological well-being among persons with diabetes during COVID-19 pandemic: diabetes distress as a mediator.

Purposes: The study examined the relationship between depression, diabetes distress and psychological well-being and also assessed the mediating role of diabetes distress on depression relationship with psychological well-being among persons with diabetes during the covid-19 pandemic. Methods: The study conducted a cross-sectional survey design. A total of 223 (age 35 to 73 years, mean = 53.26 years and SD = 11.05 years) people living with diabetes who are registered patients and were attending the clinic in Department of medicine, Ondo State Specialist Hospital, Okitipupa were selected for the study using the convenient sampling technique. The data were analysed using Pearson Multiple correlation and mediation model 4 of PROCESS macro. The analyses were carried out with ROCESS macro for IBM/SPSS Version 25.0. Results: Showed psychological well-being has negative significant relationship between diabetes distress (r = -0.42, p < .05) and depression (r = 0.52, p < .05) among persons with diabetes during covid-19 pandemic. The result showed significant and negative direct relationship between depression and diabetes distress (ß = -0.47, p < 0.05), 95% Cl: = -0.60 (-0.34). The results also showed significant direct relationship depression and psychological well-being (ß = 0.36, p < 0.05), 95% Cl: = 0.26 (0.47) and further that diabetes distress significantly mediate indirect relationship between depression and psychological well-being among persons with diabetes during covid-19 pandemic (ß = -0.19, p < .05), 95% Cl: = 0.29 (-0.09). Conclusion: Depression and diabetes distress associated with the psychological well-being of persons with diabetes during covid-19 pandemic and diabetes distress may play vital role on the association between depression and with the psychological well-being of persons with diabetes during covid-19 pandemic.

Exploring and Developing a New Culturally-Appropriate Diabetes Distress Scale in Taiwan.

Introduction: The aim of this study was to develop and validate a new diabetes distress scale suitable for Chinese and Taiwanese culture. Methods: This study collected the current diabetes distress measurement tools, re-organized current definitions about the domains of diabetes distress, and then developed a new tool. Three hundred and ninety-five participants from four hospitals in northern Taiwan were recruited by cluster randomized sampling for validity test. Results: We found the new diabetes distress scale had appropriate reliability and validity, including an acceptable model fit for the 12-item scale. Conclusions: This new diabetes distress scale might be more directly related to emotional distress issues blood glucose control, improve the clinical conspicuity of diabetes distress, and even benefit the overall care of diabetic patients in Taiwan. Further studies about the validity and reliability of this new tool in a nationwide setting are needed.

Prevalence and correlates of diabetes distress and depressive symptoms among individuals with type-2 diabetes mellitus during Ramadan fasting: A cross-sectional study in Bangladesh amid the COVID-19.

AIMS: Psychological concerns relating to "diabetes distress" (DD) and depressive symptoms (DS) in individuals with type-2 diabetes mellitus (T2DM) may negatively impact adherence to medical treatments and overall mental health. Thus, this study was undertaken to investigate DS and DD in relation to fasting during the month of Ramadan. METHODS: A cross-sectional survey was conducted among 735 patients with T2DM in 2021. DD and DS were measured by the Problem Areas in Diabetes scale and Patient Health Questionnaire-9, respectively. Logistic regression and correlation analyses were executed. RESULTS: More than one-third of the participants (41.2%) had DD and DS (36.9%). DS was significantly higher in participants who did not fast (p = 0.027). Participants who had higher dietary diversity were less likely to have DD (p = 0.004) and DS (p = 0.001). Females (AOR = 1.89, 95% CI: 1.25-2.85) and those who lived alone (AOR = 1.89, 95% CI: 1.25-2.85) were more likely to have DS. Participants with diabetes-related complications were more likely to experience DS (AOR = 2.17; 95% CI: 1.5-3.13) and DD (AOR = 3.46; 95% CI: 2.42-4.95). DD was also associated with being younger (p = 0.003), having hypertension (p = 0.030), having heart disease (p = 0.012), and taking insulin (p = 0.010). CONCLUSIONS: Individuals with T2DM who were not fasting experienced more mental health concerns. Psychosocial support and other interventions from health professionals should be examined and empirical interventions should be implemented to promote the mental health and well-being of individuals with T2DM.

COVID-19-specific worries among people with type 2 diabetes following the continuation of the pandemic and occurrence of multiple waves of COVID-19 in Iran.

Purpose: To assess COVID-19-specific diabetes worries, and to determine characteristics of people with high levels of these worries among people with type 2 diabetes (T2D) following the continuation of the pandemic and occurrence of multiple waves of COVID-19 in Iran. Methods: An interviewer-based, cross-sectional study was conducted using 500 T2D people in a diabetes specialty clinic. The questionnaire package comprised five parts: sociodemographic and clinical characteristics, COVID-19-specific worries, diabetes-related distress, feelings of isolation and changes in diabetes-specific behaviors. Clinical history and serum measurements were collected from electronic medical records. Descriptive statistics and logistic regressions were performed in the study. Results: Worries related to COVID-19 pandemic were highly prevalent in T2D people. Around 60% were worried about being severely affected due to diabetes if infected with COVID-19 and being described as a high-risk group for COVID-19, and more than half about being possibly faced with lack of diabetes medications. Logistic regressions demonstrated that being female, higher age, diabetes-related complications, duration of diabetes, insulin use, feeling isolation, diabetes-related distress and having changed self-management behaviors were associated with being more worried about diabetes and COVID-19. Conclusion: Diabetes-related worries relating to the COVID-19 were strongly associated with poorer psychosocial status. Findings emphasize the importance of conveying up-to-date information regarding diabetes and COVID-19 that patients want and need to know, also of providing emotional support associated with COVID-19-specific diabetes worries.

Impact of worries associated with COVID-19 on diabetes-related psychological symptoms in older adults with Type 2 diabetes.

This study examined the associations between worries associated with COVID-19, diabetes-specific distress, and depressive symptoms in older adults with type 2 diabetes (T2D), who are particularly vulnerable to COVID-19 and its psychological impacts. A cross-sectional online survey was conducted with 84 older adults with T2D from June to December 2020. Participants had little to moderate worries associated with COVID-19, with the greatest worries about the economy recession, followed by a family member catching COVID-19, lifestyle disruptions, and overwhelmed local hospitals. Bivariate correlation and tobit regression revealed that increases in worries associated with COVID-19 were associated with increased diabetes distress and depressive symptoms. Specifically, worries associated with COVID-19 increased diabetes-specific emotional burden and physician-related and regimen-related distress. Increased diabetes distress and depressive symptoms worsened by COVID-19 may ultimately lead to poor glucose control. Additional assessment by mental health experts should be considered for older adults with T2D during and after infectious disease pandemic.

Perceptions and Correlates of Distress Due to the COVID-19 Pandemic and Stress Management Strategies Among Adults With Diabetes: A Mixed-Methods Study.

BACKGROUND: Greater risk of adverse health outcomes and public health measures have increased distress among people with diabetes during the coronavirus-2019 (COVID-19) pandemic. The objectives of this study were to explore how the experiences of people with diabetes during the COVID-19 pandemic differ according to sociodemographic characteristics and identify diabetes-related psychosocial correlates of COVID distress. METHODS: Patients with type 1 or 2 diabetes were recruited from clinics and community health centres in Toronto, Ontario, as well as patient networks. Participants were interviewed to explore the experiences of people with diabetes with varied sociodemographic and clinical identities, with respect to wellness (physical, emotional, social, financial, occupational), level of stress and management strategies. Multiple linear regression was used to assess the relationships between diabetes distress, diabetes self-efficacy and resilient coping with COVID distress. RESULTS: Interviews revealed that specific aspects of psychosocial wellness affected by the pandemic, and stress and illness management strategies utilized by people with diabetes differed based on socioeconomic status, gender, type of diabetes and race. Resilient coping (ß=-0.0517; 95% confidence interval [CI], -0.0918 to -0.0116; p=0.012), diabetes distress (ß=0.0260; 95% CI, 0.0149 to 0.0371; p<0.0001) and diabetes self-efficacy (ß=-0.0184; 95% CI, -0.0316 to -0.0052; p=0.007) were significantly associated with COVID distress. CONCLUSIONS: Certain subgroups of people with diabetes have experienced a disproportionate amount of COVID distress. Assessing correlates of COVID distress among people with diabetes will help inform interventions such as diabetes self-management education to address the psychosocial distress caused by the pandemic.

Emotional burden and care of adults with type 1 diabetes during the COVID-19 pandemic in Brazilian regions.

AIMS: This study investigated the emotional burden in persons with type 1 diabetes (PWT1D) during the COVID-19 pandemic in Brazilian regions and evaluated which COVID-19, sociodemographic/clinical characteristics are related to it. METHODS: In a cross-sectional study, T1D adults completed a web-based survey from May to July 2020. We collected sociodemographic/clinical data, and participants answered COVID-19 related questions. Diabetes burnout was evaluated by Diabetes burnout scale. Type 1 Diabetes scale assessed Diabetes Distress and PHQ-8 measured depressive symptoms. RESULTS: DD and DS levels were similar in all Brazilian regions. DB was higher in Central-West/North/Northeast. Higher DB was associated with females, lower-income, higher HbA1c, and shorter time since T1D diagnosis. Predictors of experiencing higher levels of DD included: difficulty access to safe places to exercise, participants without a partner, male gender, young age, and higher HbA1c. Higher depressive symptoms were associated with difficulty to access diabetes supplies, and higher HbA1c (p < 0.05). CONCLUSIONS: The mean levels of DB, DD, and DS were high in all Brazilian regions. A great number of PWT1D had their diabetes care impaired and relied on family as their main support during the pandemic. The subgroups identified at risk should be prioritized in mental health support.

Diabetes Related Distress in Children with Type 1 Diabetes before and during the COVID-19 Lockdown in Spring 2020.

Our aim was to compere diabetes-related distress (DD) in young patients with type 1 diabetes mellitus (T1DM) and in their parents before and during the national COVID-19-related lockdown when schools operated on-line. Problems Areas in Diabetes-Child (PAID-Ch), Teen (PAID-T) and Parent (P-PAID-Ch, P-PAID-T) questionnaires in paper version were used to evaluate DD before COVID-19 pandemic (November 2019-February 2020) and during the lockdown (April 2020) the same surveys were performed by phone. We enrolled 76 patients (median age (Q1-Q3): 13.6 (11.8-15.2) years; 21 children, 55 adolescents; T1DM duration 3.7 (1.7-6.8) years). Initial PAID score was lower in teenage boys than in girls (34.0 (24.0-42.0) vs. 44.5 (40.0-50.5), p = 0.003). In teens PAID score decreased significantly during the lockdown (-3.0 (-11.0-3.0), p = 0.018), more in girls than boys (p = 0.028). In children (-3.0 (-14.0-7.0), p = 0.131) and parents PAID did not change (teens' parents: 3.0 (-9.0-10.0), p = 0.376; children's parents: -5.0 [-9.0-1.0], p = 0.227). In the studied group COVID-19 pandemic-related lockdown was associated with decrease in DD in teens with T1DM, particularly in girls, while no significant change in DD was observed in children or parents. DD decrease in teens during the pandemic should attract attention to the potential "rebound" of DD related to return to regular on-site school routine.

Psychological adaptive difficulties and their management during COVID-19 pandemic in people with diabetes mellitus.

BACKGROUND AND AIMS: People with diabetes have multiple psychosocial issues related to diabetes and its complications and this may be exacerbated during the COVID-19 pandemic. METHODS: We reviewed the psychological adaptative difficulties in people with diabetes especially during natural disasters including the prevailing COVID-19 pandemic. RESULTS: There are significant concerns regarding worsening of glycemic control, unavailability of appropriate medicines, inaccessibility to health care or acquiring SARS- CoV-2 infection and subsequent poorer outcomes during the COVID-19 pandemic. Although there are some guidance documents for managing diabetes and associated complications during COVID-19 pandemic but very few address the psychological issues in people with diabetes. We discuss the psychological adaptive difficulties and an approach to address the psychosocial concerns in people with diabetes during the COVID-19 pandemic. CONCLUSIONS: People with diabetes have significant diabetes distress and psychological adaptive difficulties that is aggravated by the COVID-19 pandemic. An integrated multidisciplinary approach is needed to manage the prevailing psychological issues amongst people with diabetes during the COVID-19 pandemic.