ABSTRACT
Purpose: The current study aimed to explore the potential effect of diabetes-related distress on the association between fear of hypoglycaemia and poor glycaemic control. We evaluated the specific aspects of fear of hypoglycaemia that affect glycaemic control among Saudi patients with type 2 diabetes (T2D). Methods: Descriptive cross-sectional survey of patients with T2D attending a specialist diabetes clinic in Taif, Saudi Arabia. We used the Hypoglycaemia Attitudes and Behaviour Scale (HABS) for assessing fear of hypoglycaemia among our sample. We used Structural Equation Modelling to evaluate the moderators and correlates of fear of hypoglycaemia. Results: We surveyed 365 patients with T2D. Cronbach's alpha for the HABS assessment was 0.84, an indication of excellent internal consistency. The composite reliability for hypoglycaemic anxiety was 86.8%; hypoglycaemic avoidance was 85.2%; and hypoglycaemic confidence was 92.6%. The mean HABS score was 32.7 points (out of 70 points; SD = 9.8 points). Fear of hypoglycaemia was associated with increased levels of glycated haemoglobin (HbA1c), presence of eye disease, heart disease, and stroke. Fear of hypoglycaemia was associated with poor glycaemic control. No significant moderating effect of diabetes-related distress was observed. However, only hypoglycaemic anxiety and avoidance were associated with poor glycaemic control. Confidence in the ability to control low glucose levels was not associated with elevated HbA1c levels. Conclusion: A significant finding of this study highlighted the considerable and direct effect of fear of hypoglycaemia on poor glycaemic control among patients with T2D. However, only fear-related anxiety and avoidance-and not confidence in the ability to control low glucose levels-had an effect on poor glycaemic control.
ABSTRACT
Background: It is essential for practicing clinicians to have core knowledge of biostatistics. However, surveys indicated that clinicians' attitudes towards biostatistics are negative. Despite its importance, little is known about the knowledge of and attitudes towards statistics among trainees in family medicine, particularly in Saudi Arabia. The current investigation attempts to evaluate knowledge and attitudes held by family medicine trainees in Taif and explore their correlates. Materials and Methods: This was a descriptive, questionnaire-based, cross-sectional study of residents in family medicine training programme in Taif, Saudi Arabia. We used Poisson regression modelling to evaluate the effect of background factors on knowledge and attitudes towards biostatistics. Results: The study included 113 family medicine trainees at different levels of training. Only 36 (31.9%) of the participating trainees expressed positive attitudes towards biostatistics. On the other hand, 30 (26.5%) participating trainees were found to have good biostatistics knowledge, compared to 83 (73.5%) trainees whose knowledge level was found to be poor. Upon adjusting for all background factors simultaneously, only younger age, level R4 training, publishing one or three papers were found to be associated with poorer attitudes towards biostatistics. Older age was associated with worsening of attitudes (adjusted odds = 0.9900, P = 0.00924), and so also was being a senior R4 trainee (adjusted odds = 0.9045, P = 0.01301). Publishing one paper (compared to publishing over three papers) was associated with poorer attitudes towards biostatistics (adjusted odds = 0.8857, P = 0.03525). Also, having published three papers (compared to publishing over three papers) was still associated with worse attitudes towards biostatistics (adjusted odds = 0.8528, P = 0.01318). Conclusion: The main finding of our current study is the poor level of knowledge and overtly negative attitudes held by family medicine trainees in Taif towards biostatics. Knowledge was particularly poor about advanced statistical concepts such as survival analysis and linear regression modelling. However, poor levels of knowledge about biostatistics could be a function of poor research productivity among family medicine trainees. Age, seniority in training and involvement in research also impacted positively on attitudes towards biostatistics. Therefore, it is recommended that the training curriculum for family medicine trainees should first cover essential biostatistics in a creative and accessible way and secondly encourage engagement research and publication from an early stage of training.
ABSTRACT
Background: Diabetes is associated with a range of psychosocial stressors that could lead to considerable distress and increased risk of depressive symptoms. There is a pressing need to understand the underpinnings of diabetes-related distress and how it evolves in connection with depressive moods, and fears related to hypoglycaemia. Our current study attempts to fill this knowledge gap and further explore the interconnections between distress, fear, and depression among Saudi diabetic patients. Methods: Descriptive questionnaire-based cross-sectional study of type II diabetes patients in a specialist diabetes clinic in Taif, Saudi Arabia. We carried out Poisson regression modelling to evaluate the correlates of depressive and distress symptoms. Results: The study included (n = 365) patients living with type II diabetes. Cronbach's alpha for the DDS-17 was 0.93, and for HABS was 0.84, indicative of excellent internal consistency. Diabetes-related distress affected (n = 114, 22.8%) patients, whereas depressive symptoms affected (n = 190, 52.1%) patients. The mean HABS score was 32.7 points (out of 70 points) (SD = 9.8 points). High physical activity levels were found only in (n = 23, 6.3%) patients and moderate physical activity in (n = 65, 17.8%), whereas patients with low physical activity were (n = 277, 75.9%). Diabetes-related distress was associated with increased HbA1c, presence of eye disease, comorbid mental illness, heart disease, stroke, and low physical activity levels. Depressive symptoms were associated with increased HbA1c, longer diabetes duration, presence of eye disease, comorbid mental illness, comorbid neuropathy, heart disease, and low physical activity levels. Conclusions: Distress and depression levels are worryingly higher than previous estimates from Saudi Arabia among patients with type II diabetes, indicative of an upward trend and/or a pandemic-related jump. One significant finding from our results is the substantial effect of glycaemic control on increased distress, and depression among our type II diabetes patients. This interaction is likely due to effects on self-care and medication adherence. We also confirmed the association between depressive symptoms and the duration of diabetes. Our results indicated a connection between comorbid medical illness with depressive and distress symptoms.
