Development and Validation of the Depression Inventory for Type 1 Diabetes (DID-1).

People with type 1 diabetes (T1D) are more likely to have depression than the general population and their prognosis is worse. Unfortunately, the characteristics of persons with T1D lead to inadequate screening for depression in this population. To aid in the detection of depression in this population, this study was undertaken to develop a depressive symptoms assessment instrument specific to patients with T1D and to examine its psychometric properties. A total of 207 people with T1D participated in this study. The reliability of the new scale was assessed using Cronbach's alpha and the Spearman-Brown split-half coefficient. The Depression Inventory for type 1 Diabetes (DID-1), composed of 45 items on a Likert scale (1-7), shows high internal and temporal consistency, as well as adequate concurrent, convergent and discriminant validity. Factor analysis identified 7 factors (Symptoms of depression, Diminished interest, Hopelessness and dissatisfaction, Guilt, Fear, frustration and irritability, Defenselessness, and Interference in daily life) that explained 61.612% of the total variability. The cut-off score for diagnosis was set at 155 points. It was concluded that the DID-1 scale is a reliable, valid and useful tool for the assessment of depressive symptoms, eliminating the bias of other nonspecific diabetes scales.

Development and Preliminary Validation of a New Type 1 Diabetes Adjustment Scale (DAS-1).

BACKGROUND: This study focuses on the development and validation of a new Type 1 Diabetes Adjustment Scale (DAS-1). METHOD: A total of 204 participants aged 15-65 with type 1 diabetes completed the self-report measures of the DAS-1, which includes clinical and psychological variables. RESULTS: Robust confirmatory factor analysis detected a unidimensional structure of the item scores. The omega coefficient was 0.91 and test-retest reliability was 0.87. Classifying subjects as in a Positive or Negative mood state, ROC analysis yielded an optimal cut-off of 50 for the DAS-1 scores, with a clinical accuracy of AUC = 0.85. The DAS-1 demonstrated evidence of good reliability and acceptable construct validity. CONCLUSION: The DAS-1 demonstrated good clinical utility, good sensitivity and adequate specificity. Clinical and theoretical implications of these results are discussed.

Diabetes Summer Camp in children and adolescents with type 1 diabetes: Effects on well-being and quality of life / Campamento de verano en niños y adolescentes con diabetes tipo 1: efectos sobre el bienestar y la calidad de vida

OBJETIVE: The aim of this study was to examine the quality of life, anxiety and affectivity in children and adolescents with type 1 diabetes (T1D) and in their parents after participating in a diabetes summer camp. METHOD: A total of 20 children and adolescents with T1D, aged 8-14, and their parents participated. The study design was quasi-experimental longitudinal with an intra-subject factor with two measurements (pre/post), and an inter-group factor (child/parent). RESULTS: After attending camp, a significantly increased quality of life, demonstrated by the emotional well-being and self-esteem scores, was found in the children but not in the parents. Less negative affectivity and an improvement in positive affectivity was seen in the parents, but not in the children. Differences in anxiety were found in both the children and the parents. CONCLUSIONS: This research presents empirical evidence of the benefits of participation in a diabetes camp in both children and their parents

OBJETIVO: El objetivo de este estudio fue examinar la calidad de vida, la ansiedad y la afectividad en niños y adolescentes con diabetes mellitus tipo 1 (DM1), y en sus padres después de participar en un campamento de verano de diabetes. MÉTODO: Participaron un total de 20 niños y adolescentes con DM1 de 8 a 14 años, además de sus padres. El diseño del estudio fue longitudinal cuasi-experimental con un factor intra-sujeto con 2 mediciones (pre/post), y un factor intergrupo (niño/padre). RESULTADOS: Después de asistir al campamento se observa un aumento significativo en la calidad de vida, demostrado en las puntuaciones de bienestar emocional y autoestima en los niños. Los padres mostraron menos afectividad negativa y más positiva. Se encontraron diferencias en ansiedad en niños y sus padres. CONCLUSIONES: Se muestra evidencia empírica sobre los beneficios de un campamento de diabetes tanto en niños como en sus padres

Diabetes Summer Camp in children and adolescents with type 1 diabetes: Effects on well-being and quality of life.

OBJETIVE: The aim of this study was to examine the quality of life, anxiety and affectivity in children and adolescents with type 1 diabetes (T1D) and in their parents after participating in a diabetes summer camp. METHOD: A total of 20 children and adolescents with T1D, aged 8-14, and their parents participated. The study design was quasi-experimental longitudinal with an intra-subject factor with two measurements (pre/post), and an inter-group factor (child/parent). RESULTS: After attending camp, a significantly increased quality of life, demonstrated by the emotional well-being and self-esteem scores, was found in the children but not in the parents. Less negative affectivity and an improvement in positive affectivity was seen in the parents, but not in the children. Differences in anxiety were found in both the children and the parents. CONCLUSIONS: This research presents empirical evidence of the benefits of participation in a diabetes camp in both children and their parents.

Bolus Calculator Reduces Hypoglycemia in the Short Term and Fear of Hypoglycemia in the Long Term in Subjects with Type 1 Diabetes (CBMDI Study).

BACKGROUND: In a previous study we demonstrated improvement in metabolic control and reduction in hypoglycemia in people with type 1 diabetes on multiple daily injections, after having used a bolus calculator for 4 months. OBJECTIVE: To demonstrate whether (1) extending its use (2) or introducing it in the control group, previously subjected to treatment intensification, could further improve metabolic control and related psychological issues. METHODS: After the previous clinical trial, in which the subjects were randomized either to treatment with the calculator or to control group for 4 months, both groups used the calculator during an additional 4-month period. RESULTS: In the previous control group, after using the device, HbA1c did not improve (7.86% ± 0.87% vs. 8.01% ± 0.93%, P 0.215), although a significant decrease in postprandial hypoglycemia was observed (2.3 ± 2 vs. 1.1 ± 1.2/2 weeks, P 0.002). In the group in which the treatment was extended from 4 to 8 months, HbA1c did not improve either (7.61 ± 0.58 vs. 7.73 ± 0.65, P 0.209); however this group had a greater perceived treatment satisfaction (12.03 ± 4.26 vs. 13.71 ± 3.75, P 0.007) and a significant decrease in fear of hypoglycemia (28.24 ± 8.18 basal vs. 25.66 ± 8.02 at 8 months, P 0.026). CONCLUSIONS: The extension in the use of the calculator or its introduction in a previously intensified control group did not improve metabolic control, although it did confirm a decrease in hypoglycemic episodes in the short term, while the extension of its use to 8 months was associated with a reduction in fear of hypoglycemia and greater treatment satisfaction.

Comparison between a multiple daily insulin injection regimen (basal once-daily glargine plus mealtime lispro) and continuous subcutaneous insulin infusion (lispro) using continuous glucose monitoring in metabolically optimized type 1 diabetes patients: A randomized open-labelled parallel study / Comparación entre múltiples dosis de insulina (insulina glargina una vez al día y lispro en las comidas) e infusión subcutánea continua de insulina con monitorización continua de glucosa en pacientes con diabetes tipo 1 metabólicamente optimizados. Estudio randomizado

Background and objective: Advantages of continuous subcutaneous insulin infusion (CSII) over multiple daily injections with glargine (MDI/G) are still uncertain. We compared CSII vs. MDI/G therapy in unselected patients with type 1 diabetes using continuous glucose monitoring (CGSM). The primary end-points were glycaemic control and quality of life (QOL). Methods: A total of 45 patients with long-term diabetes and mean HbA1c values of 8.6 ± 1.8% (70.5 ± 15.4 mmol/mol), previously treated with MDI/NPH, were switched to MDI/G for 6 months and then, unfulfilling therapy CSII indication, were randomly assigned to CSII or MDI/G for another six months. We evaluated QOL (EsDqol) and glycaemic control by measuring HbA1c levels, rate of hypoglycaemia, ketoacidosis and CGSM data. Results: After the first phase (MDI/NPH to MDI/G) there was a significant improvement in total EsDQOL (99.72 ± 18.38 vs. 92.07 ± 17.65; p < 0.028), a 0.5% decrease in HbA1c values (8.4 ± 1.2 vs. 7.9 ± 0.7% [68 ± 9.7 vs. 63 ± 5.5 mmol/mol]; p < 0.032), an improvement in glycaemic variability (standard deviation 66.9 ± 14 vs. 59.4 ± 16 mg/dl; p < 0.05), a decrease in insulin requirements (0.87 ± 0.29 vs. 0.80 ± 0.25 U/kg; p < 0.049), a decrease in number of severe hypoglycaemia episodes (0.44 ± 0.9 vs. 0.05 ± 0.2; p < 0.014), and an increase in periods of normoglycaemia measured with CGSM (15.8 ± 10.9% vs. 23 ± 18.4%; p < 0.003). Six months after randomization, significant improvements were seen in the HbA1c (7.9 ± 0.7 vs. 7 ± 0.6% [63 ± 5.5 vs. 53 ± 4.5 mmol/mol]; p < 0.001) and EsQOL (91.66 ± 22 vs. 84.53 ± 1.63; p < 0.045) only in the CSII group. The HbA1c value was significantly lower when compared with the MDI/G group (CSII 7 ± 0.6% [53 ± 4.5 mmol/mol] vs. MDI/G 7.6 ± 0.9% 59.6 ± 7.7 mmol/mol];p < 0.03). Conclusions: Intensive insulin therapy with CSII vs. MDI/G was associated with better levels of HbA1c in patients with long-term type 1 diabetes (AU)

Introducción y objetivo: Las ventajas de la infusión subcutánea continua de insulina (ISCI) sobre múltiples inyecciones diarias de insulina con glargina (MDI/G) son todavía inciertas. Comparamos ISCI frente a MDI/G en pacientes con diabetes tipo 1 sin indicación de terapia ISCI utilizando la monitorización continua de glucosa (CGSM). Los objetivos primarios fueron el control glucémico y la calidad de vida (QOL). Métodos: Un total de 45 pacientes con diabetes 1 de largo tiempo de evolución y valores medios de HbA1c de 8,6 ± 1,8% (70,5 ± 15,4 mmol/mol), previamente tratados con MDI/NPH, fueron cambiados a MDI/G durante 6 meses y luego sin cumplir criterios clínicos para terapia ISCI asignados aleatoriamente a ISCI o MDI/G durante seis meses. Se evaluó la calidad de vida (EsDqol) y el control de la glucemia mediante la medición de los niveles de HbA1c, la tasa de hipoglucemias, cetoacidosis y datos de CGSM. Resultados: Después de la primera fase (MDI/NPH a MDI/G) hubo una mejora significativa en EsDQOL total (99,72 ± 18,38 vs. 92,07 ± 17,65; p < 0.028), una disminución de 0,5% en los valores de HbA1c (8,4 ± 1,2 vs. 7,9 ± 0,7% [68 ± 9,7 vs. 63 ± 5,5 mmol/mol]; p < 0,032), una mejora en la variabilidad de la glucemia (desviación estándar 66,9 ± 14 vs. 59,4 ± 16 mg/dl; p <0,05), una disminución en las necesidades de insulina (0,87 ± 0,29 vs. 0,80 ± 0,25 U/kg; p <0,049), una disminución en el número de episodios de hipoglucemia grave (0,44 ± 0,9 vs. 0,05 ± 0,2; p <0,014), y un aumento en los periodos de normoglucemia medidos con CGSM (15,8 ± 10,9% vs. 23 ± 18,4%; p <0,003). Seis meses después de la aleatorización, se observaron mejoras significativas en la HbA1c (7,9 ± 0,7 vs. 7 ± 0,6%; [63 ± 5,5 vs. 53 ± 4.5 mmol/mol]; p <0,001) y la calidad de vida (91,66 ± 22 vs. 84,53 ± 1,63; p <0,045) sólo en el grupo ISCI. El valour de HbA1c fue significativamente menor en ISCI en comparación con el grupo MDI/G (CSII 7 ± 0,6% [53 ± 4,5 mmol/mol] vs. MDI/G 7,6 ± 0,9% [59,6 ± 7,7 mmol/mol]; p < 0,03). Conclusiones: La terapia insulínica intensiva con ISCI vs. MDI/G se asoció con mejores niveles de HbA1c en pacientes con diabetes tipo 1 de larga evolución (AU)

Comparison between a multiple daily insulin injection regimen (basal once-daily glargine plus mealtime lispro) and continuous subcutaneous insulin infusion (lispro) using continuous glucose monitoring in metabolically optimized type 1 diabetes patients: A randomized open-labelled parallel study.

BACKGROUND AND OBJECTIVE: Advantages of continuous subcutaneous insulin infusion (CSII) over multiple daily injections with glargine (MDI/G) are still uncertain. We compared CSII vs. MDI/G therapy in unselected patients with type 1 diabetes using continuous glucose monitoring (CGSM). The primary end-points were glycaemic control and quality of life (QOL). METHODS: A total of 45 patients with long-term diabetes and mean HbA1c values of 8.6±1.8% (70.5±15.4mmol/mol), previously treated with MDI/NPH, were switched to MDI/G for 6 months and then, unfulfilling therapy CSII indication, were randomly assigned to CSII or MDI/G for another six months. We evaluated QOL (EsDqol) and glycaemic control by measuring HbA1c levels, rate of hypoglycaemia, ketoacidosis and CGSM data. RESULTS: After the first phase (MDI/NPH to MDI/G) there was a significant improvement in total EsDQOL (99.72±18.38 vs. 92.07±17.65; p<0.028), a 0.5% decrease in HbA1c values (8.4±1.2 vs. 7.9±0.7% [68±9.7 vs. 63±5.5mmol/mol]; p<0.032), an improvement in glycaemic variability (standard deviation 66.9±14 vs. 59.4±16mg/dl; p<0.05), a decrease in insulin requirements (0.87±0.29 vs. 0.80±0.25U/kg; p<0.049), a decrease in number of severe hypoglycaemia episodes (0.44±0.9 vs. 0.05±0.2; p<0.014), and an increase in periods of normoglycaemia measured with CGSM (15.8±10.9% vs. 23±18.4%; p<0.003). Six months after randomization, significant improvements were seen in the HbA1c (7.9±0.7 vs. 7±0.6% [63±5.5 vs. 53±4.5mmol/mol]; p<0.001) and EsQOL (91.66±22 vs. 84.53±1.63; p<0.045) only in the CSII group. The HbA1c value was significantly lower when compared with the MDI/G group (CSII 7±0.6% [53±4.5mmol/mol] vs. MDI/G 7.6±0.9% [59.6±7.7mmol/mol]; p<0.03). CONCLUSIONS: Intensive insulin therapy with CSII vs. MDI/G was associated with better levels of HbA1c in patients with long-term type 1 diabetes.

Identification of risk factors for suffering fear of hypoglycemia in type 1 Diabetes Mellitus patients.

Hypoglycemia is one of the main burdens for type I Diabetes Mellitus (DM I) patients. The consequences of hypoglycemia can be quite unpleasant due to the variety of disagreeable physical and psychological symptoms it triggers. The patient's previous experience with hypoglycemia episodes will condition his psychological reaction to future episodes, promoting behavioral modifications that associate with poor glycemic control and worse prognosis, and even with developing psychological disorders, leading to fear of hypoglycemia (FH). To be able to provide tailored prevention and treatment of patients with FH it is necessary to identify the risk factors in DM I patients. We developed and validated the FH-15 scale, a novel instrument to assess FH, which showed good concurrent and predictive validity in DM I patients. In this work we aim to identify the risk factors for suffering FH by detecting DM I patients with FH using the FH-15 scale and then analyzing the association of clinical and sociodemographic variables. We found that age, needing help to resolve an episode of hypoglycemia, and a perceived lack of social support are risk factors for suffering FH.

Use of telemedicine in subjects with type 1 diabetes equipped with an insulin pump and real-time continuous glucose monitoring.

We evaluated a telemedicine system in patients with type 1 diabetes who had optimized treatment with an insulin pump and a real-time continuous glucose monitoring system. We conducted a prospective, one-year study of 15 subjects. Three medical visits took place: pre-baseline, baseline and at 6 months. Each month the subjects transmitted information from the glucose meter, glucose sensor and insulin pump. We adjusted the treatment and returned the information by email. We evaluated psychological and metabolic variables, including HbA(1c), hypoglycaemia, hyperglycaemia and glucose variability. At baseline the mean age of the subjects was 40 years and the mean duration of diabetes was 22 years. There was a significant reduction in HbA(1c) (7.50 to 6.97%) at 6 months, a significant increase in the number of self-monitoring blood glucose checks per day (5.2 to 6.2), and significant improvements in variability: MODD, mean of daily difference (67 to 53) and MAGE, mean amplitude of glycaemic excursions (136 to 102). There were significant improvements in quality of life (92 to 87), satisfaction with the treatment (34 to 32) and less fear of hypoglycaemia (36 to 32). Adult subjects with type 1 diabetes on treatment with a continuous insulin infusion system and a real time glucose sensor and who have acceptable metabolic control and optimized treatment can benefit from the addition of a telemetry system to their usual outpatient follow-up.

Depresión en la diabetes mellitus tipo 1 y factores asociados / Depression in type 1 diabetes mellitus and associated factors

Fundamento y objetivo: En los últimos años ha aumentado el interés por la depresión y los factores de riesgo en diabetes. Objetivos: 1) estudiar las variables asociadas a la presencia de depresión en pacientes con diabetes mellitus tipo 1 (DM1); 2) analizar posibles factores de riesgo de depresión en estos pacientes; 3) determinar un posible modelo explicativo de las puntuaciones de depresión en este tipo de pacientes. Pacientes y método: Doscientos siete pacientes con DM tipo 1. Las variables sociodemográficas y biomédicas fueron evaluadas mediante entrevista estructurada y las variables psicológicas mediante la Escala de Depresión en Diabetes Tipo 1 (EDDI-1) y la Versión española del Diabetes Quality of Life (Es DQOL). Resultados: La prevalencia de depresión fue del 21,7%. Variables asociadas con riesgo de depresión en la muestra estudiada: ser mujer; no estar empleado; fumador; tener complicaciones por la diabetes u otra afección física; no percibir apoyo de la familia, amigos ni compañeros de trabajo en relación a la diabetes; número elevado de hiperglucemias semanales; y baja calidad de vida. Se ha obtenido un modelo, basado en investigaciones previas, que explica un alto porcentaje de la variabilidad en las puntuaciones de los pacientes en la Escala de Depresión en Diabetes Tipo 1.Conclusiones: Estos resultados proporcionan apoyo empírico sobre los factores de riesgo asociados a la depresión en pacientes con DM tipo1. Las variables control glucémico y calidad de vida han tenido un peso importante en las puntuaciones de la Escala de Depresión en Diabetes Tipo 1, lo que aporta una valiosa información para la planificación del tratamiento de estos pacientes (AU)

Background and objective: In recent years, there has been an increased interest in depression and diabetes risk factors. Our objectives were 1) Study the variables associated with the presence of depression in patients with type 1 diabetes mellitus (DM1), 2) to analyze potential risk factors for depression in these patients, and 3) to study a possible explanatory model of depression scores in these patients.Patients and methods: 207 patients with DM1. We evaluated sociodemographic and biomedical variables by means of a structured interview. We assessed psychological variables by means of the Scale for Depression in Type 1 Diabetes (EDDI-1) and the Spanish version of Diabetes Quality of Life (Es DQOL).Results: Prevalence of depression was 21,7%. Variables associated with risk of depression in this sample were to be female; be unemployed; smoking; having complications of diabetes or other physical conditions; not perceiving family support or support from friends or colleagues in relation to diabetes; having a high number of weekly hyperglycemia; and a poor quality of life. A model based on previous research was obtained. This model explains a high percentage of the variability in the scores of patients in the EDDI-1. Conclusions: These results provide an empirical support to the knowledge of the risk factors associated with depression in patients with DM1. Glycemic control and quality of life have an important effect on the scores of depression in these patients, providing information for their treatment (AU)

[Depression in type 1 diabetes mellitus and associated factors]. / Depresión en la diabetes mellitus tipo 1 y factores asociados.

BACKGROUND AND OBJECTIVE: In recent years, there has been an increased interest in depression and diabetes risk factors. Our objectives were 1) Study the variables associated with the presence of depression in patients with type 1 diabetes mellitus (DM1), 2) to analyze potential risk factors for depression in these patients, and 3) to study a possible explanatory model of depression scores in these patients. PATIENTS AND METHODS: 207 patients with DM1. We evaluated sociodemographic and biomedical variables by means of a structured interview. We assessed psychological variables by means of the Scale for Depression in Type 1 Diabetes (EDDI-1) and the Spanish version of Diabetes Quality of Life (Es DQOL). RESULTS: Prevalence of depression was 21,7%. Variables associated with risk of depression in this sample were to be female; be unemployed; smoking; having complications of diabetes or other physical conditions; not perceiving family support or support from friends or colleagues in relation to diabetes; having a high number of weekly hyperglycemia; and a poor quality of life. A model based on previous research was obtained. This model explains a high percentage of the variability in the scores of patients in the EDDI-1. CONCLUSIONS: These results provide an empirical support to the knowledge of the risk factors associated with depression in patients with DM1. Glycemic control and quality of life have an important effect on the scores of depression in these patients, providing information for their treatment.

El constructo de personalidad tipo c: una contribución a su definición a partir de datos empíricos / The personality Type C construct: a contribution to its definition based on empirical data

En este artículo se presentan tres estudios. El objetivo del primero ha sido analizar las dimensiones que conforman el constructo Tipo C. Para ello se aplicó un cuestionario desarrollado en una investigación previa a una muestra de la población general (n = 618). Un análisis factorial arrojó cinco factores: Control emocional, Racionalidad, Represión emocional, Necesidad de armonía y Comprensión, pero el análisis de ecuaciones estructurales indicó que tan sólo forman parte del constructo el Control emocional, la Represión emocional y la Comprensión. Con el objetivo de replicar estos hallazgos, se llevó a cabo un segundo estudio con similares resultados. En el tercer estudio se compararon las puntuaciones en los cinco factores de un grupo de pacientes oncológicos (n = 100) y de sujetos sanos (n = 98). Los resultados mostraron que el grupo de pacientes oncológicos puntuaba más alto en todos los factores, si bien las diferencias tan sólo fueron estadísticamente significa-tivas en Control emocional, Racionalidad y Necesidad de armonía. Los resultados son discutidos en base a teorías e investigaciones previas (AU)

Evaluación del patrón de conducta tipo C en pacientes crónicos / Assessment of type C in chronic patients

Numerosas investigaciones se han dirigido a determinar las características de personalidad que podrían guardar relación no sólo con el inicio, sino también con la progresión de la enfermedad. En concreto, el Patrón de Conducta Tipo C (PCTC) ha acaparado las páginas de diversas revistas nacionales e internacionales, afirmándose que dicho patrón está estrechamente relacionado con el cáncer. El objetivo de la presente investigación es comprobar sí, como viene afirmándose, el Tipo C es un patrón exclusivo de personas que padecen cáncer o por el contrario es un estilo de conducta característico de personas que padecen una enfermedad crónica. El estudio se realizó con una muestra de 203 pacientes con enfermedades crónicas (103 pacientes diabéticos y 100 pacientes con cáncer) para la que se seleccionó una muestra equivalente de la población general. Para evaluar el constructo Tipo C se utilizó el Autoinforme de Personalidad Tipo C (Amorós, Anarte, Esteve, López y Ramírez, 1998; Esteve, López, Anarte, Ramírez y Amorós, 1998; López, Esteve, Ramírez y Anarte, 1998). Hemos encontrado diferencias significativas en este patrón de conducta entre pacientes con cáncer y personas sanas (Control, Racionalidad, Necesidad de Armonía y Total de la Escala), entre pacientes diabéticos y personas sanas (Control, Represión Emocional y Necesidad de Armonía) y entre pacientes con cáncer y pacientes diabéticos (Control, Racionalidad, Necesidad de armonía y Total de la Escala). A la luz de estos resultados, podría decirse que el "Tipo C" no es exclusivo de personas con cáncer, sino que más bien parece ser un patrón de conducta multidimensional característico de personas que padecen una enfermedad crónica. Futuras investigaciones tendrán como objetivo replicar estos hallazgos en personas con distintas enfermedades crónicas (cardiovasculares, renales, etc.). (AU)