Association between diabetes-related distress and glycemic control in primary care patients with Type 2 diabetes during the coronavirus disease 2019 (COVID-19) pandemic in Egypt.

BACKGROUND: Diabetes-related distress and glycemic control are of a particular concern to primary care physicians because of the impact of the coronavirus disease 2019 pandemic on diabetic patients' lifestyle, psychological well-being and healthcare access. Our aim was to evaluate the relationship between diabetes-related distress and glycemic control in diabetic patients with Type 2 diabetes mellitus (T2DM) in primary care settings during the pandemic. MATERIALS AND METHODS: This cross-sectional study was conducted at primary healthcare clinics in a rural area in Egypt among 430 patients with T2DM during the period from September 2020 to June 2021. All patients were interviewed for their sociodemographic, lifestyle, and clinical characteristics. Diabetes-related distress was measured by the problem areas in the diabetes scale (PAID), where a total score of ≥40 indicated a severe diabetes-related distress. The most recent glycosylated hemoglobin (HbA1c) measurements were used to indicate the glycemic control. Quantile regression model (0.50 quantile) was used to perform the multivariate analysis to identify significant factors associated with HbA1c level. RESULTS: Most of the participants had a suboptimal glycemic control (92.3%), while 13.3% had severe diabetes-related distress. HbA1c level was significantly and positively correlated with the total PAID score and all its sub-domains. Multivariate quantile regression revealed that obesity, multi-morbidity, and severe diabetes-related distress were the only significant determinants of the HbA1c median level. Obese patients had significantly higher median HbA1c compared to patients who were not obese (coefficient = 0.25, P < 0.001). Patients with two or more comorbidities (i.e., multimorbidity) had a significantly higher median HbA1c than patients with single or no chronic comorbidities (coefficient = 0.41, P < 0.001). Severe diabetes-related distress was significantly associated with higher median HbA1c compared to nonsevere diabetes-related distress (coefficient = 0.20, P = 0.018). CONCLUSION: Diabetes-related distress had a significant association with HbA1c level. Family physicians should implement multifaceted programs to optimize diabetes control and reduce any associated distress.

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.

Psychometric evaluation of the Arabic version of the 5-item Problem Areas in Diabetes (AR-PAID-5) scale.

BACKGROUND: Screening for diabetes distress is recommended when caring for patients with type 2 diabetes mellitus (T2DM) in primary healthcare (PHC). The 5-item Problem Areas in Diabetes (PAID-5) scale is widely used to measure diabetes distress, but its Arabic validation studies are scarce, so this study was carried to assess the psychometric properties of the Arabic version of the PAID-5 (AR-PAID-5) in Egyptian PHC patients with T2DM. METHODS: We conducted a cross-sectional study including 260 participants from six rural PHC settings in Ismailia governorate, Egypt. Internal consistency using Cronbach's α and one-month test-retest reliability using intraclass correlation coefficient (ICC) were investigated. Confirmatory factor analysis (CFA) was used to evaluate the one-factor structure of the AR-PAID-5. Correlations of the AR-PAID-5 with the Arabic versions of the 20-item Problem Areas in Diabetes (PAID), Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7), 5-item World Health Organization Well-Being Index (WHO-5) scales and glycated hemoglobin (HbA1c) were investigated for supporting the convergent validity. Associations of the PAID-5 with sociodemographic, and clinical characteristics were assessed for demonstrating the discriminant validity. Criterion validity was also evaluated. RESULTS: There was a good internal consistency (α = 0.88) and a stable test-retest reliability (ICC = 0.74). The CFA confirmed the one-factor structure of the AR-PAID-5. Significant positive correlations existed between the AR-PAID-5 with diabetes distress evaluated by the Arabic version of the PAID (rho = 0.93, p < 0.001), depressive symptoms (PHQ-9) (rho = 0.56, p < 0.001), anxiety symptoms (GAD-7) (rho = 0.47, p < 0.001), emotional well-being (WHO-5) (rho = - 0.38, p < 0.001), and HbA1c (rho = 0.16, p = 0.003). A satisfactory discriminant validity, and an acceptable criterion validity were demonstrated. CONCLUSIONS: The AR-PAID-5 scale is a reliable and valid tool that can be used for diabetes distress screening and in research in Arabic speaking PHC patients with T2DM.

Plasma thrombin-activatable fibrinolysis inhibitor levels in children and adolescents with type 1 diabetes mellitus: possible relation to diabetic microvascular complications.

Thrombin-activatable fibrinolysis inhibitor (TAFI) is a potent inhibitor of fibrinolysis isolated from human plasma. This study was designed to investigate the association between TAFI levels in relation to metabolic control, microvascular complications and lipid profile in a cohort of Egyptian children and adolescents with type 1 diabetes mellitus (T1DM). Eighty normotensive nonobese type 1 diabetic patients (45 with and 35 without microvascular complications) with a mean age of 12.75 ± 3.6 years and mean disease duration of 7.42 ± 2.4 years in addition to 60 sex and age-matched normal individuals were enrolled in this study. Anthropometric measurements, blood pressure and microvascular complications were analysed. HbA1c, albumin-to-creatinine ratio in urine, lipid profile and TAFI levels were measured. Plasma level of TAFI in diabetic patients was significantly elevated, compared with normal individuals (16 ± 2.8 vs. 10.3 ± 0.7 µg/ml; P < 0.004). Plasma level of TAFI in diabetic patients with microvascular complications was significantly higher than in diabetic patients without complications (17.9 ± 1.8 vs. 12.9 ± 0.6 µg/ml; P < 0.001). Plasma TAFI levels were positively correlated with HbA1c levels (r = 0.38; P < 0.03) and SBP (r = 0.37; P < 0.02). Total cholesterol and triglycerides were higher in patients with microvascular complications than in those without complications (P < 0.001, P < 0.05, respectively). Our results showed that TAFI is considered a valid predictor for microvascular complications with best cut off value 15 µg/ml with sensitivity of 99% and specificity of 100%. Our data imply that increased plasma TAFI as well as high lipid levels may be involved in the mechanism of vascular endothelial damage in patients with T1DM. This suggests the possibility of TAFI participating in the mechanism of hypofibrinolysis, hence occurrence of microvascular complications in diabetes.

Knowledge, attitude and practice of family physicians regarding smoking cessation counseling in family practice centers, suez canal university, egypt.

INTRODUCTION: Family physicians are the first point of medical contact for most patients, and they come into contact with a large number of smokers. Also, they are well suited to offer effective counseling to people, because family physicians already have some knowledge of patients and their social environments. AIMS: The present study was conducted to assess family physicians' knowledge, attitude and practice of smoking cessation counseling aiming to improve quality of smoking cessation counseling among family physicians. MATERIALS AND METHODS: The study was descriptive analytic cross sectional study. It was conducted within family medicine centers. Sample was comprehensive. it included 75 family physicians. They were asked to fill previously validated anonymous questionnaire to collect data about their personal characteristics, knowledge, attitude and practice of smoking cessation counseling, barriers and recommendations of physicians. Equal or above the mean scores were used as cut off point of the best scores for knowledge, attitude and practice. STATISTICAL ANALYSIS: SPSS version 18 was used for data entry and statistical analysis. RESULTS: The best knowledge, attitude and practice scores among family physicians in the study sample were (45.3 %, 93.3% and 44% respectively). Age (P = 0.039) and qualification of family physicians (P = 0.04) were significant variables regarding knowledge scores while no statistically significance between personal characteristics of family physicians and their attitude or practice scores regarding smoking cessation counseling. More than half of the family physicians recommended training to improve their smoking cessation counseling. CONCLUSIONS: Favorable attitude scores of family physicians exceed passing knowledge scores or practice scores. Need for knowledge and training are stimulus to design an educational intervention to improve quality of smoking cessation counseling.