Aims
The second Diabetes Attitudes, Wishes and Needs (DAWN2) study aimed to assess psychosocial outcomes in people with diabetes across countries for benchmarking.
Methods
Surveys included new and ...adapted questions from validated questionnaires that assess health‐related quality of life, self‐management, attitudes/beliefs, social support and priorities for improving diabetes care. Questionnaires were conducted online, by telephone or in person.
Results
Participants were 8596 adults with diabetes across 17 countries. There were significant between‐country differences for all benchmarking indicators; no one country's outcomes were consistently better or worse than others. The proportion with likely depression WHO‐5 Well‐Being Index (WHO‐5) score ≤ 28 was 13.8% (country range 6.5–24.1%). Diabetes‐related distress Problem Areas in Diabetes Scale 5 (PAID‐5) score ≥ 40 was reported by 44.6% of participants (17.2–67.6%). Overall quality of life was rated ‘poor’ or ‘very poor’ by 12.2% of participants (7.6–26.1%). Diabetes had a negative impact on all aspects investigated, ranging from 20.5% on relationship with family/friends to 62.2% on physical health. Approximately 40% of participants (18.6–64.9%) reported that their medication interfered with their ability to live a normal life. The availability of person‐centred chronic illness care and support for active involvement was rated as low. Following self‐care advice for medication and diet was most common, and least common for glucose monitoring and foot examination, with marked country variation. Only 48.8% of respondents had participated in diabetes educational programmes/activities to help manage their diabetes.
Conclusions
Cross‐national benchmarking using psychometrically validated indicators can help identify areas for improvement and best practices to drive changes that improve outcomes for people with diabetes.
What's new?
Diabetes impacts on physical, emotional, social and financial aspects of life across cultures and countries, yet gaps in care exist around psychosocial and self‐management education and support.
The DAWN2 study highlights significant country variation in indicators of person‐centred diabetes care and psychosocial outcomes of diabetes.
Most people with diabetes are not actively engaged by their healthcare professionals to take control of their condition; education and psychosocial care are often unavailable.
The DAWN2 study provides new insights from four continents that may help identify unmet needs and best practices to drive changes that improve outcomes for people with diabetes.
Purpose We evaluated quality of life in pregnant women with diabetes followed up at Italian diabetes clinics. Methods A total of 245 pregnant women (30 type 1 diabetes mellitus (T1DM), 176 ...gestational diabetes (GDM) and 39 controls) were asked to fill in a questionnaire including the SF-36 Health Survey and the Center for Epidemiological Studies-Depression (CES-D) Scale in third trimester of pregnancy and after delivery. GDM and T1DM also completed two diabetes-specific questionnaires (Diabetes-related stress and Diabetes health distress). Quality of life scores were compared between the groups with the Mann-Whitney U-test, mean changes in scores (after delivery to 3rd trimester) were compared between groups by ANCOVA. Results Regarding the SF-36 scores in the third trimester of pregnancy, T1DM and GDM women had a better Standardised Physical Component score than controls (P < 0.0001, P = 0.009, respectively). GDM and T1DM pregnant women scored significantly lower for general health perception than controls (P = 0.009 and P = 0.001, respectively). T1DM patients had lower Standardised Mental Component scores than controls (P = 0.03). Compared with the third trimester of pregnancy, the severity of depressive symptoms increased significantly after delivery in both diabetic groups, but not in controls (P < 0.0001). Scores improved in all SF-36 areas in healthy and GDM women, while they all became worse in the T1DM group. Conclusions Pregnancy is associated with a perception of poor general health in women with both T1DM and GDM. After delivery, significantly worse depressive symptoms were documented in both groups, while a generally worse physical and psychological well-being was only identified in women with T1DM. These findings have important implications for pregnancy follow-up.
Aims
The second Diabetes Attitudes, Wishes and Needs (DAWN2) study examined the experiences of family members of people with diabetes for benchmarking and identifying unmet needs or areas for ...improvement to assist family members and those with diabetes to effectively self‐manage.
Methods
In total, 2057 family members of people with diabetes participated in an online, telephone or in‐person survey designed to assess the impact of diabetes on family life, family support for people with diabetes and educational and community support.
Results
Supporting a relative with diabetes was perceived as a burden by 35.3% (range across countries 10.6–61.7%) of respondents. Over half of respondents 51.4% (22.5–76.0%) rated their quality of life as ‘good’ or ‘very good’. However, distress about the person with diabetes was high, with 61.3% (31.5–86.4%) worried about hypoglycaemia. The impact of diabetes on aspects of life was felt by 51.8% (46.9–58.6%). The greatest negative effect was on emotional well‐being 44.6% (31.8–63.0%), although depression was less common 11.6% (4.2–20.0%). Many respondents did not know how to help the person with diabetes 37.1% (17.5–53.0%) and wanted to be more involved in their care 39.4% (15.5–61.7%). Participation in diabetes educational programmes was low 23.1% (9.4–43.3%), although most of those who participated found them helpful 72.1% (42.1–90.3%).
Conclusions
Diabetes has a negative impact on family members of people with diabetes. DAWN2 provides benchmarking indicators of family members' psychosocial needs that will help identify the support required for, and from, them to improve the lives of people with diabetes and their families.
What's new?
The second Diabetes Attitudes, Wishes and Needs (DAWN2) study surveyed adult family members of adults with diabetes across 17 countries to provide the first in‐depth assessment of their views and needs, and identified areas requiring improvement that would help optimize diabetes management and coping. These indicators can serve as benchmarks for future research and action initiatives.
DAWN2 found that diabetes impacts the lives of family members, resulting in substantial burden and distress.
DAWN2 confirms that psychosocial problems of family members are barriers to their effective involvement in self‐management, but current healthcare systems are poorly equipped to provide support or education to the families of people with diabetes.
Aims
The second Diabetes Attitudes, Wishes and Needs (DAWN2) study sought cross‐national comparisons of perceptions on healthcare provision for benchmarking and sharing of clinical practices to ...improve diabetes care.
Methods
In total, 4785 healthcare professionals caring for people with diabetes across 17 countries participated in an online survey designed to assess diabetes healthcare provision, self‐management and training.
Results
Between 61.4 and 92.9% of healthcare professionals felt that people with diabetes needed to improve various self‐management activities; glucose monitoring (range, 29.3–92.1%) had the biggest country difference, with a between‐country variance of 20%. The need for a major improvement in diabetes self‐management education was reported by 60% (26.4–81.4%) of healthcare professionals, with a 12% between‐country variance. Provision of diabetes services differed among countries, with many healthcare professionals indicating that major improvements were needed across a range of areas, including healthcare organization 30.6% (7.4–67.1%), resources for diabetes prevention 78.8% (60.4–90.5%), earlier diagnosis and treatment 67.9% (45.0–85.5%), communication between team members and people with diabetes 56.1% (22.3–85.4%), specialist nurse availability 63.8% (27.9–90.7%) and psychological support 62.7% (40.6–79.6%). In some countries, up to one third of healthcare professionals reported not having received any formal diabetes training. Societal discrimination against people with diabetes was reported by 32.8% (11.4–79.6%) of participants.
Conclusions
This survey has highlighted concerns of healthcare professionals relating to diabetes healthcare provision, self‐management and training. Identifying between‐country differences in several areas will allow benchmarking and sharing of clinical practices.
What's new?
The original DAWN study found that diabetes is often associated
with multiple psychosocial problems that are barriers to
self‐management behaviours, and that current healthcare resources
in various countries are poorly equipped or utilized to support people
with diabetes.
The current DAWN2 study has provided a new in‐depth
understanding of the views and needs of healthcare professionals, allowed
for cross‐national comparisons and identified areas for
improvement to achieve optimal diabetes care.
Healthcare professionals stress the importance of improving
healthcare organization, as well as addressing emotional problems and
improving self‐management activities in people with
diabetes.
Since 2006, the Italian AMD (Associations of Medical Diabetologists) Annals Initiative promoted a continuous monitoring of the quality of diabetes care, that was effective in improving process, ...treatment and outcome indicators through a periodic assessment of standardized measures. Here, we show the 2022 AMD Annals data on type 2 diabetes (T2D).
A network involving ∼1/3 of diabetes centers in Italy periodically extracts anonymous data from electronic clinical records, by a standardized software. Process, treatment and outcome indicators, and a validated score of overall care, the Q-score, were evaluated.
295 centers provided the annual sample of 502,747 T2D patients. Overall, HbA1c value ≤7.0% was documented in 54.6% of patients, blood pressure <130/80 mmHg in 23.0%, and LDL-cholesterol levels <70 mg/dl in 34.3%, but only 5.2% were at- target for all the risk factors. As for innovative drugs, 29.0% of patients were on SGLT2-i, and 27.5% on GLP1-RAs. In particular, 59.7% were treated with either GLP1-RAs or SGLT2-i among those with established cardiovascular disease (CVD), 26.6% and 49.3% with SGLT2-i among those with impaired renal function and heart failure, respectively. Notably, only 3.2% of T2D patients showed a Q score <15, which correlates with a 80% higher risk of incident CVD events compared to scores >25.
The 2022 AMD Annals data show an improvement in the use of innovative drugs and in the overall quality of T2D care in everyday clinical practice. However, additional efforts are needed to reach the recommended targets for HbA1c and major CVD risk factors.
Estimated pulse wave velocity (ePWV), a surrogate measure of arterial stiffness, was shown to independently predict morbidity and mortality from cardiovascular disease and other causes in both the ...general population and high-risk individuals. However, in people with type 2 diabetes, it is unknown whether ePWV adds prognostic information beyond the parameters used for calculating it.
To assess the independent association of ePWV with all-cause mortality in individuals with type 2 diabetes.
Prospective cohort study that enrolled 15,773 patients in 19 Italian centres in 2006-2008.
ePWV was calculated from a regression equation using age and mean blood pressure (BP). All-cause mortality was retrieved for 15,656 patients in 2015.
Percentage and rate of deaths, Kaplan-Meier estimates, and unadjusted hazard ratios increased from quartile I to quartile IV of ePWV. After adjustment for age, sex, BP levels and anti-hypertensive treatment, the strength of association decreased but mortality risk remained significantly higher for quartiles II (+34%), III (+82%), and IV (+181%) versus quartile I and was virtually unchanged when further adjusting for other cardiovascular risk factors and complications/comorbidities. Each m·s - 1 increase in ePWV was associated with an increased adjusted risk of death in the whole cohort (+53%) and in participants with (+52%) and without (+65%) cardiorenal complications. Moreover, ePWV significantly improved prediction of mortality risk over cardiovascular risk factors and complications/comorbidities, though the net increase was modest.
These findings suggest that ePWV may represent a simple and inexpensive tool for providing prognostic information beyond traditional cardiovascular risk factors.
ClinicalTrials.gov, NCT00715481, https://clinicaltrials.gov/ct2/show/NCT00715481.
Objectives
Poorer control of risk factors for cardiovascular disease (CVD) has been reported in diabetic women, as compared with diabetic men. It has been proposed that this finding is due to gender ...disparities in treatment intensity. We investigated this hypothesis in a large contemporary cohort of subjects with type 2 diabetes.
Design
Observational, cross‐sectional study.
Subjects and setting
Consecutive patients with type 2 diabetes from the Renal Insufficiency And Cardiovascular Events (RIACE) Italian multicentre study (n = 15 773), attending 19 hospital‐based diabetes clinics in 2007–2008.
Main outcome measures
Traditional CVD risk factors, macro‐ and microvascular complications and current glucose‐, lipid‐ and blood pressure (BP)‐lowering treatments were assessed.
Results
Although CVD was more prevalent in men, women showed a less favourable CVD risk profile and worse performance in achieving treatment targets for haemoglobin A1c, LDL, HDL and non‐HDL cholesterol, systolic blood pressure (BP) and in particular obesity body mass index (BMI) and waist circumference, but not for triglycerides and diastolic BP. However, women were more frequently receiving pharmacological treatment for hypertension and to a lesser extent hyperglycaemia and dyslipidaemia than men, and female gender remained an independent predictor of unmet therapeutic targets after adjustment for confounders such as treatments, BMI, duration of diabetes and, except for the systolic BP goal, age.
Conclusions
In women with type 2 diabetes from the RIACE cohort, a more adverse CVD risk profile and a higher likelihood of failing treatment targets, compared with men, were not associated with treatment differences. This suggests that factors other than gender disparities in treatment intensity are responsible.
An initiative of continuous monitoring of the quality of diabetes care, promoted by the Association of Medical Diabetologists, is in place in Italy since 2006 (AMD Annals). The initiative was ...effective in improving quality of care indicators, assessed periodically through standardized measures. Here, we show the 2023 AMD Annals data on type 2 (T2D) and type 1 (T1D) diabetes.
A network of over 1/3 of diabetes centers in Italy periodically extracts anonymous data from electronic medical records, using a standardized software. Process, treatment and outcome indicators, and a validated score of overall care, the Q-score, were evaluated.
296 centers provided data on 573,164 T2D (mean age 69.7 ± 11.2 years) and 42,611 T1D subjects (mean age 48.6 ± 16.9 years). A HbA1c value ≤ 7.0 % was documented in 56.3 % of patients with T2D and 35.9 % of those with T1D. Only 6.6 % of T2D patients and 3.5 % of those with T1D reached the composite outcome of HbA1c ≤ 7.0 % + LDL-C < 70 mg/dl + BP < 130/80 mmHg. Notably, only 2.8 % and 3.2 % of T2D and T1D patients, respectively, showed a Q score < 15, which correlates with an 80 % higher risk of incident CVD events compared to scores > 25.
We documented an overall good quality of care in both T1D and T2D subjects. However, the failure to achieve the targets of the main risk factors, especially if combined, in a still too large proportion of patients testify the difficulty to apply the more and more stringent indications recommended by guidelines in the everyday clinical practice.
Aims
To assess country‐ and individual‐level correlates of psychological outcomes, and differences among countries in the associations of individual characteristics with psychological outcomes among ...adults with diabetes.
Methods
The second Diabetes Attitudes, Wishes and Needs (DAWN2™) study assessed self‐reported characteristics of people with diabetes in 17 countries, including 1368 adults with Type 1 diabetes and 7228 with Type 2 diabetes. In each country, a sample of 500 adults, stratified by diabetes type and treatment, completed a questionnaire incorporating the validated WHO‐5 wellbeing index, the WHOQOL‐BREF, and the five‐item Problem Areas in Diabetes Scale, as well as the newly developed Diabetes Impact on Life Dimensions that assessed impact ranging from very positive to very negative, with no impact as the midpoint. Multilevel regression analyses identified significant (P < 0.05) independent correlates of psychological outcomes.
Results
There were significant variations in all outcomes across countries before adjustment for individual‐level factors; adjustment reduced between‐country disparities. Worse psychological outcomes were associated with more complications, incidence of hypoglycaemia, hypoglycaemic medication, perceived burden of diabetes, family conflict and experience of discrimination. Better psychological outcomes were associated with higher self‐rated health, greater access to diabetes education and healthcare, and more psychosocial support from others. The associations of many factors with the outcomes were mediated by modifiable factors. The association of all factors with the outcomes varied across (interacted with) countries, highlighting the need for country‐specific analyses.
Conclusions
Improvements in modifiable risk factors (reductions in burden and increases in support) may lead to better psychological outcomes in adults with diabetes.
What's new?
The results of this study provide a comprehensive assessment of the risk and protective factors for psychological outcomes among adults with diabetes on a global scale.
Modifiable risk/protective factors mediate the impact of demographic and clinical factors on psychological outcomes.
Accounting for individual‐level risk and protective factors reduces between‐country disparities in psychological outcomes, but results show that risk/protective factors operate differently in different countries.
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