MyDiaMate is a web-based intervention specifically designed for adults with type 1 diabetes (T1D) that aims to help them improve and maintain their mental health. Prior pilot-testing of MyDiaMate ...verified its acceptability, feasibility, and usability.
This study aimed to investigate the real-world uptake and usage of MyDiaMate in the Netherlands.
Between March 2021 and December 2022, MyDiaMate was made freely available to Dutch adults with T1D. Usage (participation and completion rates of the modules) was tracked using log data. Users could volunteer to participate in the user profile study, which required filling out a set of baseline questionnaires. The usage of study participants was examined separately for participants scoring above and below the cutoffs of the "Problem Areas in Diabetes" (PAID-11) questionnaire (diabetes distress), the "World Health Organization Well-being Index" (WHO-5) questionnaire (emotional well-being), and the fatigue severity subscale of the "Checklist Individual Strength" (CIS) questionnaire (fatigue). Two months after creating an account, study participants received an evaluation questionnaire to provide us with feedback.
In total, 1008 adults created a MyDiaMate account, of whom 343 (34%) participated in the user profile study. The mean age was 43 (SD 14.9; 18-76) years. Most participants were female (n=217, 63.3%) and higher educated (n=198, 57.6%). The majority had been living with T1D for over 5 years (n=241, 73.5%). Of the study participants, 59.1% (n=199) of them reported low emotional well-being (WHO-5 score≤50), 70.9% (n=239) of them reported elevated diabetes distress (PAID-11 score≥18), and 52.4% (n=178) of them reported severe fatigue (CIS score≥35). Participation rates varied between 9.5% (n=19) for social environment to 100% (n=726) for diabetes in balance, which opened by default. Completion rates ranged from 4.3% (n=1) for energy, an extensive cognitive behavioral therapy module, to 68.6% (n=24) for the shorter module on hypos. There were no differences in terms of participation and completion rates of the modules between study participants with a more severe profile, that is, lower emotional well-being, greater diabetes distress, or more fatigue symptoms, and those with a less severe profile. Further, no technical problems were reported, and various suggestions were made by study participants to improve the application, suggesting a need for more personalization.
Data from this naturalistic study demonstrated the potential of MyDiaMate as a self-help tool for adults with T1D, supplementary to ongoing diabetes care, to improve healthy coping with diabetes and mental health. Future research is needed to explore engagement strategies and test the efficacy of MyDiaMate in a randomized controlled trial.
Evidence suggests that many adults with type 1 diabetes (T1D) experience clinically relevant levels of diabetes distress, indicating coping difficulties. Studies have primarily focused on emotion ...regulation as a possible construct to be addressed in psychological interventions to alleviate diabetes distress. This study extends the literature by investigating the cross-sectional association between emotion regulation, diabetes distress and the construct of emotional self-awareness as an additional variable to be considered in potentially reducing diabetes distress.
Via an online survey, data was collected on emotional self-awareness dimensions (attention to feelings, clarity of feelings), emotion regulation strategies (cognitive reappraisal, expressive suppression, mood repair) and diabetes distress, along with self-reported clinical and sociodemographic information. Multiple linear regression with stepwise backward method was used to examine associations, controlling for country.
= 262 Italian and Dutch adults with T1D (80.5% women,
= 38.12 years, SD = 12.14) participated. Clarity of feelings was significantly negatively associated with diabetes distress, resulting in a medium effect size (
= -0.22,
< 0.001). Likewise, mood repair was negatively related to diabetes distress, showing a small effect size (
= -0.26,
< 0.001).
These findings shed light on the importance of a dimension of emotional self-awareness, namely clarity of feelings. This represents the ability to identify one's emotional states and discriminate between them. Thus, it should be considered in psychological interventions, such as mentalization-based treatment, that might contribute to alleviating T1D-related distress.
Aim: EF (ability to initiate, plan, monitor behavior) impacts self-care and glycemic control in teens with T1D. We examined demographics, insulin therapy, A1c, and EF in 3 international cohorts of ...teens with T1D.
Methods: Parents of 337 teens (13-18) with T1D from Belgium (BE), Netherlands (NL), and U.S. completed the BRIEF to assess teen EF. Parents/medical records provided demographic and diabetes data. BRIEF score ≥60 (composite score or either of 2 main indices) defined EF problems. Logistic regression determined associations of EF problems with A1c (<7.5 vs. ≥7.5%), controlling for country, sex, T1D duration, and pump use.
Results: Teens (54% male; 27% BE, 24% NL, 49% U.S.) were 15.0±1.5 yrs old with T1D duration 7.4±4.0 years, A1c 8.1±1.2%, 61% pump. Teens from BE, NL, U.S. differed with respect to A1c (7.4±1.0, 8.1±1.3, 8.5±1.2%) and pump use (27%, 72%, 74%) (all p<.01). Overall, 30% had EF problems (26% BE, 32% NL, 32% U.S.). Generally, teens with EF problems had higher A1c vs. those without (Table). Pump use was less common in teens with EF problems in NL and U.S. and more common in BE. Odds of A1c ≥7.5% was 2.0 (95% CI 1.1, 3.6; p=.03) in teens with EF problems.
Conclusion: In an international sample, teens with T1D and EF problems were twice as likely to have suboptimal A1c. Given country differences in pump use in teens with EF problems, future studies can assess potential benefit of technology in at-risk teens.
Disclosure
E.R. Goethals: None. M. de Wit: None. L.K. Volkening: None. K. Luyckx: None. K. Casteels: None. L.M. Laffel: Advisory Panel; Self; Roche Diabetes Care. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., ConvaTec Inc., Dexcom, Inc., Insulet Corporation, Insulogic LLC, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc., Sanofi US.
Funding
Iacocca Family Foundation; National Institutes of Health (P30DK036836, R01DK095273, K12DK094721); JDRF (2-SRA-2014-253-M-B)
Type 2 diabetes mellitus (T2DM) is a highly prevalent chronic metabolic disease characterized by hyperglycemia and cardiovascular risks. Without proper treatment, T2DM can lead to long-term ...complications. Diabetes self-management is recognized as the cornerstone of overall diabetes management. Web-based self-management programs for T2DM patients can help to successfully improve patient health behaviors and health-related outcomes. Theories can help to specify key determinants of the target behaviors and behavior change strategies required to arrive at the desired health outcomes, which can then be translated into specific behavioral techniques or strategies that patients can learn to apply in their daily life. From previous reviews of a wide range of online diabetes self-management tools and programs, it appears that it is still unclear which behavioral change techniques (BCTs) are primarily used and are most effective when it comes to improving diabetes self-management behaviors and related health outcomes.
We set out to identify which BCTs are being applied in online self-management programs for T2DM and whether there is indication of their effectiveness in relation to predefined health outcomes.
Articles were systematically searched and screened on the mentioned use of 40 BCTs, which were then linked to reported statistically significant improvements in study outcomes.
We found 13 randomized controlled trials reporting on 8 online self-management interventions for T2DM. The BCTs used were feedback on performance, providing information on consequences of behavior, barrier identification/problem solving, and self-monitoring of behavior. These BCTs were also linked to positive outcomes for health behavior change, psychological well-being, or clinical parameters.
A relatively small number of theory-based online self-management support programs for T2DM have been reported using only a select number of BCTs. The development of future online self-management interventions should be based on the use of theories and BCTs and should be reported accurately.
Shared decision making (SDM) is a patient-centered approach in which clinicians and patients work together to find and choose the best course of action for each patient's particular situation. Six ...SDM key elements can be identified: situation diagnosis, choice awareness, option clarification, discussion of harms and benefits, deliberation of patient preferences, and making the decision. The International Patient Decision Aid Standards (IPDAS) require that a decision aid (DA) support these key elements. Yet, the extent to which DAs support these six key SDM elements and how this relates to their impact remain unknown.
We searched bibliographic databases (from inception until November 2017), reference lists of included studies, trial registries, and experts for randomized controlled trials of DAs in patients with cardiovascular, or chronic respiratory conditions or diabetes. Reviewers worked in duplicate and independently selected studies for inclusion, extracted trial, and DA characteristics, and evaluated the quality of each trial.
DAs most commonly clarified options (20 of 20; 100%) and discussed their harms and benefits (18 of 20; 90%; unclear in two DAs); all six elements were clearly supported in 4 DAs (20%). We found no association between the presence of these elements and SDM outcomes.
DAs for selected chronic conditions are mostly designed to transfer information about options and their harms and benefits. The extent to which their support of SDM key elements relates to their impact on SDM outcomes could not be ascertained.
PROSPERO registration number: CRD42016050320 .
Objective: Health-related quality of life (HRQoL) is a key patient-reported outcome in care and research. The few instruments that assess the HRQoL of parents and partners of people with type 1 ...diabetes (T1D) emphasize caregiving burden or are usually proxy measures (reporting on behalf of person with T1D). We created measures assessing parents’ and partners’ own HRQoL as part of a larger study to develop and validate a suite of instruments to measure HRQoL in children through older adults with T1D.
Methods: Qualitative interviews (n=81 people with T1D and parents/partners, 8 providers) identified HRQoL themes to include. Drafts were piloted with n=41. Resulting measures were validated with n=644 parents and n=186 partners from 6 T1D Exchange sites across the U.S., including the HRQoL measure (2 times, approx. 3 months apart), measures of relevant constructs (SF-12, Satisfaction with Life Scale, Diabetes Family Impact Scale, Partner Diabetes Distress Scale), and medical chart-confirmed HbA1c. We report exploratory factor analyses (Promax rotation) and psychometric data for the 4 parent measures (child age <8, 8-11, 12-17, 18-25) and 1 partner measure (person with T1D age ≥18).
Results: Each measure had a unique set of 21-30 positive and negative items loading on 3-4 scales. Reliability was good: total score α range=0.80-0.88, test-retest r range=0.75-0.86. Significant correlations between the total HRQoL scores and measures of general quality of life (r=0.30-0.53), mental well-being (r=0.37-0.53), T1D family impact (parents of youth, r=-0.64--0.72), and diabetes distress (parents/partners of adults, r=-0.76--0.75) indicated construct validity. Scores were not correlated with HbA1c.
Conclusions: The new measures of T1D-specific HRQoL in parents and partners have relevant items and factors, and demonstrate strong psychometric properties. These innovative tools will permit assessment of the experiences of parents and partners of people with T1D for use in research and practice.
Disclosure
M.E. Hilliard: None. C.G. Minard: None. D.G. Marrero: None. M. de Wit: Research Support; Self; Sanofi. D. Thompson: None. A. Verdejo: None. B. Anderson: None.
Funding
The Leona M. and Harry B. Helmsley Charitable Trust (2015PG-T1D084)
Purpose of Review
This manuscript describes how person-reported outcomes (PROs) can be utilized in care for young people with diabetes in the context of motivation.
Recent Findings
The use of ...person-reported outcome measures (PROMS) in clinical care is feasible and acceptable, and helps focus the clinical encounter on life domains important to the person with diabetes. Results with regard to impact on self-management and glycemic outcomes are limited. Motivation is an important factor for self-management. Based on self-determination theory, autonomy-supportive, person-centered, and collaborative communication by diabetes care providers is associated with better outcomes. PROMs can facilitate this conversation.
Summary
Understanding of youth motivation for maintaining or improving self-management behaviors requires a person-centered approach. PROMs can be used to facilitate an autonomy-supportive and person-centered conversation in clinical care. Training diabetes care providers in autonomy-supportive, person-centered conversation skills to discuss PROs might help to tap into youth’s motivation, but further research is needed.
Abstract
Background
Medication non-adherence is a prevalent health problem in people with type 2 diabetes mellitus (T2DM). Interventions have previously been developed to improve medication ...adherence, but inconsistent outcomes have been reported. A potential explanation for this inconsistency is a ‘one size fits all’ approach, with interventions not tailored to the needs and preferences of individuals. Therefore, the aim of this study is to evaluate the effectiveness of a personalised intervention programme aimed at improving adherence to oral antidiabetic and/or antihypertensive medication in people with T2DM.
Methods
A parallel-group randomised controlled trial will be conducted in 40–50 community pharmacies in the Netherlands and the United Kingdom (UK). A total of 300 participants will be included and followed up for a period of 6 months. Participants will be people with T2DM identified as non-adherent to oral antidiabetic and/or antihypertensive medication, aged 35–75 years and mobile phone users. The intervention group will receive a personalised intervention programme that is based on one or more of the participants’ pre-defined non-adherence profile(s), namely (I) Knowledge and perceptions, (II) Practical problems, (III) Side effects and (IV) Negative mood and beliefs. The intervention comprises of one or more supporting modules, namely (I) Brief messaging, (II) Clinical medication review, (III) Medication schedule, (IV) Reminding messaging, (V) Medication dispensing systems, (VI) Smart messaging, (VII) Referral to general practitioner and (VIII) Unguided web-based Self Help Application for low mood. The control group will receive usual care including access to a publicly available informative diabetes website. The primary study outcome is medication adherence measured with a telephone pill count. Secondary outcomes are systolic blood pressure, HbA1c level, self-reported medication adherence, attitude and beliefs toward medication, satisfaction with diabetes treatment, health status and medical consumption and productivity cost. In addition, a process evaluation will be undertaken to establish the fidelity, reach and the extent to which intervention delivery is normalised in the daily practice of community pharmacy teams.
Discussion
The study can lead to a personalised intervention programme that improves medication adherence in people with T2DM that are non-adherent to oral antidiabetic and/or antihypertensive medication.
Trial registration
Dutch Trial Register, Trial NL8747, registered 02 July, 2020; ISRCTN Registry, ISRCTN36009809, registered 05 February, 2020.
Psychological distress and fatigue are common in persons with diabetes, adversely affecting quality of life and complicating diabetes self-management. Offering diabetes-specific self-guided cognitive ...behavioral therapy (CBT) may be helpful for persons with diabetes and mild symptoms of psychological distress and fatigue. We are the first to test the feasibility and user experiences of a web-based self-help app called ‘MyDiaMate’ in adults with type 1 and type 2 diabetes.
MyDiaMate was developed in close collaboration with persons with diabetes and professionals, building on elements from existing (guided) diabetes-specific CBT interventions. The study was advertised, offering free access to the app for adults with diabetes for a period of three months. Feasibility and user experiences were tested in a non-randomized study with pre- and post- measurements and interviews in a small sample.. In addition usage of the app was studied using log-data..
In total N = 55 adults with diabetes signed up for the study. Mean age was M = 42.7 (SD = 15.6), mostly women (n = 39, 70.9%), higher educated (n = 36, 65.5%), and diagnosed with type 1 diabetes (n = 37, 67.3%). About half reported current or a history of psychological complaints. All the participants completed baseline assessments, and n = 32 participants (58%) completed the follow-up questionnaire. Main reasons for participating in the study were: to preserve or improve mental fitness (40.6%), curiosity (25.0%) and wanting to contribute to research (34.4%). No major technical issues were encountered in accessing or using the app. The app was opened at least once by n = 51 participants, median use of the modules was 28 min (1–80) within a period of 1 to 92 days (median = 10). Almost all participants (n = 50, 98.0%) opened the basic module ‘Diabetes in balance’, of whom 32 (62.7%) completed this module. ‘My mood’ and ‘My energy’ were opened by n = 40 (78.4%) and n = 32 (62.7%) participants, respectively, and completed by n = 21 (52.5%) and n = 9 (28.1%) of the participants. Of all participants, 40.6% would recommend the app to others living with diabetes.
This study confirmed the feasibility of MyDiaMate as a diabetes-specific self-guided app for adults wishing to preserve or improve their psychological health. While user experiences were overall positive, further tailoring the content to individual needs and preferences could enhance uptake, usage and appreciation. Future research should explore its effectiveness in a randomized controlled trial.
•MyDiaMate is the first diabetes-specific self-help app to help prevent and reduce psychological distress and fatigue.•The study shows promising results in terms of feasibility and user experiences of the app.•Personalizing content may further improve engagement and appreciation.•Further research should test the efficacy with regard to reduction and prevention of psychological distress and fatigue.
OBJECTIVE: To test the feasibility and impact of implementing the computer-assisted Monitoring of Individual Needs in Diabetes (MIND) procedure, which is aimed at improving recognition and management ...of the psychological needs of diabetic patients in routine care. RESEARCH DESIGN AND METHODS: The MIND study was implemented in diabetes clinics across eight countries as part of the annual review. The computerized assessment covered emotional well-being (World Health Organization 5 Well-Being Index), diabetes-related distress (Problem Areas in Diabetes), life events, and the patient's agenda. Medical data were retrieved from the charts, and agreed-upon actions were recorded. RESULTS: Of 1,567 patients monitored using the MIND, 24.9% had either likely depression or high diabetes-related distress; 5.4% had both. Over 80% of these patients were newly identified cases, and 41% of patients with depression were referred to a mental health professional. CONCLUSIONS: Monitoring of well-being and diabetes-related distress as part of routine diabetes care is feasible and helps to identify and discuss unmet psychosocial needs.
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