Over the past 25 years, there has been significant acknowledgement of the importance of assessing the impact of diabetes on quality of life. Yet, despite the development of several diabetes‐specific ...quality of life measures, the challenges we faced in 1995 remain. There is little consensus on the definition of quality of life because of the complexity and subjectivity of the concept. General quality of life comprises several domains of life, and these are highly individualized. Assessing the impact of diabetes on these life domains adds to the complexity. While comprehensive diabetes‐specific quality‐of‐life measures typically increase respondent burden, brief questionnaires may not capture all relevant/important domains. Today, the lack of resolution of these challenges may explain why the impact of diabetes on quality of life is not systematically assessed in research or clinical care. Few researchers report detailed rationales for assessment, there is often a mismatch between the concept of interest and the measure selected, and data are misinterpreted as assessing the impact of diabetes on quality of life when, in reality, related but distinct constructs have been assessed, such as diabetes distress, treatment satisfaction or health status. While significant efforts are being made to increase routine monitoring of psychological well‐being and understand the lived experience, no guidelines currently recommend routine clinical assessment of diabetes‐specific quality of life, and there is no consensus on which questionnaire(s) to use. The gaps identified in this review need urgent attention, starting with recognition that assessment of diabetes‐specific quality of life is as important as biomedical markers, if we are to improve the lives of people with diabetes.
What's new?
Quality of life (QoL) is a multidimensional, subjective and dynamic construct that is recognized as an important outcome in its own right.
It remains a challenge to assess the impact of diabetes on QoL with a standardized tool, balancing comprehensiveness, subjectivity and brevity.
Monitoring well‐being and providing psychological care is recommended in diabetes guidelines, but there is no recommendation to assess QoL or guidance on how to assess this.
This review highlights several gaps in research and clinical practice, which need to be addressed if we are to improve the QoL of people with diabetes.
Diabet. Med. 29, 293–302 (2012)
As a common side effect of insulin treatment for diabetes, hypoglycaemia is a constant threat and can have far‐reaching and potentially devastating consequences, ...including immediate physical injury as well as more pervasive cognitive, behavioural and emotional effects. Moreover, as a significant limiting factor in achieving optimal glycaemic control, exposure to hypoglycaemia can influence diabetes self‐management.
Although hypoglycaemia is known to occur in Type 2 diabetes, its morbidity and impact on the individual are not well recognized. The aim of the current review is to examine published evidence to achieve a synthesis of the scope and significance of the potential detriment caused by hypoglycaemia to individuals with Type 2 diabetes. The implications of these observations for treatment and research have also been considered.
A narrative review was performed of empirical papers published in English since 1966, reporting the effect of hypoglycaemia on quality of life and related outcomes (including generic and diabetes‐specific quality of life, emotional well‐being and health utilities) in Type 2 diabetes.
Research demonstrates the potential impact of hypoglycaemia on the lives of people with Type 2 diabetes, from an association with depressive symptoms and heightened anxiety, to impairment of the ability to drive, work and function in ways that are important for quality of life. Few studies consider hypoglycaemia as an explanatory variable in combination with quality of life or related primary endpoints. As a consequence, there is a pressing need for high‐quality research into the overall impact of hypoglycaemia on the lives of people with Type 2 diabetes.
Aims
Optimal diabetes management requires daily selfmanagement. While little time is spent with health professionals, they can have a substantial impact on how a person manages and feels about living ...with diabetes. The aim of this qualitative study was to explore what people with diabetes wish their health professionals understood about living with diabetes.
Methods
Thematic analysis was conducted of responses to a single open‐ended question, ‘What do you wish your health professional understood about living with diabetes?’, which was part of the Diabetes MILES‐2 survey, assessing the psychological and behavioural aspects of living with type 1 or type 2 diabetes in Australian adults.
Results
In total, 1316 responses (56% response rate) were collected, with 1190 responses included for analysis (54% from respondents with type 1 diabetes, 46% from those with type 2 diabetes). Seven major themes emerged; respondents wished their health professional understood: 1) the potential barriers to diabetes management; 2) that it is ‘easier said than done’; 3) the social/emotional impact; 4) that they want, need and deserve more; 5) that judgements, assumptions and negative perspective are not helpful; 6) more about diabetes; and 7) that the respondent is the expert in his/her diabetes. Other comments suggested satisfactory experiences with health professionals, highlighting that some respondents had no wish for their health professional to understand more.
Conclusions
This study highlights that, although some adults with diabetes are satisfied with their health professionals’ understanding of living with diabetes, many report unmet needs and perceive a lack of person‐centred care from their health professionals.
What's new?
Satisfactory encounters and relationships with health professionals play a crucial role in a person's diabetes self‐management and outcomes.
This large‐scale, qualitative study highlights that some adults living with diabetes are satisfied with their health professionals’ understanding, while others wish their health professional understood more about the challenges of living with diabetes, such as the complexity and full impact of the condition, that judgements/assumptions are not helpful, and that they are experts in their own diabetes.
Health professionals need to better implement current, evidence‐based policies and guidelines, which focus on providing empathic, non‐judgemental, patient‐centred care.
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, defined on a Riemann surface
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antivortices. Their moduli space is a ...noncompact complex manifold
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of dimension
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which inherits a natural Kähler metric
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governing the model’s low energy dynamics. This paper presents the first detailed study of
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are obtained which imply that
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has finite volume and is geodesically incomplete. On
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is proposed in terms of a certain limit of gauged linear sigma models, leading to formulae for its volume and total scalar curvature. The volume formula agrees with the result established for
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, and allows for a detailed study of the thermodynamics of vortex-antivortex gas mixtures. It is found that the equation of state is independent of the genus of
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Aims
To develop and validate a self‐report measure designed to assess perceived and experienced stigma for adults with Type 1 diabetes: the Type 1 Diabetes Stigma Assessment Scale (DSAS‐1).
Methods
A ...large item‐pool (64 items) was drafted based on qualitative data from interviews with 27 adults with Type 1 diabetes. Eleven adults with Type 1 diabetes completed the draft questionnaire (responding to items using a five‐point Likert scale), and participated in cognitive debriefing interviews. Based on their feedback, the item‐pool was reduced and refined. Adults with Type 1 diabetes (N=898) completed an online survey including the draft stigma questionnaire (41 items) and other validated measures. Psychometric validation included principal components analysis and confirmatory factor analysis (split samples), internal consistency reliability assessment and Spearman's rho correlations.
Results
Scale reduction techniques resulted in 19 items (α=0.93). An unforced three‐factor solution suggested three subscales: Treated Differently (six items, α=0.89); Blame and Judgement (six items, α=0.88); and Identity Concerns (seven items, α=0.89). This was corroborated with a confirmatory factor analysis, which demonstrated reasonable model fit with the three factors; less so for a single‐factor model. Satisfactory concurrent, convergent and discriminant validity were demonstrated.
Conclusions
The 19‐item DSAS‐1 is a valid and reliable measure of the perceptions and experiences of Type 1 diabetes stigma. This novel, relatively brief measure has satisfactory psychometric properties. The DSAS‐1 is now available for investigations into the nature and magnitude of the relationships between diabetes stigma and diabetes self‐care behaviours and outcomes.
What's new?
This paper reports on the rigorous development and validation of the first self‐report measure of perceived and experienced stigma specific to Type 1 diabetes: the novel Type 1 Diabetes Stigma Assessment Scale (DSAS‐1).
Questionnaire design was informed by exploratory qualitative research and items were confirmed after cognitive debriefing with people with Type 1 diabetes.
Psychometric validation showed that this 19‐item measure was acceptable, had a three‐factor structure, high internal consistency reliability, and satisfactory concurrent, convergent and discriminant validity.
The DSAS‐1 could facilitate research to quantify the extent and impact of stigma associated with Type 1 diabetes.
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