Roles and competencies of the clinical psychologist in adult diabetes care-A consensus report.

AIMS: Psychological care is recognised as an integral part of quality diabetes care. We set out to describe the roles and competencies of the clinical psychologist as a member of the multidisciplinary adult diabetes care team, focused on secondary care. METHODS: The authors are clinically experienced psychologists involved in adult diabetes care, from Australia, Europe and North America, and active members of the international psychosocial aspects of diabetes study group. Consensus was reached as a group on the roles and competencies of the clinical psychologist working in adult diabetes secondary care, building both on expert opinion and a selective review and discussion of the literature on psychological care in diabetes, clinical guidelines and competency frameworks. RESULTS: The clinical psychologist fulfils multiple roles: (1) as a clinician (psychological assessment and therapy), (2) as advisor to the healthcare team (training, consulting), (3) as a communicator and promotor of person-centred care initiatives and (4) as a researcher. Four competencies that are key to successfully fulfilling the above-mentioned roles in a diabetes setting are as follows: (a) specialised knowledge, (b) teamwork and advice, (c) assessment, (d) psychotherapy (referred to as STAP framework). CONCLUSIONS: The roles and competencies of clinical psychologists working in diabetes extend beyond the requirements of most university and post-graduate curricula. There is a need for a comprehensive, accredited specialist post-graduate training for clinical psychologists working in diabetes care, building on the proposed STAP framework. This calls for a collaborative effort involving diabetes organisations, clinical psychology societies and diabetes psychology interest groups.

Assessment of the spectrum of depression and bipolarity in patients with type 1 diabetes.

AIMS: The aim of the study was to check the prevalence of unipolarity (depression), bipolarity, as well as the quality of sleep and temperament traits in patients with type 1 diabetes (T1DM) who are provided with optimal conditions of diabetes care and to identify possible risk factors connected with affective traits. MATERIALS AND METHODS: Out of the 107 T1DM patients, 78 (54 females, 24 males) were included for the analysis (HbA1c [%] 7.11 ± 1.0, BMI [kg/m2 ] 25.3 ± 5.6; Years of disease duration [N] 13.7 ± 8.3). The patients filled in a set of questionnaires during their regular visit to the outpatient clinic. Three patients from the whole group were on intensive insulin therapy with Multiple Daily Injections (MDI) and Self-Monitoring of Blood Glucose (SMBG), all the rest were on various types of personal insulin pumps (years on insulin pump [N] 9.1 ± 4.5). All the patients were on regular diabetologist care, with regular visits in a Centre for Advanced Technologies in Diabetes (at least every 6 months). RESULTS: In QIDS-S (full explanation and abbreviation 26 patients (33.8%) were screened positive for depression, in PHQ (full explanation and ab 57.7% of the patients (45 patients) had symptoms of depression (age was negatively correlated with PHQ score [r = -0.26; p = 0.023]). In CES-D 16 (20%) of the patients assessed their present affect as depressed. None of the analysed clinical variables correlated with depression scores. In the Mood Disorder Questionnaire (MDQ), 16 patients reported having symptoms of bipolarity (20.5% vs. 79.5%). Hypomania Checklist (HCL) analysis indicated 10 patients with bipolar traits (>14) (14.9% vs. 85.1%). None of the analysed clinical variables correlated with HCL results. 11.5% of patients were indicated to be of morning type. Morningness was more often seen in younger patients (r = 0.39; p = 0.001). As many as 46.6% declared that they had poor sleep quality. The temperament traits analysis correlated with clinical parameters: Cyclothymic temperament trait was negatively correlated with age (r = -0.30; p = 0.007) and positively with HbA1c level (r = 0.30; p = 0.025). Hyperthymic temperament was positively correlated with (BMI r = 0.28; p = 0.016). Quality of sleep was highly correlated with depressive symptoms CESD (r = 0.61, p = 0.001), PHQ Score (r = 0.62; p = 0.001), QISD (r = 0.68; p = 0.001) and bipolarity MDQ (p = 0.50, p = 0.001) and HCL (r = 0.42, p = 0.001). In addition, QIDS was shown to be correlated with the following features of temperament: depressive factor (r = 0.41; p = 0.001), irritable factor (r = 0.53; p = 0.001), cyclothymic factor (r = 0.59; p = 0.001), anxious factor (r = 0.58, p = 0.001). CONCLUSIONS: The prevalence of affective disorders and poor sleep quality in the examined T1DM patients was much higher than in the general population. Even if the patients have in general good glycaemic control, their mental health condition should not be neglected. Well organised cooperation between patients, diabetologists, psychiatrists and psychotherapists is needed (Clinical Trials Identifier: NCT04616391).

Psychiatric comedication in patients with epilepsy.

Psychiatric disorders are more common in patients with epilepsy than in the general population. The aims of the study were to assess the frequency and type of psychotropic drug usage in patients with epilepsy, to assess the risk factors for their use, and to assess their proconvulsive potential and the risk of interactions with antiepileptic drugs. This 20-month prospective study included patients treated at the university hospital outpatient clinic. Psychotropic drugs have been classified according to the Anatomical Therapeutic Chemical Classification System. Of the 621 patients (with a mean age of 35.4years), 60% were women, and 37.5% were in remission; 54.8% of the patients used antiepileptic drug monotherapy. The most commonly used antiepileptic drugs were valproate, levetiracetam, lamotrigine, and carbamazepine. Eighty-nine (14.3%) patients received psychiatric comedication. Sertraline, perazine, and hydroxyzine were the predominantly used psychotropic drugs. Independent variables associated with psychotropic drug usage in the logistic regression model included age, active epilepsy, combined focal and generalized epilepsy type, use of somatic comedication, and phenobarbital. Over one-third of the patients simultaneously received antiepileptic drugs and psychotropic drugs, between which clinically significant interactions may occur, 10% of patients used psychotropic drugs to lower the seizure threshold. The results of the study indicate the need for closer cooperation between doctors of various specialties when caring for patients with epilepsy.

[Psychotherapy for pregnant women with psychiatric disorders]. / Psychoterapia ciezarnych kobiet cierpiacych na zaburzenia psychiczne.

Pregnancy is a major life change for many women. The related biological changes, especially complications in its course and in the course of delivery, carry a risk of developing a variety of psychological problems and mental disorders. However, their treatment is challenging due to the teratogenic effects of most psychoactive drugs and specific requirements for entering different psychotherapeutic programs. Mental disorders during pregnancy are undoubtedly an important issue for both gynecology and psychiatry. There is still a discussion considering the question whether psychotherapy during pregnancy is safe, although no scientifically valid data contradicting the safety of psychotherapy during pregnancy has been published so far. Together with psychotherapy - as a treatment of choice - clinicians approve some other relatively safe treatment methods for psychiatric disorders in pregnant women. Light therapy, limited pharmacotherapy, ECT are included. The goal of this paper is to review current opinions of clinicians and researches concerning possibilities, indications and outcome of psychological treatments as a way to help pregnant women who suffer from different psychiatric conditions, and also because this subject is not yet present in Polish psychiatric journals.

[Effectiveness of intensive group psychotherapy in treatment of neurotic and personality disorders]. / Skutecznosc intensywnej psychoterapii grupowej stosowanej w leczeniu zaburzen nerwicowych i osobowosci.

AIM: The aim of this study was to analyze the effectiveness of intensive (150 - 210 sessions), short-term (10 - 14 weeks) group psychotherapy in the treatment of neurotic disorders, and selected personality disorders. METHODS: The study involved 145 patients treated in day hospital due to neurotic disorders and selected personality disorders. The measurements were performed twice - at the beginning and at the end of hospitalization. The effectiveness of psychotherapy in the reduction of symptoms of neurotic disorders was measured with symptom checklist "0". The change in the severity of personality traits characteristic for neurotic disorders was examined using Neurotic Personality Questionnaire KON-2006. RESULTS: A significant reduction in symptoms of neurotic disorders was found in 84% of patients (85,7% women and 80,8% men). 70,3% of the examined patients obtained in the measurement at the end of treatment results indicating the level of severity of neurotic disorders symptoms below the cutoff point separating population of healthy individuals from patients. A significant reduction in the severity of personality traits characteristically occurring in patients suffering from neurotic disorders was found in 76% of patients (74.5% women and 78.7% men). 42.8% of the examined patients obtained in the measurement at the end of the treatment the value of neurotic personality traits index (X-KON) typical for healthy population. CONCLUSIONS: Intensive, short-term group psychotherapy with elements of individual therapy is an effective treatment for neurotic disorders. The majority of treated persons obtains a significant symptomatic improvement and a reduction in the severity of neurotic personality traits.

Multiaxial changes in pregnancy: mental health--a review of the literature.

Pregnancy constitutes not only a challenge for the body of the woman, but also a developmental and psychological task for the mother-to-be, her partner and the entire family. Considerable amount of research has been published on the subject of the puerperal period and treatment options of various disorders emerging after pregnancy. However, data on psychiatric disorders and their treatment during that period, although available, remain insufficient. The paper reviews the literature on mental disorders occurring in pregnancy taking into account the overall emotional situation of the pregnant woman.

[Influence of cumulated sexual trauma on sexual life and relationship of a patient]. / Wplyw kumulacji urazów seksualnych na zycie seksualne i zwiazek pacjenta.

AIM: The assessment of links of accumulated traumatic events of a sexual nature, recollected from the past, with the current functioning of the patients in the area of sexual life and relationship. MATERIAL AND METHODS: Comorbidity of memories of traumatic sexual events from childhood and puberty in patients with the features of their current partner relationships and sexual life were analyzed on the basis of Live Inventory completed by 2,582 women and 1,347 men, before treatment in day hospital (years 1980-2002). The accumulation was evaluated for a combination of two or three selected events. RESULTS: The presence of relatively numerous traumatic events in the field of sexuality early initiation or enforced initiation, incest or its attempt, sub-optimal sexual education and punishment for masturbation was indicated. In some patients, these events occurred simultaneously. Especially in women, the presence in the same person of two or three aggravating circumstances of life was associated with a higher risk of among others fleeting, casual sexual contacts, marriage under the influence of environment pressures, reluctance to partner. CONCLUSIONS: Increased accumulation - the presence in the same patient of more than one adverse circumstances associated with sexual development - leads to a higher incidence of interference in relationship with a partner including the elements of sexual dysfunction. The obtained results are generally consistent with clinical observations and literature despite different, simplified methodology of the study based on the analysis of single variables from questionnaire interviews. Finding fewer links in the group of men can be explained by their much lower number in the study group and less frequent burdening with certain traumatic events or different experiencing.

Diabetes distress and diabetes burnout explored in various areas of life in patients with type 1 diabetes: effect of short-term psychological intervention.

INTRODUCTION: Diabetes distress (DD) and diabetes burnout (DB) are recognized psychological phenomena in patients with T1DM (type 1 diabetes mellitus). Still, there is an urgent need to create professional psychological intervention procedures to provide patients with adequate care. AIM: The aim of the study was to assess the level of DD and DB in T1DM patients at baseline and after 5 of sessions psychological intervention in the group of participants who applied for help. METHODS: 34 T1DM patients who requested psychological support (22 females, 12 males) and 30 patients in a control group (14 females, 16 males) participated in the study. At baseline clinical test results between groups were compared. Next, in the studied group measurements were repeated after a set of five psychological face-to-face individual interventions which lasted 30-60 min each. They were support sessions with elements of cognitive-behavioral interventions done by clinical psychologists. Session 1: introduction, interview and collection of test results; session 2-4: work on the indicated by the patient and test results most problematic aspect of diabetes, session 5: a summary and plan for further treatment if needed. The control group results were obtained only at baseline. Research tools: DDS; PAID, Diabetes Burnout test by Polonsky. RESULTS: At the baseline, significant differences were observed between the studied group and control group: in DB/DD levels: DB (3.9 ± 1.7 vs 2.4 ± 1.6; p < 0.001); DDS (3.2 ± 1.0 vs 2.7 ± 1.0; p = 0.064); PAID (62.3 ± 14.1vs 34.4 ± 21.0; p < 0.001). There were also group differences in HbA1c levels (8.7 ± 2.4 vs 7.3 ± 1.5; p = 0.028). After psychological interventions, there was a significant improvement in DB (3.9 ± 1.7vs 2.9 ± 1.2; p < 0.001; DDS (3.2 ± 1 vs 3.0 ± 0.7; p = 0.03); PAID (62.3 ± 14.1 vs 51.8 ± 12.5; p < 0.001). CONCLUSIONS: DD and DB constitute a significant problem in the group of T1DM patients, but providing appropriate specialist care may help them accept diabetes and improve life satisfaction, as well as regain control over their diabetes management.

[Social Avoidance and Distress Scale (SAD) and Fear of Negative Evaluation Scale (FNE)--reliability and the preliminary assessment of validity]. / Skala Unikania i Dystresu Spolecznego (SAD) oraz Skala Obaw przed Negatywna Ocena (FNE)--ocena rzetelnosci i wstepna ocena trafnosci.

AIM: Assessment of reliability, cross-validity and usefulness in everyday clinical practice of two related tools: Social Avoidance and Distress Scale (SAD) and Fear of Negative Evaluation Scale (FNE). MATERIAL AND METHOD: Analysis of tests results of 453 females and 172 males diagnosed in the years 2008-2010 in the Outpatient Clinic for Neurotic and Behavioral Disorders of the Cracow University Hospital, including, inter alia, results of the questionnaires SAD and FNE. The scales have been, with the consent of their authors (R. Friend) and the copyright holder (APA), translated into Polish and back-translated. Subjects also completed the symptom checklist KO '0'(n = 512), and neurotic personality questionnaire KON-2006 (n = 505), as well as the NEO-PI-R personality inventory (n = 46). The reliability and cross-validity coefficients of Polish versions were assessed in the patient population and their results were compared with those of the group of 75 medical students. RESULTS: The translation was verified by retranslation. The reliability coefficients of Polish version of the SAD and FNE scales turned out to be high--Cronbach's alpha coefficient was 0.94 for both scales, Guttman's split-half reliability coefficient 0.93. Correlations with symptom checklist KO '0 'and neurotic personality questionnaire KON-2006, as well as with the NEO -PI-R personality inventory were significant and indicate a good cross-validity of the analyzed tools. The average results in the patient population for both scales were significantly higher than the results in the preliminary control group of medical students. CONCLUSIONS: Polish versions of SAD and FNE questionnaires, like their other translations from English, proved to be reliable and have a high cross-validity with other original Polish tools used in the diagnosis of neurotic disorders, which allows to recommend them to be used in further studies, also in comparing healthy persons with those suffering from a variety of neurotic disorders.

[Sexual traumatic events and neurotic disorders picture--sexuality-related and sexuality-unrelated symptoms]. / Seksualne wydarzenia urazowe a obraz zaburzen nerwicowych--objawy zwiazane i nie zwiazane z seksualnoscia.

INTRODUCTION: There is an ample evidence of the impact of severe traumatic events, such as sexual abuse in childhood, on the formation of disorders--especially the non-psychotic ones: sexual, neurotic and personality. So far, an increase of the risk with the accumulation of traumatic factors has been indicated, but less attention has been paid to adverse events such as lack of sexual education, negative attitudes of the caregivers towards sexuality, etc. AIM: Assessment of the risk of such adverse events in childhood and adolescence, concerning the symptoms from the area of sexuality as well as other neurotic disorders areas. METHOD: The coexistence of the earlier life circumstances and currently present symptoms was examined on the basis of KO "0" Symptom Checklist and Life Inventory, completed prior to treatment in a day hospital for neurotic disorders. RESULTS: In the group of 2582 females and 1347 males, there was a significant prevalence of symptoms related to sexuality, as well as of other neurotic symptoms. Patients reported traumatic events of varying frequency (from a relatively rare incest, to much more frequent sense of lack of sex education). Regression analyses showed a significant relationship between the analyzed events and symptoms, for instance, lack of sexual satisfaction in adulthood co-occurred in women with punishing for childhood sexual plays or masturbation. The other analyzed symptoms--'non-sexual', such as panic attacks, were not so clearly related to the burdensome circumstances. CONCLUSIONS: The presence of adverse life events concerning sexuality, not necessarily the most serious ones e.g. abuses, but such as inadequate sex education, child punishing for masturbation or sexual plays, unwanted sexual initiation, are associated with a higher occurrence of most of the analyzed symptoms in the sphere of sexuality. Weaker connection for other than sexual neurotic symptoms suggests that the impact of childhood sexual trauma is mainly focused on the area of sexual dysfunctions.

[Parental attitudes recollected by patients and neurotic disorders picture--sexuality-related and sexuality-unrelated symptoms]. / Zapamietane postawy rodziców pacjenta a obraz zaburzen nerwicowych--objawy zwiazane i niezwiázane z seksualnoscia.

OBJECTIVES: To evaluate the risks associated with non-optimal characteristics of the picture of parents in the patient's memories, concerning the sexuality-related symptoms and other areas of neurotic disorders. METHODS: Coexistence of memories of parental attitudes and the current symptoms were analyzed on the basis of KO"0" Checklist and Life Inventory completed prior to treatment in the day hospital for neurotic disorders. RESULTS: In questionnaires, obtained from 2582 females and 1347 males between 1980-2002, there was a significant incidence of memories of adverse parental attitudes, the feeling of not being loved, the parent indifference, rejection. Regression analysis showed a significant relationship between the parental attitudes and symptoms, for instance reluctance of men to sexual contacts coexisted (OR = 3.41) with hostile mother's attitude, the same association in women was weaker (OR = 1.64) but still significant. Also, the absence of mother in childhood was associated with a risk of disruptions in the conduct of intercourse (erectile dysfunction or pain) in women (OR = 2.43) and men (OR = 3.29). Other analyzed symptoms, also sexuality -unrelated, though weaker and less frequently, were associated with non-optimal pictures of parents, e.g. pessimism in women with the hostile mother (OR = 1.97). Higher global severity of symptoms was associated with non-optimal parental attitudes. CONCLUSIONS: The type of recollected attitudes of parents was associated with a higher incidence of symptoms, primarily in the field of sexuality, and with other selected symptoms, as well as with higher global symptom level. The results indicate importance of life circumstances in the development of psychopathology and encourage to further research.

Quality of life in the course of a one-year use of an advanced hybrid closed-loop system in adults with type 1 diabetes previously naïve to advanced diabetes technology.

Aim: To evaluate the effect of a one-year use of an advanced hybrid closed-loop (AHCL) system on the quality of life, level of anxiety, and level of self-efficacy in adults with type 1 diabetes (T1D) previously treated with multiple daily injections (MDI) and naïve to advanced diabetes technology. Methods: A total of 18 participants of a previously published 3-month randomized trial (10 men, 8 women; age 40.9 ± 7.6 years) who were switched directly from MDI/BMG to AHCL completed 12 months of MiniMed 780G™system use (a 3-month randomized trial followed by a 9-month follow-up phase). At month 6 of the study, patients were switched from the sensor GS3 (Continuous Glucose Monitoring) system, powered by Guardian™ Sensor 3) to GS4. Quality of life was assessed using the Polish validated version of the 'QoL-Q Diabetes' questionnaire. The level of anxiety was evaluated with the use of the State-Trait Anxiety Inventory (STAI). Self-efficacy was assessed with the General Self-Efficacy Scale (GSES). Results were obtained at baseline and at the end of the study. Results: Significant increase in QoL was reported in the global score (p=0.02, Cohen d=0.61) and in as many as 11 out of 23 analyzed areas of life: being physically active (p=0.02, Cohen d = 0.71); feeling well (p<.01, Cohen d = 0.73); feeling in control of my body (p<.01, Cohen d = 0.72); looking good (p<.01, Cohen d = 1.07); working (p<.01, Cohen d = 1.12); sleeping (p=0.01, Cohen d = 0.66); eating as I would like (p<.01, Cohen d = 0.79); looking after or being useful to others (p= 0.02, Cohen d = 0.65); being active with pets/animals (p<.01, Cohen d = 0.95); being spontaneous (p=0.02, Cohen d = 0.67); and doing "normal" things (p=0.02, Cohen d = 0.67). Both state (p=0.04, Cohen d = 0.56) and trait (p=0.02, Cohen d = 0.60) anxiety decreased while the general self-efficacy increased (p=0.03, Cohen d = 0.76). No participant stopped the use of the pump. Conclusion: Adult patients with T1D previously treated with MDI and naïve to modern technologies experienced significant improvement in their psychological well-being after transitioning to the AHCL system after 12 months of treatment.

Evaluation of Psychological Resources of Young Adults With Type 1 Diabetes Mellitus During the Transition From Pediatric to Adult Diabetes Clinics: Multicenter Cross-sectional Study.

BACKGROUND: The transition period of patients with type 1 diabetes from pediatric to adult-oriented health care is associated with poorer glycemic control and less frequent clinic attendance. Fears and anxiety about the unknown, care approach differences in adult settings, and sadness about leaving the pediatric provider all contribute to a patient's reluctance to transition. OBJECTIVE: This study aimed to evaluate the psychological parameters of young patients with type 1 diabetes transitioning to an adult outpatient clinic during the first visit. METHODS: We examined 50 consecutive patients (n=28, 56% female) transitioning from March 2, 2021, to November 21, 2022, into adult care (3 diabetes centers from 3 regions in southern Poland: A, n=16; B, n=21; and C, n=13) and their basic demographic information. They completed the following psychological questionnaires: State-Trait Anxiety Inventory (STAI), Generalized Self-Efficacy Scale, Perceived Stress Scale, Satisfaction with Life Scale, Acceptance of Illness Scale, Multidimensional Health Locus of Control Scale Form C, Courtauld Emotional Control Scale, and Quality of Life Questionnaire Diabetes. We compared their data with those for the general healthy population and patients with diabetes from Polish Test Laboratory validation studies. RESULTS: During the first adult outpatient visit, patients' mean age was 19.2 (SD 1.4) years, with a diabetes duration of 9.8 (SD 4.3) years and BMI of 23.5 (SD 3.1) kg/m2. Patients came from diverse socioeconomic backgrounds: 36% (n=18) live in villages, 26% (n=13) live in towns with ≤100,000 inhabitants, and 38% (n=19) live in bigger cities. Regarding therapy type, 68% (n=34) were treated with insulin pump therapy, whereas 32% (n=16) were treated with multiple daily injections. Patients from center A had a mean glycated hemoglobin level of 7.5% (SD 1.2%). There was no difference regarding the level of life satisfaction, perceived level of stress, and state anxiety between the patients and reference populations. Patients had similar health locus of control and negative emotions control to the general population of patients with diabetes. Most patients (n=31, 62%) believe that control over their health depends on themselves, whereas 52% (n=26) believe that it depends mostly on others. Patients had higher levels of suppression of negative emotions-anger, depression, and anxiety-than the age-matched general population. Additionally, the patients were characterized by a higher acceptance of illness and higher level of self-efficacy compared to the reference populations: 64% (n=32) had a high level of self-efficacy and 26% (n=13) had a high level of life satisfaction. CONCLUSIONS: This study indicated that young patients transitioning to adult outpatient clinics have good psychological resources and coping mechanisms, which might result in adequate adaptation and adult life satisfaction including future metabolic control. These result also disprove the stereotypes that young people with chronic disease have worse life perspectives when entering adulthood.

Lack of major impact of implementation of the Advanced Hybrid Closed Loop System in technologically-naïve patients with Type 1 Diabetes mellitus on their food choices or weight - a one year follow-up.

INTRODUCTION AND OBJECTIVE: The purpose of this follow-up study on the implementation of advanced closed-loop hybrid insulin pumps in people with type 1 diabetes was to assess the impact of introducing this advanced technology on quantitative and qualitative parameters of diet. MATERIAL AND METHODS: 18 patients (8 women and 10 men, mean age 40.9 years) patients using the CE-marked MiniMed 780G AHCL system who completed 1 year of follow-up were included into the study. The research tool was the KomPAN questionnaire with several own questions added, asked in three study periods, concerning the number of meals consumed, general and night snacking, carbohydrate counting, frequency of consumption of various groups of products that affect postprandial glycaemia. RESULTS: Although the mean body weight of the examined group did not increase significantly (from 75.1 kg at the beginning to 75,9 kg at the end), five various individual scenarios of weight change were observed. The eating habits has not changed, but patients began to consume less products containing simple sugars, e.g. fruit preserves, milk chocolate or fish in sauces (p<0.05). No statistically significant correlation was found between the change in body weight at the end of the study and the average amount of carbohydrates entered into the pump from the entire 12 months (p = 0.460). CONCLUSIONS: The implementation of AHCL system in technology naïve patients, despite offering more freedom of food choices due to better glycaemic control, did not have a significant impact on patients' dietary patterns, also did not result in weight gain. This is important since AHCL system offers more freedom of food choices due to better glycaemic control. However, the longer follow up and the study based on larger population is required to finally address the issue of the impact of AHCL on body mass.

Improvement of Selected Psychological Parameters and Quality of Life of Patients With Type 1 Diabetes Mellitus Undergoing Transition From Multiple Daily Injections and Self-Monitoring of Blood Glucose Directly to the MiniMed 780G Advanced Hybrid Closed-Loop System: Post hoc Analysis of a Randomized Control Study.

BACKGROUND: While introducing new technologies and methods of treatment for type 1 diabetes mellitus (T1DM), it seems essential to monitor whether modern technologies in diabetes treatment may improve the psychological and emotional status of patients. OBJECTIVE: This study aims to assess the baseline psychological parameters of patients with T1DM during investigation of the direct transition from multiple daily injections (MDI) and self-monitoring of blood glucose (SMBG) to the MiniMed 780G advanced hybrid closed-loop (AHCL) system and to evaluate changes in the psychological well-being and quality of life (QoL) after the transition in these individuals versus the control group. METHODS: The trial was a 2-center, randomized controlled, parallel group study. In total, 41 patients with T1DM managed with MDI or SMBG were enrolled and randomized either to the AHCL or the MDI+SMBG group. Of these, 37 (90%) participants (mean age 40.3 years, SD 8.0 years; mean duration of diabetes 17.3, SD 12.1 years; mean hemoglobin A1c [HbA1c] 7.2%, SD 1.0%) completed the study (AHCL: n=20, 54%; MDI+SMBG: n=17, 46%). Psychological parameters (level of stress, coping mechanisms, level of anxiety, self-efficacy level, acceptance of illness, locus of control of illness, life satisfaction, QoL) were measured at baseline and at the end of the study using 10 psychological questionnaires. RESULTS: At baseline, the general level of stress of the examined patients was higher than in the general healthy Polish population (P=.001), but coping strategies used in stressful situations were significantly more effective and the level of self-efficacy (P<.001) was much higher than in the general population. The patients in this study accepted their illness more than patients with diabetes from the general Polish population (P<.001), but they felt that their health does not depend on them compared to the general population (P<.001). The overall life satisfaction was similar to that of the general population (P=.161). After 3 months from transition, the AHCL group reported an increase in 4 scales of the QoL-feeling well (P=.042), working (P=.012), eating as I would like (P=.011), and doing normal things (P=.034)-in comparison to the control group, where no significant change occurred. The level of both state anxiety and trait anxiety decreased in the AHCL group: State-Trait Anxiety Inventory (STAI) X1 scores (P=.009), STAI X1 stens (P=.013), and STAI X2 scores (P=.022). The AHCL group became more emotion oriented in stressful situations (Coping Inventory for Stressful Situations [CISS] E; P=.043) and significantly less self-blaming after 3 months of the study (P=.020). CONCLUSIONS: The results indicate that the patients who decided to take part in the transition study were characterized by higher levels of stress than the general healthy population but had better coping strategies and self-efficacy. Furthermore, transitioning from MDI+SMBG treatment to the AHCL in patients naive to technology may significantly improve psychological well-being and QoL within 3 months. The rapidity of these changes suggests that they may be related to the significant improvement in glycemic outcomes but also significantly less burdened diabetes self-management. TRIAL REGISTRATION: ClinicalTrials.gov NCT04616391; https://clinicaltrials.gov/ct2/show/NCT04616391.

Association of short- and long-term metabolic control parameters with personality traits in adult type 1 diabetes treated with personal insulin pumps. / Korelacja krótko- i dlugoterminowych parametrów kontroli metabolicznej z cechami osobowosci u doroslych chorych na cukrzyce typu 1 leczonych za pomoca osobistych pomp insulinowych.

AIM: Several studies have assessed the association between personality traits and metabolic outcomes in children and adolescents with type 1 diabetes (T1DM). The aim of this observational single-visit study was to investigate whether specific personality traits were related to the degree of metabolic control/diabetes duration in adult T1DM patients. METHOD: Data were collected from 56 adults (40 men) with T1DM treated in a tertiary care center. "Big Five" personality traits were assessed using the NEO-Five Factor Inventory questionnaire. Several variables were obtained from the insulin pumps, glucometers and blinded continuous glucose monitoring system. RESULTS: All personality traits but neuroticism (low level of the trait) showed average intensity. Agreeableness was associated with most variables from CGMS data. Higher conscientiousness was associated with longer diabetes duration. Higher neuroticism was correlated with greater glycemic variability (GV), while high Extraversion was associated with lower GV. Lower Openness was associated with prolonged time in clinically significant hypoglycaemia. CONCLUSIONS: Our study suggest that personality traits manifest in individual approach to diabetes management and emotion regulation, translating also into the attitude to treatment. On the other hand, T1DM patients' overall trait scores were consistent with healthy nonpsychiatric norms, which debunks myths and stereotypes suggesting that chronic disease is usually associated with psychopathology.

One-Year Follow-Up of Advanced Hybrid Closed-Loop System in Adults with Type 1 Diabetes Previously Naive to Diabetes Technology: The Effect of Switching to a Calibration-Free Sensor.

The aim of this study was to observe the 1-year clinical outcomes of people with type 1 diabetes who switched from multiple daily injection + blood glucose meter to an advanced hybrid closed-loop (AHCL) system (Medtronic MiniMed™ 780G system [MM 780G]). In addition, the effect of changing at month 6 to a calibration-free sensor (Guardian™ 4 Sensor [G4S]) was evaluated. Eighteen participants (10 men, age 40.9 ± 7.6 years) completed 1 year of MM 780G use. Time in range (TIR; 70-180 mg/dL) remained stable and ranged from 83.2% in month 9 to 84.8% in month 3. There was no difference between TIR at 3 months before switching versus 3 months after switching to G4S (P = 0.614). AHCL system in adults significantly improves glycemic outcomes. This improved glycemic control was maintained over the 12 months. Switching to a calibration-free sensor (G4S) did not affect outcomes but required less patient involvement.

Polish adaptation of the Dimensional Anhedonia Rating Scale (DARS) - validation in the clinical sample.

Background: Anhedonia is the core symptom of depression. Its presence has been linked to worsened prognosis. The Dimensional Anhedonia Rating Scale (DARS) is a scale measuring desire, motivation, effort and consummatory pleasure across different domains. The aim of this paper was to confirm factor structure, assess reliability and validity of the Polish adaptation of the DARS in a clinical sample of patients with mood disorders and healthy controls (HC). Methods: The study sample included 161 participants aged 18-65 years - 34 HC, 72 patients with bipolar disorder and 55 with major depressive disorder (in depressive episode or remission). Reliability of the Polish adaptation of the DARS was assessed using Cronbach's α and the average inter-item correlation (AIC). Convergent and divergent validity was established by Pearson's correlations between the DARS and the Snaith-Hamilton Pleasure Scale (SHAPS), the Quick Inventory of Depressive Symptomatology- self-report (QIDS-SR), the Hospital Anxiety and Depression Scale (HADS). The structure of the scale was examined by factor analysis. Results: The factor structure was consistent with the original scale. Strong internal consistency for the DARS total score (Cronbach's α = 0.95) and all subscales (0.86-0.93) was observed. The DARS demonstrated good convergent (moderate to strong correlations with measures of anhedonia and depression) and divergent validity (weak correlations with anxiety level). Conclusion: The Polish DARS demonstrated excellent internal consistency and very good validity. The scale is a valuable contribution to the psychometrics of anhedonia measures in patients with mood disorders.

[Differences in marital communication and parental attitudes between parents of healthy children and parents of children with type 1 diabetes]. / Róznice w komunikacji malzenskiej i postawach rodzicielskich miedzy rodzicami dzieci zdrowych a rodzicami dzieci chorych na cukrzyce typu 1.

AIM: The study investigated the differences between marital communication and parental attitudes in families of children with type 1 diabetes. METHOD: Three instruments were used: Communication in Marriage Questionnaire--versions for self assessment and for the assessment of spouse, Parental Attitude Scale (SPR) by Plopa--versions for fathers and for mothers, and self-constructed questionnaire examining socio-demographic status. Two groups of parents (120 persons) from the Opole and Silesia regions were selected: the study group (30 mothers and 30 fathers, staying in marital union, who bring up a diabetic child with at least 5 year period of the disease), and the control group (30 mothers and 30 fathers, staying in marital union, who bring up their offspring with no chronic disease). The children were from 5 to 18 years old. RESULTS: The analysis of the marital communication results indicated that the fathers of diabetics assess themselves to be less supportive towards their wives than the fathers from the control group. At the same time, they evaluate their wives' supportiveness, involvement and depreciation similarly to the fathers of healthy children and no significant differences were found between the groups of males in their partners' evaluation. Mothers form the study group evaluate themselves in terms of marital communication on an equal level as compared to mothers form the control group in all the three communication dimensions. However, they perceive their husbands to be less supportive and less involved in the marital relationship than the females from the control group do. Fathers of diabetics present a less accepting attitude towards their children than the fathers of healthy children. They also give their children more autonomy than the fathers from the control group and the mothers of diabetics, who are not different in this dimension from the mothers of healthy children. Diabetics' mothers accept their children less that the mothers of healthy children, but at the same time they are more protective towards their offspring than women form the control group. They are also more inconsequent towards their children than the fathers of diabetics and parents of healthy children. CONCLUSIONS: Statistically significant differences were found in some dimensions of marital communication and parental attitudes between diabetics' fathers and the fathers from the control groups as well as between the two groups of mothers. This indicates that there may be a relationship between the child's chronic and marital communication, as well as between the child's disease and parental attitudes, and thus between the disease and the functioning of the whole family system.