Analysis System for Self-Efficacy Training (ASSET). Assessing treatment fidelity of self-management interventions.

OBJECTIVE: The paper presents the development of a coding tool for self-efficacy orientated interventions in diabetes self-management programmes (Analysis System for Self-Efficacy Training, ASSET) and explores its construct validity and clinical utility. METHODS: Based on four sources of self-efficacy (i.e., mastery experience, role modelling, verbal persuasion and physiological and affective states), published self-efficacy based interventions for diabetes care were analysed in order to identify specific verbal behavioural techniques. Video-recorded facilitating behaviours were evaluated using ASSET. RESULTS: The reliability between four coders was high (K=0.71). ASSET enabled assessment of both self-efficacy based techniques and participants' response to those techniques. Individual patterns of delivery and shifts over time across facilitators were found. In the presented intervention we observed that self-efficacy utterances were followed by longer patient verbal responses than non-self-efficacy utterances. CONCLUSION: These detailed analyses with ASSET provide rich data and give the researcher an insight into the underlying mechanism of the intervention process. PRACTICE IMPLICATIONS: By providing a detailed description of self-efficacy strategies ASSET can be used by health care professionals to guide reflective practice and support training programmes.

Unrealistic pessimism about risk of coronary heart disease and stroke in patients with type 2 diabetes.

OBJECTIVE: We examined the accuracy of type 2 diabetes (T2D) patients' risk estimates of developing coronary heart disease (CHD)/having a stroke as a consequence of diabetes and their mood about these risks. METHODS: Patients reported their perceived risks of developing CHD/having a stroke and rated their mood about these risks using a self-report measure. Using an objective risk calculator, they were then told their actual risk of CHD and stroke and their mood was re-assessed. RESULTS: Patients' estimates of their risk of CHD/stroke were grossly inflated. A negative relationship between disease risk and mood was also seen where higher risk of actual and perceived CHD/stroke was related to worse mood. A positive relationship between mood and extent of perceptual error was further observed; the more inaccurate patients' perceptions of CHD/stroke risk were, the better their mood. Mood improved after patients were given accurate risk information. CONCLUSION: T2D patients are unrealistically pessimistic about their risk of developing CHD/stroke. These risks and the extent of perceptual risk error are associated with mood, which improves upon providing patients with accurate risk information about CHD/stroke. PRACTICE IMPLICATIONS: These results have implications for the routine communication of risk to T2D patients.

A pilot randomized control trial investigating the effect of mindfulness practice on pain tolerance, psychological well-being, and physiological activity.

OBJECTIVE: To investigate the effect of mindfulness training on pain tolerance, psychological well-being, physiological activity, and the acquisition of mindfulness skills. METHODS: Forty-two asymptomatic University students participated in a randomized, single-blind, active control pilot study. Participants in the experimental condition were offered six (1-h) mindfulness sessions; control participants were offered two (1-h) Guided Visual Imagery sessions. Both groups were provided with practice CDs and encouraged to practice daily. Pre-post pain tolerance (cold pressor test), mood, blood pressure, pulse, and mindfulness skills were obtained. RESULTS: Pain tolerance significantly increased in the mindfulness condition only. There was a strong trend indicating that mindfulness skills increased in the mindfulness condition, but this was not related to improved pain tolerance. Diastolic blood pressure significantly decreased in both conditions. CONCLUSION: Mindfulness training did increase pain tolerance, but this was not related to the acquisition of mindfulness skills.

Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND): process modelling of pilot study.

OBJECTIVE: To determine the effects of a structured education program on illness beliefs, quality of life and physical activity in people newly diagnosed with Type 2 diabetes. METHODS: Individuals attending a diabetes education and self-management for ongoing and newly diagnosed (DESMOND) program in 12 Primary Care Trusts completed questionnaire booklets assessing illness beliefs and quality of life at baseline and 3-month follow-up, metabolic control being assessed through assay of HbA1c. RESULTS: Two hundred and thirty-six individuals attended the structured self-management education sessions, with 97% and 64% completing baseline and 3-month follow-up questionnaires. At 3 months, individuals were more likely to: understand their diabetes; agree it is a chronic illness; agree it is a serious condition, and that they can affect its course. Individuals achieving a greater reduction in HbA1c over the first 3 months were more likely to agree they could control their diabetes at 3 months (r=0.24; p=0.05), and less likely to agree that diabetes would have a major impact on their day to day life (r=0.35; p=0.006). CONCLUSION: Pilot data indicate the DESMOND program for individuals newly diagnosed with Type 2 diabetes changes key illness beliefs and that these changes predict quality of life and metabolic control at 3-month follow-up. PRACTICE IMPLICATIONS: Newly diagnosed individuals are open to attending self-management programs and, if the program is theoretically driven, can successfully engage with the true, serious nature of diabetes.

Serious diabetes-specific emotional problems and depression in a Croatian-Dutch-English Survey from the European Depression in Diabetes [EDID] Research Consortium.

It has been hypothesized that coverage of diabetes-specific issues (e.g. coping with complications, incapacity, pain) during psychotherapy may optimize the likelihood of treatment success for depression in patients with diabetes. However, it is still unclear how often depression is confounded by diabetes-specific emotional problems. We aim to determine the levels of diabetes-specific emotional problems in diabetic individuals with high versus low levels of depression in a sample of 539 outpatients with diabetes (202 Dutch, 185 Croatian and 152 English). Subjects completed the Center for Epidemiological Studies Depression and the Problem Areas in Diabetes scales. Percentages of patients with high depression scores were: 39 and 34% (Croatian men and women), 19 and 21% (Dutch men and women), 19 and 39% (English men and women). Moreover, 79% (Croatian), 47% (Dutch) and 41% (English) of the patients with a severe depression score reported to have four or more serious diabetes-specific emotional problems. For patients with low depression scores, these percentages were: 29% (Croatian), 11% (Dutch) and 1% (English). Serious diabetes-specific emotional problems are particularly prevalent in depressed diabetes patients. Randomized controlled trials are warranted to test whether coverage of diabetes-specific issues during psychotherapy can further improve the treatment of depression in diabetes.

Personality, personal model beliefs, and self-care in adolescents and young adults with Type 1 diabetes.

This study compared 3 models of association between personality, personal model beliefs, and self-care in a cross-sectional design. These models were as follows: (a) Emotional stability determines self-care indirectly through personal model beliefs, and conscientiousness is a direct predictor of self-care; (b) emotional stability determines self-care indirectly through personal model beliefs, and conscientiousness moderates the association between beliefs and self-care; (c) both emotional stability and conscientiousness determine self-care indirectly through personal model beliefs. Participants (N = 358, aged 12-30 years) with Type 1 diabetes completed measures of personality, personal model beliefs, and self-care. Structural equation modeling indicated that Model C was the best fit to the data.

Educational and psychosocial programmes for adolescents with diabetes: approaches, outcomes and cost-effectiveness.

Diabetes incurs heavy personal and health system costs. Self-management is required if complications are to be avoided. Adolescents face particular challenges as they learn to take responsibility for their diabetes. A systematic review of educational and psychosocial programmes for adolescents with diabetes was undertaken. This aimed to: identify and categorise the types of programmes that have been evaluated; assess the cost-effectiveness of interventions; identify areas where further research is required. Sixty-two papers were identified and subjected to a narrative review. Generic programmes focus on knowledge/skills, psychosocial issues, and behaviour/self-management. They result in modest improvements across a range of outcomes but improvements are often not sustained, suggesting a need for continuous support, possibly integrated into normal care. In-hospital education at diagnosis confers few advantages over home treatment. The greatest returns may be obtained by targeting poorly controlled individuals. Few studies addressed resourcing issues and robust cost-effectiveness appraisals are required to identify interventions that generate the greatest returns on expenditure.

Screening for the metabolic syndrome using simple anthropometric measurements in south Asian and white Europeans: a population-based screening study. The Leicester Ethnic Atherosclerosis and Diabetes Risk (LEADER) Study.

AIMS: To estimate the prevalence of metabolic syndrome in a general population sample of south Asians and white Europeans and compare predictors of metabolic syndrome, using ethnic specific definitions of obesity. METHODS: 3099 participants (71.4% white European, 28.6% south Asian) aged 40-75 years were screened using a 75 g oral glucose tolerance test. Metabolic syndrome was defined using National Cholesterol Education Programme and International Diabetes Federation definitions. We compared sensitivity, specificity and area under the curve of waist circumference, body mass index and waist-hip ratio. RESULTS: The prevalence of metabolic syndrome using the definitions above was 29.9% (29.2% south Asian, 30.2% white European), and 34.4% (34.2% south Asian, 34.5% white European), respectively. Using the National Cholesterol Education Programme definition, waist circumference was significantly more predictive of metabolic syndrome than body mass index or waist-hip ratio. The area under the curve for waist circumference was 0.75 (95% CI: 0.69-0.80) and 0.76 (0.72-0.81) for south Asian men and women; 0.83 (0.80-0.85) and 0.80 (0.77-0.82) for white European men and women. CONCLUSIONS: The prevalence of metabolic syndrome is high in both south Asian and white European populations. Waist circumference is a simple and effective measure for predicting metabolic syndrome in different populations.

Recurrent diabetic ketoacidosis: causes, prevention and management.

Longitudinal studies indicate that 20% of paediatric patients account for 80% of all admissions for diabetic ketoacidosis (DKA). The frequency of DKA peaks during adolescence and, although individuals generally go into remission, they may continue to have bouts of recurrent DKA in adulthood. The evidence for insulin omission being the behavioural precursor to recurrent DKA is reviewed and discussed. Thereafter the range of possible psychosocial causes is explored and the evidence for each discussed. Approaches to assessing the individual and their family to identify aetiology and therefore appropriate intervention are considered and treatment options reviewed. Finally, the paper examines potential risk factors for recurrent DKA, possible strategies for identifying these early and how to use these assessments to prevent subsequent recurrent DKA.