Health promotion in diabetes care : studies on adult type 1 diabetes patients
Author: Amsberg, Susanne
Date: 2008-05-23
Location: Föreläsningssal 1, hus 18, plan 5, Danderyds sjukhus
Time: 09.00
Department: Institutionen för kliniska vetenskaper, Danderyds sjukhus / Department of Clinical Sciences, Danderyd Hospital
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Thesis (1.218Mb)
Abstract
Introduction: A landmark report has shown that improving glycaemic
control among type 1 diabetes patients markedly reduces diabetes-related
complications. In clinical practice, however, many patients have problems
in adhering to the treatment, and thus remain in poor glycaemic control.
Research suggests a more behaviour-oriented approach to diabetes, but
there is a lack of evidence on the efficacy of interventions, especially
for those adult type 1 diabetes patients who are in poor glycaemic
control. Diabetes-related distress has been associated with poor
adherence to treatment and poor glycaemic control. There is a need for
validated measures in this area, to identify patients who experience
diabetes-related distress. Additionally, injection technique is crucial
for the management of diabetes, and lipohypertrophy is a common side
effect which deserves further attention.
Objectives: The overall aim of this thesis was to evaluate a behavioural medicine intervention among poorly controlled adult type 1 diabetes patients, and to gain a deeper knowledge in an area of diabetes self-management.
Methods: Quantitative design was used for the studies, and the clinical settings comprised two diabetes care units in Stockholm, Sweden. Study I: The Swedish version of the Problem Areas in Diabetes (Swe-PAID-20) scale was evaluated regarding its psychometric properties by type 1 diabetes patients, as well as by an expert panel of diabetes specialist nurses. Study II: A behavioural medicine intervention based on Cognitive Behaviour Therapy (CBT) was evaluated in a randomised controlled trial among poorly controlled adult type 1 diabetes patients. Study III: Using the same sample as in study II, descriptive statistics were produced, and predictive and comparative analyses performed, in order to find predictors of or associations with improvements in glycaemic control as a response to the intervention. Study IV: In a randomised crossover trial insulin absorption in lipohypertrophic injection sites was investigated in type 1 diabetes patients.
Results and conclusions: Study I: A three-factor solution of the scale was found, comprising sub-dimensions of diabetes-related emotional problems, treatment-related problems and support-related problems. Cronbach s alpha for the total score was 0.94 and varied between 0.61 and 0.94 in the three subscales. The findings also supported the convergent and content validity. The Swe-PAID-20 seems to be a reliable and valid outcome for measuring diabetes-related distress in type 1 diabetes patients. Study II: Significant differences were observed with respect to HbA1c, well-being, diabetes-related distress, frequency of blood glucose testing, fear of hypoglycaemia, perceived stress, and depression, all of which improved more in the intervention group compared with the control group. The CBT based behavioural medicine intervention appears to be a promising approach to diabetes self-management. Study III: The participation rate in the study was 41% and attrition was 24%. Of those patients who actually participated in the intervention, 13% withdrew. From the regression models no predictors or associations were found with regard to improvement in HbA1c. The programme proved to be feasible in terms of design and methods. However, no clear pattern was found regarding predictors of or associations with improved metabolic control. Study IV: Impairment of insulin absorption from lipohypertrophic injection sites was also found with analogue insulins. It is suggested that patients should be advised to refrain from injecting insulin aspart into lipohypertrophic subcutaneous tissue.
Objectives: The overall aim of this thesis was to evaluate a behavioural medicine intervention among poorly controlled adult type 1 diabetes patients, and to gain a deeper knowledge in an area of diabetes self-management.
Methods: Quantitative design was used for the studies, and the clinical settings comprised two diabetes care units in Stockholm, Sweden. Study I: The Swedish version of the Problem Areas in Diabetes (Swe-PAID-20) scale was evaluated regarding its psychometric properties by type 1 diabetes patients, as well as by an expert panel of diabetes specialist nurses. Study II: A behavioural medicine intervention based on Cognitive Behaviour Therapy (CBT) was evaluated in a randomised controlled trial among poorly controlled adult type 1 diabetes patients. Study III: Using the same sample as in study II, descriptive statistics were produced, and predictive and comparative analyses performed, in order to find predictors of or associations with improvements in glycaemic control as a response to the intervention. Study IV: In a randomised crossover trial insulin absorption in lipohypertrophic injection sites was investigated in type 1 diabetes patients.
Results and conclusions: Study I: A three-factor solution of the scale was found, comprising sub-dimensions of diabetes-related emotional problems, treatment-related problems and support-related problems. Cronbach s alpha for the total score was 0.94 and varied between 0.61 and 0.94 in the three subscales. The findings also supported the convergent and content validity. The Swe-PAID-20 seems to be a reliable and valid outcome for measuring diabetes-related distress in type 1 diabetes patients. Study II: Significant differences were observed with respect to HbA1c, well-being, diabetes-related distress, frequency of blood glucose testing, fear of hypoglycaemia, perceived stress, and depression, all of which improved more in the intervention group compared with the control group. The CBT based behavioural medicine intervention appears to be a promising approach to diabetes self-management. Study III: The participation rate in the study was 41% and attrition was 24%. Of those patients who actually participated in the intervention, 13% withdrew. From the regression models no predictors or associations were found with regard to improvement in HbA1c. The programme proved to be feasible in terms of design and methods. However, no clear pattern was found regarding predictors of or associations with improved metabolic control. Study IV: Impairment of insulin absorption from lipohypertrophic injection sites was also found with analogue insulins. It is suggested that patients should be advised to refrain from injecting insulin aspart into lipohypertrophic subcutaneous tissue.
List of papers:
I. Amsberg S, Wredling R, Lins PE, Adamson U, Johansson UB (2007). The psychometric properties of the Swedish version of the Problem Areas in Diabetes Scale (Swe-PAID-20): Scale development. Int J Nurs Stud. Nov 5: Epub ahead of print
Pubmed
II. Amsberg S, Anderbro T, Wredling R, Lisspers J, Lins P-E, Adamson U, Johansson U-B. (2008). A behavioral medicine intervention among poorly controlled adult type 1 diabetes patients a randomized controlled trial. [Submitted]
III. Amsberg S, Anderbro T, Wredling R, Lisspers J, Lins P-E, Adamson U, Johansson U-B (2008). Experience from a behavioural medicine intervention among poorly controlled adult type 1 diabetes patients. [Submitted]
IV. Johansson UB, Amsberg S, Hannerz L, Wredling R, Adamson U, Arnqvist HJ, Lins PE (2005). Impaired absorption of insulin aspart from lipohypertrophic injection sites. Diabetes Care. 28(8): 2025-7.
Pubmed
I. Amsberg S, Wredling R, Lins PE, Adamson U, Johansson UB (2007). The psychometric properties of the Swedish version of the Problem Areas in Diabetes Scale (Swe-PAID-20): Scale development. Int J Nurs Stud. Nov 5: Epub ahead of print
Pubmed
II. Amsberg S, Anderbro T, Wredling R, Lisspers J, Lins P-E, Adamson U, Johansson U-B. (2008). A behavioral medicine intervention among poorly controlled adult type 1 diabetes patients a randomized controlled trial. [Submitted]
III. Amsberg S, Anderbro T, Wredling R, Lisspers J, Lins P-E, Adamson U, Johansson U-B (2008). Experience from a behavioural medicine intervention among poorly controlled adult type 1 diabetes patients. [Submitted]
IV. Johansson UB, Amsberg S, Hannerz L, Wredling R, Adamson U, Arnqvist HJ, Lins PE (2005). Impaired absorption of insulin aspart from lipohypertrophic injection sites. Diabetes Care. 28(8): 2025-7.
Pubmed
Issue date: 2008-05-02
Rights:
Publication year: 2008
ISBN: 978-91-7357-566-9
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