Mark Peyrot

Prevalence of Depression in Individuals With Impaired Glucose Metabolism or Undiagnosed Diabetes: A systematic review and meta-analysis of the European Depression in Diabetes (EDID) Research Consortium

OBJECTIVE Meta-analyses have shown that the risk for depression is elevated in type 2 diabetes. Whether this risk in individuals with impaired glucose metabolism (IGM) or undiagnosed diabetes (UDD) is elevated relative to normal glucose metabolism (NGM) or decreased relative to previously diagnosed type 2 diabetes (PDD) has not been the subject of a systematic review/meta-analysis. This study examined the prevalence of depression in IGM and UDD subjects relative to each other and to NGM and PDD subjects by reviewing the literature and conducting a meta-analysis of studies on this topic. RESEARCH DESIGN AND METHODS EMBASE and MEDLINE databases were searched for articles published up to May 2010. All studies that compared the prevalence of depression in subjects with IGM and UDD were included. Odds ratios (ORs) were calculated using fixed and random-effects models. RESULTS The meta-analysis showed that the risk for depression was not increased in IGM versus NGM subjects (OR 0.96, 95% CI 0.85–1.08). Risk for depression did not differ between individuals with UDD and individuals with either NGM (OR 0.94, 95% CI 0.71–1.25) or IGM (OR 1.16, 95% CI 0.88–1.54). Finally, individuals with IGM or UDD both had a significantly lower risk of depression than individuals with PDD (OR 0.59, 95% CI 0.48–0.73, and OR 0.57, 95% CI 0.45–0.74, respectively). CONCLUSIONS Results of this meta-analysis show that the risk of depression is similar for NGM, IGM, and UDD subjects. PDD subjects have an increased risk of depression relative to IGM and UDD subjects.

Access to Diabetes Self-management Education Results of National Surveys of Patients, Educators, and Physicians

Purpose To examine factors related to access to diabetes self-management education (DSME), including services delivered and sought; patient, physician, and program barriers to access; educator outreach and expansion efforts; and perceptions of alternative DSME delivery strategies. Methods Internet surveys were completed by 1169 adults with diabetes (661 with prior DSME, 508 with no prior DSME) from a national community survey panel, 1871 educators who were AADE members, and 629 physicians (212 diabetes specialists, 417 primary care practitioners) from a national physician survey panel. Results Physicians want patients to receive more self-management support, but some report that patients are told to do things with which the physician does not agree. Provider (physician and educator)—delivered DSME is more highly regarded among those who have received it than among those who have not received it. Physicians generally have positive perceptions of provider-delivered DSME, and educators see physicians as key to encouraging DSME use in patients. Some physicians are concerned about losing patients sent to DSME, and 11% of patients report changing physicians as a result of DSME. Most DSME programs have grown recently as a result of recruiting efforts and adding new programs/services; most programs plan more such efforts. Patients prefer traditional DSME sources/settings and are moderately accepting of media sources. Conclusions Additional efforts are required to guarantee that all people with diabetes receive the DSME they need. This will require increased referral by physicians, increased follow-through by patients, and increased availability of DSME in forms that make it appealing to patients and physicians.

Providers' knowledge of genetics: A survey of 5915 individuals and families with genetic conditions

Purpose: Individuals affected by genetic conditions are increasingly likely to seek information about inheritance and risk factors from their primary care physicians rather than a geneticist, but several studies suggest that few health care providers are capable of fulfilling that role or are comfortable doing so. Acknowledging that the adoption of new genetics knowledge and technologies is often patient-driven, we asked affected individuals and family members about their experiences in encounters with a variety of nongenetics-trained health care providers.Methods: Staff at the National Coalition for Health Professional Education in Genetics, the Genetic Alliance, and a University of Maryland graduate student in genetic counseling drafted a web-based survey. We recruited study participants from the Genetic Alliance, and a total of 5915 respondents completed the questionnaire between December 2004 and August 2005.Results: Overall, 64% of respondents reported receiving no genetics education materials from the provider type named most important in the management of the condition in the family. We present knowledge ratings for various provider types and themes emerging from written descriptions of positive and disappointing experiences.Conclusion: We discuss the implications of these and other results for continuing genetics education and for clinical practice.

Epidemiology and correlates of weight worry in the multinational Diabetes Attitudes, Wishes and Needs study

ABSTRACT Objective: This study examined the epidemiology of worry about weight among adults with diabetes and whether this weight worry was associated with worse quality of life and diabetes self-management. Research design and methods: Participants were 5088 adults with type 1 or type 2 diabetes from the multi-national DAWN study. Random samples of approximately 500 were obtained from each of 11 countries/regions in Asia, Australia, Europe, and North America. All measures were self-reported data obtained during structured interviews. High weight worry was represented by the highest level of agreement with the statement ‘I feel very anxious about my weight.’ Results: One-quarter (25.1%) of respondents reported high weight worry. Using multivariate logistic regression to assess independent relationships, high weight worry was significantly (pu2009<u20090.05) more common among respondents who were women, less educated, had type 2 diabetes and more comorbidities, were diagnosed more recently and reported weight gain with diabetes. Using multivariate logistic regression to control for confounding factors, high weight worry was significantly (pu2009<u20090.05) associated with most of the adverse outcomes examined, including lower self-rated health, poorer reported regimen adherence and diabetes control, more diabetes-related distress, poorer psychological well-being, and more psychological treatment. Limitations: The cross-sectional, correlational analysis could not assess causal relationships among patient reported outcomes, and the study did not include objective outcome measures. Conclusions: High weight worry was common among adults with diabetes and associated with several adverse outcomes, including multiple indicators of diabetes-related distress, poor physical and psychological well-being, and regimen non-adherence. These findings suggest that healthcare providers should assess and address weight worry among their patients with diabetes.

Development and Pilot Evaluation of Literacy-Adapted Diabetes and CVD Education in Urban, Diabetic African Americans

BackgroundDespite prevalent low literacy nationally, empirical research on the development and testing of literacy-adapted patient education remains limited.ObjectiveTo describe procedures for developing and evaluating usability and acceptability of an adapted diabetes and CVD patient education.DesignMaterials adaptation for literacy demand and behavioral activation criteria, and pre-/post-test intervention evaluation design.ParticipantsPilot sample of 30 urban African-American adults with type 2 diabetes with Below Average literacy (nu2009=u200915) and Average literacy (nu2009=u200915).MeasurementsWide Range Achievement Test (WRAT-3, Reading), assessment of diabetes and CVD knowledge, and patient rating scale.ResultsReading grade levels were: >12th, 30%; 10th–12th, 20%; 7th–9th, 10%; 4th–6th grade, 10%; and ≤3rd grade or unable to complete WRAT-3, 30%. Education materials were modified to a reading level of ≤4th grade. Knowledge improved for Below Average (2.7 to 4.7, pu2009=u20090.005) and Average (3.8 to 5.7, pu2009=u20090.002) literacy groups, with up to a ten-fold increase, at post-education, in the number of participants responding correctly to some content items. The print materials and class received maximum usability and acceptability ratings from patients.ConclusionsDevelopment of patient education meeting very low literacy criteria was feasible, effective for knowledge acquisition, and highly acceptable irrespective of literacy level.