Thomas Kubiak

How to screen for depression and emotional problems in patients with diabetes: comparison of screening characteristics of depression questionnaires, measurement of diabetes-specific emotional problems and standard clinical assessment

Aims/hypothesisWe compared the screening performance of different measures of depression: the standard clinical assessment (SCA); the Beck Depression Inventory (BDI); the Center of Epidemiological Studies-Depression Scale (CES-D); and the Problem Areas in Diabetes (PAID) questionnaire, which assesses diabetes-specific distress. We also studied the ability of these measures to detect diabetes-related distress.Materials and methodsA total of 376 diabetic patients (37.2% type 1; 23.9% type 2 without insulin treatment, 38.8% type 2 with insulin) completed the BDI and CES-D; patients who screened positive participated in a diagnostic interview, the Composite International Diagnostic Interview (CIDI). Also, all patients completed the PAID questionnaire. Results of the SCA that related to depression diagnosis were reviewed to correct for false negative screening results.ResultsThe prevalence of clinical depression was 14.1%, with an additional 18.9% of patients receiving a diagnosis of subclinical depression. Sensitivity for clinical depression in SCA (56%) was moderate, whereas BDI, CES-D and the PAID questionnaire showed satisfactory sensitivity (87, 79 and 81%, respectively). For subclinical depression, the sensitivity of the PAID questionnaire (79%) was sufficient, whereas that of SCA (25%) was poor. All methods showed low sensitivity for the detection of diabetes-specific emotional problems (SCA 19%, CIDI 34%, BDI 60%, CES-D 49%).Conclusions/interpretationThe screening performance of SCA for clinical and subclinical depression was modest. Additional screening for depression using the PAID or another depression questionnaire seems reasonable. The ability of depression screening measures to identify diabetes-related distress is modest, suggesting that the PAID questionnaire could be useful when screening diabetic patients for both depression and emotional problems.

Affective and anxiety disorders in a German sample of diabetic patients: prevalence, comorbidity and risk factors

Aims  The aims of this study were to examine (1) the prevalence of clinical and subclinical anxiety and affective disorders in a sample of diabetic patients attending a secondary care clinic in Germany and (2) risk factors associated with the occurrence of these disorders.

Cardiac vagal tone is associated with social engagement and self-regulation.

The polyvagal theory (Porges, 2007) represents a biobehavioral model that relates autonomic functioning to self-regulation and social engagement. The aim of the two presented studies was to test the proposed association of cardiac vagal tone (CVT), assessed via resting high-frequency heart rate variability (respiratory sinus arrhythmia, RSA), with coping, emotion-regulation, and social engagement in young adults. In Study 1 (retrospective self-report), RSA was positively associated with engagement coping (situation control, response control, positive self-instructions, social-support seeking) and aspects of social well-being. In Study 2 (ecological momentary assessment), for 28 days following the initial assessment, RSA predicted less use of disengagement strategies (acceptance and avoidance) for regulating negative emotions and more use of socially adaptive emotion-regulation strategies (i.e., social-support seeking as a reaction to sadness and making a concession as a reaction to anger caused by others). Furthermore, RSA was higher in participants who reported no anger episodes compared to those who reported at least one anger episode and was positively associated with reported episodes of negative emotions. Results support the association proposed by the PVT between CVT and self-regulatory behavior, which promotes social bonds.

Assessment of hypoglycaemia awareness using continuous glucose monitoring

Aims  To investigate the possibility of assessing hypoglycaemia awareness in patients with Type 1 diabetes using continuous glucose monitoring.

SGS: a structured treatment and teaching programme for older patients with diabetes mellitus—a prospective randomised controlled multi-centre trial

Objectives: evaluation of the effectiveness of a new structured diabetes teaching and treatment programme (DTTP) with specific didactical approaches and topics for geriatric patients with diabetes mellitus. Design: a prospective randomised controlled multi-centre trial. Setting and participants: a total of 155 geriatric patients were randomly admitted to either the new DTTP SGS (n = 83) or the standard DTTP (n = 72) for insulin-treated patients with type 2 diabetes mellitus (HbA1c 8.0 ± 1.4%, age 76.2 ± 6.3 years). Measurements: biometrical data, metabolic control, acute complications, diabetes knowledge, self-management. Results: SGS participants showed improved levels of HbA1c 6 months after the DTTP, and less acute complications than the standard group (P<0.009). Both groups demonstrated a good capacity for diabetes self-management and improvement in diabetes knowledge after the DTTP (P<0.01). Conclusion: the new SGS diabetes education programme, focusing on the learning capabilities and the particular needs of older persons, is effective in improving metabolic control and in maintaining auto-sufficiency in geriatric patients with diabetes mellitus.

The effect of an education programme (HyPOS) to treat hypoglycaemia problems in patients with type 1 diabetes

In a randomized, prospective multi‐centre trial, the effect of a specific training programme (HyPOS) for patients with hypoglycaemia problems was compared with a control group (CG), receiving a standardized education programme aiming at avoidance of hypoglycaemia by optimization of insulin therapy.

Direct Quantification of Cell-Free, Circulating DNA from Unpurified Plasma

Cell-free DNA (cfDNA) in body tissues or fluids is extensively investigated in clinical medicine and other research fields. In this article we provide a direct quantitative real-time PCR (qPCR) as a sensitive tool for the measurement of cfDNA from plasma without previous DNA extraction, which is known to be accompanied by a reduction of DNA yield. The primer sets were designed to amplify a 90 and 222 bp multi-locus L1PA2 sequence. In the first module, cfDNA concentrations in unpurified plasma were compared to cfDNA concentrations in the eluate and the flow-through of the QIAamp DNA Blood Mini Kit and in the eluate of a phenol-chloroform isoamyl (PCI) based DNA extraction, to elucidate the DNA losses during extraction. The analyses revealed 2.79-fold higher cfDNA concentrations in unpurified plasma compared to the eluate of the QIAamp DNA Blood Mini Kit, while 36.7% of the total cfDNA were found in the flow-through. The PCI procedure only performed well on samples with high cfDNA concentrations, showing 87.4% of the concentrations measured in plasma. The DNA integrity strongly depended on the sample treatment. Further qualitative analyses indicated differing fractions of cfDNA fragment lengths in the eluate of both extraction methods. In the second module, cfDNA concentrations in the plasma of 74 coronary heart disease patients were compared to cfDNA concentrations of 74 healthy controls, using the direct L1PA2 qPCR for cfDNA quantification. The patient collective showed significantly higher cfDNA levels (mean (SD) 20.1 (23.8) ng/ml; range 5.1–183.0 ng/ml) compared to the healthy controls (9.7 (4.2) ng/ml; range 1.6–23.7 ng/ml). With our direct qPCR, we recommend a simple, economic and sensitive procedure for the quantification of cfDNA concentrations from plasma that might find broad applicability, if cfDNA became an established marker in the assessment of pathophysiological conditions.

Long-Term Effect of an Education Program (HyPOS) on the Incidence of Severe Hypoglycemia in Patients With Type 1 Diabetes

A new education program for treating diabetic patients with hypoglycemia problems, named HyPOS, was developed and evaluated in a randomized controlled trial. The present study investigated the long-term effect of HyPOS on the prospectively assessed incidence of severe hypoglycemia defined as an episode requiring medical assistance by injection of glucose intravenously or glucagon intramuscularly. HyPOS comprises five lessons of 90 min each over 5 weeks. The program informs about the vicious cycle of frequent hypoglycemia increasing the risk for future hypoglycemia (1,2). Patients were trained in symptom awareness by using diaries and performing blood glucose estimation. The control …

Heart rate variability predicts self-control in goal pursuit

The aim of our study was to investigate the effects of a failure experience on the exercise of self‐control in goal pursuit. We hypothesized that tonic heart rate variability (tonic HRV), a possible physiological marker of inhibitory capacity, increases the exercise of self‐control in the pre‐ and post‐actional phase in goal pursuit after failure. Participants received feedback for an alleged intelligence test and subsequently worked on the same test again. As indicators of exercised self‐control, we assessed self‐confidence in the pre‐actional phase and rumination in the post‐actional phase. As hypothesized, tonic HRV was positively associated with pre‐ and post‐actional self‐control, even after controlling for the effect of neuroticism. We discuss the implications of our results for the self‐regulatory strength model. Copyright

Emotional changes during experimentally induced hypoglycaemia in type 1 diabetes

Emotional changes during experimentally induced hypoglycaemia in type 1 diabetic patients were investigated using a hyperinsulinaemic glucose clamp. In the experimental group (n=11), blood glucose was stabilised at euglycaemia (5.6 mmol/l, phase 1), then lowered to 2.5 mmol/l (phase 2) and raised to 5.6 mmol/l (phase 3). In the control group (n=11), euglycaemia was maintained during all phases. Hypoglycaemia elicited the expected endocrine, symptomatic and neuroglycopenic effects. During hypoglycaemia negative mood states increased significantly, whereas positive mood states decreased. Hypoglycaemia prolonged rating time of emotional stimuli (drawn from IAPS) significantly. The arousal ratings of the slides were higher during hypoglycaemia. Valence and dominance ratings were not affected. Epinephrine and norepinephrine release correlated with a higher arousal rating and a decrease in positive mood states. Deterioration in neuropsychological tasks correlated with an increase in negative mood states. Experimental induction of hypoglycaemia can offer a new research model to study emotional processes.