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Diabetes mellitus is associated with cognitive dysfunction and abnormalities that can be seen with brain imaging. Recent studies provide important new insights into the nature and severity of these cerebral complications that help to explain why some patients with diabetes have clinically relevant neurocognitive morbidity, whereas most are apparently unaffected. This Personal View investigates the hypothesis that clinically relevant diabetes-related cognitive decrements mainly occur at two crucial periods in life: when the brain is developing in childhood, and when the brain undergoes neurodegenerative changes associated with ageing. Outside of these periods cognitive decrements mainly occur in patients with notable diabetes-related comorbidities, in particular microvascular or macrovascular complications. The identification of crucial periods and conditions for the development of diabetes-related cognitive decrements helps to draw the attention of physicians to individuals at risk and can direct future studies into the mechanisms that underlie these conditions.

To estimate the odds and prevalence of clinically relevant depression in adults with type 1 or type 2 diabetes. Depression is associated with hyperglycemia and an increased risk for diabetic complications; relief of depression is associated with improved glycemic control. A more accurate estimate of depression prevalence than what is currently available is needed to gauge the potential impact of depression management in diabetes. MEDLINE and PsycINFO databases and published references were used to identify studies that reported the prevalence of depression in diabetes. Prevalence was calculated as an aggregate mean weighted by the combined number of subjects in the included studies. We used chi(2) statistics and odds ratios (ORs) to assess the rate and likelihood of depression as a function of type of diabetes, sex, subject source, depression assessment method, and study design. A total of 42 eligible studies were identified; 20 (48%) included a nondiabetic comparison group. In the controlled studies, the odds of depression in the diabetic group were twice that of the nondiabetic comparison group (OR = 2.0, 95% CI 1.8-2.2) and did not differ by sex, type of diabetes, subject source, or assessment method. The prevalence of comorbid depression was significantly higher in diabetic women (28%) than in diabetic men (18%), in uncontrolled (30%) than in controlled studies (21%), in clinical (32%) than in community (20%) samples, and when assessed by self-report questionnaires (31%) than by standardized diagnostic interviews (11%). The presence of diabetes doubles the odds of comorbid depression. Prevalence estimates are affected by several clinical and methodological variables that do not affect the stability of the ORs.

OBJECTIVE:--To estimate the prevalence rate of depression among adults with diabetes using a large population-based sample in the U.S. RESEARCH DESIGN AND METHODS--Data from the 2006 Behavioral Risk Factor Surveillance System, a standardized telephone survey among U.S. adults aged >=18 years, were analyzed (n = 18,814). The Patient Health Questionnaire diagnostic algorithm was used to identify major depression. RESULTS:--The age-adjusted prevalence rate of major depression was 8.3% (95% CI 7.3-9.3), ranging from a low of 2.0% in Connecticut to a high of 28.8% in Alaska. There were 25-fold differences in the rate among racial/ethnic subgroups (lowest, 1.1% among Asians; highest, 27.8% among American Indians/Alaska Natives). People with type 2 diabetes who were currently using insulin had a higher rate than people with type 1 diabetes (P = 0.0009) and those with type 2 diabetes who were currently not using insulin (P = 0.01). CONCLUSIONS:--Major depression was highly prevalent among people with diabetes; the prevalence rate varied greatly by demographic characteristics and diabetes types.

Background Non‐attendance at diabetes appointments is costly to the health service and linked with poorer patient outcomes. Objective Peer researchers aimed to conduct interviews and survey people who miss appointments about their beliefs and perceptions regarding their diabetes and diabetes appointments. Design A mixed‐methods cross‐sectional design with interviews conducted by peer researchers with diabetes and a questionnaire was used. Setting and participants Peer researchers conducted semi‐structured telephone interviews in one health board in Scotland with ten people who had missed diabetes appointments. A further 34 people who had missed appointments completed a questionnaire. The study was informed by two psychological theories (the Theory of Planned Behaviour and the Self‐Regulation Model), and interviews were analysed using thematic analysis. Results Interviewees planned to attend appointments but practical barriers, low perceived value of appointments and the feeling that diabetes had little impact upon their lives’ emerged as key reasons for missing appointments. Questionnaire data supported these findings and showed that respondents perceived diabetes to have only mildly serious consequence and cause limited concern and emotional impact. Participants’ understanding of their condition and perceptions of personal control and treatment control were low. Gender, perceived behavioural control and emotional representations were significantly associated with the number of appointments missed in the previous year. Conclusions These findings highlight the importance of psychological variables in predicting non‐attendance at diabetes appointments and provide avenues for how non‐attendance might be tackled.

ObjectivesTo assess the psychometric properties of the short form of The Problem Areas in Diabetes scale (PAID-5) in Norwegian adult patients with type 1 or type 2 diabetes.DesignCross-sectional survey design.MethodsParticipants (n=143) were included from three Western-Norway endocrinology outpatient clinics. Demographic and clinical data were collected in addition to questionnaires concerning diabetes-related distress, fear of hypoglycaemia, symptoms of depression, emotional well-being and perception of general health. Psychometric evaluation of the PAID-5 included confirming its postulated one-factor structure using confirmatory factor analysis (CFA) and assessing convergent validity, discriminant validity, internal consistency and test-retest reliability. The retest questionnaire was sent out 35±15 days after the initial assessment to those who agreed (n=117).ResultsThe CFA for the PAID-5 scale showed excellent one-factor structure, and there was high internal consistency (α=0.89) and good test-retest reliability (Intraclass Correlation Coefficient, ICC=0.81). The PAID-5 correlated positively with fear of hypoglycaemia (r=0.598) and depression (r=0.380) and negatively with emotional well-being (r=−0.363) and perception of general health (r=−0.420), thus satisfying convergent validity. Patients who had experienced episodes of serious hypoglycaemia in the past 6 months had a significantly higher PAID-5 mean score (7.5, SD=4.95) than those who had not had these episodes (5.0, SD=4.2 (p=0.043)).ConclusionThe Norwegian PAID-5 was shown to be a reliable and valid short questionnaire for assessing diabetes-related distress among people with type 1 or type 2 diabetes. However, its ability to discriminate between groups needs to be tested further in larger samples. The PAID-5 scale can be a particularly valuable screening instrument in outpatient clinics, as its brevity makes it easy to use as a tool in patient-provider encounters. This short questionnaire is useful in the national diabetes registry or population cohort studies as it enables increased knowledge regarding the prevalence of diabetes-related distress.

Diabetes-distress is prevalent in persons with diabetes. However, studies on the association between diabetes-distress, costs and healthcare utilization are scarce. We aim to explore whether diabetes-distress is related to healthcare utilization and medical costs. In this cross-sectional study, diabetes patients completed the Problem Areas in Diabetes Short Form (PAID5) and the Patient Health Questionnaire (PHQ9). Healthcare utilization (in number of yearly visits) was measured using the Trimbos and iMTA questionnaire on Costs associated with Psychiatric illness (TiC-P), and extraction from the hospital's medical records. Healthcare costs were calculated using Dutch standard costs. Generalized linear models (Gamma log link) were used to estimate the associations while adjusting for confounders. Diabetes-distress was related to healthcare utilization, mean difference 10, 95 % CI 9 to 14, but not to healthcare costs, mean difference €467, 95 % CI -71 to 1006. When controlling for depressive symptoms, comorbidity, age, ethnicity, socioeconomic status and diabetes duration, diabetes-distress remained associated with healthcare utilization, mean difference 9, 95 % CI 2 to 16. This is the first study to evaluate associations between diabetes-distress and healthcare utilization and costs in diabetes patients. Diabetes-distress was significantly related to an increased amount of healthcare utilization, but not costs. •This is the first study to evaluate associations between diabetes-distress and healthcare utilization and costs in diabetes patients.•Diabetes-distress was significantly related to an increased amount of healthcare utilization, but not costs.

The Diabetes Empowerment Scale: a measure of psychosocial self-efficacy. R M Anderson , M M Funnell , J T Fitzgerald and D G Marrero Department of Medical Education, University of Michigan Medical School, Ann Arbor 48109-0201, USA. boba@umich.edu Abstract OBJECTIVE: The purpose of this study was to assess the validity, reliability, and utility of the Diabetes Empowerment Scale (DES), which is a measure of diabetes-related psychosocial self-efficacy. RESEARCH DESIGN AND METHODS: In this study (n = 375), the psychometric properties of the DES were calculated. To establish validity, DES subscales were compared with 2 previously validated subscales of the Diabetes Care Profile (DCP). Factor and item analyses were conducted to develop subscales that were coherent, meaningful, and had an acceptable coefficient alpha. RESULTS: The psychometric analyses resulted in a 28-item DES (alpha = 0.96) with 3 subscales: Managing the Psychosocial Aspects of Diabetes (alpha = 0.93), Assessing Dissatisfaction and Readiness To Change (alpha = 0.81), and Setting and Achieving Diabetes Goals (alpha = 0.91). Consistent correlations in the expected direction between DES subscales and DCP subscales provided evidence of concurrent validity. CONCLUSIONS: This study provides preliminary evidence that the DES is a valid and reliable measure of diabetes-related psychosocial self-efficacy. The DES should be a useful outcome measure for various educational and psychosocial interventions related to diabetes.

OBJECTIVE: To study variation in quality of life and quality of care in patients with diabetes experiencing three different models of care: traditional hospital care, hospital/general practitioner (GP) shared care, and structured GP care. RESEARCH DESIGN AND METHODS: A cross-sectional study involving 1,456 patients with diabetes (71% response rate) was conducted. Quality of life was assessed with the Audit of Diabetes-Dependent Quality of Life (ADDQoL) instrument and quality of care with a 10-point process-of-care report card. RESULTS: The adjusted odds ratio (OR) for a high (upper quartile) ADDQoL score was significantly increased in the structured care relative to the traditional hospital care group (OR 1.7 [95% CI 1.2-2.5]). A significantly higher proportion of structured GP care patients reported compliance with seven or more key process-of-care measures compared with the other models of care. CONCLUSIONS: Diabetes quality of life may be enhanced when care is provided in a primary care setting without compromising quality of care.

Living with diabetes over an extended period impacts not only physical health but also the psychosocial well-being of patients. Diabetes distress is a widespread concern affecting individuals with diabetes mellitus across all age groups, cultures, and populations. Given its significance in effective disease management, identifying modifiable factors that contribute to diabetes distress is essential for developing targeted interventions. This study was therefore undertaken to examine the prevalence and associated determinants of diabetes distress among patients receiving care at the University of Gondar Comprehensive Specialized Referral Hospital in northwest Ethiopia. An institution-based cross-sectional study was conducted from August to September 2021. A systematic random sampling technique was employed to select 376 diabetes patients. A structured, pretested, interviewer-administered questionnaire was used to collect data. The data was entered in Epi Info version 7, analyzed using SPSS version 21, and presented using frequencies, percentages, tables, and graphs. Bivariable and multivariable analyses were investigated using a binary logistic regression model. Finally, variables with a P value < 0.05 were declared statistically significant. A total of 364 diabetes patients participated in the current study, making a response rate of 96.8%. Of the 364 participants, 45.6% (95% CI (40.1–50.8%)) of them had moderate to high levels of diabetes distress. Having type 1 DM [AOR = 3.03, 95% CI (1.71, 5.37)], rural residency [AOR = 2.73, 95% CI (1.55, 4.79)], insulin injection only [AOR = 2.38, 95% CI (1.73, 4.39)], and poor family support [AOR = 2.76, 95% CI (1.73, 4.39)] were associated with increased odds of diabetes distress. The prevalence of diabetes distress among diabetes patients was high. Having type 1 DM, rural residency, using insulin injection only, and having poor family support were significantly associated with diabetes distress. It is better to combine the assessment for diabetes distress as part of regular actions for diabetes care and give attention to modifiable factors like family support. To improve outcomes, healthcare policies should prioritize integrating psychosocial support into diabetes management programs, especially in rural settings, and train providers to routinely screen for diabetes distress.