Importance Of Individual Variations Over Time In Diabetes Treatment

10-23-2006 | Categories:

Clinical Info

Psychological Outcomes of Patients With Screen-Detected Type 2 Diabetes: The influence of time since diagnosis and treatment intensity. Bart J. Thoolen, Denise T. de Ridder, et al. Diabetes Care 2006 29: 2257-2262.

Early Intensive Diabetes Treatment Can Negatively Affect Stress and Outcome Medscape Today (Reuters) 12 Oct 2006

This study examined 196 patients diagnosed with diabetes that was detected by screening, who were receiving either usual care or intensive treatment. Outcome measures, including anxiety, depression, diabetes-related distress, perceived seriousness and vulnerability, self-efficacy, and self-care, were evaluated for differences caused by time since diagnosis (<1 vs. 2–3 years) and treatment intensity.

While most patients demonstrated little distress and low perceived seriousness and vulnerability as well as reporting high self-efficacy and low self-care, there was significant variation across conditions.

1. Perceived vulnerability increased over time:
Compared to the first year after diagnosis, patients viewed their diabetes as more threatening 2-3 years after diagnosis.

2. The degree of distress & self-efficacy varied by type of treatment over time:

B. Two to three years after diagnosis, patients receiving intensive treatment reported less distress and greater self-efficacy than patients receiving usual care.

The authors articulate the central conundrum:

There is an ongoing debate on screening for type 2 diabetes. Advocates emphasize the advantages of detecting diabetes in patients at an early stage of the disease, as an early and intensive treatment may reduce diabetes-related morbidity and mortality. This study emphasizes the importance of taking variations between patients into account in the development and implementation of (self-care) programs for patients with a recent diagnosis of type 2 diabetes during a screening trial. It also suggests that clinicians should be more attuned to patients’ psychological needs when they first prescribe (more) intensive treatments, when acknowledging the distress that strict regimens may produce, when assessing their illness cognitions, and when actively addressing problems with regard to their self-care.

Commentary

While these specific findings dealing with patients’ psychological perceptions during the treatment of diabetes may prove useful in planning individualized regimens and setting screening policy, the larger, more significant issue would appear to be the indication that a patient’s attitudinal set regarding any chronic disorder and, by extension, the likelihood of his or her adherence to treatment, may vary not only with type of disorder but also with intensity of treatment and passage of time.

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