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Well-being and glycemic control in diabetes patients: Baseline data from the cross-national DAWN Monitoring of Individual Needs in Diabetes (MIND) Study

The ongoing cross-national DAWN MIND study aims to promote systematic psychological evaluation in diabetes care to enhance well-being and self- management. The psychological status is assessed at 12 month intervals in diabetes centers across 9 countries, using a computerized, nurse-led procedure assessing demographics, clinical status, well-being (WHO-5), diabetes-distress (PAID), recent life events and the patients’ agenda. The assessment is scheduled prior to the annual review and takes 5-7 minutes. A report on the patient’ s psychological status is automatically generated (scores standardized 0-100) and discussed with the patient. Action is taken if needed (e.g. referral). All diabetes outpatients are eligible if >17 yrs., diabetes duration > 6 months and sufficient language/reading skills. Between Oct 2006 and Dec 2007, 1153 diabetes patients were monitored in 9 countries. Mean age 53.8 yrs. ± 14.8 ; 47.9% male, 63.2% type 2. Overall mean HbA1c was 7.9% ± 1.5 (range 4.5 - 15.7) with no differences by sex or type of diabetes ; 45.2% had ≥ 1 diabetes complication, 55.7% reported ≥ 1 major life event. Mean overall WHO-5 score was 60.3 ± 22.0, between centers range 52.0 - 67.2. Mean PAID also differed across centers (range 15.9 - 35.2) with overall mean of 24.5 ± 19.4. Approximately 1/3 reported reduced well-being (WHO-5 score < 50), range across centers 20.8 - 45.0%, while 1/10 had scores indicative for Depression (WHO-5 score ≤ 28), range 5.3 - 18.1%. One in 5 reported high Diabetes Distress (PAID score ≥ 40), with substantial center differences (range 6.4 - 35.0%). Of all patients, 5.1% (N=59) (range 0.0 - 7.4% across centers) was classified as Depressed-Distressed. Of these, 79.3% (N=46) (range 50 - 100%) were newly identified cases. Those with HbA1c’ s ≥ 8.5% (N=365) had poorer WHO- 5 and PAID scores compared to the rest (p< .05). Patients with complications and/or a major life event also showed poorer psychological functioning (p<.01) warranting attention. The results confirm that monitoring well-being is feasible, without burdening the health care system and helps to identify patients’ psychosocial needs that are otherwise likely to stay unrecognized.

diabetes; emotional well-being; glycemic control; multicentric study

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