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Contribution of psychological symptoms on immediate and prolonged effects of diabetes self-management education

Background and aims: Depressive symptoms and diabetes-related distress may adversely interact with patients' effectiveness in the learning process during diabetes self-management education. This study was aimed at comparing baseline and follow-up indicators of diabetes knowledge and glycaemic control in patients with and without these symptoms who attended an educational course. Patients and methods: One hundred and sixty-six patients (aged 48± 15 years, 52% female, 38% type 1, with diabetes duration of 10± 8 yrs, 78% insulin treated) who participated in a 5-day educational course were assessed for depression and diabetes-related distress using the Center for Epidemiological Studies-Depression scale (CES-D) and the Problem Areas in Diabetes (PAID) scale. The CES-D score ≥ 16 and the PAID score ≥ 40 were considered indicative of severe depressive symptoms and high distress caused by diabetes. Diabetes knowledge was assessed at the beginning and at the end of the course using parallel forms of the Diabetes Knowledge Test (DKT). Indicators of glycaemic control as measured by HbA1C were assessed at the beginning of the course and after 3, 6 and 12 months. Baseline and follow-up indicators of diabetes knowledge and glycaemic control were compared in the subgroups of depressed-distressed, depressed, distressed and symptom-free individuals using the Kruskal-Wallis ANOVA. Results: Thirty-two percent of patients attending the educational course reported elevated depressive symptoms and high diabetes-related distress, 9% expressed elevated depressive symptoms, 10% high diabetes distress and 49% reported none of these symptoms. The four subgroups differed with respect to diabetes knowledge assessed at the beginning of the course (H=11.2 p=0.01), with depressed-distressed individuals having poorer knowledge as compared to the symptom-free individuals (p=0.02). Diabetes knowledge did not differ across the subgroups after the course (H=6.2 p=0.10), indicating comparable improvement in all participants. Depressed-distressed, depressed, distressed and symptom-free individuals had comparable baseline HbA1C values (H=3.6 p=0.31), which improved correspondingly after 3 and 6 months (H=3.2 p= 0.36 and H= 6.7 p=0.08 respectively). Differences in HbA1C values across the subgroups were observed at 12-month follow-up assessment (H=7.7 p=0.05), indicating poorer control in depressed-distressed vs depressed individuals (p=0.04). Conclusions: The benefits of a five-day educational course defined as improvements in diabetes knowledge and long-term diabetes control were shown to be comparable in patients reporting depressive symptoms and diabetes-related distress as compared to patients without these symptoms. Patients with double symptoms have greater difficulties in maintaining an acceptable long-term glycemic control, suggesting a need for a more intensive follow-up.

Diabetes; depression; diabetes-related distress; self-management education

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