Vol. 153 No. 5 (2023)
Analysis of diabetes attitudes, wishes and needs in Switzerland, the Swiss DAWN2™ Study
- Oliver Andreas Kuratli
- Carolina Gross
- Markus Laimer
- Andreas Melmer
AIMS OF THE STUDY: Swiss DAWN2™ aimed to evaluate the difficulties and unmet needs of individuals with diabetes and stakeholders, based on the assessments of diabetes care and self-management: the individual burden of disease, the perception of the quality of medical care, and the treatment satisfaction of individuals with diabetes living in the Canton of Bern. The results of the Swiss cohort were analysed and compared with the global DAWN2™ results.
METHODS: 239 adult individuals with diabetes were enrolled in a cross-sectional study at the Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism at the University Hospital of Bern between 2015 and 2017. The participants completed validated online questionnaires regarding health-related quality of life (EQ-5D-3L) and emotional distress (PAID-5), diabetes self-care activities (SDSCA-6), treatment satisfaction (PACIC-DSF), and health-related wellbeing (WHO-5). Eligibility criteria were as follows: participants were aged >18 years, had a diagnosis of diabetes type 1 or 2 since at least 12 months and gave written informed for the participation in the present study.
RESULTS: When compared globally, the Swiss cohort reported a higher quality of life (77.28 ± 16.73 vs. 69.3 ± 17.9 EQ-5D-3L score, p <0.001) and lower emotional distress (22.28 ± 20.94 vs. 35.2 ± 24.2 PAID-5 score, p = 0.027). Higher frequencies of self-measurement of blood glucose (6.43 ± 1.68 vs. 3.4 ± 2.8 SDSCA-6 score, p <0.001) and physical activity (4.40 ± 2.04 vs. 3.8 ± 2.7 SDSCA-6 score, p = 0.05) were reported. PACIC-DSF revealed higher satisfaction concerning organisational aspects of patient care (60.3 ± 1.51 vs. 47.3 ± 24.3, p<0.001) and higher health-related well-being as compared to the global score (71.38 ± 23.31 vs. 58 ± 13.8 WHO-5 Well-Being Index, p <0.001). HbA1c >7% correlated to emotional distress (PAID-5, 26.08 ± 23.37 vs. 18.80 ± 17.49, p = 0.024), unfavourable eating habits (4.28 ± 2.22 vs. 4.99 ± 2.15, p = 0.034) and decreased physical activity (3.95 ± 2.16 vs. 4.72 ± 1.92, p = 0.014). Sleeping problems were most commonly reported (35.6%). In total, 28.8% of respondents completed diabetes-related educational programs.
CONCLUSION: In global comparison, Swiss DAWN2™ showed a lower burden of disease and yet a higher level of treatment satisfaction in patients who were treated in Switzerland. Further studies are required to assess the quality of diabetes treatment and unmet needs in patients treated outside of a tertiary care center.
- Barnard KD, Peyrot M, Holt RI. Psychosocial support for people with diabetes: past, present and future. Diabet Med. 2012 Nov;29(11):1358–60. https://doi.org/10.1111/j.1464-5491.2012.03727.x226815301464-5491
- Skovlund SE, Peyrot M; DAWN International Advisory Panel. The Diabetes Attitudes, Wishes, and Needs (DAWN) program: a new approach to improving outcomes of diabetes care. Diabetes Spectr. 2005 Jul;18(3):136–42. https://doi.org/10.2337/diaspect.18.3.1361040-9165
- World Health Organization. Diabetes [Internet]. World Health Organization; 2022. https://www.who.int/health-topics/diabetes#tab=tab_1
- Bădescu SV, Tătaru C, Kobylinska L, Georgescu EL, Zahiu DM, Zăgrean AM, et al. The association between Diabetes mellitus and Depression. J Med Life. 2016;9(2):120–5.274537391844-3117
- Bajor LA, Gunzler D, Einstadter D, Thomas C, McCormick R, Perzynski AT, et al. Associations between comorbid anxiety, diabetes control, and overall medical burden in patients with serious mental illness and diabetes. Int J Psychiatry Med. 2015;49(4):309–20. https://doi.org/10.1177/0091217415589307260602620091-2174
- Dybdal D, Tolstrup JS, Sildorf SM, Boisen KA, Svensson J, Skovgaard AM, et al. Increasing risk of psychiatric morbidity after childhood onset type 1 diabetes: a population-based cohort study. Diabetologia. 2018 Apr;61(4):831–8. https://doi.org/10.1007/s00125-017-4517-7292429851432-0428
- Gandhi KK, Baranowski T, Anderson BJ, Bansal N, Redondo MJ. Psychosocial aspects of type 1 diabetes in Latino- and Asian-American youth. Pediatr Res. 2016 Sep;80(3):347–55. https://doi.org/10.1038/pr.2016.87270741241530-0447
- Delamater AM, Jacobson AM, Anderson B, Cox D, Fisher L, Lustman P, et al.; Psychosocial Therapies Working Group. Psychosocial therapies in diabetes: report of the Psychosocial Therapies Working Group. Diabetes Care. 2001 Jul;24(7):1286–92. https://doi.org/10.2337/diacare.24.7.1286114235170149-5992
- Rechenberg K, Whittemore R, Grey M. Anxiety in youth with type 1 diabetes. J Pediatr Nurs. 2017;32:64–71. https://doi.org/10.1016/j.pedn.2016.08.007276630961532-8449
- Rubin RR, Peyrot M, Siminerio LM; International DAWN Advisory Panel. Health care and patient-reported outcomes: results of the cross-national Diabetes Attitudes, Wishes and Needs (DAWN) study. Diabetes Care. 2006 Jun;29(6):1249–55. https://doi.org/10.2337/dc05-2494167320040149-5992
- Peyrot M, Burns KK, Davies M, Forbes A, Hermanns N, Holt R, et al. Diabetes Attitudes Wishes and Needs 2 (DAWN2): a multinational, multi-stakeholder study of psychosocial issues in diabetes and person-centred diabetes care. Diabetes Res Clin Pract. 2013 Feb;99(2):174–84. https://doi.org/10.1016/j.diabres.2012.11.016232735151872-8227
- Nicolucci A, Kovacs Burns K, Holt RI, Comaschi M, Hermanns N, Ishii H, et al.; DAWN2 Study Group. Diabetes Attitudes, Wishes and Needs second study (DAWN2™): cross-national benchmarking of diabetes-related psychosocial outcomes for people with diabetes. Diabet Med. 2013 Jul;30(7):767–77. https://doi.org/10.1111/dme.12245237110190742-3071
- Iturralde E, Rausch JR, Weissberg-Benchell J, Hood KK. Diabetes-related emotional distress over time. Pediatrics. 2019 Jun;143(6):e20183011. https://doi.org/10.1542/peds.2018-3011310434531098-4275
- Peter P, Lipska K. The rising cost of diabetes care in the USA. Lancet Diabetes Endocrinol. 2016 Jun;4(6):479–80. https://doi.org/10.1016/S2213-8587(15)00519-7271560522213-8595
- Mansell K, Perepelkin J. Patient awareness of specialized diabetes services provided in community pharmacies. Res Social Adm Pharm. 2011 ;7(4):396–405. https://doi.org/10.1016/j.sapharm.2010.10.00421272537
- CoreTeam. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. Available from: http://www.R-project.org/. 2013
- Kulzer B, Lüthgens B, Landgraf R, Hermanns N. Diabetesbezogene Belastungen, Wohlbefinden und Einstellung von Menschen mit Diabetes. Diabetologe (Heidelb). 2015 May;11(3):211–8. https://doi.org/10.1007/s11428-015-1335-81860-9716
- Reach G, Consoli SM, Halimi S, Colas C, Duclos M, Fontaine P, et al. The multinational second Diabetes, Attitudes, Wishes and Needs study: results of the French survey. Patient Prefer Adherence. 2015 Feb;9:289–97. https://doi.org/10.2147/PPA.S68941257094151177-889X
- Nouwen A, Adriaanse MC, van Dam K, Iversen MM, Viechtbauer W, Peyrot M, et al.; European Depression in Diabetes (EDID) Research Consortium. Longitudinal associations between depression and diabetes complications: a systematic review and meta-analysis. Diabet Med. 2019 Dec;36(12):1562–72. https://doi.org/10.1111/dme.14054312150771464-5491
- Group TE; EuroQol Group. EuroQol—a new facility for the measurement of health-related quality of life. Health Policy. 1990 Dec;16(3):199–208. https://doi.org/10.1016/0168-8510(90)90421-9101098010168-8510
- Kalra S, Jena BN, Yeravdekar R. Emotional and psychological needs of people with diabetes. Indian J Endocrinol Metab. 2018;22(5):696–704. https://doi.org/10.4103/ijem.IJEM_579_17302945832230-8210
- Lustman PJ, Anderson RJ, Freedland KE, de Groot M, Carney RM, Clouse RE. Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care. 2000 Jul;23(7):934–42. https://doi.org/10.2337/diacare.23.7.934108958430149-5992
- Peyrot M, Rubin RR, Lauritzen T, Snoek FJ, Matthews DR, Skovlund SE. Psychosocial problems and barriers to improved diabetes management: results of the Cross-National Diabetes Attitudes, Wishes and Needs (DAWN) Study. Diabet Med. 2005 Oct;22(10):1379–85. https://doi.org/10.1111/j.1464-5491.2005.01644.x161762000742-3071
- Fiore, V., Marci, M., Poggi, A., Giagulli, V., Licchelli, B., Iacoviello, M., Guastamacchia, E., De Pergola, G. and Triggiani, V., 2021. The association between diabetes and depression: a very disabling condition.
- Moulton CD, Pickup JC, Ismail K. The link between depression and diabetes: the search for shared mechanisms. Lancet Diabetes Endocrinol. 2015 Jun;3(6):461–71. https://doi.org/10.1016/S2213-8587(15)00134-5259951242213-8595
- Beck J, Greenwood DA, Blanton L, Bollinger ST, Butcher MK, Condon JE, et al.; 2017 Standards Revision Task Force. 2017 National standards for diabetes self-management education and support. Diabetes Care. 2017 Oct;40(10):1409–19. https://doi.org/10.2337/dci17-0025287547801935-5548
- Diafit i. DIAfit, Diabetes mellitus, Rehabilitation, Selbsthilfegruppe, Therapie, Ausbildung, Diabetes-Gesellschaft, SDG, SGED [Internet]. Diafit.ch. 2022. Available from: http://www.diafit.ch/
- Beaser RS, Okeke E, Neighbours J, Brown J, Ronk K, Wolyniec WW. Coordinated primary and specialty care for type 2 diabetes mellitus, guidelines, and systems: an educational needs assessment. Endocr Pract. 2011;17(6):880–90. https://doi.org/10.4158/EP10398.OR215509531934-2403
- Mosnier-Pudar H, Hochberg G, Eschwege E, Virally ML, Halimi S, Guillausseau PJ, et al. How do patients with type 2 diabetes perceive their disease? Insights from the French DIABASIS survey. Diabetes Metab. 2009 Jun;35(3):220–7. https://doi.org/10.1016/j.diabet.2009.02.001193033381262-3636
- Nassar CM, Montero A, Magee MF. Inpatient diabetes education in the real world: an overview of guidelines and delivery models. Curr Diab Rep. 2019 Sep;19(10):103. https://doi.org/10.1007/s11892-019-1222-6315156531539-0829