DAWN2: Addressing emotional distress may improve diabetes self management

ORLANDO – Emotional distress associated with a diabetes diagnosis explains many patients’ difficulties with self-management, based on results from the DAWN2 study presented at the annual meeting of the American Association of Diabetes Educators.

The Novo Nordisk–sponsored DAWN2 (Diabetes Attitudes Wishes and Needs 2) study included 15,438 adults from 17 countries: 8,596 were people with diabetes (1,368 with type 1 and 7,228 with type 2), 2,057 were family members of people with diabetes, and 4,785 were health care providers. The researchers set out primarily to determine the factors that prevent and facilitate active and successful diabetes management.

"The ultimate goal for all of us and for this study is to enable all people with diabetes to live full, healthy, and productive lives, and to be engaged in their own care, preserving their health, and improving their quality of life," said Martha Funnell, a certified diabetes educator, associate research scientist at the University of Michigan, Ann Arbor, and a member of an advisory panel for the DAWN studies.

The first results from DAWN, published in 2005 and 2006, indicated that the psychosocial needs of patients with diabetes were not being met. The findings were based on the results of a survey that covered a broad range of topics, such as health and quality of life, attitudes and beliefs about diabetes, diabetes training, care and support, active self-management, and diabetes education and information. The first global benchmarking results were published in three articles in Diabetic Medicine (Diabet. Med. 2013;30:767-98).

Although a number of themes emerged from the DAWN findings, those with respect to emotional health stand out. In response to those results, emotional well-being has been incorporated into standards of care, Ms. Funnell said. In DAWN2, slightly more patients reported experiencing ongoing emotional distress as a result of diabetes (45% vs. 43%); 14% likely had clinical depression as a result of their diagnosis.

The findings are concerning as emotional distress – feelings of anger, fear, frustration, sadness, and guilt – are among the biggest influencers of self-management. Further, diabetes-related distress has an adverse impact on outcomes, including hemoglobin A_1c levels, dietary and exercise behaviors, quality of life, and depression, Ms. Funnell said.

Diabetes also affects other aspects of life: 44% of people with diabetes in DAWN2 said their finances were affected, 38% said leisure activities were affected, 35% said that work and studies were affected, and 21% reported problems with family and peer relationships.

"We have to address diabetes-related distress if we want our patients to make changes and improve their outcomes," she said.

Notably, 52% of health care providers in DAWN2 reported asking patients how their life was affected by diabetes, yet only 24% of patients said their health care provider asked them that question.

"If I was going to do a one-question educational assessment, that would be the question [I would ask] because that tells pretty much all I need to know to work with that person," Ms. Funnell said.

Other findings from DAWN2 included the following:

• Family members of diabetes patients are burdened by the disease as well; 39% said they wanted to be more involved and 37% said they didn’t know how to be more involved.

• Most people with diabetes said that they want to be actively engaged and to participate in their care, but most aren’t.

• Half of the respondents with diabetes had never participated in a diabetes education program.

• Health care providers report a desire for more training in many aspects of diabetes care.

• Discrimination because of diabetes was reported by 19% of patients, implying a lack of awareness about diabetes.

An analysis of U.S.-only data from DAWN2 also shed light on important issues related to diabetes care and self-management.

The more than 500 U.S. respondents with diabetes in the DAWN2 study reported following a healthy eating plan for a mean of 4.7 days per week. They participated in at least 30 minutes of physical activity on a mean of 2.7 days per week and 65% expressed a desire to improve on this measure. Patients tested their blood sugar levels as recommended by their health care provider a mean of 4.5 days per week and took all medication as prescribed on a mean of 6.4 days per week. They checked their feet on a mean of 4.7 days per week (Curr. Med. Res. Opin. 2014 July 31:1-39).

Adherence varied considerably by ethnic group. For example, non-Hispanic white patients had the lowest scores for physical activity, Chinese Americans had the lowest scores for testing their blood sugar as recommended, and African Americans and Hispanics had the best scores for checking their feet.

Psychological outcomes also differed by ethnicity. African Americans had the best scores and non-Hispanic whites had the worst scores for well-being, quality of life, diabetes empowerment, and diabetes impact. Hispanics had the worst scores for quality of life and diabetes distress.

The DAWN2 data for U.S. survey respondents also indicated a substantial level of distress among people with diabetes and their family members. Having a large social support network for diabetes was related to better psychosocial outcomes, but few people with diabetes let others know how they can best provide support.

Also, U.S. respondents were pleased with the level of involvement of their family in diabetes care, and they feel that family members help a great deal by listening to them when they talk about difficulties associated with living with diabetes.

Diabetes is a burden from a management and psychological perspective. Patients need to be encouraged to ask for support when it is needed, and clinicians need to recognize that family members are untapped resources for patient support as well as a group in need of support as they deal with the burdens of caring for a family member with diabetes, Ms. Funnell added.

"Finally, we absolutely have to involve the person with diabetes and their family members as equal partners when developing care solutions," she said. Family members need to be taught how to help, and patients need to be asked how diabetes is affecting their life to identify problems and set appropriate goals for solving them.

"We need to truly focus on patient-centered care. ... We really need to surround the patient with their family and their friends, their health care, their communities, their workplaces, and the larger society if they are going to be successful in their self-management. It takes a village to manage diabetes, and every one of us has a role to play to make person-centered diabetes care and patient-centered diabetes education and ongoing support the reality that it needs to be," she said.

Ms. Funnell reported serving as a board or advisory panel member for Novo Nordisk, the sponsor of DAWN2, as well as several other drug companies involved in diabetes care, and receiving grant funding from BMS Foundation.

ORLANDO – Emotional distress associated with a diabetes diagnosis explains many patients’ difficulties with self-management, based on results from the DAWN2 study presented at the annual meeting of the American Association of Diabetes Educators.

The Novo Nordisk–sponsored DAWN2 (Diabetes Attitudes Wishes and Needs 2) study included 15,438 adults from 17 countries: 8,596 were people with diabetes (1,368 with type 1 and 7,228 with type 2), 2,057 were family members of people with diabetes, and 4,785 were health care providers. The researchers set out primarily to determine the factors that prevent and facilitate active and successful diabetes management.

"The ultimate goal for all of us and for this study is to enable all people with diabetes to live full, healthy, and productive lives, and to be engaged in their own care, preserving their health, and improving their quality of life," said Martha Funnell, a certified diabetes educator, associate research scientist at the University of Michigan, Ann Arbor, and a member of an advisory panel for the DAWN studies.

The first results from DAWN, published in 2005 and 2006, indicated that the psychosocial needs of patients with diabetes were not being met. The findings were based on the results of a survey that covered a broad range of topics, such as health and quality of life, attitudes and beliefs about diabetes, diabetes training, care and support, active self-management, and diabetes education and information. The first global benchmarking results were published in three articles in Diabetic Medicine (Diabet. Med. 2013;30:767-98).

Although a number of themes emerged from the DAWN findings, those with respect to emotional health stand out. In response to those results, emotional well-being has been incorporated into standards of care, Ms. Funnell said. In DAWN2, slightly more patients reported experiencing ongoing emotional distress as a result of diabetes (45% vs. 43%); 14% likely had clinical depression as a result of their diagnosis.

The findings are concerning as emotional distress – feelings of anger, fear, frustration, sadness, and guilt – are among the biggest influencers of self-management. Further, diabetes-related distress has an adverse impact on outcomes, including hemoglobin A_1c levels, dietary and exercise behaviors, quality of life, and depression, Ms. Funnell said.

Diabetes also affects other aspects of life: 44% of people with diabetes in DAWN2 said their finances were affected, 38% said leisure activities were affected, 35% said that work and studies were affected, and 21% reported problems with family and peer relationships.

"We have to address diabetes-related distress if we want our patients to make changes and improve their outcomes," she said.

Notably, 52% of health care providers in DAWN2 reported asking patients how their life was affected by diabetes, yet only 24% of patients said their health care provider asked them that question.

"If I was going to do a one-question educational assessment, that would be the question [I would ask] because that tells pretty much all I need to know to work with that person," Ms. Funnell said.

Other findings from DAWN2 included the following:

• Family members of diabetes patients are burdened by the disease as well; 39% said they wanted to be more involved and 37% said they didn’t know how to be more involved.

• Most people with diabetes said that they want to be actively engaged and to participate in their care, but most aren’t.

• Half of the respondents with diabetes had never participated in a diabetes education program.

• Health care providers report a desire for more training in many aspects of diabetes care.

• Discrimination because of diabetes was reported by 19% of patients, implying a lack of awareness about diabetes.

An analysis of U.S.-only data from DAWN2 also shed light on important issues related to diabetes care and self-management.

The more than 500 U.S. respondents with diabetes in the DAWN2 study reported following a healthy eating plan for a mean of 4.7 days per week. They participated in at least 30 minutes of physical activity on a mean of 2.7 days per week and 65% expressed a desire to improve on this measure. Patients tested their blood sugar levels as recommended by their health care provider a mean of 4.5 days per week and took all medication as prescribed on a mean of 6.4 days per week. They checked their feet on a mean of 4.7 days per week (Curr. Med. Res. Opin. 2014 July 31:1-39).

Adherence varied considerably by ethnic group. For example, non-Hispanic white patients had the lowest scores for physical activity, Chinese Americans had the lowest scores for testing their blood sugar as recommended, and African Americans and Hispanics had the best scores for checking their feet.

Psychological outcomes also differed by ethnicity. African Americans had the best scores and non-Hispanic whites had the worst scores for well-being, quality of life, diabetes empowerment, and diabetes impact. Hispanics had the worst scores for quality of life and diabetes distress.

The DAWN2 data for U.S. survey respondents also indicated a substantial level of distress among people with diabetes and their family members. Having a large social support network for diabetes was related to better psychosocial outcomes, but few people with diabetes let others know how they can best provide support.

Also, U.S. respondents were pleased with the level of involvement of their family in diabetes care, and they feel that family members help a great deal by listening to them when they talk about difficulties associated with living with diabetes.

Diabetes is a burden from a management and psychological perspective. Patients need to be encouraged to ask for support when it is needed, and clinicians need to recognize that family members are untapped resources for patient support as well as a group in need of support as they deal with the burdens of caring for a family member with diabetes, Ms. Funnell added.

"Finally, we absolutely have to involve the person with diabetes and their family members as equal partners when developing care solutions," she said. Family members need to be taught how to help, and patients need to be asked how diabetes is affecting their life to identify problems and set appropriate goals for solving them.

"We need to truly focus on patient-centered care. ... We really need to surround the patient with their family and their friends, their health care, their communities, their workplaces, and the larger society if they are going to be successful in their self-management. It takes a village to manage diabetes, and every one of us has a role to play to make person-centered diabetes care and patient-centered diabetes education and ongoing support the reality that it needs to be," she said.

Ms. Funnell reported serving as a board or advisory panel member for Novo Nordisk, the sponsor of DAWN2, as well as several other drug companies involved in diabetes care, and receiving grant funding from BMS Foundation.

ORLANDO – Emotional distress associated with a diabetes diagnosis explains many patients’ difficulties with self-management, based on results from the DAWN2 study presented at the annual meeting of the American Association of Diabetes Educators.

The Novo Nordisk–sponsored DAWN2 (Diabetes Attitudes Wishes and Needs 2) study included 15,438 adults from 17 countries: 8,596 were people with diabetes (1,368 with type 1 and 7,228 with type 2), 2,057 were family members of people with diabetes, and 4,785 were health care providers. The researchers set out primarily to determine the factors that prevent and facilitate active and successful diabetes management.

"The ultimate goal for all of us and for this study is to enable all people with diabetes to live full, healthy, and productive lives, and to be engaged in their own care, preserving their health, and improving their quality of life," said Martha Funnell, a certified diabetes educator, associate research scientist at the University of Michigan, Ann Arbor, and a member of an advisory panel for the DAWN studies.

The first results from DAWN, published in 2005 and 2006, indicated that the psychosocial needs of patients with diabetes were not being met. The findings were based on the results of a survey that covered a broad range of topics, such as health and quality of life, attitudes and beliefs about diabetes, diabetes training, care and support, active self-management, and diabetes education and information. The first global benchmarking results were published in three articles in Diabetic Medicine (Diabet. Med. 2013;30:767-98).

Although a number of themes emerged from the DAWN findings, those with respect to emotional health stand out. In response to those results, emotional well-being has been incorporated into standards of care, Ms. Funnell said. In DAWN2, slightly more patients reported experiencing ongoing emotional distress as a result of diabetes (45% vs. 43%); 14% likely had clinical depression as a result of their diagnosis.

The findings are concerning as emotional distress – feelings of anger, fear, frustration, sadness, and guilt – are among the biggest influencers of self-management. Further, diabetes-related distress has an adverse impact on outcomes, including hemoglobin A_1c levels, dietary and exercise behaviors, quality of life, and depression, Ms. Funnell said.

Diabetes also affects other aspects of life: 44% of people with diabetes in DAWN2 said their finances were affected, 38% said leisure activities were affected, 35% said that work and studies were affected, and 21% reported problems with family and peer relationships.

"We have to address diabetes-related distress if we want our patients to make changes and improve their outcomes," she said.

Notably, 52% of health care providers in DAWN2 reported asking patients how their life was affected by diabetes, yet only 24% of patients said their health care provider asked them that question.

"If I was going to do a one-question educational assessment, that would be the question [I would ask] because that tells pretty much all I need to know to work with that person," Ms. Funnell said.

Other findings from DAWN2 included the following:

• Family members of diabetes patients are burdened by the disease as well; 39% said they wanted to be more involved and 37% said they didn’t know how to be more involved.

• Most people with diabetes said that they want to be actively engaged and to participate in their care, but most aren’t.

• Half of the respondents with diabetes had never participated in a diabetes education program.

• Health care providers report a desire for more training in many aspects of diabetes care.

• Discrimination because of diabetes was reported by 19% of patients, implying a lack of awareness about diabetes.

An analysis of U.S.-only data from DAWN2 also shed light on important issues related to diabetes care and self-management.

The more than 500 U.S. respondents with diabetes in the DAWN2 study reported following a healthy eating plan for a mean of 4.7 days per week. They participated in at least 30 minutes of physical activity on a mean of 2.7 days per week and 65% expressed a desire to improve on this measure. Patients tested their blood sugar levels as recommended by their health care provider a mean of 4.5 days per week and took all medication as prescribed on a mean of 6.4 days per week. They checked their feet on a mean of 4.7 days per week (Curr. Med. Res. Opin. 2014 July 31:1-39).

Adherence varied considerably by ethnic group. For example, non-Hispanic white patients had the lowest scores for physical activity, Chinese Americans had the lowest scores for testing their blood sugar as recommended, and African Americans and Hispanics had the best scores for checking their feet.

Psychological outcomes also differed by ethnicity. African Americans had the best scores and non-Hispanic whites had the worst scores for well-being, quality of life, diabetes empowerment, and diabetes impact. Hispanics had the worst scores for quality of life and diabetes distress.

The DAWN2 data for U.S. survey respondents also indicated a substantial level of distress among people with diabetes and their family members. Having a large social support network for diabetes was related to better psychosocial outcomes, but few people with diabetes let others know how they can best provide support.

Also, U.S. respondents were pleased with the level of involvement of their family in diabetes care, and they feel that family members help a great deal by listening to them when they talk about difficulties associated with living with diabetes.

Diabetes is a burden from a management and psychological perspective. Patients need to be encouraged to ask for support when it is needed, and clinicians need to recognize that family members are untapped resources for patient support as well as a group in need of support as they deal with the burdens of caring for a family member with diabetes, Ms. Funnell added.

"Finally, we absolutely have to involve the person with diabetes and their family members as equal partners when developing care solutions," she said. Family members need to be taught how to help, and patients need to be asked how diabetes is affecting their life to identify problems and set appropriate goals for solving them.

"We need to truly focus on patient-centered care. ... We really need to surround the patient with their family and their friends, their health care, their communities, their workplaces, and the larger society if they are going to be successful in their self-management. It takes a village to manage diabetes, and every one of us has a role to play to make person-centered diabetes care and patient-centered diabetes education and ongoing support the reality that it needs to be," she said.

Ms. Funnell reported serving as a board or advisory panel member for Novo Nordisk, the sponsor of DAWN2, as well as several other drug companies involved in diabetes care, and receiving grant funding from BMS Foundation.