Dataset Information

Development and validation of the insulin treatment appraisal scale (ITAS) in patients with type 2 diabetes.

ABSTRACT:

Background

Timely initiation of insulin therapy in type 2 diabetes is important to achieve metabolic control but can be hindered by negative perceptions of patients regarding insulin treatment. To assess the appraisal of insulin therapy of persons with type 2 diabetes, we developed the insulin treatment appraisal scale (ITAS) and tested its reliability and validity in insulin treated type 2 diabetes patients.

Methods

A sample of 282 patients with type 2 diabetes form the United States (US) completed the ITAS, the WHO-5 Well-being index (WHO-5) and the Problem Areas in Diabetes (PAID) Survey. Exploratory factor analysis (EFA), internal consistency (Cronbach's alpha) and item-total correlations were determined to test the reliability of the instrument. Concurrent validity was examined by calculating Pearson correlation coefficients between the different measures. Discriminant validity was examined by comparing ITAS scores of insulin naive and insulin using patients.

Results

EFA suggested a two-factor structure, separating positively worded and negatively worded items. Cronbach's alpha was 0.90 for the negative appraisal scale and 0.68 for the positive appraisal scale. Yet, Cronbach's alpha of the total 20-item scale was 0.89, suggesting high homogeneity and allowing for calculation of an overall score. Item-total correlations were in the range of 0.46-0.74 for the negative and 0.34 - 0.53 for the positive appraisal scale. The item pertaining to weight gain, as part of the negative appraisal subscale, showed low communality and deserves further testing. Concurrent validity was confirmed with low to moderate correlations in the expected direction between ITAS and WHO-5 and PAID. Discriminant validity was confirmed by the fact that patients using insulin had significantly less negative appraisals than insulin naive patients.

Conclusion

The ITAS is a brief, psychometrically sound instrument that can be used in insulin naive and insulin-treated patients to assess positive and negative perceptions regarding insulin treatment and changes therein.

SUBMITTER: Snoek FJ

PROVIDER: S-EPMC2241589 | biostudies-literature | 2007 Dec

REPOSITORIES: biostudies-literature

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Publications

Development and validation of the insulin treatment appraisal scale (ITAS) in patients with type 2 diabetes.

Snoek Frank J FJ Skovlund Søren E SE Pouwer Frans F

Health and quality of life outcomes 20071220

<h4>Background</h4>Timely initiation of insulin therapy in type 2 diabetes is important to achieve metabolic control but can be hindered by negative perceptions of patients regarding insulin treatment. To assess the appraisal of insulin therapy of persons with type 2 diabetes, we developed the insulin treatment appraisal scale (ITAS) and tested its reliability and validity in insulin treated type 2 diabetes patients.<h4>Methods</h4>A sample of 282 patients with type 2 diabetes form the United St ...[more]

PMID: 18096074

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Project description:ObjectivesTo develop and evaluate the psychometric properties of a Chinese questionnaire which assesses the barriers and enablers to commencing insulin in primary care patients with poorly controlled Type 2 diabetes.Research design and methodQuestionnaire items were identified using literature review. Content validation was performed and items were further refined using an expert panel. Following translation, back translation and cognitive debriefing, the translated Chinese questionnaire was piloted on target patients. Exploratory factor analysis and item-scale correlations were performed to test the construct validity of the subscales and items. Internal reliability was tested by Cronbach's alpha.ResultsTwenty-seven identified items underwent content validation, translation and cognitive debriefing. The translated questionnaire was piloted on 303 insulin naïve (never taken insulin) Type 2 diabetes patients recruited from 10 government-funded primary care clinics across Hong Kong. Sufficient variability in the dataset for factor analysis was confirmed by Bartlett's Test of Sphericity (P<0.001). Using exploratory factor analysis with varimax rotation, 10 factors were generated onto which 26 items loaded with loading scores > 0.4 and Eigenvalues >1. Total variance for the 10 factors was 66.22%. Kaiser-Meyer-Olkin measure was 0.725. Cronbach's alpha coefficients for the first four factors were ?0.6 identifying four sub-scales to which 13 items correlated. Remaining sub-scales and items with poor internal reliability were deleted. The final 13-item instrument had a four scale structure addressing: 'Self-image and stigmatization'; 'Factors promoting self-efficacy; 'Fear of pain or needles'; and 'Time and family support'.ConclusionThe Chinese Attitudes to Starting Insulin Questionnaire (Ch-ASIQ) appears to be a reliable and valid measure for assessing barriers to starting insulin. This short instrument is easy to administer and may be used by healthcare providers and researchers as an assessment tool for Chinese diabetic primary care patients, including the elderly, who are unwilling to start insulin.

Project description:BackgroundMany patients with type 2 diabetes eventually require insulin, yet little is known about the patterns and quality of pharmacologic care received following insulin initiation. Guidelines from the American Diabetes Association and the European Association for the Study of Diabetes recommend that insulin secretagogues such as sulfonylureas be discontinued at the time of insulin initiation to reduce the risk of hypoglycemia, and that treatment be intensified if HbA1c levels remain above-target 3 months after insulin initiation.ObjectiveTo describe pharmacologic treatment patterns over time among adults initiating insulin and/or intensifying insulin treatment.DesignObservational study.SubjectsA large commercially insured population of adult patients without recorded type 1 diabetes who initiated insulin.Main measuresWe evaluated changes in non-insulin antidiabetic medication use during the 120 days immediately following insulin initiation, rates of increase in insulin dose and/or dosing frequency during the 270 days following an insulin initiation treatment period of 90 days, and rates of insulin discontinuation.Key resultsSeven thousand, nine hundred and thirty-two patients initiated insulin during 2003-2008, with the majority (61 %) initiating basal insulin only. Metformin (55 %), sulfonylureas (39 %), and thiazolidinediones (30 %) were commonly used prior to insulin initiation. Metformin was continued by 64 % of patients following mixed or mealtime insulin initiation; the continuation rate was nearly as high for sulfonylureas (58 %). Insulin dose and/or dosing frequency increased among 22.9 % of patients. Insulin was discontinued by 27 % of patients.ConclusionsWe found evidence of substantial departures from guideline-recommended pharmacotherapy. Insulin secretagogues were frequently co-prescribed with insulin. The majority of patients had no evidence of treatment intensification following insulin initiation, although this finding is difficult to interpret without HbA1c levels. While each patient's care should be individualized, our data suggest that the quality of care following insulin initiation can be improved.

Project description:IntroductionThe aim of this study is to establish reliability and validity of the Diabetes Burnout Scale (DBS) among adults with type 1 diabetes (T1D).MethodsWe used a multi-stage, mixed methods approach to developing the DBS. First, the research team identified twenty-eight candidate items through a review of the literature and 117 qualitative narratives from adults living with T1D. Next, items were revised based on the expert (n = 20) and individual with T1D (n = 10) feedback. The resulting 18-item DBS measure along with validated measures of diabetes distress, depressive symptoms, and questions related to diabetes outcomes (i.e., last reported hemoglobin A1c [HbA1c] and Time-in-Range [TiR]) were completed by 1099 adults with T1D across the U.S. The sample was randomly divided into two subsets (n1 = 561, n2 = 538) for exploratory and confirmatory factor analyses (EFA/CFA) to determine the underlying structure of the DBS. Regression analyses examined the relationships of the DBS with self-reported glycemic control and socio-demographic characteristics.ResultsBased on the EFA three factors are identified and the DBS demonstrated strong internal consistency with Cronbach alphas (≥0.80). The validation and confirmatory analysis for the structure of the DBS provided consistent results with EFA. Higher burnout (overall DBS) was positively associated with diabetes distress (b = 0.74; p < 0.01) and depressive symptoms (b = 0.61; p < 0.01). Overall DBS, however was the strongest predictor for poorer HbA1c (r2 = 0.19; p < 0.01) and lower TiR (r2 = 0.17; p < 0.01) compared to diabetes distress and depressive symptoms.ConclusionThe 12-item DBS is a reliable and valid scale to measure diabetes burnout in adults with diabetes. The results provide a weak to strong degree of association between the validated DBS scale, T1-DDS and PHQ-8. The DBS can contribute to advancement of diabetes science by measuring diabetes burnout and informing clinical interventions to improve psychosocial care in individuals with diabetes.

Project description:BackgroundType 2 diabetes mellitus (T2DM) and its related complications represent a growing economic burden for many countries and health systems. Diabetes complications can be prevented through better disease control, but there is a large gap between the recommended treatment and the treatment that patients actually receive. The treatment of T2DM can be challenging because of different comprehensive therapeutic targets and individual variability of the patients, leading to the need for precise, personalized treatment.ObjectiveThe aim of this study was to develop treatment recommendation models for T2DM based on deep reinforcement learning. A retrospective analysis was then performed to evaluate the reliability and effectiveness of the models.MethodsThe data used in our study were collected from the Singapore Health Services Diabetes Registry, encompassing 189,520 patients with T2DM, including 6,407,958 outpatient visits from 2013 to 2018. The treatment recommendation model was built based on 80% of the dataset and its effectiveness was evaluated with the remaining 20% of data. Three treatment recommendation models were developed for antiglycemic, antihypertensive, and lipid-lowering treatments by combining a knowledge-driven model and a data-driven model. The knowledge-driven model, based on clinical guidelines and expert experiences, was first applied to select the candidate medications. The data-driven model, based on deep reinforcement learning, was used to rank the candidates according to the expected clinical outcomes. To evaluate the models, short-term outcomes were compared between the model-concordant treatments and the model-nonconcordant treatments with confounder adjustment by stratification, propensity score weighting, and multivariate regression. For long-term outcomes, model-concordant rates were included as independent variables to evaluate if the combined antiglycemic, antihypertensive, and lipid-lowering treatments had a positive impact on reduction of long-term complication occurrence or death at the patient level via multivariate logistic regression.ResultsThe test data consisted of 36,993 patients for evaluating the effectiveness of the three treatment recommendation models. In 43.3% of patient visits, the antiglycemic medications recommended by the model were concordant with the actual prescriptions of the physicians. The concordant rates for antihypertensive medications and lipid-lowering medications were 51.3% and 58.9%, respectively. The evaluation results also showed that model-concordant treatments were associated with better glycemic control (odds ratio [OR] 1.73, 95% CI 1.69-1.76), blood pressure control (OR 1.26, 95% CI, 1.23-1.29), and blood lipids control (OR 1.28, 95% CI 1.22-1.35). We also found that patients with more model-concordant treatments were associated with a lower risk of diabetes complications (including 3 macrovascular and 2 microvascular complications) and death, suggesting that the models have the potential of achieving better outcomes in the long term.ConclusionsComprehensive management by combining knowledge-driven and data-driven models has good potential to help physicians improve the clinical outcomes of patients with T2DM; achieving good control on blood glucose, blood pressure, and blood lipids; and reducing the risk of diabetes complications in the long term.

Dataset Information

Development and validation of the insulin treatment appraisal scale (ITAS) in patients with type 2 diabetes.

Background

Methods

Results

Conclusion

Publications

Development and validation of the insulin treatment appraisal scale (ITAS) in patients with type 2 diabetes.

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