Prädiktoren und langfristige Auswirkungen der Gesundheitsverhaltensänderung bei Personen mit vor kurzem diagnostiziertem Diabetes mellitus Typ 2: Analyse einer randomisierten kontrollierten multifaktoriellen Verhaltensänderungsintervention mit fünf Jahren Follow-up
Zusammenfassung der Projektergebnisse
Aims: There is limited evidence about predictors (socio-demographic, clinical and psychological) of health behaviour change and the association between diabetes-specific quality of life (QoL), health status and glycaemic control (HbA1c) in people with screendetected type 2 diabetes (T2D). The research project contained three aims: i) to identify predictors of health behaviour change and to access change in these behaviours among individuals with screen-detected or recently clinically diagnosed T2D over one year; ii) to quantify the cross-sectional association between diabetes-specific QoL, health status and HbA1c in screen-detected T2D patients, and iii) to examine the longitudinal association between change (one- to five-year follow-up) in HbA1c and diabetes-specific QoL and health status at five-years of follow-up in a cohort of screen-detected T2D patients. Methods: All data were taken from the randomised clinical trials: i) the ADDITION-Plus (screen-detected/ recently clinically (during the three previous years) diagnosed T2D patients aged 40-69 years (n=478), baseline to one-year follow-up); ii) the ADDITION-Europe (screen-detected T2D patients aged 66 years (n=1,876), five years after diagnosis) and iii) the ADDITION-Cambridge (screen-detected T2D patients aged 40-69 years (n=510), one- to five-year follow-up). Diabetes-specific QoL was assessed using the Audit of Diabetes Dependent Quality of Life (ADDQoL) questionnaire, which measures an individual's perception- and importance of the impact of diabetes on various aspects of their QoL. A low ADDQoL overall score reflects a negative impact of diabetes on QoL. Health status was assessed using the 36-ltem Short Form Health Survey (SF-36) with higher scores indicating better health. Multivariable logistic and/or linear regression was performed. Results: With respect to the first aim, the results revealed that younger age predicted a greater reduction in fat (unstandardized b-coefficient [95% CI]: b=-0.43 [-0.72, -0.13]) and energy intake (b=-6.62 [-13.2, -0.05]). Patients with screen-detected diabetes reported a greater increase in fruit intake (b=74.2 [27.92, 120.41]) compared to clinically diagnosed diabetes patients. There were no significant predictors of change in self-reported physical activity. Beliefs about behaviour change and diabetes did not predict behaviour change. The second analysis showed that individuals who reported a negative impact of diabetes on their diabetes-specific QoL had higher HbA1c levels at five years after diagnosis compared to those who reported a positive or no impact of diabetes (unstandardized b-coefficient [95% Cl]: b=0.2 [0.1, 0.3]). Physical and mental health summary SF-36 scores were not significantly associated with HbA1c. The results of the third analysis suggested that change in HbA1c (increase) was independently associated with reporting a negative impact of diabetes on diabetes-related QoL (odds ratio [95%CI]: OR=1.38, [1.03 to 1.85] but not with the SF-36 summary scores. Conclusions: Older patients, men and those with a longer duration of T2D may need more intensive support for dietary change. Future studies should use objective measurement of health behaviours and researchers should add predictors beyond the individual level. The results support a focus on establishing healthy lifestyle changes early in the T2D disease trajectory. The results of the cross-sectional analysis revealed that diabetes-specific QoL but not health status was independently associated with HbAic. Practitioners should take account of the complex relationship between diabetes-specific QoL and glucose, particularly with regards to dietary behaviour. Fulure research should attempt to elucidate via which pathways this association might act. The longitudinal findings showed that increases in HbA1c from one to five years post-diagnosis were independently associated with increased odds of reporting a negative impact of diabetes on QoL. These results suggest that efforts to reduce HbAic do not adversely affect health-related QoL and that tight glycaemic control early in the disease trajectory may improve QoL.
Projektbezogene Publikationen (Auswahl)
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'Predictors of change in objectively measured and selfreported health behaviours among individuals with recently diagnosed type 2 diabetes: results from the ADDITION-Plus trial cohort'. 7th World Congress on Prevention of Diabetes and its Complications, 11-14 November 2012, Madrid, Spain; Minerva Endocrinol. Vol. 37, Suppl. I, N.4, p.57
Kuznetsov L. Simmons RK, Sutton S, Kinmonth AL, Griffin SJ, Hardeman W
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'Are changes in glycaemic control associated with quality of life and health status? Four year follow-up of screen-detected diabetes patients'. World Diabetes Congress, 2 - 6 December 2013, Melbourne, Australia
Kuznetsov L. Long GH, Griffin SJ, Simmons RK
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'Health-related quality of life and glycaemic control among patients with type 2 diabetes: a cross-sectional analysis ofthQADDIT/ON-Europe trial cohort'. 48th Annual Meeting of the European Diabetes Epidemiology Group, 13-16 April 2013, Potsdam, Germany
Kuznetsov L. Griffin SJ, Davies MJ, Lauritzen T, Khunti K, Rutten GEHM, Simmons RK
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Predictors of change in objectively measured and self-reported health behaviours among individuals with recently diagnosed type 2 diabetes: longitudinal results from the ADDFTION-Plus trial cohort. Int J Behav Nutr Phys Act 2013; 10(1):118
Kuznetsov L, Simmons RK, Sutton S, Kinmonth AL, Griffin SJ, Hardeman W
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Diabetes-specific quality of life but not health status is independently associated with glycaemic control among patients with type 2 diabetes: a cross-sectional analysis of the ADDITION-Europe trial cohort. Diabetes Res Clin Pract 2014, Volume 104, Issue 2, May 2014, Pages 281-287
Kuznetsov L. Griffin SJ, Davies MJ, Lauritzen T, Khunti K, Rutten GEHM, Simmons RK
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Are changes in glycaemic control associated with diabetes-specific quality of life and health status in screen-detected type 2 diabetes patients? Four-year follow up of the ADDITION-Cambridge cohort. Diabetes Metab Res Rev, Vol 31 Issue 1, January 2015, Pages 69-75. First published: 10 May 2014
Kuznetsov L. Long G, Griffin SJ, Simmons RK
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Change in cardio-protective medication and health-related quality of life after diagnosis of screen-detected diabetes: Results from the ADDITION-Cambridge cohort. Diabetes Research and Clinical Practice
Volume 109, Issue 1, July 2015, Pages 170-177
Black J, Long G, Sharp S, Kuznetsov L, Boothby C, Griffin SJ, Simmons RK
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The impact of intensive multifactorial treatment on perceptions of chronic care among individuals with screen-detected diabetes: results from the ADDITION-Denmark trial. Int J Clin Pract, Vol 69 Issue 4, April 2015, pages 466-473. First publ.: Nov 2014
Kuznetsov L, Simmons RK, Sandbaek A, Maindal HT
