Allison A Lewinski1,2, Abigail Shapiro1, Hayden B Bosworth1,2,3,4, Matthew J Crowley1,5, Felicia McCant1, Teresa Howard1, Amy S Jeffreys1, Eleanor McConnell2,6, Paula Tanabe2,7, Susan Barcinas8, Cynthia J Coffman1,9, Heather A King1,3,10. 1. Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina. 2. School of Nursing, Duke University, Durham, North Carolina. 3. Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina. 4. Department of Medicine, Division of General Internal Medicine, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina. 5. Division of Endocrinology, Diabetes and Metabolism, Duke University School of Medicine, Durham, North Carolina. 6. Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina. 7. Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina. 8. College of Education, Raleigh, North Carolina. 9. Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina. 10. Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
Abstract
PURPOSE: The purpose of this project was to identify additional facets of diabetes distress (DD) in veterans that may be present due to the veteran's military-related experience. METHODS: The study team completed cognitive interviews with veterans with type 2 diabetes mellitus (T2DM) to examine how they answered the Diabetes Distress Scale (DD Scale), a tool that assesses DD. The DD Scale was used because of its strong associations with self-management challenges, physician-related distress, and clinical outcomes. RESULTS: The veterans sample (n= 15) was 73% male, mean age of 61 (SD = 8.6), 53% Black, 53% with glycosylated hemoglobin level <9%, and 67% with prescribed insulin. The DD Scale is readily understood by veterans and interpreted. Thematic analysis indicated additional domains affecting DD and T2DM self-management, including access to care, comorbidities, disruptions in routine, fluctuations in emotions and behaviors, interactions with providers, lifelong nature of diabetes, mental health concerns, military as culture, personal characteristics, physical limitations, physical pain, sources of information and support, spirituality, and stigma. CONCLUSIONS: This study describes how a veteran's military experience may contribute to DD in the context of T2DM self-management. Findings indicate clinicians and researchers should account for additional domains when developing self-management interventions and discussing self-management behaviors with individuals with T2DM.
PURPOSE: The purpose of this project was to identify additional facets of diabetes distress (DD) in veterans that may be present due to the veteran's military-related experience. METHODS: The study team completed cognitive interviews with veterans with type 2 diabetes mellitus (T2DM) to examine how they answered the Diabetes Distress Scale (DD Scale), a tool that assesses DD. The DD Scale was used because of its strong associations with self-management challenges, physician-related distress, and clinical outcomes. RESULTS: The veterans sample (n= 15) was 73% male, mean age of 61 (SD = 8.6), 53% Black, 53% with glycosylated hemoglobin level <9%, and 67% with prescribed insulin. The DD Scale is readily understood by veterans and interpreted. Thematic analysis indicated additional domains affecting DD and T2DM self-management, including access to care, comorbidities, disruptions in routine, fluctuations in emotions and behaviors, interactions with providers, lifelong nature of diabetes, mental health concerns, military as culture, personal characteristics, physical limitations, physical pain, sources of information and support, spirituality, and stigma. CONCLUSIONS: This study describes how a veteran's military experience may contribute to DD in the context of T2DM self-management. Findings indicate clinicians and researchers should account for additional domains when developing self-management interventions and discussing self-management behaviors with individuals with T2DM.
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