Changes in Diabetes Distress Over Time

Statement of Problem/Purpose 

The fundamental purpose of the article is to report on the changes in diabetes distress, including concerns over hypoglycaemia, a year into pump therapy. The research study explains this purpose in a suitable way. The details contained in the article that support this claim include the provision that the study identified the participants, all of whom filled a self-report questionnaire that contained the fundamental elements being assessed. The population under survey, including the variables of the study, was addressed in a clear way. However, the authors do not provide detailed information regarding the setting of the study, particularly concerning the 12-month follow-up. Even though the research does not explicitly explain how it will contribute to nursing knowledge, nursing professionals can refer to the conclusion of the study to determine the most appropriate care to implement when caring for diabetic patients. However, the study only covers the fundamental elements associated with the use of pump therapy, including the reduction in a patient’s burden of diabetes, as indicated by distress as well as the fear of hypoglycaemia.

Review of Literature/Theoretical Framework 

The theoretical concepts presented include the provision that there is a correlation between pump therapy and psychological variables of diabetes management. In this regard, the researchers opine that the themes associated with diabetes are inclusive of diabetes distress, anxieties emanating from the complications of the condition, body concerns, blame, guilt, as well as hypoglycaemia (Shaban et al., 2017). In line with the presented theoretical concepts, the purpose of the research question fits with the study. On the other hand, the literature review provides vital reasons for undertaking the study, considering the need to understand concepts such as diabetes distress and the fear of hypoglycaemia. These concepts impose significant burdens to diabetic patients responsible for the self-management of their condition. For this reason, the lack of significant information on the psychological outcomes of self-care makes it necessary for the researchers to conduct a survey to report on the effects of pump therapy on the outcomes in consideration. The diminutive information regarding the psychological outcome of self-care has prompted the undertaking of the baseline study.

Research Question/Hypothesis 

The research question relates to whether the use of insulin pumps by diabetic patients can improve their psychological outcomes, which are caused by diabetes distress and the fear of hypoglycaemia. The researchers take note of the idea that self-management creates burdens to patients with type I diabetes. The psychological issues that such patients face include emotional burdens, stress, as well as worry, which emanate from the demands and complexity associated with self-management. The identified concerns constitute the major concepts of the research question. The researchers explain the fundamental concepts considered in detail. For instance, the authors create a clear distinction between the meaning of diabetes distress and depression, which is an essential component that can enhance the understanding of the primary difference between the two psychological concepts. The independent variables in the study include diabetes distress and the fear of hypoglycaemia. The dependent variable is the use of insulin pump therapy for diabetes self-care. The researchers measured these variables using the respondent information derived from the self-report questionnaires, guided by the demographic information derived from the patient clinical records.

Study Design 

The study design employed in the research is a cohort study design. In this regard, the researchers obtain data from individuals with diabetes type I. Scientists using the cohort study design do not have to make allocations of exposure. Cohort studies follow a given population over a specific period, during which scientists undertaking the study track the development of the outcome. During the research process, the outcome of the participants is measured and the relationships emanating from predetermined characteristics are determined. The design is suitable for this study because of the effect of the predictive factors considered on the outcome of the patients using the insulin pump. Conversely, it is instrumental for answering the research question primarily because the researchers can match the subjects, including the capability of establishing timing as well as the directionality of the events that would affect the results of the study. On the other hand, the research design makes it possible for the researchers to standardize the eligibility criteria and the outcome assessments. Another beneficial element associated with this research design is based on the provision that it is easy and cheap to carry out, especially when comparing the process with randomized controlled trials. However, one of the challenges that characterize this research design is associated with the difficulty of blinding, considering the idea that controls are important for providing essential information needed for deriving logical conclusions. Regardless of the difficulties that might be experienced, the research design fits the research problem.

Sample/Sampling Method 

The target population for the study included adults with type I diabetes. The researchers were able to access 190 adults to participate in the study. The population is appropriate for the study based on the provision that the participants were engaging in diabetes self-care, which means that they are prone to experience the psychological disturbances described in the study. The study cannot be conducted on individuals without the condition since they would not be using the remedy for self-care. This provision is indicative of the idea that the population participating in the study is appropriate for the research. The inclusion criteria includes individuals with type I diabetes. The medical records justify the sample used by the researchers as they are specifically focused on using participants with type I diabetes. It would be difficult to use other randomized methods to recruit participants for the study.

Data Collection 

The researchers explain the methods used to collect the data for the study in a clear way. In this case, they indicate that the data is collected through self-report questionnaires, which can be considered as an effective way of deriving essential information related to the psychological status of the patients using the insulin pump for self-care. The participants provided the data collected by the researchers during the initiation of the insulin pump for self-care, and 12 months after the initiation. On the other hand, the researchers obtained demographic data relevant to the study from the patients’ clinical records. In relation to the quality control measures used in the study, the researchers considered using clinical records, which are known to contain accurate information about a patient, including the demographic factors that the researchers were interested in obtaining. However, to protect the rights of the human subjects, the scientists used approved medication for self-care in diabetes patients. By protecting the identities of the participants, the researchers followed ethical provisions in the study.

Discussion 

The researchers primarily focus on discussing the results obtained from the study in the discussion section. They do not provide detailed explanations concerning the strengths as well as limitations of the study. However, one of the strengths that can be identified from the study includes the provision that it provides essential information related to the effects of insulin pumps on diabetes distress and the fear of hypoglycaemia. Not so many studies are available to avail information related to the research question under consideration, which makes the study instrumental to identifying the psychological benefits associated with the use of insulin pumps in place of other self-care methods. The authors also fail to explain the availability of alternative explanations for the findings, particularly in relation to the association between the assessed psychological variables and HbA1c. However, the researchers provide information regarding the implications of this study on future research by indicating that the future audit of the presented data can determine whether patients maintain the psychological benefits reported in the research. The research findings can be used to inform the need for using targeted interventions that could be used in the first few months following the initiation of pump therapy.

Conclusion 

The study reveals that pump therapy is associated with an improvement in the assessed medical as well as psychological variables. In this case, the researchers conclude the pump therapy assists in reducing the emotional distress, worries, and the undesired behaviors related to the fear of hypoglycaemia. However, the therapy does not relate to the reduction in the patients’ HbA1c. The conclusions could be used to indicate that the study addresses the primary purpose of the research. The strengths associated with the research include the provision that this novel study contributes to medical knowledge, particularly in relation to the benefits associated with pump therapy. In spite of the identified strength, the study does not provides factor structures needed for determining the behaviors that contributed to the reduction in diabetes distress as well as the fear of hypoglycaemia in patients using pump therapy for their self-care. The findings can be used in nursing practice as it provides essential information that contributes to the expansion of nursing knowledge, particularly in relation to the identification and mitigation of the psychological effects associated with self-care.

Reference

Shaban, C., Knott, J., Jenkins, E., Weiss, M., Ryder, J., Charman, J., & Partridge, H. (2017). Diabetes distress and fear of hypoglycaemia: what are the psychological benefits of insulin pump therapy?  Practical Diabetes ,  34 (8), 273-276.