Psychological Aspects and Insulin Pump Therapy

• ClinicalTrials.gov Identifier: NCT02138188
• Recruitment Status: Unknown
• First Posted: May 14, 2014
• Last Update Posted: May 14, 2014
• Sponsor: Universita di Verona
• Information provided by (Responsible Party): Maddalena Trombetta, Universita di Verona

Study Description

Brief Summary:

The Continuous Subcutaneous Insulin Infusion (CSII) might have an impact on psychological distress and some psychological factors might be predictors of metabolic control; however, very few studies conducted so far were specifically focused on the psychological aspects of CSII therapy in adults affected by T1DM.

Condition or disease
Type 1 Diabetes

Detailed Description:

The aim of this project is to study the psychological effect of Continuous Subcutaneous Insulin Infusion (CSII) in a cohort of type 1 diabetic patients and to explore the influence of psychological factors (coping style, locus of control, self-efficacy) on glycaemic control. A sample of 36 type 1 diabetic patients will be recruited at Endocrinology, Diabetes and Metabolism Division of Verona City Hospital.

Among T1DM patients routinely followed by our Institution the study will be proposed to those starting the CSII therapy based on the inclusion and exclusion criteria.

Each study participants will provide a written informed consent and will undergo a set of 4 psychological evaluation assessing depression, anxiety, self-efficacy, perceived interference caused by diabetes, family support, locus of control and coping strategies on top of routine medical examination and laboratory testing for outcome measures at baseline and after 6, 12 and 24 months after study entry.

Study Design

• Study Type: Observational
• Estimated Enrollment: 36 participants
• Observational Model: Cohort
• Time Perspective: Prospective
• Official Title: Psychological Aspects and Continuous Subcutaneous Insulin Infusion in Type 1 Diabetic Adults.
• Study Start Date: September 2013
• Estimated Primary Completion Date: April 2015
• Estimated Study Completion Date: April 2016

Groups and Cohorts

Group/Cohort
T1D patients on CSII; Patients affected by Type 1 Diabetes on insulin pump therapy

Outcome Measures

Primary Outcome Measures :

1. Change from baseline glycosylated haemoglobin (HbA1c) at 6th, 12th and 24th months after transition to CSII. [ Time Frame: Baseline, 6, 12 and 24 months ]
   Glycosylated haemoglobin (HbA1c) is a lab test that shows the average level of blood glucose over the previous 3 months. HbA1c is used in the present study as measure of the glycaemic control: it will be assessed at baseline, after 6, 12 and 24 months.

Secondary Outcome Measures :

1. Change from baseline glucose variability as measured by standard deviation (SD) and coefficient of variation (CV) of capillary blood glucose test [mg/dL] at 6th, 12th and 24th months after transition to CSII. [ Time Frame: Baseline, 6, 12, 24 months ]
   SD and CV will be calculated from daily measurements of at least 3 capillary blood glucose measurements representative of pre- and post-meal glucose excursion over the entire day.
2. Change from baseline glucose variability as measured by the Low Blood Glucose Index (%LBGI) at 6th, 12th and 24th months after transition to CSII. [ Time Frame: Baseline, 6, 12, 24 months ]
   The LBGI is a validated percentage index of frequency and amplitude of glucose excursions below a conventional glucose threshold set at 6.25 mmol/L and allows the normalization of non-Gaussian distributions of both capillary and interstitial blood glucose measurements collected over a pre-determined time frame.
3. Change from baseline glucose variability as measured by High Blood Glucose Index (%HBGI) at 6th, 12th and 24th months after transition to CSII. [ Time Frame: Baseline, 6, 12, 24 months ]
   The HBGI is a validated percentage index of frequency and amplitude of glucose excursions over a conventional glucose threshold set at 6.25 mmol/L, as previously described.
4. Change from baseline depressive symptoms at 6th,12th and 24th months (BDI-II score) [ Time Frame: Baseline, 6, 12, 24 months ]

   The Beck Depression Inventory II is a 21-item questionnaire developed to assess the intensity of depression as defined by the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV). The BDI-II items include cognitive symptoms such as sadness and pessimism, affective symptoms such as loss of pleasure and loss of interest, somatic symptoms such as loss of energy, appetite changes and changes in sleep pattern. The BDI-II is calculated by summing the ratings for the 21 items. The 4-point scale ranges from 0 to 3 for each item. The maximum total score is 63. The measurement of outcome variables will be conducted 6, 12 and 24 months after transition to CSII.

   The difference of the BDI-II scores among baseline, at 6,12 and 24 months will be also calculated.

5. Change from baseline anxiety symptoms at 6th,12th and 24th months (BAI score) [ Time Frame: Baseline, 6, 12, 24 months ]
   The Beck Anxiety Inventory is a 21- item questionnaire developed to assess the severity of anxiety by describing its emotional, physiological and cognitive symptoms. The 4-point scale of BAI score ranges from 0 to 3 for each item, with a maximum total score of 63. Outcome variables will be evaluated at 6, 12 and 24 months after transition to CSII. The difference of the BAI scores among baseline, 6, 12 and 24 months will be also calculated.
6. Change from baseline general perceptions of diabetes at 6th, 12th and 24th months (MDQ Section 1 score) [ Time Frame: Baseline, 6, 12, 24 months ]

   The Multidimensional Diabetes Questionnaire (MDQ) was designed to provide a comprehensive assessment of diabetes-related cognitive and social factors. It includes 41 items subcategorized in three sections. The first section assesses the general perceptions of diabetes and related social support. It is comprised of three scales. These scales targets:

   perceived interference caused by diabetes to daily activities, work and social activities (9 items); perceived severity of diabetes (3 items); perceived diabetes-related social support from a significant other such as family, friends and health professionals (4 items).

   Responses were rated on 7-point rating scales (from 0 to 6), with higher scores indicating higher levels of perceived interference, social support and severity.

7. Change from baseline family support at 6th, 12th and 24th months (MDQ section II score) [ Time Frame: Baseline, 6, 12 and 24 months ]
   This section of the MDQ measures social incentives in relation to self-care activities. The scales included in this section were designed to measure the frequency of positive reinforcing behaviour (8 items) and the frequency of non supportive behaviours (4 items). Subjects recorded their responses on 7-point Likert scales (from 0 to 6) with higher scores indicating higher levels of positive and negative reinforcement behaviours.
8. Change from baseline Diabetes Self-Efficacy at 6th, 12th and 24th months (MDQ section III score) [ Time Frame: Baseline, 6, 12, 24 months ]
   This section of the MDQ is used to assess self-efficacy expectancies (7 items) and outcome expectancies (6 items). The self-efficacy scale measured patients' confidence in their ability to perform behaviors specific to the diabetes self-care activities. Responses were rated on a 0 to 100 rating scale. The outcome expectancies scale assessed patients' perceptions of the effect of diabetes self-care behaviors on metabolic control. Responses were rated on a 0 to 100 rating scale.
9. Determination of Health Locus of Control (MHLC) at Baseline [ Time Frame: Baseline ]
   The multidimensional Health Locus of Control Scale consists of three subscale with six items each. The three subscales are: Internal Health Locus of Control (IHLC), Powerful Others Externality (PHLC), Chance Health Locus of Control (CHLC).
10. Measures of Coping Strategies at Baseline [ Time Frame: Baseline ]
    Coping strategies will be measured with the Coping Orientation to Problems Experienced-New Italian Version (COPE-NVI). The instrument is a multidimensional 60-items coping inventory to assess the different ways in which people respond to stress and it was developed to assess a broad range of coping responses.

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 65 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No
• Sampling Method: Non-Probability Sample

Study Population

Outpatient setting

Criteria

Inclusion Criteria:

• Type 1 Diabetes
• Transition to CSII
• Age >18 years

Exclusion Criteria:

• Current schizophrenia/ psychotic disorders, bipolar disorders, addictive disorders, personality disorders
• Pregnancy

Contacts and Locations

Locations

Italy

Division of Endocrinology, Diabetes and Metabolism-Department of Medicine-AOUI Verona; Recruiting

Verona, Italy, 37126

Contact: Maddalena Trombetta, MD Phd +39 045 8123110 maddalena.trombetta@univr.it

Principal Investigator: Maddalena Trombetta, MD Phd

Sub-Investigator: Liliana Indelicato, Psychologist

Sponsors and Collaborators

Universita di Verona

Investigators

• Principal Investigator: Maddalena Trombetta, MD Phd; AOUI Verona

More Information

• Responsible Party: Maddalena Trombetta, MD, PhD, Universita di Verona
• ClinicalTrials.gov Identifier: NCT02138188
• Other Study ID Numbers: ISP-DT1-ITA13 (CE-2393)
• First Posted: May 14, 2014
• Last Update Posted: May 14, 2014
• Last Verified: May 2014

Additional relevant MeSH terms:

Diabetes Mellitus, Type 1; Diabetes Mellitus; Glucose Metabolism Disorders; Metabolic Diseases; Endocrine System Diseases; Autoimmune Diseases; Immune System Diseases