Diabetes & Metabolism Journal

Original Articles

Evaluation of Stress in Korean Patients with Diabetes Mellitus Using the Problem Areas in Diabetes-Korea Questionnaire: Young Sil Eom, Hwa Sun Park, Sei-Hyun Kim, Sun Mee Yang, Moon Suk Nam, Hyoung Woo Lee, Ki Young Lee, Sihoon Lee, Yeun Sun Kim, Ie Byung Park; Diabetes Metab J. 2011;35(2):182-187. Published online April 30, 2011; DOI: https://doi.org/10.4093/dmj.2011.35.2.182

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Background

It is known that diabetes and stress are directly or indirectly related, and that it is important to evaluate stress in patients with diabetes. The relationship between Korean diabetics and diabetes-related stress has never been reported. The objective of this study was to develop a stress questionnaire suitable for use with Korean diabetics and to evaluate its utility.

Methods

This study subjects were 307 Korean diabetics, aged 40 to 74 years old, who visited the Department of Endocrinology and Metabolism at Gachon University Gil Hospital, Yeungnam University Medical Center, and Inha University Hospital in Korea between March 2006 and February 2008. We developed a Korean version of Polonsky's Problem Areas in Diabetes (PAID) stress questionnaire (PAID-K) and used it to assess degrees of stress in our sample of Korean patients. We evaluated the utility of the questionnaire and analyzed the relationships between clinical characteristics of the study subjects and degrees of stress.

Results

Cronbach's alpha for PAID-K was 0.95, and PAID-K scores were significantly correlated with Hypoglycemia Fear Survey scores (r=0.44, P<0.05) and State Trait Anxiety Inventory-6 scores (r=0.21, P<0.05). PAID-K scores were significantly higher in patients with longer durations of diabetes, patients using insulin, and female patients (P=0.02, P=0.038, and P=0.001, respectively). The score also tended to increase as HbA1c levels increased, except for very high HbA1c levels (above 11%) (P for trend<0.05).

Conclusion

We developed the PAID-K questionnaire and demonstrated its utility to evaluate levels of stress in diabetic patients in Korea.

Citations

Citations to this article as recorded by

Impact of diabetes distress on glycemic control and diabetic complications in type 2 diabetes mellitus
Hye-Sun Park, Yongin Cho, Da Hea Seo, Seong Hee Ahn, Seongbin Hong, Young Ju Suh, Suk Chon, Jeong-Taek Woo, Sei Hyun Baik, Kwan Woo Lee, So Hun Kim
Scientific Reports.2024;[Epub] CrossRef
Development and Validation of a Distress Measurement Related to Glucose Monitoring of Diabetes Patients
Eujin Choi, Sooyeon Kim, Juhee Cho, Min-Sun Kim, Eun Kyung Kwon, Youngha Kim, Danbee Kang, Sung Yoon Cho
Diabetes Therapy.2023; 14(4): 737. CrossRef
Development and validation of a distress measurement for insulin injections among patients with diabetes
Eujin Choi, Min-Sun Kim, Juhee Cho, Sooyeon Kim, Eun Kyung Kwon, Youngha Kim, Danbee Kang, Sung Yoon Cho
Scientific Reports.2023;[Epub] CrossRef
The Mediating Effect of Experiential Avoidance on the Relationship between Diabetes Distress and Self-Stigma in People with Diabetes Mellitus Type 2 in Republic of Korea
Kawoun Seo
Healthcare.2023; 11(20): 2773. CrossRef
Patient-reported outcome measures for assessing health-related quality of life in people with type 2 diabetes: A systematic review
Marlous Langendoen-Gort, Lenka Groeneveld, Cecilia A. C. Prinsen, Joline W. Beulens, Petra J. M. Elders, Ilana Halperin, Geetha Mukerji, Caroline B. Terwee, Femke Rutters
Reviews in Endocrine and Metabolic Disorders.2022; 23(5): 931. CrossRef
The Mediating Effect of Acceptance Action in the Relationship between Diabetes Distress and Self-stigma among Old Adults with Diabetes in South Korea
Hyesun Kim, Kawoun Seo
Journal of Korean Academy of Community Health Nursing.2022; 33(4): 446. CrossRef
Mobile Healthcare System Provided by Primary Care Physicians Improves Quality of Diabetes Care
Tae Jung Oh, Jie-Eun Lee, Seok Kim, Sooyoung Yoo, Hak Chul Jang
CardioMetabolic Syndrome Journal.2021; 1(1): 88. CrossRef
Measurement Properties of Patient-Reported Outcome Measures for Diabetes: Systematic Review
Priscilla Jia Ling Wee, Yu Heng Kwan, Dionne Hui Fang Loh, Jie Kie Phang, Troy H Puar, Truls Østbye, Julian Thumboo, Sungwon Yoon, Lian Leng Low
Journal of Medical Internet Research.2021; 23(8): e25002. CrossRef
Validity and Reliability of the Korean Version of the Acceptance and Action Questionnaire-Stigma (AAQ-S-K)
Hyunjin Lee, Myoungjin Kwon, Kawoun Seo
Healthcare.2021; 9(10): 1355. CrossRef
Adherence to Mediterranean diet and advanced glycation endproducts in patients with diabetes
Marko Grahovac, Marko Kumric, Marino Vilovic, Dinko Martinovic, Ante Kreso, Tina Ticinovic Kurir, Josip Vrdoljak, Karlo Prizmic, Joško Božić
World Journal of Diabetes.2021; 12(11): 1942. CrossRef
The Impact of a Community-Based Food Education Program on Nutrition-Related Knowledge in Middle-Aged and Older Patients with Type 2 Diabetes: Results of a Pilot Randomized Controlled Trial
Carlos Vasconcelos, António Almeida, Maria Cabral, Elisabete Ramos, Romeu Mendes
International Journal of Environmental Research and Public Health.2019; 16(13): 2403. CrossRef
The Effects of the 2030 Diabetes Camp Program on Depression, Anxiety, and Stress in Diabetic Patients
Jin Hee Jung, Jung Hwa Lee
The Journal of Korean Diabetes.2019; 20(3): 194. CrossRef
Research of Type 2 Diabetes Patients’ Problem Areas and Affecting Factors
Sebahat Atalikoğlu Başkan, Mehtap Tan
Journal of Diabetes Mellitus.2017; 07(03): 175. CrossRef
Diabetes-related emotional distress instruments: A systematic review of measurement properties
Jiyeon Lee, Eun-Hyun Lee, Chun-Ja Kim, Seung Hei Moon
International Journal of Nursing Studies.2015; 52(12): 1868. CrossRef
Internet-Based Mentoring Program for Patients with Type 1 Diabetes
Sun-Hye Ko, Seung-Hyun Ko
Diabetes & Metabolism Journal.2014; 38(2): 107. CrossRef
Influence of the Duration of Diabetes on the Outcome of a Diabetes Self-Management Education Program
Seung-Hyun Ko, Sin-Ae Park, Jae-Hyoung Cho, Sun-Hye Ko, Kyung-Mi Shin, Seung-Hwan Lee, Ki-Ho Song, Yong-Moon Park, Yu-Bae Ahn
Diabetes & Metabolism Journal.2012; 36(3): 222. CrossRef

Association of Educational Level and Socioeconomic Status with Glucose Metabolism.: Young Sil Eom, Sun Mee Yang, Pyung Chun Oh, Jung Hyun Lee, Ki Young Lee, Yeun Sun Kim, Sihoon Lee, Jung Soo Im, Jun Yim, Dae Kyu Oh, Moon Suk Nam, Ie Byung Park; Korean Diabetes J. 2008;32(4):377-385. Published online August 1, 2008; DOI: https://doi.org/10.4093/kdj.2008.32.4.377

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Abstract PDF

BACKGROUND
The objective of the present study was to examine the association of educational level and socioeconomic status with glucose metabolism including prediabetes. METHODS: This cross-sectional study subjects were 882 (mean age: 51.0 +/- 13.4 years, M:F = 241:641) without diabetes, aged more than 20 years and residing in Whasu 2 dong in Incheon. We classified them into three levels according to their educational level: primary (illiterate or up to elementary school), secondary (middle school or high school) and tertiary (university), and into three levels according to their socioeconomic status by self reported questionnaire: low, middle and high. Subjects were diagnosed as three groups (normal, prediabetes and diabetes) by American Diabetes Association criteria using 75 g oral glucose tolerance test. The association of educational level and socioeconomic status with glucose metabolism was analyzed. RESULTS: The number of normal group was 300 (34.0%), that of prediabetes was 470 (53.3%) and that of diabetes was 112 (12.7%). In women, the proportion of primary educational group was larger than that of secondary educational group in diabetes (Odds ratio [OR] = 1.88; 95% confidence interval [CI]: 1.01-3.51) and larger than that of tertiary educational group in prediabetes ([OR] = 2.00; [CI]: 1.06-3.78). But socioeconomic status did not have the statistical association with glucose metabolism in women. Also both educational level and socioeconomic status had no statistical association with glucose metabolism in men. CONCLUSIONS: The proportion of low educational level is larger in prediabetes and diabetes compared with normal group in women.

Citations

Citations to this article as recorded by

How do life-course trajectories of socioeconomic position affect quality of life in patients with diabetes mellitus?
Hye Ah Lee, Ko Eun Lee, Yool Won Jeong, Jaeseon Ryu, Minkyung Kim, Jung Won Min, Young Sun Hong, Kyunghee Jung-Choi, Hyesook Park
Quality of Life Research.2014; 23(4): 1337. CrossRef

Inflammatory Markers are Associated with Microvascular Complications in Type 2 Diabetes.: Sun Mee Yang, Sung Yong Kim, Ki Young Lee, Yeun Sun Kim, Moon Suk Nam, Ie Byung Park; Korean Diabetes J. 2007;31(6):472-479. Published online November 1, 2007; DOI: https://doi.org/10.4093/jkda.2007.31.6.472

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Abstract PDF

BACKGROUND
Inflammatory markers are known to be sensitive predictors of atherosclerotic disease such as coronary heart disease. Diabetic patients have higher level of inflammatory markers such as fibrinogen, high sensitivity C-reactive protein (hsCRP) or IL-6. We investigated the association of inflammatory markers with microvascular complications in type 2 diabetes. METHODS: We studied cross-sectionally 244 consecutive patients with type 2 diabetes without macrovascular disease such as cerebral infarct, coronary heart disease and peripheral arterial disease. The urinary albumin/creatinine ratio was determined in a morning, untimed, urine specimen. Ophthalmoscopic examinations were performed to evaluate diabetic retinopathy. Diabetic neuropathy was examined by 10-g monofilament, Neuropathic Disability Score and Michigan Neuropathy Screening Instrument. RESULTS: 47 patients (23.5%) had diabetic retinopathy, 81 (34.6%) had nephropathy and 132 (54.2%) had neuropathy. Fibrinogen and erythrocyte sedimentation rate (ESR) were significantly higher in the patients with nephropathy, retinopathy and neuropathy than in those without (P = 0.009, 0.003 and 0.047; P = 0.011, 0.02 and 0.006 , respectively). There were no differences in the hsCRP and IL-6 level between in patients with microvascular complications and in those without. Inflammatory parameters were correlated with each other. The hsCRP was correlated with IL-6 (r = 0.40, P < 0.001) and fibrinogen (r = 0.45, P < 0.001), but fibrinogen was not significantly correlated with IL-6 (r = 0.13, P = 0.08). CONCLUSION: Although IL-6, hsCRP and fibrinogen may be associated with microvascular complications in type 2 diabetes, we show that fibrinogen is a strong marker of microvascular complications.

Citations

Citations to this article as recorded by

Hesperetin suppresses LPS/high glucose-induced inflammatory responses via TLR/MyD88/NF-κB signaling pathways in THP-1 cells
Aeri Lee, HyunJi Gu, Min-Hee Gwon, Jung-Mi Yun
Nutrition Research and Practice.2021; 15(5): 591. CrossRef

Effects of Rosiglitazone on Body Fat Mass and Distribution in Type 2 Diabetic Patients.: Hong Kyu Kim, Hyo Joong Yoon, Seung Min You, Ki Young Lee, Hye Young Park, Moon Ho Kang; Korean Diabetes J. 2003;27(3):272-279. Published online June 1, 2003

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Abstract PDF: BACKGROUND
Rosiglitazone, an insulin-sensitizing drug of the thiazolidinediones class, has a high affinity for the ligands of the peroxisome proliferator activated receptor-gamma(PPAR-gamma), is highly expressed in adipose tissue, and plays an important role in the differentiation of adipocyte. The influence of rosiglitazone was investigated on the total fat mass and regional adiposity in type 2 diabetic patients. METHODS: Rosiglitazone (4 mg/day) was administered for 6 months to type 2 diabetic patients (n=20) whose glycemic control was unacceptable with the use of other treatments. Measurements of the total, trunk and leg region body fats (by dual energy X-ray absorptiometry) and abdominal fat distributions (by computed tomography) were compared before and after treatment. RESULTS: Nine patients received rosiglitazone monotherapy and 11 a combined therapy of sulfonylurea and/or metformin. The HbA1C, serum insulin level and homeostasis model assessment insulin resistance index were decreased following the rosiglitazone therapy, but the body weight and BMI were increased. As for the body fat changes, the total (19,382+/-4,786 vs. 22,940+/- 7,300 g, p<0.01), trunk (11,399+/- 2,678 vs. 13,960+/-4,698 g, p<0.01) and leg (4,734+/-1,319 vs. 6,203+/-2,231g, p<0.05) region fat masses were significantly increased. The percentage increase in the total, trunk and leg region fat masses were 20+/-25, 25+/-35 and 58+/-130%, respectively. As for abdominal fat distribution after the treatment, the visceral fat area (225+/-84 vs. 187+/-87 cm2, p<0.05) was significantly decreased, while the subcutaneous fat area tended to increase (178+/-83 vs. 201+/-80 cm2, NS), although these were not statistically significant. The visceral/subcutaneous fat ratio (V/S ratio) was significantly decreased (1.45+/- 0.64 vs. 0.95+/-0.25, p<0.05). CONCLUSION: Although the total body fat mass was increased following the rosiglitazone therapy, a shift in the body fat distribution, from the visceral to the subcutaneous region, was observed, which may be associated with an improvement in insulin resistance. However, a long-term assessment of the consequences of an increasing total fat mass and change in the body fat distribution will be required.

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