Aims: The Stepping Up Study is testing a new model of care for insulin initiation in general practice for adults with type 2 diabetes and suboptimal glycaemic control (HbA1c ≥7.5%). This preliminary analysis of baseline data explored the associations between HbA1c, disease burden and emotional well-being.
Methods: Descriptive statistics were performed. Data are mean (SD) or median (IQR). Non-parametric tests explored correlations between baseline HbA1c and demographics, comorbidity, medication burden (total and oral hypoglycaemic agents (OHA)), health utility (AQOL8D), depressive symptoms (PHQ-9), and diabetes-related distress (PAID).
Findings: Interim analysis of the first 253 participants showed that their median HbA1c was 8.6 (8, 9.6) % (70.5mmol/mol)). Mean age was 61.8 (10.2) years, median diabetes duration 9 (5, 13) years, 60% were male, and 44% were employed. HbA1c was negatively correlated with age (p=0.0001) but no other demographic variables. Participants had a median of 3 (2,4) chronic conditions. Mean number of medications was 7 (4) and OHAs was 2 (0.6). Mean AQoL8D utility score was 0.75 (0.19). HbA1c was negatively correlated with total medications (p=0.0072) but not total OHAs or health utility. Fourteen percent reported moderate-to-severe depressive symptoms (PHQ9, median 3 (1,7)) and 14% reported severe diabetes-related distress (PAID, median 13.8 (6.3, 27.5)). There was no significant correlation between HbA1c and generic or diabetes-specific emotional well-being.
Conclusion: In this study cohort, despite suboptimal HbA1c levels and multimorbidity, diabetes-related distress and depressive symptom scores were relatively low. Previous research suggests that low PAID scores in conjunction with suboptimal HbA1c may reflect a level of denial of diabetes, which could contribute to the sub-optimal HbA1c observed in this cohort. The Stepping Up model of care is seeking to engage this high need group in treatment intensification to improve diabetes outcomes.
The Stepping Up Study is principally funded by the NHMRC with additional support from Roche Diagnostics and Sanofi.