Low-fat diets and regular physical activity are recommended for good health, but U.K. household expenditure on butter, sugar, preserves, and soft drinks has risen steadily; fewer than half of men (46%) and women (37%) report walking for 10 min at least once per month and 67% of men and 57% of women are overweight or obese (1). With 86% of people with type 2 diabetes and 62% of those with type 1 diabetes being overweight or obese (1), their lifestyles are likely to be influenced by the overall societal trend for busy lives, quick meals, and little physical activity.
The global second Diabetes Attitudes, Wishes and Needs (DAWN2) study was a multi-stakeholder survey conducted in 17 countries (2), exploring factors affecting diabetes self-management and support for people with diabetes. Nearly half of the people with diabetes surveyed (45%) reported diabetes-related distress and ∼14% had likely depression (3). Emotional support from health care professionals was reported by only 32% of people with diabetes (3). Global DAWN2 results demonstrated notable differences in findings concerning people with diabetes among participating countries (3). Here, we provide a descriptive analysis of key U.K. DAWN2 data examining potential barriers to active and optimal self-management among people with diabetes.
DAWN2 (ClinicalTrials.gov identifier NCT01507116) methodology has been published previously (2). Data were generated through stakeholder-specific questionnaires, including standardized instruments and questions based on validated instruments. Data for people with diabetes were weighted; those for health care professionals were not weighted.
Overall, 500 people with diabetes and 281 health care professionals from the U.K. participated. The two stakeholder groups were not matched; i.e., health care professionals did not necessarily care for the people with diabetes taking part in DAWN2. Many people with diabetes wanted to improve self-management, including handling their diabetes-associated emotions (26% with type 2 diabetes and 39% with type 1 diabetes).
Thirty percent of people with type 2 diabetes and 32% of those with type 1 diabetes reported having been depressed; 32% and 39% of people with type 2 and type 1 diabetes, respectively, reported being currently “moderately anxious or depressed.” Self-management activities were applied less frequently by people with diabetes and emotional conditions than by those with diabetes and other physical conditions (e.g., glucose testing, 2.9 vs. 4.2 days/week; foot checks, 3.0 vs. 4.1 days/week; regular use of medications, 6.2 vs. 6.7 days/week, respectively; all P < 0.05).
During the past 12 months, 64% and 42% of people with diabetes had seen a general practitioner or diabetes specialist, respectively. Most health care professionals reported assessing depression but less frequently than assessing the physical aspects of diabetes (Fig. 1). A minority of people with diabetes recalled health care professionals asking about their emotional well-being (Fig. 1).
Diabetes care received and provided as reported by people with diabetes and health care professionals participating in DAWN2 and living in the U.K. Data for people with diabetes were adjusted for age, sex, education, and U.K. region. Health care professionals and people with diabetes were not matched; i.e., health care professionals did not necessarily care for the people with diabetes.
Diabetes care received and provided as reported by people with diabetes and health care professionals participating in DAWN2 and living in the U.K. Data for people with diabetes were adjusted for age, sex, education, and U.K. region. Health care professionals and people with diabetes were not matched; i.e., health care professionals did not necessarily care for the people with diabetes.
Although ∼30% of people with diabetes experienced anxiety and depression, we found that health care professionals assessed depression less often than physical health. Diabetes together with emotional conditions was associated with the less consistent application of self-management activities. Therefore, the low emphasis on emotional well-being, exacerbated by the even lower perceived emotional care received, may leave people with diabetes at risk for suboptimal self-management.
Article Information
Acknowledgments. On behalf of the DAWN2 International Publication Planning Committee (IPPC), the manuscript was reviewed by Angus Forbes (King’s College London, London, U.K.), Dr. Norbert Hermanns (Diabetes Zentrum Mergentheim, Bad Mergentheim, Germany), and Mark Peyrot (Loyola University Maryland, Baltimore, MD).
Funding. Medical writing support was provided by Regine Harford on behalf of Bioscript Medical Ltd. and Kim Croskery of Bioscript Medical Ltd. (Macclesfield, U.K.) and funded by Novo Nordisk Health Care AG, Zurich, Switzerland, in compliance with international Good Publication Practice guidelines.
Duality of Interest. K.D.B. has received funding for travel expenses to attend DAWN2 meetings but has not received any fee for this work from Novo Nordisk. She is a global advisory board and European Insulin Delivery Systems Advisory Board member for Roche Diagnostics and a CHOICE advisory board member for Animas. She has received honoraria from Sanofi, AstraZeneca, AbbVie, Novo Nordisk, LifeScan, and Janssen. She has received grants in support of investigator trials from Novo Nordisk, Roche Diagnostics, and Animas. R.I.G.H. has received funding for travel and accommodation to attend DAWN2 IPPC meetings but has not received any fee for this work from Novo Nordisk. He has acted as an advisory board member and speaker for Novo Nordisk and as a speaker for Sanofi, Eli Lilly, Otsuka, and Bristol-Myers Squibb. He has received grants in support of investigator trials from Novo Nordisk. P.A.D. has received funding for travel and accommodation to attend DAWN2 meetings but has not received any fees for this work from Novo Nordisk. She has received honoraria from Abbott Laboratories, Eli Lilly, MSD, Novo Nordisk, and Sanofi and has received grants in support of clinical trials from Abbott Laboratories and the Sugar Bureau. M.H.C. has received funding for travel and accommodation to attend DAWN2 IPPC meetings but has not received any fee for this work from Novo Nordisk. He has acted as an advisory board member and speaker for Novo Nordisk, Eli Lilly, Boehringer Ingelheim, MSD, and Abbott and as a speaker for Sanofi and AstraZeneca. N.K. has received funding for travel to attend DAWN2 meetings and has received honoraria from Novo Nordisk, Sanofi, Bristol-Myers Squibb, Eli Lilly, MSD, and Janssen for educational meeting/advisory boards and support to attend international conferences. G.H. has received honoraria and expenses from Novo Nordisk, Eli Lilly, AstraZeneca, MSD, Janssen, and Sanofi. G.H. has not received any fee for this work from Novo Nordisk.
Author Contributions. K.D.B. was involved in the conceptualization of the manuscript, reviewed and edited the first draft, and contributed revisions and editorial support to subsequent drafts and the final version of the manuscript. R.I.G.H. contributed revisions to the second draft and reviewed the final version of the manuscript. P.A.D., S.O., and G.H. were involved in the conceptualization of the manuscript, contributed revisions to the second draft, and reviewed the final version of the manuscript. M.H.C. and N.K. were involved in conceptualization of the manuscript and reviewed the second draft and final version of the manuscript. K.D.B. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Clinical trial reg. no. NCT01507116, clinicaltrials.gov.
