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London Health 2012 Dr Keith Meadows DHP Research & Consultancy Ltd The Diabetes Health Profile – Developments and Practical Applications
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London Health 2012
Dr Keith MeadowsDHP Research & Consultancy Ltd
The Diabetes Health Profile – Developments and
Practical Applications
Copyright DHP Research & Consultancy Ltd
Diabetes in the U.K.
UK Diagnosed
2.9 million diagnosed with diabetes by 2011
Diabetes type
10% of people with
diabetes have Type 1
90% of people with
diabetes have Type 2
Financial costs
£192 million a week spent by the NHS
The impact
Deaths due cardiovascular disease
Type 1 Deaths due to kidney disease
Of people die within 5 years of an amputation
52%
21%
70%
Copyright DHP Research & Consultancy Ltd
Diabetes in the U.K.
Copyright DHP Research & Consultancy Ltd
The psychological impact of living with diabetes
The facts
“Yet there is little routine
psychological support for people
with diabetes.”Diabetes UK
of the population in Britain have
depression at any one time
10%However
,
…and the risk is higher for women than for man
according to Diabetes UK, people
with diabetes are twice as likely to experience depression…
ANXIETY
aggressionDenial
Eating problems
disruption to social lifePOOR QUALITY OF LIFE
Copyright DHP Research & Consultancy Ltd
The Diabetes Health profile (DHP-18)
The conceptual model
Copyright DHP Research & Consultancy Ltd
The Diabetes Health profile
25 In-depth patient interviews
Literature review/Interviews with clinicians/HCP
Patient /HCP review
Psychometric testing and validation
DHP-1
DHP-18
Insulin dependent (TYPE 1)
32-items
Insulin dependent
Insulin requiringOralDiet
18-items
Copyright DHP Research & Consultancy Ltd
Ways of administering the DHP-18
The Diabetes Health Profile (DHP-18)
Copyright DHP Research & Consultancy Ltd
Stable factor structure across samples and
language groups
High levels of internal reliability
α = 0.70-0.88
Good construct validity
Ability to discriminate between treatment
groups
For the psychometrician
Copyright DHP Research & Consultancy Ltd
Over
8,000Type 1 and Type 2
patients have completed the
DHP-18
Using the DHP
An international perspective
Living with diabetes - Interpreting the DIABETES HEALTH PROFILE (DHP)
91% Type 2 and 9% Type 1 patients completed the
questionnaire.
55% 45%
77%Of patients experiencing three severe hypoglycaemic episodes reported their days are tied to meal times.
59%Of patients experiencing one severe hypoglycaemic episode reported their days are tied to meal times.
Oral
Insulin
44 46 48 50 52 54 56
Disinhibeted eat-ingPsycholigical dis-tressBarriers to activity
Score 0=No dysfunctioning p<0.05
DHP domain scores by treatment modality
63.9 years
Mean age
Patients (mean) scores on the Disinhibited eating domain
by BMI
BMI<25
BMI25-34
BMI>35
47.849.2
52.435-44 45-54 55-64 65-74 >75
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Patients reporting severe hy-
poglycaemic epis-odes
Barriers to activity domain scores
3173
Copyright DHP Research & Consultancy Ltd
Score 0=No dysfunctioning p<0.05 Score 0=No dysfunctioning
Copyright DHP Research & Consultancy Ltd
Getting an in-depth look at diabetes with the DHP-18
Psychological distress
Barriers to activity
Disinhibited eating
MOST AT RISK MOST AT RISK MOST AT RISK
• Comorbidity
• Severe hypoglycaemia
• Female
• > Age
• Visit to the pyschiatrist
• Younger women
• Forgetting to take insulin
• Unaware of HbA1 level
• Visit to the psychiartrist
• Severe hypoglycaemia
• Other health issues
• Visit to the psychiatrist
Frequent and or substantial emotional stress including: dysphoric mood, irritability and externally directed hostility.
Very significant levels of anxiety restricting behaviour and perceived limitations in social/role activities
Substantial and or frequent levels of eating in response to food cues and emotional arousal.
Hard saying no to food you like
Eat to cheer self up
Depressed due to
diabetes
Food controls life
Represents high scores
Yes53%
Yes50%
Yes 69%
Yes69%
PD BA DE
Copyright DHP Research & Consultancy Ltd
Interpreting the Diabetes Health Profile
What does a DHP-18 score mean?
the minimally important difference (MID) is the smallest score difference on the Diabetes Health Profile that represents the minimal clinically significant difference.
The required MID change in score for the DHP-18 domains
Psychological distress
7 - 11
Barriers to activity
Disinhibited eating
6.5 - 9.9
7.5 - 11.4
M
I
D
Minimally
Difference
Important
Copyright DHP Research & Consultancy Ltd
Interpreting the Diabetes Health Profile
