Monitoring of Individual Needs in Diabetes (MIND)-2

Monitoring of Individual Needs in Diabetes (MIND)-2

Follow-up data from the Cross-National Diabetes Attitudes, Wishes, and Needs (DAWN) MIND Study

Abstract

OBJECTIVES To test the effects of implementing computer-assisted Monitoring of Individual Needs in Diabetes (MIND) in routine diabetes care on psychological status and glycemic control; to identify predictors of poor psychological outcomes; and to evaluate care providers’ experiences.

RESEARCH DESIGN AND METHODS The MIND procedure was implemented as part of the annual review in diabetes clinics across eight countries in a prospective observational study with 1-year follow-up. MIND encompasses well-being (World Health Organization Five Well-Being Index [WHO-5]), diabetes-related distress (Problem Areas in Diabetes [PAID]), a Life Event inventory, and the patient’s agenda for their consultation. Medical data and agreed case-management actions were retrieved from the charts.

RESULTS Of the total 1,567 patients, 891 patients (57%) were monitored at a 1-year follow-up. Twenty-eight percent of the patients screened positive for depression and/or diabetes distress at baseline and considered cases, 17% of whom were receiving psychological care. Cases were significantly more often female and had type 2 diabetes and worse glycemic control compared with noncases. Clinically relevant improvements in WHO-5 and PAID were observed over time in cases, irrespective of referral (effects sizes 0.59 and 0.48, respectively; P < 0.0001). Glycemic control did not change. Female sex, life events, and concomitant chronic diseases were predictors of poor psychological outcomes. MIND was well received by patients and staff.

CONCLUSIONS MIND appears suitable for screening and discussion of emotional distress as part of the annual review. Broader dissemination in diabetes care is recommendable, but sustainability will depend on reimbursement and availability of support services.

COMMENT: This is a continuation of the DAWN study on psychological aspects of diabetes both on the patients and their providers.  The DAWN study gave us important insights into the problems with adjustment to diabetes by the patients and the large communication gap between patients and providers.  Martha Funnell summarized its major findings in 2006:

http://clinical.diabetesjournals.org/content/24/4/154.full

In this paper the authors describe the MIND procedure and its ability to detect psychological issues and follow them over time.

Diabetes Care published 26 July 2012, 10.2337/dc11-1326

http://care.diabetesjournals.org/cgi/content/abstract/dc11-1326v1