The document summarizes key findings from the DAWN2 study on the psychosocial impact of diabetes. It finds that: - Living with diabetes negatively impacts quality of life and emotional well-being. Nearly half of people with diabetes experience significant diabetes-related distress. - Family members of people with diabetes also experience burden and worry. Many family members want to help but do not know how. - Participation in diabetes education is associated with better psychosocial outcomes for people with diabetes. However, over half have never participated in education programs. - There are gaps in psychosocial support from healthcare systems and many providers want more training to better support patients. Discrimination due to diabetes is also common.

1. Psychosocial impact of diabetes:
DAWN 2
multi-national results
Ingrid Willaing
Steno Diabetes Center, Denmark
on behalf of the DAWN2 study group

2. WONCA 2015
Duality of Interest Declaration
Ingrid Willaing
I report the following potential
duality/dualities of interest in the field
covered by my lecture:
Advisory board member for Novo Nordisk A/S
Employed by Steno Diabetes Center A/S,
a research hospital working in the Danish
National Health Service and owned by Novo
Nordisk A/S

3. Background
 Living with diabetes is demanding and many experience
psychosocial challenges1
 Effective psychosocial support can help reduce stress,
improve psychological functioning and improve
outcomes2,3
 Healthcare professionals feel ill-equipped to provide
required psychosocial support4
1. Rubin RR, et al. Diabetes Care 1992;11:1640–57
2. Alloway SC, et al. Can J Diet Pract Res 2001;62:188–92
3. Jacobson AM. N Eng J Med. 1996;334:1249–53
4. Peyrot M, et al. Diabet Med 2005;22:1379–85

4. Impact of diabetes on
quality of life and
well-being

5. Diabetes has a negative impact on a
wide range of life domains
Nicolucci A, et al. Diabet Med 2013;30:767–77
100
80
60
40
20
0
Relationships
with family/
friends/peers
Work and
studies
Leisure
activities
FinancesReduced
emotional
well-being
Reduced
physical
health
21
35
38
4446
62
Proportionofpeoplewith
diabetes(%)
People with diabetes reported a negative impact on the
following aspects of living:

6. Almost half of people with diabetes
have diabetes-related emotional
distress (PAID-5 ≥ 40)
Proportion of people with diabetes who had significant
emotional distress related to diabetes80
0
Proportionofpeoplewithdiabetes
(%,95%CI)
10
20
30
40
70
60
50
Nicolucci A et al. Diabet Med 2013;30:767–77
*Global score
Country-specific data and the mean (dotted line) are adjusted for clustering, and weighted on age,
gender, region, and education to allow generalization from the sample to larger populations.
These data differ from the unadjusted global score and country score (range).
CI, confidence interval; PAID-5, Problem Areas in Diabetes Short Form – 5 items.

7. 14% of people with diabetes report
likely depression (WHO-5 ≤28)
Nicolucci A et al. Diabet Med 2013;30:767–77
Holt RIG et al. IDF Melbourne 2013;P-1726
Proportion of people with diabetes with likely depression30
0
Proportionofpeoplewithdiabetes
(%,95%CI)
5
10
15
20
25
*Global score
Country-specific data and the mean (dotted line) are adjusted for clustering, and weighted on age,
gender, region, and education to allow generalization from the sample to larger populations.
These data differ from the unadjusted global score and country score (range).
CI, confidence interval; WHO-5, World Health Organization Well-Being Index-5.

8. Women with diabetes report worse
psychosocial outcomes than men
Nicolucci A, et al. IDF Melbourne 2013;P-1653
Indicators Men
N=4523
Women
N=4073
p
WHO-5: Psychological well-being 59±23 55±24 <0.0001
PAID-5: Diabetes distress 32±25 37±26 <0.0001
EQ-5D VAS: Health perception 68±19 66±20 <0.0001
DIDP: diabetes impact
(% reporting a slightly negative
to very negative impact):
Physical health
Financial situation
Relationship with family, friends and peers
Leisure activities
Work or studies
Emotional well-being
61
38
20
38
32
43
62
45
21
36
33
48
0.22
<0.0001
0.71
0.23
0.64
<0.0001
I am very worried about the risk
of hypoglycemic events
(% who mainly or fully agree)
51 57 <0.0001

9. Discrimination is common and
associated with worse outcomes
 19% of people with diabetes experienced discrimination
from their community1
 Experiencing discrimination due to diabetes is
associated with increased diabetes-related emotional
distress2
1. Nicolucci A, et al. Diabet Med 2013;30:767–77
2. Wens J, et al. EASD, Barcelona 2013; PS 095-P1142

10. Discrimination varies across countries
Country-specific data and the mean (dotted line) are adjusted for clustering,
and weighted on age, gender, region, and education to allow generalization
from the sample to larger populations. These data differ from the
unadjusted global score and country score (range). Wens J, et al. EASD, Barcelona 2013; PS 095-P1142
Proportionofpeoplewithdiabetes
(%,95%CI)
0
10
20
30
50
40
Proportion of people with diabetes who feel discriminated
against because of their diabetes

11. Higher levels of empowerment are
associated with a less negative impact
on different aspects of life
Percentage of respondents reporting a negative impact by tertiles (from empowerment scale)
0 10 20 30 40 50 60
Leisure activities
Work or studies
Emotional well-being
Percentage
Lower
Middle
Higher
Tertile

12. Family burden
and support:
DAWN2
multinational
results

13. Background
 Family support and social support are essential for
living well with diabetes1
 Limited evidence is available about adult family
members’ burden of diabetes2
 Only a few, small studies have evaluated the
burden of diabetes on adult family members of
people with diabetes
 The DAWN2 study provides an opportunity to
review this globally
1. Peyrot M, et al. Diabet Med 2005;22:1379–85
2. Torenholt R, et al. Diabet Med 2013]

14. Total participants globally n=15,438
People with diabetes1
n=8596
Type 1
n=1368
Type 2 (n= 7228)
-Insulin Med (n=2591)
-Non-Insulin Med (n=2937)
-Non-Med (n=1700)
Family members2
n=2057
Healthcare professionals3
n=4785
PCPs/GPs
n=2066
Diabetes specialists
n=1350
Nurses
n=827
Dietitians
n=542
Family members in DAWN2
1. Nicolucci A, et al. Diabet Med 2013;30:767–77; 2. Kovacs Burns K, et al. Diabet Med 2013;30:778–88
3. Holt R, et al. Diabet Med 2013;30:789–98

15. Diabetes has a negative impact on a
wide range of life domains of family members
Kovacs Burns K, et al. Diabet Med 2013;30:778–88
Negativeimpact
(%)
Work and
studies
Reduced
physical
health
Leisure
activities
FinancesReduced
emotional
well-being
Relationships
with family/
friends/peers
Family members of people with diabetes reported
a negative impact on the following aspects of living:

16. Diabetes results in burden, worry
and distress for adult family members
of people with diabetes
Kovacs Burns K, et al. Diabet Med 2013;30:778–88
Kovacs Burns K, et al. IDF Melbourne 2013;PD-0924
40% 35%
expressed high
levels of
distress related
to concerns
about their
relative with
diabetes
reported a
‘moderate’ to
‘very large’
burden from
caring for a
relative with
diabetes

17. 61% of family members are very
worried about hypoglycemia
Kovacs Burns K, et al. Diabet Med 2013;30:778–88
Proportionoffamilymembers
(%,95%CI)
100
0
10
20
30
40
60
80
90
70
50
Global score
Country-specific data and the mean (dotted line) are adjusted for clustering,
and weighted on age, gender, region, and education to allow generalization
from the sample to larger populations. These data differ from the unadjusted
global score and country score (range).

18. Many family members want to help,
but do not know how to
Kovacs Burns K, et al. Diabet Med 2013;30:778–88
...want to be
more involved in
helping with
diabetes care
… do not know
how best to help
46%
39% 37%
% of family members who…
…would like to be more
involved in helping their
relative with diabetes deal
with feelings about the
condition

19. The majority of family members have
not participated in diabetes education
71% 77%
Type 1 diabetes Type 2 diabetes
of family
members did
not participate
in any diabetes
educational
activity
Willaing I, et al. Diabetes 2013;62(suppl 1):A79
of family
members did
not participate
in any diabetes
educational
activity

20. Family member participation in
diabetes education varied by country
Country-specific data and the mean (dotted line) are adjusted for
clustering, and weighted on age, gender, region, and education to allow
generalization from the sample to larger populations. These data differ
from the unadjusted global score and country score (range). Family
member participation in education 463/2057=23% Kovacs Burns K, et al. Diabet Med 2013;30:778–88
60
50
40
30
20
10
0
Proportionoffamilymembers
(%,95%confidenceinterval)

21. Active
involvement of
people with
diabetes and
support for
self-management

22. Background
 Active self-management is essential to achieving good
health and quality of life in diabetes1,2
 Strategies are available today that can increase
involvement of people with diabetes in their disease
management3,4
 The DAWN2 study allows us to review the current
situation in terms of involvement and education of
people with diabetes
1. Peyrot M, et al. Diabet Med 2005;22:1379–85
2. Funnell MM, et al. Clinical Diabetes 2004;22:123–7
3. Coulter A, et al. BMJ 2007;335:24–7
4. Haas L, et al. Diabetes Care 2012;35:2393–401

23. Gaps in care for psychosocial and
behavioral assessment
*Percentages given are weighted and do not reflect crude
rates of respondents for each indicator; thus crude numbers
and percentages do not coincide Nicolucci A et al. Diabet Med 2013;30:767–77
In the past 12 months, did anyone from
your healthcare team (% reporting ‘yes’):
Global score,
%*
Country score,
median (range)
Measure your long-term blood sugar
control level?
72 75.3 (61.6–92.8)
Examine your feet? 45 53.6 (14.8–81.8)
Ask if you have been anxious or depressed? 32 32.5 (14.6–57.3)
Ask about the types of foods you have
been getting?
49 45.4 (26.6–63.8)

24. Differences in perceptions about
communication across countries
0
20
40
60
80
100 Proportion of people with diabetes who said their healthcare
team asked them how diabetes affects their lives
Proportionofpeoplewithdiabetes
Proportion of healthcare professionals who said they asked their
patients how diabetes affects their lives

25. Perceptions of communication differ
between people with diabetes and
healthcare professionals
People with diabetes
were listened to
regarding how they
would like to do things
29
37 38
56
77
72
0
20
40
60
80
100
Individuals(%)
People with diabetes
being asked by their
healthcare professional
for ideas when making
their diabetes
care plan
People with diabetes
felt that their
healthcare professional
conveyed confidence
in their ability to
make changes
People with diabetes Healthcare professionals

26. Education and training

27. Base: All Qualified HCPs (PCPs/GPs: n=2,066; Specialists: n=1,350;
Nurses: n=827, Dietitians n=542)
Q1050 Have you ever attended post-graduate training in any of
the following areas?
Post-graduate training (HCPs)
Base: All Qualified HCPs (PCPs/GPs: n=2,066; Specialists:
n=1,350; Nurses: n=827, Dietitians n=542)
Q1055 In which of the following areas would you like to
receive more training or support on an ongoing basis in order
to provide better care for your patients with diabetes?
Training Attended Training Desired
AD
AB
A
AD
CD
AB
A
BD
ACD
AC
A
A
AD
BD
BCD
A
D
ABC
A
ABD
B
A
AB
AB
AB
A

28. Beliefs about diabetes management
(HCPs)
Base: All Qualified HCPs (PCPs/GPs: n=2,066; Specialists: n=1,350; Nurses: n=827, Dietitians: n=542)
Q950 Please think about your personal beliefs around diabetes management and indicate the extent to which you agree or
disagree with each of the following statements.
53%
16%
52%
58%
26%
60%
57%
16%
51%
43%
17%
37%
0% 100%
It is important for me to advocate on behalf of
people with diabetes and be involved in health
policy issues for improvement of care of diabetes
HCPs have a very limited influence on how well
people take care of their diabetes
My success in caring for people with diabetes
depends largely on my ability to understand and
manage the emotional issues my patients face
PCPs/GPs (A) Specialists (B) Nurses (C) Dietitians (D)
Ratings of ‘5’ or ‘6’ on a 6-Point Agreement Scale
(‘1’ = Fully Disagree and ‘6’= Fully Agree)
A
A
A
ABD
A
ABD
A

29. Participation in diabetes education is
associated with better psychological outcomes
 Participation in diabetes education was
associated with:
− better quality of life (p=0.0002)
− higher diabetes empowerment (p<0.0001)
− fewer psychological problems (p=0.001)
− better wellbeing (p=0.005)
Willaing I et al. EASD 2013, Barcelona; PS 094-P1136

30. Diabetes is associated with significant psychosocial
challenges
Family members are burdened by diabetes – but they
represent an untapped potential for support
Active engagement and participation of people with
diabetes is lacking – and there are significant
communication gaps
Half of all people with diabetes never participated in a
diabetes education program, but those who did, found it
very helpful
Training and support for healthcare professionals is
limited - but much wanted
Discrimination due to diabetes is prevalent and is linked to
worse treatment outcomes
DAWN2: Key global findings

31.  For further information,
please see:
− www.dawnstudy.com
Thank you for your attention!
Thank you