These findings suggest that the PAID, a brief, easy-to-administer instrument, may be valuable in assessing psychosocial adjustment to diabetes. In addition to high internal reliability, the consistent pattern of correlational findings indicates that the PAID is tapping into relevant aspects of emotional distress and that its particular feature, the measurement of diabetes-related emotional distress, is uniquely associated with diabetes-relevant outcomes. These data are also consistent with the hypothesis that diabetes-related emotional distress, separate from general emotional distress, is an independent and major contributor to poor adherence. Given that the study was limited to female patients using insulin, further examination of the clinical usefulness of the PAID will need to focus on more heterogeneous samples.

The study findings provided support for the construct validity of the PAID, including evidence for discriminant validity from its ability to detect differences between IDDM and NIDDM treatment groups expected to differ in the emotional impact of life with diabetes. Future studies should explore the PAID's performance in nonspecialist treatment settings as well as its responsiveness to clinical change.

OBJECTIVE -To examine the cross-cultural validity of the Problem Areas in Diabetes Scale (PAID) in Dutch and U.S. diabetic patients.RESEARCH DESIGN AND METHODS -A total of 1,472 Dutch people with diabetes completed the PAID along with other self-report measures of affect. Statistics covered Cronbach' s ␣, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA), Pearson' s product-moment correlation, and t tests. Psychometric properties of PAID were compared for Dutch and U.S. diabetic patients.RESULTS -Internal consistency of the Dutch PAID was high and stable across sex and type of diabetes. Test-retest reliability was high. Principal component analyses confirmed 1 general 20-item factor, whereas EFA identified 4 new subdimensions: negative emotions, treatment problems, food-related problems, and lack of social support. These dimensions were confirmed with CFA and were replicated in the U.S. sample. The PAID and its subscales demonstrated moderate to high associations in the expected direction with other measures of affect. Dutch and U.S. subjects reported having the same problem areas, with U.S. patients reporting higher emotional distress levels both in type 1 and type 2 diabetes.CONCLUSIONS -The Dutch and U.S. 20-item PAID appeared to be psychometrically equivalent, which allowed for cross-cultural comparisons.

OBJECTIVETo test whether a theory-based, literacy, and culturally tailored self-management intervention, Latinos en Control, improves glycemic control among low-income Latinos with type 2 diabetes.RESEARCH DESIGN AND METHODSA total of 252 patients recruited from community health centers were randomized to the Latinos en Control intervention or to usual care. The primarily group-based intervention consisted of 12 weekly and 8 monthly sessions and targeted knowledge, attitudes, and self-management behaviors. The primary outcome was HbA1c. Secondary outcomes included diet, physical activity, blood glucose self-monitoring, diabetes knowledge and self-efficacy, and other physiological factors (e.g., lipids, blood pressure, and weight). Measures were collected at baseline and at 4- and 12-month follow-up. Change in outcomes over time between the groups and the association between HbA1c and possible mediators were estimated using mixed-effects models and an intention-to-treat approach.RESULTSA significant difference in HbA1c change between the groups was observed at 4 months (intervention −0.88 [−1.15 to −0.60] versus control −0.35 [−0.62 to 0.07], P < 0.01), although this difference decreased and lost statistical significance at 12 months (intervention −0.46 [−0.77 to −0.13] versus control −0.20 [−0.53 to 0.13], P = 0.293). The intervention resulted in significant change differences in diabetes knowledge at 12 months (P = 0.001), self-efficacy (P = 0.001), blood glucose self-monitoring (P = 0.02), and diet, including dietary quality (P = 0.01), kilocalories consumed (P < 0.001), percentage of fat (P = 0.003), and percentage of saturated fat (P = 0.04). These changes were in turn significantly associated with HbA1c change at 12 months.CONCLUSIONSLiteracy-sensitive, culturally tailored interventions can improve diabetes control among low-income Latinos; however, strategies to sustain improvements are needed.

OBJECTIVE -To examine psychometric properties of the Self-Care Inventory-revised (SCI-R), a self-report measure of perceived adherence to diabetes self-care recommendations, among adults with diabetes.RESEARCH DESIGN AND METHODS -We used three data sets of adult type 1 and type 2 diabetic patients to examine psychometric properties of the SCI-R. Principal component and factor analyses examined whether a general factor or common factors were present. Associations with measures of theoretically related concepts were examined to assess SCI-R concurrent and convergent validity. Internal reliability coefficients were calculated. Responsiveness was assessed using paired t tests, effect size, and Guyatt's statistic for type 1 patients who completed psychoeducation.RESULTS -Principal component and factor analyses identified a general factor but no consistent common factors. Internal consistency of the SCI-R was ␣ ϭ 0.87. Correlation with a measure of frequency of diabetes self-care behaviors was r ϭ 0.63, providing evidence for SCI-R concurrent validity. The SCI-R correlated with diabetes-related distress (r ϭ Ϫ0.36), self-esteem (r ϭ 0.25), self-efficacy (r ϭ 0.47), depression (r ϭ Ϫ0.22), anxiety (r ϭ Ϫ0.24), and HbA 1c (r ϭ Ϫ0.37), supporting construct validity. Responsiveness analyses showed SCI-R scores improved with diabetes psychoeducation with a medium effect size of 0.62 and a Guyatt's statistic of 0.85.CONCLUSIONS -The SCI-R is a brief, psychometrically sound measure of perceptions of adherence to recommended diabetes self-care behaviors of adults with type 1 or type 2 diabetes. Diabetes Care 28:1346 -1352, 2005T o prevent serious morbidity and mortality, diabetes treatment requires dedication to demanding self-care behaviors in multiple domains, including food choices, physical activity, medications, glucose monitoring, and symptom management (1,2). Because no universally accepted regimens incorporating all of these domains exist for the treatment of diabetes, assessment of selfcare behaviors is extremely challenging (3,4) and remains a critical problem for clinical care and research. Although clinicians and researchers require a simple, practical method of assessing self-care behaviors, there are few easy-to-use instruments with established psychometric properties (3). Most methods to assess self-care behaviors rely on patient memory, using time-intensive interviews of behavior recall over a specific time period, typically 24 h (5) or 1 week (6), or using surveys covering the previous week (7). Another approach uses patients' reports of frequency of specific self-care behaviors (7), but such measures may not take into account differences in patients' prescriptions for diabetes care. The Self-Care Inventory (SCI) developed by La Greca and colleagues (8,9) is a self-report questionnaire assessing patients' perceptions of self-care behaviors. Self-care is defined as the daily regimen tasks that the individual performs to manage diabetes. The SCI, unlike measures that assess the frequency of self-care behaviors,...

Despite the pilot nature of the studies, the pattern of findings provided strong support for the responsiveness of the PAID. Information on responsiveness helps clinical researchers select measures, accurately estimate sample size to ensure adequate statistical power, and prioritize outcomes to be assessed.

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Bariatric surgery has emerged as an important tool in the fight against morbid obesity. However, reviewers have noted that there is a scarcity of long-term clinical surveillance data for bariatric surgery beyond 1-year follow-up and that a high percentage of patients are lost to follow-up, raising questions regarding the accuracy of current outcomes estimates. A meta-analysis of clinical reports providing bariatric surgery weight loss outcomes for morbidly obese patients was conducted over the period 2003-2007. Studies included were randomized controlled trials, nonrandomized controlled trials, and consecutive case series involving patients receiving either laparoscopic adjustable gastric banding (LAGB) or laparoscopic gastric bypass (LGB) surgery. Included studies involved n = 7,383 patients and were largely academic hospital-based (78.6%) and retrospective in design (71.4%). Weight loss outcome was defined by percent excess weight loss (%EWL). Composite estimates showed a significantly greater %EWL for LGB surgery (62.6%) compared to LAGB (49.4%). The superiority of LGB persisted at all three postsurgical time points examined (1, 2, and >3 years). Problems were identified regarding incomplete or suboptimal data reporting in many studies reviewed, and high patient attrition was evident at 2-year (49.8% LAGB, 75.2% LGB) and >3-year (82.6% LAGB, 89% LGB) end points. This meta-analysis confirms the superiority of LGB to LAGB in %EWL found in earlier studies. Although problems in study quality raised significant concerns regarding the validity of current weight loss estimates in this area, there was no evidence of publication bias.