DAWN2: Findings from the Largest Global Study on the Psychosocial Side of Diabetes and Where to Go from Here
By Alexander Wolf
Twitter summary: Largest ever global study on pressing needs of people with #diabetes – our takeaways from DAWN 2
Short summary: The DAWN2 study is the largest global study on the psychosocial aspects of diabetes – emotional wellbeing, family dynamics, and more. The study surveyed people with diabetes, family members, and health care providers, giving a comprehensive view of the pressing needs in diabetes. In a recent Novo Nordisk webinar series, our team heard endocrinologist Dr. Anne Peters discuss the study’s results. A summary of the key findings is below.
Novo Nordisk’s Diabetes Education Exchange program recently broadcasted a webinar series highlighting the results from the 2nd Diabetes Attitudes, Wishes and Needs study. Initiated in 2011, the DAWN 2 study is the largest ever to explore the needs of people with diabetes – 15,438 participants from 17 countries, including patients, family members, and health care professionals. It focuses on the non-medical side of diabetes, such as family relationships, psychological well-being, and other factors that influence diabetes management.
As the name suggests, DAWN2 is the second iteration of the DAWN studies (DAWN1 was completed in 2001), and it aimed to look at the ever-growing definition of what it means to live with diabetes and shed light on the barriers patients face globally. Our team had the pleasure of listening to Dr. Anne Peters present, though the web series also featured presentations from other powerhouse health professionals such as Dr. Steve Edelman, Dr. Anthony Cannon, and Ms. Melissa Magwire. The study’s results are extensive, but below is our summary of the most eye-opening findings.
Pressing Needs for People with Diabetes
As we discussed in our learning curve on diabetes and depression, diabetes-related distress affects more people than does depression. Diabetes distress refers to the expected worries, concerns, or threats associated with diabetes. According to results from DAWN2, 45% of people with diabetes reported having diabetes-related distress, whereas 14% reported having depression. In terms of daily impact, most patients expressed that diabetes negatively affected their physical health (65% of respondents), following by emotional well-being (46%) and finances (44%).
For example, many respondents (39%) cited that their diabetes medication routine affects their ability to live a normal life. Not only do patients express these ‘psychosocial’ burdens, but they also report that these burdens often are ignored in their health care visits. Only 33% of respondents said a health care provider had asked them about anxiety or depression in the previous year, and less than half of the patients said they were asked about diet.
Unfortunately, these findings only highlight that health care providers often don’t have the training necessary to start these conversations. Furthermore, they increasingly have less time to address these important issues. One study from 2013 found that primary care physicians on average spend only about 18 minutes with a patient during visits, and a study from 2007 noted that, on average, a primary care physician will spend about five minutes on the “longest topic” of the visit (e.g., chest pain, diabetes, etc.) and then only allocate about one minute on every other topic. In short, that means that these delicate topics of mental well-being are often ignored or under-addressed in the standard visit.
On a positive note, 28% of people with diabetes reported that the disease has had a positive impact on at least one aspect of life, such as strengthening family relationships. As Dr. Peters advised, it’s important to figure out ways in which diabetes can be a positive in your life; identifying these silver linings may help cope with the downsides of the disease.
It’s All in the Family
Of course, diabetes does not just affect the individual patient – it affects the entire family. DAWN2 found that 35% of family members report a “moderate” or “very large” burden from caring for a relative with diabetes. What we found most critical, though, was that many family members admitted not knowing how to help. Nearly half of the respondents said they wanted to be more involved in their loved one’s diabetes management, but 37% of the total respondents said they didn’t know how to help. Dr. Peters suggested that family members could go to meetings with health care providers, dieticians, and other members of the person’s care team. As she points out, though, “family members tend to be as busy as health care providers,” making these in-person meetings hard to attend. We recommend family members check out the following resources below.
The Top 10 Things I Wish My Parents Knew When I Was Diagnosed with Type 1 Diabetes – our learning curve on what parents need to know about caring for a child with diabetes.
Children with Diabetes – the “online community for kids, families, and adults with diabetes.”
Family Communication with Diabetes – the American Diabetes Association’s resources on communicating about diabetes within a family.
Parents of Children with Diabetes - Diabetes Advocates Members as Resources – the Diabetes Advocates group lists other diabetes parents who can be helpful resources to other parents and family members.
Behavioral Diabetes Etiquette Card – For people who don’t have diabetes.
The DAWN2 report raises awareness of gaps in care and emphasizes that we need to find new ways to support patients. Many would argue this is not a new finding; still, it is valuable to see it reinforced. There is still certainly a very long way to go until people with diabetes get comprehensive care that goes beyond just A1c and physical health and addresses the very real mental and emotional challenges of living with the disease. The study’s authors hope that the DAWN2 findings will spur a conversation on addressing these needs and that future studies will continue to look at the progress made in these areas. For more information about the DAWN2 study results, please visit this page.