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Articles by F. J. Snoek
Total Records ( 4 ) for F. J. Snoek
  K. M. P. Van Bastelaar , F. Pouwer , P. H. L. M. Geelhoed-Duijvestijn , C. J. Tack , E. Bazelmans , A. T. Beekman , R. J. Heine and F. J. Snoek
  Objectives To investigate whether diabetes-specific emotional distress mediates the relationship between depression and glycaemic control in patients with Type 1 and Type 2 diabetes.
Research design and methods Data were derived from the baseline assessment of a depression in diabetes screening study carried out in three tertiary diabetes clinics in the Netherlands. Most recent glycated haemoglobin (HbA1c) measurement was obtained from medical records. The Centre for Epidemiologic Studies Depression Scale (CES-D) and Problem Areas in Diabetes scale (PAID) were used to measure depression and diabetes-specific emotional distress respectively. Linear regression was performed to examine the mediating effect of diabetes–distress.
Results Complete data were available for 627 outpatients with Type 1 (= 280) and Type 2 (n = 347) diabetes. Analyses showed that diabetes–distress mediated the relation between depression and glycaemic control and not differently for both disease types. Post-hoc analyses revealed that patients depressed and distressed by their diabetes were in significantly poorer glycaemic control relative to those not depressed nor distressed (HbA1c 8.7 ± 1.7 vs. 7.6 ± 1.2% in those without depressive symptoms, 7.6 ± 1.1% in depressed only and 7.7 ± 1.1% in the distressed only, < 0.001). Depressed patients without elevated diabetes-distress did not show a significantly increased risk of elevated HbA1c.
Conclusions In explaining the association between depression and glycaemic control, diabetes-specific emotional distress appears to be an important mediator. Addressing diabetes-specific emotional problems as part of depression treatment in diabetes patients may help improve glycaemic outcomes.
  F. Pouwer , P. H. L. M. Geelhoed-Duijvestijn , C. J. Tack , E. Bazelmans , A.-J. Beekman , R. J. Heine and F. J. Snoek
  Aims: Depression is common in diabetes, but the scope of the problem and associated correlates are not well established in specialist diabetes care. We aimed to determine the prevalence of depression among adult outpatients with Type 1 (T1DM) or Type 2 diabetes (T2DM) using both self-report measures and a diagnostic interview, and to establish demographic and clinical characteristics associated with depressive affect.Methods: A random sample of 2055 diabetes out-patients from three diabetes clinics was invited to participate. Depressive affect was assessed using the World Health Organization-5 Well Being Index (WHO-5), the Centre for Epidemiologic Studies-Depression scale (CESD) using predefined cut-off scores, and depressive disorder with the Composite International Diagnostic Interview (CIDI). Associations between depression and patient characteristics were explored using regression analyses.Results: Seven hundred and seventy-two patients completed the depression questionnaires. About one-third of T1DM patients and 37–43% of T2DM patients reported depressive affect (WHO-5). The prevalence of depressive affect (CESD) was 25% and 30% for men and women with T1DM, and 35% and 38% for men and women with T2DM, respectively. Based on the CIDI, 8% of T1DM patients (no gender difference) and 2% of men and 21% of women with T2DM suffered from a depressive disorder. Depressive affect was associated with poor glycaemic control and proliferative retinopathy in T1DM, while non-Dutch descent, obesity and neuropathy were correlates in T2DM.Conclusions: Depressive symptoms and major depressive disorder constitute a common comorbid problem among Dutch out-patients with T1DM or T2DM and appear particularly common in migrants and women with T2DM.
  T. R. S. Hajos , F. Pouwer , R. de Grooth , F. Holleman , J. W. R. Twisk , M. Diamant and F. J. Snoek
  Aims  To study prospectively the impact of initiating insulin glargine in suboptimally controlled insulin-naive patients with Type 2 diabetes on health-related quality of life in relation to glycaemic control. Methods  Insulin-naive Dutch patients with Type 2 diabetes in suboptimal glycaemic control (HbA1c > 53 mmol/mol; 7%) on maximum dose of oral glucose-lowering medications were included from 363 primary care practices (n = 911). Patients started insulin glargine and were followed up for 6 months. At baseline (start insulin therapy), 3 and 6 months, HbA1c was measured and patients completed self-report health-related quality of life measures, including emotional well-being (World Health Organization-5 well-being index), fear of hypoglycaemia (Hypoglycaemia Fear Survey) and diabetes symptom distress (Diabetes Symptom Checklist−revised). Data were analysed using generalized estimating equations analysis. Results  HbA1c (mmol/mol; %) decreased from 69 ± 16; 8.5 ± 1.7 to 60 ± 11; 7.6±1.0 and 57 ± 11; 7.3 ± 1.0 at 3 and 6 months, respectively (P < 0.001). Pre-insulin BMI (kg/m2) was 30 ± 5.7, which remained stable at 3 months (30 ± 5.8) and increased to 31 ± 5.9 at 6 months (P = 0.004); no significant changes in self-reported symptomatic and severe hypoglycaemia were observed, while nocturnal hypoglycaemia slightly decreased. The Hypoglycaemia Fear Survey score decreased from 14.6 ± 16.2 to 12.1 ± 15.2 and 10.8 ± 14.4 at 3 and 6 months, respectively (P < 0.001). The Diabetes Symptom Checklist−revised score decreased from 15 ± 14 to 10 ± 12 and 10 ± 13 (P < 0.001), with most pronounced reductions in hyperglycaemic symptoms and fatigue. The World Health Organization-5 score increased from 57 ± 25.3 to 65 ± 21.6 at 3-month follow-up and 67 ± 21-8 at 6-month follow-up (P < 0.001). Conclusions  Results of this observational study demonstrate combined glycaemic and health-related quality of life benefits of initiating insulin glargine in patients with Type 2 diabetes in routine primary care.
  M Belendez , M de Wit and F. J. Snoek

To identify and evaluate psychometric properties of available measures to assess dimensions of parent-adolescent partnership in diabetes care, including parent-adolescent responsibility in diabetes management, parental monitoring, diabetes family conflict, and parental involvement.


A literature review that included searches of electronic databases from 1990 to April 2009 was conducted. Instruments were reviewed extracting information about aim, target population, and psychometric properties.


Eight instruments were identified. Study samples appear to be large enough for psychometric validation but with a small proportion of fathers. The instruments have been designed and evaluated with adolescents and parents in the United States. Most of the instruments have adequate reliability, both for adolescents’ and parents’ forms. Regarding construct validity, factor structure of most of the instruments was evaluated either with exploratory factor analysis or confirmatory factor analysis. In addition, some measures have significant relationships with age in the direction expected or with other outcomes such as adherence or quality of life. Finally, all the reviewed studies are cross-sectional and have not yet addressed predictive validity or instrument responsiveness.


Valid measures tapping into aspects of diabetes-related adolescent-parent partnership are available, but longitudinal studies are needed to determine if the instruments are able to detect clinically significant change (eg, impact on metabolic control, adherence, quality of life). Rather than develop new measures, refinement and further validation of existing instruments is suggested.

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