Mary de Groot

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https://hdl.handle.net/1805/11673

One in four patients with diabetes will experience depression in their lifetime which is associated with poorer outcomes, greater functional disability, and early mortality. Dr. Mary de Groot is a clinical psychologist whose research is focused on examining the mechanisms that link diabetes and depression as well as the development of accessible interventions to treat depression among adults and socio-economically and culturally diverse populations with diabetes.

Dr. de Groot’s Program ACTIVE (Adults Coming Together to Increase Vital Exercise) is a research study funded by the National Institute of Diabetes, Digestive Diseases and Kidneys within the National Institutes of Health. The study looks at a combination of cognitive behavioral therapy and exercise for individuals with type 2 diabetes to be used as a model of an interdisciplinary approach to the treatment of depression in diabetes.

Dr. de Groot has contributed more than 80 articles and presentations on the psychosocial aspects of type 1 and type 2 diabetes.

Dr. de Groot’s work on treatment of depression for those with diabetes is another example of how IUPUI faculty are TRANSLATING RESEARCH INTO PRACTICE.

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COVID-19 and Type 1 Diabetes: Addressing Concerns and Maintaining Control
(ADA, 2021-09) DiMeglio, Linda A.; Pediatrics, School of Medicine
The worldwide outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been an unprecedented pandemic. Early on, even as the signs and symptoms of coronavirus disease 2019 (COVID-19) were first characterized, significant concerns were articulated regarding its potential impact on people with chronic disease, including type 1 diabetes. Information about the basic and clinical interrelationships between COVID-19 and diabetes has rapidly emerged. Initial rapid reports were useful to provide alerts and guide health care responses and initial policies. Some of these have proven subsequently to have durable findings, whereas others lacked scientific rigor/reproducibility. Many publications that report on COVID-19 and “diabetes” also have not distinguished between type 1 and type 2 (1). Available evidence now demonstrates that people with type 1 diabetes have been acutely affected by COVID-19 in multiple ways. This includes effects from limited access to health care, particularly during lockdown periods, and increased morbidity/mortality in infected adults with type 1 diabetes compared with peers without diabetes.
Emotional Correlates of the COVID-19 Pandemic in Individuals With and Without Diabetes
(American Diabetes Association, 2022-01) Myers, Barbara A.; Klingensmith, Rachel; de Groot, Mary; Medicine, School of Medicine
OBJECTIVE To compare the mental health experiences associated with coronavirus disease 2019 (COVID-19) in adults with and without diabetes. RESEARCH DESIGN AND METHODS Between 29 May 2020 and 30 June 2020, 2,176 U.S. adults completed an online survey including demographics, COVID-19 experiences, depression (eight-item Patient Health Questionnaire) and anxiety (seven-item Generalized Anxiety Disorder) symptoms, perceived stress (10-item Perceived Stress Scale), resilience (Brief Resilience Scale), and diabetes-related distress (in participants with diabetes) (17-item Diabetes Distress Scale). RESULTS Mean age was 49.6 years (SD 16.9); participants were primarily women (80.0%) and White (88.3%), with an annual household income of ≥$60,000 (57.6%). One hundred reported a diagnosis of type 1 diabetes (4.6%), 304 type 2 diabetes (13.9%), and 145 prediabetes (6.6%). Nearly one-third (29.7%) indicated decreases in income attributable to the pandemic. Participants with type 1 diabetes had higher levels of diabetes distress than participants with type 2 diabetes (P < 0.05), with moderate severity in both groups. Participants with type 2 diabetes had significantly more comorbidities and COVID-19 risk factors than all other groups (all P < 0.01). After controlling for covariates, participants with type 2 diabetes reported significantly more depressive symptoms than those without diabetes (P < 0.05) and lower levels of resilience (P < 0.05). Subgroup analyses by sex and age indicated that women and younger adults, particularly those age 18–34 years, reported significantly more depression and anxiety symptoms, stress, and diabetes-related distress and lower levels of resilience than men and adults age ≥51 years. CONCLUSIONS In this naturalistic observational study, participants with type 2 diabetes reported more depression, lower resilience, and significantly more COVID-19 risk factors and medical comorbidities than participants without diabetes. Overall, our participants demonstrated worse depression and anxiety symptoms during compared with before the pandemic.
5-OR: Health Disparities in People with and without Diabetes during the COVID-19 Pandemic
(American Diabetes Association, 2021-06-01) Myers, Barbara A.; Klingensmith, Rachel; de Groot, Mary; Medicine, School of Medicine
Purpose: To characterize the psychosocial experiences of adults with (PWD) and without diabetes (ND) during the COVID-19 pandemic. US adults (2176) completed a web-based survey in May-June, 2020 and November-December, 2020, including demographics, COVID-19 exposure, diabetes-related distress (DDS-17), depressive symptoms (PHQ-8) and anxiety (GAD-7). At baseline, mean age was 49.6 years (S.D. = 16.9), 80% female, 88.3% White, with an annual household income of ≥ $60,000 (57.6%), type 2 diabetes (T2D; 301,13.9%), 145 prediabetes (145, 6.6%) and type 1 (T1D, 100, 4.6%). One-third (29.7%) reported decreased income due to the pandemic. T2Ds had more medical comorbidities and COVID risk factors than T1Ds and NDs (all p < 0.01). Mean PHQ-8 scores were 7.1 (S.D. = 5.8; mild), with the T2Ds (M = 7.7; S.D. = 5.9) exceeding NDs (M = 6.9; S.D. = 5.7; p<.001). Mean DDS-17 and GAD-7 scores were comparable for T1Ds and T2Ds (moderate level; p=NS). At 6 months (6MFU), 1,345 (62.6%) completed follow up surveys. Completers were more likely to be older, male, White, married, with higher education levels, and homeowners, with a greater proportion of medical comorbidities and lower A1cs at baseline than non-completers (all p<.05). 6MFU completers had lower baseline depressive symptoms and diabetes distress, lower household COVID-19 rates and less difficulty paying bills than non-completers (all p<.05). At 6MFU for all groups, depressive symptoms decreased (p<.0001) and financial strain improved (p<.001), while COVID exposure increased (personal and household, p<.001). Diabetes distress remained at a moderate level for T1Ds and T2Ds. T1Ds and T2Ds showed comparable levels of depressive symptoms to NDs but were more likely to report financial hardship (p<.05) and difficulty paying bills than NDs (p<.001). Health outcomes were worse for PWDs compared to NDs during the COVID-19 pandemic despite high SES protective factors. Persistent financial strain and diabetes distress increase the risk for future poor health outcomes.
Undiagnosed diabetes among immigrant and racial/ethnic minority adults in the United States: National Health and Nutrition Examination Survey 2011–2018
(Elsevier, 2020) Hsueh, Loretta; Wu, Wei; Hirsh, Adam T.; de Groot, Mary; Mather, Kieren J.; Stewart, Jesse C.; Psychology, School of Science
Purpose Undiagnosed diabetes disproportionately affects medically underserved groups. It is unknown whether being an immigrant confers additional risk for undiagnosed diabetes. The purpose of this study was to examine independent associations of immigrant status and race/ethnicity with the prevalence of diagnosed and undiagnosed diabetes in a U.S.-based population sample. Methods Respondents were 21,306 adults from the 2011–2018 National Health and Nutrition Examination Survey. Immigrant status was coded as foreign-born or U.S.-born. Six racial/ethnic categories were white, Black, Mexican American, other Hispanic, Asian, and other/multiracial. Self-report and laboratory data yielded a three-level diabetes status outcome: no diabetes (88%), diagnosed diabetes (10%), and undiagnosed diabetes (2%). Results Adjusted multinomial logistic regression models evaluating immigrant status and race/ethnicity as simultaneous predictors revealed that foreign-born (vs. U.S.-born) adults had a similar prevalence of diagnosed diabetes (OR = 0.98, 95% CI: 0.79–1.22, P = .84) but a higher prevalence of undiagnosed diabetes (OR = 1.54, 95% CI: 1.21–1.97, P = .004). Models showed that all racial/ethnic minority groups except the other/multiracial group (vs. whites) had a higher prevalence of diagnosed and undiagnosed diabetes (Ps < .04). Conclusions Immigrants and racial/ethnic minority adults have increased odds of undiagnosed diabetes, even after accounting for health insurance. These groups are likely at increased risk for diabetes complications because of prolonged periods of undetected diabetes.
50 Years of Behavioral Science in Diabetes: A 2020 Vision of the Future
(ADA, 2021) de Groot, Mary; Medicine, School of Medicine
Diabetes Risk Perception Among Immigrant and Racial/Ethnic Minority Adults in the United States
(Sage, 2019) Hsueh, Loretta; Peña, Juan M.; Hirsh, Adam T.; de Groot, Mary; Stewart, Jesse C.; Psychology, School of Science
Purpose The purpose of the study was to examine associations of immigrant and racial/ethnic status with diabetes risk perception among a population-based sample of US adults without diabetes. Racial/ethnic minorities are at increased risk of developing diabetes. Emerging research shows that immigrant (foreign born) individuals are also at increased risk, but less is understood about risk perception in this group. Methods Respondents were 11,569 adults from the NHANES (2011-2016; National Health and Nutrition Examination Survey) reporting no diabetes or prediabetes. Immigrant status was coded as foreign born or US born and analyses used NHANES racial/ethnic categories: white, black, Mexican American, other Hispanic, Asian, and other/multiracial. Immigrant status and variables comparing each minority group with whites were simultaneously entered into models predicting risk perception (yes/no), adjusting for demographic and diabetes risk factors. Results Being foreign born was associated with decreased odds of perceived risk, while being Mexican American, Asian, and other/multiracial were associated with increased odds of perceived risk. Discussion Foreign-born adults are less likely than US-born adults to report perceived risk for diabetes. Lower diabetes risk perception among immigrants could result in poorer preventative behaviors and later diabetes detection.
Longitudinal associations between depression and diabetes complications: a systematic review and meta‐analysis
(Wiley, 2019-12) Nouwen, Arie; Adriaanse, Marcel; van Dam, Kristina; Iversen, Marjolein M.; Viechtbauer, Wolfgang; Peyrot, Mark; Caramlau, Isabela; Kokoszka, Andrzej; Kanc, Karin; de Groot, Mary; Nefs, Giesje; Pouwer, François; Medicine, School of Medicine
To conduct a systematic review and meta‐analysis of longitudinal studies assessing the bi‐directional association between depression and diabetes macrovascular and microvascular complications. Embase, Medline and PsycINFO databases were searched from inception through 27 November 2017. A total of 4592 abstracts were screened for eligibility. Meta‐analyses used multilevel random/mixed‐effects models. Quality was assessed using the Newcastle‐Ottawa scale. Twenty‐two studies were included in the systematic review. Sixteen studies examined the relationship between baseline depression and incident diabetes complications, of which nine studies involving over one million participants were suitable for meta‐analysis. Depression was associated with an increased risk of incident macrovascular (HR = 1.38; 95% CI: 1.30–1.47) and microvascular disease (HR = 1.33; 95% CI: 1.25–1.41). Six studies examined the association between baseline diabetes complications and subsequent depression, of which two studies involving over 230 000 participants were suitable for meta‐analysis. The results showed that diabetes complications increased the risk of incident depressive disorder (HR = 1.14; 95% CI: 1.07–1.21). The quality analysis showed increased risk of bias notably in the representativeness of selected cohorts and ascertainment of exposure and outcome. Depression in people with diabetes is associated with an increased risk of incident macrovascular and microvascular complications. The relationship between depression and diabetes complications appears bi‐directional. However, the risk of developing diabetes complications in depressed people is higher than the risk of developing depression in people with diabetes complications. The underlying mechanisms warrant further research.
Joint international consensus statement for ending stigma of obesity
(Nature Research, 2020) Rubino, Francesco; Puhl, Rebecca M.; Cummings, David E.; Eckel, Robert H.; Ryan, Donna H.; Mechanick, Jeffrey I.; Nadglowski, Joe; Salas, Ximena Ramos; Schauer, Phillip R.; Twenefour, Douglas; Apovian, Caroline M.; Aronne, Louis J.; Batterham, Rachel L.; Berthoud, Hans-Rudolph; Boza, Camilo; Busetto, Luca; Dicker, Dror; de Groot, Mary; Eisenberg, Daniel; Flint, Stuart W.; Huang, Terry T.; Kaplan, Lee M.; Kirwan, John P.; Korner, Judith; Kyle, Ted K.; Laferrère, Blandine; le Roux, Carel W.; McIver, LaShawn; Mingrone, Geltrude; Nece, Patricia; Reid, Tirissa J.; Rogers, Ann M.; Rosenbaum, Michael; Seeley, Randy J.; Torres, Antonio J.; Dixon, John B.; Medicine, School of Medicine
People with obesity commonly face a pervasive, resilient form of social stigma. They are often subject to discrimination in the workplace as well as in educational and healthcare settings. Research indicates that weight stigma can cause physical and psychological harm, and that affected individuals are less likely to receive adequate care. For these reasons, weight stigma damages health, undermines human and social rights, and is unacceptable in modern societies. To inform healthcare professionals, policymakers, and the public about this issue, a multidisciplinary group of international experts, including representatives of scientific organizations, reviewed available evidence on the causes and harms of weight stigma and, using a modified Delphi process, developed a joint consensus statement with recommendations to eliminate weight bias. Academic institutions, professional organizations, media, public-health authorities, and governments should encourage education about weight stigma to facilitate a new public narrative about obesity, coherent with modern scientific knowledge.
Recruitment effort and costs from a multi-center randomized controlled trial for treating depression in type 2 diabetes
(BioMed Central, 2019-11-06) Myers, Barbara A.; Pillay, Yegan; Guyton Hornsby, W.; Shubrook, Jay; Saha, Chandan; Mather, Kieren J.; Fitzpatrick, Karen; de Groot, Mary; Medicine, School of Medicine
BACKGROUND: Participant recruitment for clinical trials is a significant challenge for the scientific research community. Federal funding agencies have made continuation of funding of clinical trials contingent on meeting recruitment targets. It is incumbent on investigators to carefully set study recruitment timelines and resource needs to meet those goals as required under current funding mechanisms. This paper highlights the cost, labor, and barriers to recruitment for Program ACTVE II, a successful multisite randomized controlled trial of behavioral treatments for depression in adults with type 2 diabetes, conducted in rural and urban settings in three states. METHODS: Quantitative and qualitative data on recruitment were gathered from study staff throughout the study recruitment period and were used to calculate costs and effort. The study utilized two main approaches to recruitment: (1) relying on potential participants to see ads in the community and call a toll-free number; and (2) direct phone calls to potential participants by study staff. RESULTS: Contact was attempted with 18,925 people to obtain the enrolled sample of 140. The cost of recruitment activities during the 4.5-year recruitment period totaled $190,056, an average cost of $1358 per enrolled participant. Qualitative evaluations identified multiple barriers to recruitment. CONCLUSIONS: Recruitment for Program ACTIVE II exemplifies the magnitude of resources needed to reach recruitment targets in the current era. Continuous evaluation, flexibility, and adaptation are required on the part of investigators, community partners, and funding agencies to successfully reach high-risk populations in rural and urban areas.
Implementing person-centered communication in diabetes care: a new tool for diabetes care professionals
(Dovepress, 2019-08-26) Connor, Ulla; Kessler, Lucina; de Groot, Mary; Mac Neill, Robert; Sandy, Robert; English, School of Liberal Arts
Purpose: This study tested the clinical implementation of the CoMac Communication System, an empirically validated tool for individualized Diabetes Self-Management Education and Support (DSMES). This system provides immediate feedback and guidance to health care providers (HCPs) to facilitate speaking with persons with type 2 diabetes mellitus in language reflecting patients' own worldviews and health beliefs. Patients and methods: This 6-month implementation science study at an accredited diabetes care clinic in a Midwestern US hospital was conducted in two phases. Phase I consisted of CoMac implementation, qualitative interviews with HCPs, and evaluation of clinic flow among the diabetes education team. Seventy-two participants received CoMac's linguistically tailored patient-centric communication; a control group of 48 did not receive this intervention. In Phase II, glycosylated hemoglobin A1c (HbA1c) levels from the first visit to the follow-up visit for each group were compared. Results: Interviews conducted during Phase I suggested that the system can be successfully implemented into DSMES practice. Knowing individual psychosocial profiles and participants' language use allowed for more effective patient counseling. In Phase II, multiple regression analysis with HbA1c change as the dependent variable showed that the key variable of interest, treated with the CoMac intervention, had a one-tailed t-value of -1.81, with a statistically significant probability value of 0.037. Conclusion: Findings suggest that use of the CoMac System by diabetes care professionals has the potential for improved patient health outcomes. Patients receiving the CoMac intervention showed significantly improved HbA1c levels, suggesting that this approach has great promise for effective DSMES management.

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