A study of 81 male veterans with diabetes showed that 61% of them exhibited clinically significant apathy, a psychological condition that might predict adherence to diabetic self-care.
“Clinicians and educators may want to screen for apathy routinely in clinical care of patients with diabetes, especially in patients with poor [glycemic] control,” Dr. Prasad R. Padala, of the Veterans Affairs Medical Center, Omaha, Neb., and colleagues wrote in the January issue of Diabetes Research and Clinical Practice.
The study was conducted by recruiting 100 patients from a diabetes clinic at the medical center. Each person was tested for evidence of depression and took three psychological tests–the Apathy Evaluation Scale (clinician version), the Hamilton Rating Scale for Depression, and the Self-Care Inventory, which rates adherence to diabetes management recommendations (Diabetes Res. Clin. Pract. 2008;79:37-41). Data from those tests were then correlated with patient demographic and laboratory data.
The average age of the 81 patients analyzed for the study was 59 years. Ninety-four percent were male, 88% were white, 11% were African American, and 1 patient was Hispanic; 19 patients found to be depressed were excluded from the study.
The cross-sectional study recorded a mean score on the Apathy Evaluation Scale of 36, and 50 of the 81 patients had a score above 30, which is the cutoff for clinically significant apathy.
Apathy was associated with a higher body mass index (34 kg/m
A statistically significant association between apathy and hemoglobin A1c level was not found, though there was a trend (8.3% in those with apathy vs. 7.64% in those without), Dr. Padala added.
Studies of other conditions, such as multiple sclerosis and parkinsonism, have suggested that apathy is a common feature of several chronic illnesses.
Apathy is characterized by a lack of initiative and motivation, emotional indifference, and decreased social engagement, the study said.
For clinicians who might want to screen patients with diabetes for apathy, the test that the study used takes too long to administer in a busy office. However, there is a short set of basic screening questions from an inventory developed for neuropsychiatric evaluation that clinicians can use (Neurology 1994;44:2308-14), Dr. Padala wrote.
The questions, which can be asked of either the patient or a caregiver, are: Has the patient lost interest in the world around him/her? Has he/she lost interest in doing things or does he/she lack motivation for starting new activities? Is he/she more difficult to engage in conversation or in doing chores? Is the patient apathetic or indifferent? A yes answer to any of those questions would call for more detailed testing.