title: Impact of diabetic retinopathy on patients' beliefs about diabetes.
abstract: BACKGROUND
  The aim was to compare beliefs about diabetes and determine their associations with psychological well-being, self-management behaviour and glycaemic control in those with and without diabetic retinopathy (DR).
  
  
  METHODS
  We recruited 400 patients with diabetes aged 18 years or more from specialised eye clinics, as part of the Diabetes Management Project (DMP). Two-field retinal photographs were taken to assess DR and detailed clinical and psychological well-being examinations were performed following standardised procedures. Glycaemic control was determined using glycated haemoglobin levels. We assessed beliefs about diabetes (diabetes-specific version of the Revised Illness Perception Questionnaire [IPQ-R]), self-management behaviour (Summary of Diabetes Self Care Activities [SDSCA]) questionnaire) and depression and anxiety (the Hospital Anxiety and Depression Scale [HADS]).
  
  
  RESULTS
  Patients with DR (n = 256, 64 per cent) believed that they experienced more symptoms related to their diabetes, that diabetes had a greater impact on their life and that this condition was more unpredictable compared with those without DR (p < 0.05 for all). Patients with DR were also more engaged in glucose testing compared with those without DR. Furthermore, negative beliefs about diabetes were significantly associated with higher levels of depression and anxiety (p < 0.01) but not glycaemic control, regardless of DR and other diabetic complications.
  
  
  CONCLUSIONS
  Patients with DR had more negative beliefs about diabetes than those without. We identified strong and consistent associations between negative beliefs and psychological outcomes regardless of diabetic complications. These findings suggest that management for patients with DR could include strategies to address negative beliefs about diabetes and manage the emotional implications of diabetes in addition to medical treatment.
authors.affiliation: Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, The University of Melbourne, Melbourne, Australia.
authors.forename: Gwyn
authors.initials: G
authors.lastname: Rees
authors.forename: Muhammad B
authors.initials: MB
authors.lastname: Sasongko
authors.forename: Eva K
authors.initials: EK
authors.lastname: Fenwick
authors.forename: Theona E
authors.initials: TE
authors.lastname: Nicolaou
authors.forename: Tien Y
authors.initials: TY
authors.lastname: Wong
authors.forename: Ecosse L
authors.initials: EL
authors.lastname: Lamoureux
mesh_terms: D000328:Adult; D000368:Aged; D003469:Culture; D003930:Diabetic Retinopathy / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies