中国2型糖尿病防治指南(2017年版)

  目的  了解河北省城镇中老年居民2型糖尿病患病现状及其影响因素,为开展糖尿病防控工作提供参考依据。  方法  采用多阶段分层整群随机抽样方法于2011年9月 — 2014年5月在河北省石家庄、保定、沧州、承德、邯郸、衡水、廊坊、唐山、邢台、张家口10个地区随机抽取13个社区共12 932名 ≥ 45岁城镇中老年居民进行问卷调查、血压测量和实验室检测。  结果  河北省12 932名 ≥ 45岁中老年城镇居民中,患糖尿病者3 019例,糖尿病患病率为23.35 %;多因素非条件logistic回归分析结果显示,年龄 ≥ 50岁、有糖尿病家族史、吸烟、饮酒、高血压、甘油三酯异常、低密度脂蛋白胆固醇异常和高密度脂蛋白胆固醇异常是河北省城镇中老年居民2型糖尿病患病的危险因素,文化程度初中及以上和体力劳动者是河北省城镇中老年居民2型糖尿病患病的保护因素。  结论  河北省城镇中老年居民2型糖尿病的患病率较高,年龄、文化程度、职业、有无糖尿病家族史、吸烟情况、饮酒情况及是否高血压、甘油三酯异常、低密度脂蛋白胆固醇异常和高密度脂蛋白胆固醇异常为该地区城镇中老年居民2型糖尿病患病的主要影响因素。     

Cardiovascular health in adults with type 1 diabetes

Adults with type 1 diabetes (T1D) are at risk for cardiovascular (CV) disease. Managing CV risk is an important prevention strategy. The American Heart Association has defined 7 factors for ideal CV health.The purpose of this 2016 secondary analysis was to assess the prevalence of 6 CV health factors in a sample of adults ≥ 18 (n = 7153) in the T1D Exchange Clinic registry.CV health factors include: hemoglobin A1c (HbA1c) < 7%, BMI < 25 kg/m², blood pressure < 120/80 mm Hg, total cholesterol < 200 mg/dL, non-smoking, and physical activity ≥ 150 min/week. HbA1c < 7% was substituted for the AHA health factor of fasting blood glucose. Frequencies of each factor were tabulated for the total sample and for each gender. Logistic regression examined variables associated with achievement of each CV health factor.The mean age was 37.14 ± 17 years. Mean HbA1c was 7.9 ± 1.5%, and duration was 19.5 ± 13.5 years. The majority (54%) were working full or part-time. Achievement of CV health factors in the whole sample ranged from 27% (HbA1c < 7%) to 94% nonsmoking. Achievement of some factors varied by gender. Common variables associated with several CV health factors included gender, education, employment, and T1D duration.This young sample exhibited low levels of some CV health factors, especially HbA1c and physical activity. Providers need to routinely assess and advise on management of all CV risk factors to prevent this common diabetes complication.     

Initial findings: primary diabetes care responsibility among emerging adults with type 1 diabetes post high school and move out of parental home

Background Emerging adults with diabetes are assuming diabetes care responsibility, graduating from high school and leaving their parental homes. We examined: (1) how diabetes care responsibility changed in relation to time (high school to post high school) and living situation (living independently or not of parents) and (2) the association of diabetes self‐efficacy, worry about hypoglycaemia, gender and glycaemic control with these changes in responsibility among emerging adults with type 1 diabetes. Methods During the last 6 months in high school (T1), 113 participants completed diabetes care responsibility (total, daily and non‐daily), diabetes self‐efficacy and worry about hypoglycaemia scales. Participants again completed the responsibility scales post high school graduation (T2). We used a linear mixed‐effects model with diabetes self‐efficacy, worry about hypoglycaemia, time since graduation, living situation, gender and glycaemic control as independent variables; and diabetes care responsibility (total, daily and non‐daily) as dependent variables. Moderation involving diabetes self‐efficacy, worry about hypoglycaemia, gender and glycaemic control was also tested. Findings Diabetes care responsibility increased over time for total (P < 0.001), daily (P= 0.002) and non‐daily (P < 0.001), but the associations of self‐efficacy and gender with diabetes care responsibility were moderated by living situation. Self‐efficacy was negatively related to total (P= 0.006), daily (P= 0.010) and non‐daily (P= 0.030) responsibility for those not living independently while positively related only to total responsibility (P= 0.028) for those living independently. Being female was positively related to total (P= 0.007) and non‐daily (P= 0.001) responsibility for those living independently. Conclusion Diabetes care responsibility increased from high school to post high school among these emerging adults with diabetes. There is a complex relationship between self‐efficacy, gender and responsibility related to living independently of parents for these youth.     

The Maastricht social participation profile: development and clinimetric properties in older adults with a chronic physical illness

Purpose  

To develop and test the Maastricht Social Participation Profile (MSPP), an instrument measuring the actual social participation by older adults with a chronic physical illness, in accordance with their own definition of social participation.     

Style, discourse and constraint in adjustment to chronic illness

This paper discusses the problem of adjustment to chronic illness in terms of the demands of the patient's body and the constraints of culture. Criticism is offered of explanations which reduce such adjustment to a form of functional adaptation, either to symptoms or to social expectations taken separately. The argument is made that social constraints are embodied in everyday conduct, while bodily changes are made sensible through meanings engendered within discourse. Utilising findings from a study of coronary patients and their spouses the paper describes differences between the situations of those who confront and oppose illness and those who modify their lives as they accommodate to it. A discussion is offered of the different transformations of illness experience as these relate to the role-settings of those concerned. This is used to set out a general thesis on style as a contextualisation of illness- experience, articulated in the co-ordination of bodily action and social categories.     

Sexual dysfunction and chronic illness: the role of flexibility in coping

Sexual dysfunction is common among individuals with chronic illnesses and is associated with distress and reduced quality of life. Because of the long-term, often irreversible nature of sexual dysfunction in chronic illness and limitations of pharmacological treatments, there is a need to understand cognitive and behavioral coping processes in this population. We present a model of coping with sexual dysfunction that focuses on the construct of flexibility, including the definition of sexual functioning and its centrality to overall self-concept. We describe how this model can be applied in a comprehensive approach to treating sexual dysfunction in individuals with chronic illnesses.     

Relationships and the development of transition readiness skills into early emerging adulthood for individuals with type 1 diabetes

The study examined how “transition readiness” skills develop from relationship processes with parents, friends, and healthcare providers. During their senior year of high school and one year later, participants (n = 217) with type 1 diabetes completed measures of transition readiness skills (Self-Management; Self-Advocacy), adherence, HbA1c, and relationships with providers (patient-centered communication), parents (monitoring/knowledge), and friends (knowledge/helpfulness) surrounding diabetes. Self-Management skills increased across time. Higher friend knowledge/helpfulness during emerging adulthood was associated with increased Self-Management skills. Adherence improved when relationships with providers and friends matched transition readiness skills, indicating that these relationships may facilitate transition skills in early emerging adulthood.     

Sibling empathy and behavioural adjustment of children with chronic illness

This study Investigated the relationship of healthy siblings’empathy to the psychosocial adjustment of children with a congenital heart disease (CHD) in 28 sibling dyads aged 3.5-11 years, as well as the perceived quality of sibling Interactions, reported by mothers and children with illness. As in previous studies, children with CHD were reported to have more behaviour problems in the clinical range than either siblings or normative populations. On the basis of a task unconnected with illness issues, siblings were assigned to a high or low empathy group. Children with illness, but not their mothers, saw the siblings with high empathy more positively than those with low empathy. However, the adjustment of the children with illness did not differ between high and low empathy groups. Findings suggest the need to seek children's points of view when studying psychosocial effects of paediatric conditions.     

Demographic, health, and behavioral factors associated with smoking in adults with type 1 or type 2 diabetes

OBJECTIVES: To identify demographic, health, and behavioral factors associated with smoking behavior in adults with diabetes. METHODS: Canadian adults 18+ years with type 1 (n=697) or type 2 (n=1621) were investigated. Logistic regression analyses were conducted separately for both diabetes subgroups. RESULTS: When comparing never versus ever smokers, never versus current smokers, and former smokers who quit versus current smokers, similarities and differences for demographic, health, and behavioral factors were found for the 2 diabetes subgroups. CONCLUSIONS: Diabetes type, demographic, health, and behavioral factors should be considered when tailoring smoking cessation and prevention programs.     

Patient experiences with information in a hospital setting: Associations with coping and self-rated health in chronic illness

The structural relations between patient experiences with information provided by hospital staff, coping behaviour and changes in self-rated health were studied in a cohort of people with chronic illness (n = 556) over a period of 2 years. A structural equation approach was applied to model cross-sectional and longitudinal effects. Positive experiences with information were cross-sectionally but not longitudinally associated with improved self-rated health. Patient experiences with information are not related to avoidance coping, but positive experiences contribute to more frequent use of supportant coping. The findings in the present study indicate that measures of patient experiences with information are not merely a reflection of patients’ health or coping behaviour. More theoretical work is required to describe the relationships between different patient reported outcomes. The insight into mechanisms underlying changes in physical and mental health in chronic illness could be further improved by evaluating the effects of specific educational and psychosocial interventions in a longitudinal design.     

Patients' lay expertise in chronic self‐care: a case study in type 1 diabetes

Background

The impact of chronic diseases in our society is growing. The idea of self‐care generates understandable enthusiasm and is seen as a natural answer. It is important to develop an understanding of self‐care practices that goes beyond a clinical understanding of the disease and that acknowledges everyday practicalities, and the perspective of the patient.

Objective

To shed light on some of the practicalities of everyday chronic self‐care, to expose to analysis the key role of lay expertise and to stress the importance of its recognition in future chronic care practices and technology.

Design

Ethnomethodological investigations based on observations of a patient support group (10 months) and some shadowing sessions of everyday practices, semi‐structured interviews with individuals with type 1 diabetes (n = 14) and professional caregivers (n = 7).

Analysis

The qualitative data analysis was inspired by grounded theory and aimed at ordering data under emerging categories and topics.

Results

The patient''s knowledge and expertise is critical to grounding, integrating and complementing technical‐medical/clinical knowledge in everyday chronic self‐care. To deal with the intricacies and difficulties of everyday chronic self‐care, individuals with type 1 diabetes develop different ways of knowing and dealing with the disease that need to be equally taken into account in the reorganization of care delivery, and in the design of the tools to support it.

Conclusion

Rethinking the traditional separation between hard and soft data may be a possible first step towards rethinking the role of lay expertise in chronic care towards better supports for self‐care practices and patient empowerment.     

Disruptive illness contexts and liminality in the accounts of young people with type 1 diabetes

We utilise Bury's (1982) biographical disruption to examine young people's experiences of type 1 diabetes. Our findings show that young adults adopted various ‘subject positions’ across different illness contexts. The subject positions deployed are intended to produce a particular kind of normal embodied identity unaffected by diabetes. First, participants concealed their illness in public spaces and challenged cultural stereotypes of diabetes to maintain a normal illness biography. Disruption was ever present and required careful negotiation to avoid exposure of illness in public. Young adults upheld a ‘normal public presentation’. Second, they resisted the medical system's pressure to adhere to glucose targets asserting and maintaining a subject position of ‘independent and autonomous young adults’. Here, disruption was transient and temporary, present in the clinic but not always beyond. It remained in the background for much of the time until it was reinforced by parents or at meal times. Third, young adults acquired a ‘pragmatic subject position’ with diabetes viewed as complex but manageable, no longer a target for resistance. Frank's (1995) ‘narrative restitution’ is adopted to describe the transition to life with ‘normal’ illness. We argue that illness experience was ‘liminal’ and reflected the subject positions adopted by young adults.     

Stress and coping in the explanation of psychological adjustment among chronically ill adults

This study evaluates the utility of a stress and coping paradigm for explaining individual differences in psychological adjustment to chronic illness. Using data from the first wave of a longitudinal study of 170 middle-aged and elderly adults faced with one of four chronic illnesses (hypertension, diabetes mellitus, cancer and rheumatoid arthritis), this paper examines the relationship between the stresses of chronic illness and coping, and the ability of coping to explain psychological adjustment. Results show coping strategy use tends to be minimally explained by medical diagnosis. Cognitive strategies, including information seeking, are related to positive affect while emotional strategies, particularly those involving avoidance, blame and emotional ventilation, are related to negative affect, lowered self-esteem and poorer adjustment to illness. While the findings suggest that a stress and coping model may be valuable in understanding adjustment among the chronically ill, the general modesty of coping effects and the failure of the stress buffering hypothesis to explain adjustment indicates a need for new research approaches and some modification of current theories of coping.     

Concerns of children with a chronic illness: a cognitive-developmental study of juvenile diabetes

Chronically ill children become increasingly able to understand their illnesses as they develop intellectually. But cognitive development also brings the ability to grasp the meaning of a poor prognosis or functional limitations, which may take an emotional toll on the youngster. We studied this problem in a sample of children with insulin-dependent diabetes. Those who had more advanced disease concepts were more worried about their diabetes. Children saw their parents as worried primarily about current management of the disease, suggesting that youngsters' concerns about the future were difficult to discuss at home. There is a need for clinicians and parents to integrate emotional support into the education and management of chronically ill children.     

Cigarette smoking behaviors among adults with serious mental illness in a nationally representative sample

PurposeThis study updates nationally representative information on cigarette smoking behaviors among adults with mental illness, particularly serious mental illness (SMI), to serve as a new benchmark for smoking cessation initiatives.MethodsData are from the 2008–2012 National Surveys on Drug Use and Health. Prevalence estimates for past month daily smoking, heavy smoking, mean cigarettes consumed per day, nicotine dependence, past month quit ratio, and proportion of cigarettes consumed are presented by mental illness status.ResultsAdults with SMI were more likely than adults with any mental illness (AMI) but not SMI and adults without mental illness to engage in smoking behaviors. Adults with AMI but not SMI were more likely to engage in all smoking behaviors compared with adults without mental illness. The past month quit ratio was significantly lower among adults with SMI and among adults with AMI but not SMI than among adults without mental illness. Adults with SMI comprised 6.9% of past month smokers but consumed 8.7% of all cigarettes.ConclusionsAdults with mental illness engage in more smoking behaviors and are less likely to quit than adults without mental illness. In this high-risk population, continued efforts to promote smoking cessation are needed.     

An audit of diabetes control, dietary management and quality of life in adults with type 1 diabetes mellitus, and a comparison with nondiabetic subjects

OBJECTIVES: The study's objective was to audit current diet and disease management in a community-based sample of people with type 1 diabetes. METHODS: The study involved adults with type 1 diabetes and control subjects. Reported amounts of dietary intake were collected. Indices of diabetes control were determined by standard methods. Quality of life of both groups was assessed with appropriate measures. Results were compared between two groups. RESULTS: Mean HbA(1c) concentration was 8.5% (SD 2.21%) for women with diabetes and 8.6% (SD 1.91%) for men. There was no significant difference between the diabetic and control subjects in self-reported energy intake and macronutrient intake, with the exception that the contribution of saturated fatty acid to energy intake was higher in male controls than in male diabetics. There was no association between dietary intakes and glycemic control in diabetic subjects. Anthropometric measurements, blood pressure and plasma lipids in patients were within normal range and not significantly different from the controls. Plasma fibrinogen concentration was higher in patients. Diabetic subjects did not have a diminished quality of life. CONCLUSIONS: Dietary management in these patients was generally focused on controlling carbohydrate intake. Most had suboptimal diabetes control.