青少年1型糖尿病患者心理韧性与其身心状况的关系研究

目的 探讨青少年1型糖尿病患者心理韧性现状及与血糖控制、糖尿病痛苦和生活质量的关系.方法 采用便利抽样法,选取2019年2月—2020年9月在南京市两所三级甲等医院门诊复诊或病房住院的360例青少年1型糖尿病患者作为调查对象.使用青少年糖尿病优势与韧性量表、5条目糖尿病痛苦量表、中文版简易青少年糖尿病生活质量量表及一般...     

Review of diabetes: Identification of markers for early detection,glycemic control,and monitoring clinical complications

The hallmark of diabetes mellitus, whether type I or type II, is hyperglycemia. Clinical complications associated with diabetes are most likely the consequence of hyperglycemia via both altered metabolic pathways and nonenzymatic glycation of proteins. The nonenzymatic glycation of proteins is accelerated in diabetes due to elevated blood glucose concentration. The Amadori product of nonenzymatic glycation will further crosslink with other proteins to form advanced glycosylation end products (AGEs). The reaction of AGEs with long-lived proteins, such as collagen, and the uptake of AGEs by the receptors on macrophages, endothelial cells, and platelets are major reasons for the development of various clinical complications in diabetes. Several markers have been identified for the screening, diagnosis, and monitoring of the disease. Autoantibodies against beta cells are the best markers for mass screening and for early detection of type I diabetes. In addition to glycated hemoglobin, AGEs and blood glycated proteins of various half-lives could be used for monitoring glycemic control. Several abnormal metabolites have been identified as potential markers for monitoring the severity of various clinical complications. The most interesting findings in diabetic markers could be AGEs. The amount of AGEs found in the tissues could be related to the extent of micro- and macrovascular damage and might prove useful for monitoring the treatment of patients at early stages of either nephropathy, atherosclerosis, retinopathy, or neuropathy. © 1993 Wiley-Liss, Inc.     

Diabetes knowledge and glycemic control among Chinese people with type 2 diabetes

BACKGROUND: Diabetes self-management education (DSME) is a key component of effective glycemic control and an important part of clinical diabetes management. The effects of DSME in China have not been investigated. OBJECTIVES: To identify factors that could enhance the quality of Chinese DSME programmes. The relationship between patients' diabetes knowledge and their glycemic control was explored. METHODS: A non-experimental cross-sectional study was undertaken in a large Shanghai hospital in China. Forty inpatients and 60 outpatients with type 2 diabetes mellitus were recruited. A Chinese version of the Diabetes Knowledge Scale was used to assess subjects' diabetes knowledge and collect demographic data and HbA1c levels. RESULTS: The mean diabetes knowledge scores among Chinese with type 2 diabetes was 22.1 +/- 3.76 out of a possible 30 marks. There was no difference in overall diabetes knowledge in people with HbA1c <7%, indicating good control and those with HbA1c >or=7%, indicating suboptimal glycemic control (t = -0.811, P = 0.419). However, there were differences in scores between the two groups for some specific questions on sick day management and food substitution. Moreover, sociodemographic characteristics such as age and occupation were significantly correlated with diabetes knowledge; age was negatively correlated with diabetes knowledge and white-collar workers had the highest mean knowledge score and housewives the lowest. CONCLUSION: Sociodemographic characteristics need to be considered when developing diabetes self-management programmes for Chinese people with type 2 diabetes.     

Food insecurity and glycemic control among low-income patients with type 2 diabetes

OBJECTIVE

To determine whether food insecurity—the inability to reliably afford safe and nutritious food—is associated with poor glycemic control and whether this association is mediated by difficulty following a healthy diet, diabetes self-efficacy, or emotional distress related to diabetes.

RESEARCH DESIGN AND METHODS

We used multivariable regression models to examine the association between food insecurity and poor glycemic control using a cross-sectional survey and chart review of 711 patients with diabetes in safety net health clinics. We then examined whether difficulty following a diabetic diet, self-efficacy, or emotional distress related to diabetes mediated the relationship between food insecurity and glycemic control.

RESULTS

The food insecurity prevalence in our sample was 46%. Food-insecure participants were significantly more likely than food-secure participants to have poor glycemic control, as defined by hemoglobin A_1c ≥8.5% (42 vs. 33%; adjusted odds ratio 1.48 [95% CI 1.07–2.04]). Food-insecure participants were more likely to report difficulty affording a diabetic diet (64 vs. 49%, P < 0.001). They also reported lower diabetes-specific self-efficacy (P < 0.001) and higher emotional distress related to diabetes (P < 0.001). Difficulty following a healthy diet and emotional distress partially mediated the association between food insecurity and glycemic control.

CONCLUSIONS

Food insecurity is an independent risk factor for poor glycemic control in the safety net setting. This risk may be partially attributable to increased difficulty following a diabetes-appropriate diet and increased emotional distress regarding capacity for successful diabetes self-management. Screening patients with diabetes for food insecurity may be appropriate, particularly in the safety net setting.The epidemic of type 2 diabetes has hit the poor particularly hard. Low socioeconomic status is associated with a higher prevalence of diabetes and a greater risk for diabetes complications (1–3). There are likely many specific elements of poverty that predispose adults to diabetes and poor diabetes control, but a great number of these potentially predisposing factors have not been fully investigated.Food insecurity has been postulated as one mechanism by which poverty might predispose adults of low socioeconomic status to poor diabetes control (4). Food insecurity refers to going hungry or being at risk for going hungry because of the inability to afford food. It exists “whenever the availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways [e.g., without resorting to emergency food supplies, scavenging, stealing, or other coping strategies] is limited or uncertain” (5). In 2010, 14.5% of U.S. households were food-insecure, representing 32 million adults (6).A recent study conducted with a nationally representative sample (National Health and Nutrition Examination Survey) of low-income adults found that among patients with a known diagnosis of diabetes, 69% of food-insecure and 49% of food-secure adults were unable to achieve a hemoglobin A_1c (HbA_1c) ≤7% (7). Studies among children with type 2 diabetes have demonstrated higher HbA_1c values among children living in food-insecure households compared with children living in food-secure households (8). However, the association between food insecurity and glycemic control has not been evaluated in clinical populations of adult patients with diabetes, and mechanisms for a relationship between food insecurity and glycemic control remain unclear.Food insecurity is a multidimensional concept, encompassing reductions in food quantity and food quality. Other studies suggest that food insecurity may increase patients’ difficulty following a diabetes-appropriate diet because they shift their dietary intake toward inexpensive, calorically dense foods, which generally include a high proportion of added fats, added sugars, and other refined carbohydrates, to maintain caloric needs (9). These foods generally make glycemic control more difficult to achieve. However, we hypothesized that additional mechanisms existed by which food insecurity may directly influence glycemic control. For example, food insecurity may reduce self-efficacy, defined as confidence in one’s ability to successfully manage all of the things necessary to take care of one’s own health, or it may increase emotional distress regarding diabetes management. Reduced self-efficacy and emotional distress related to diabetes may both interfere with patients’ ability to manage their diabetes (10–13).Our objective was to determine whether food insecurity was independently associated with poor glycemic control in a clinical population of low-income adults with diabetes. We hypothesized that the association between food insecurity and glycemic control would be mediated by increased difficulty following a healthy diet, decreased diabetes-specific self-efficacy, and greater emotional distress related to diabetes among the food-insecure participants.     

Monitoring glycemic control: the cornerstone of diabetes care

BACKGROUND: Diabetes mellitus is associated with significant morbidity and mortality and escalating costs, and its prevalence is increasing to epidemic proportions. Studies have consistently documented the importance of glycemic control in delaying the onset and decreasing the incidence of both the short- and long-term complications of diabetes. Although glycemic control is difficult to achieve and challenging to maintain, its impact on disease outcomes is well worth the effort. OBJECTIVE: This article reviews the importance of monitoring and tightly controlling blood glucose concentrations in patients with diabetes and the methods and tools available for achieving these goals. METHODS: This clinical review was developed using 102 a MEDLINE search of the literature from 1990 to 2005 using the terms diabetes, glucose control, glucose monitoring, A(1c), and hypoglycemia. RESULTS: The complications of diabetes can be prevented or sharply curtailed through tight glycemic control, which requires frequent monitoring of blood glucose levels, careful attention to diet and exercise, and the use of medications. The progressive nature of diabetes imposes the need for frequent and regular monitoring, leading to data-driven adjustments to therapy to maintain optimal glucose levels. Failure to achieve glycemic control is often the result of a failure to educate the patient about how to monitor blood glucose levels and the importance of accuracy in doing so. CONCLUSIONS: Tight glycemic control requires an 102 educated and motivated patient, an appropriate treatment regimen, vigilant monitoring, and a close partnership between the patient and a multidisciplinary team of health care professionals to ensure accurate monitoring and appropriate actions. The growing array of monitoring devices contributes to this effort by providing increased convenience and accuracy.     

Factors associated with glycemic control and diabetes self-care among outpatients with schizophrenia and type 2 diabetes

We investigated the influence of the severity of schizophrenia on diabetes self-care and glycemic control among outpatients with schizophrenia and diabetes. We conducted interviews with 38 participants and reviewed their clinical charts. The mean hemoglobin A1c (HbA1c) level in the full study population was 7.65%. There was no difference in the HbA1c level between two groups of subjects classified by the severity of schizophrenia. Some diabetes self-care indicators were significantly lower in patients with high Brief Psychiatric Rating Scale scores (P < .05). Although psychotic symptoms do not appear to affect glycemic control, psychotic symptoms might affect diabetes self-care behaviors in people with schizophrenia.     

Relationship of skin thickness to duration of diabetes, glycemic control, and diabetic complications in male IDDM patients

Skin thickness is primarily determined by collagen content and is increased in insulin-dependent diabetes mellitus (IDDM). We measured skin thickness in 66 IDDM patients aged 24-38 yr and investigated whether it correlated with long-term glycemic control and the presence of certain diabetic complications. With univariate analysis, skin thickness was increased and significantly related to duration of diabetes (P less than .001), previous glycemic control (P less than .001), retinopathy (P less than .001), cheiroarthropathy (P less than .001), and vibration-perception threshold (P less than .05). There was a negative correlation between forced expiratory volume at 1 s (P less than .05) and vital capacity (P less than .05) with duration of diabetes. Neither skin thickness nor ankle arteriomedial wall calcification correlated with abnormal autonomic function tests. When corrected for duration of diabetes, there was a weak correlation between skin thickness and glycemic control (P less than .05) but no correlation with retinopathy, cheiroarthropathy, and vibration-perception threshold. This study confirms that there are widespread connective tissue changes in diabetes mellitus, although the biochemistry needs further elucidation.     

Dietary pectin and glycemic control in diabetes

Seventeen diabetic subjects requiring insulin and who exhibited glycemic stability over a 9-12-mo control period received 5 g of pectin with each meal and at bedtime for 3 mo. Hemoglobin A1c (HbA1c) and glycosylated serum protein were measured in each patient on multiple occasions to assess glycemic control. No clear-cut change in these measurements occurred during the period of pectin ingestion. These data are not consistent with a beneficial effect of high-pectin diets in people with diabetes.     

Perioperative glycemic control and the risk of infectious complications in a cohort of adults with diabetes.

OBJECTIVE: Although hyperglycemia is hypothesized to increase the short-term risk of infection, this hypothesis has not been well tested in a clinical setting. This study was designed to assess the relationship of perioperative glycemic control to the subsequent risk of infectious complications. RESEARCH DESIGN AND METHODS: A total of 411 adults with diabetes who underwent coronary artery surgery from 1990 to 1995 in the cardiac surgery service of an urban university hospital were included in a nonconcurrent prospective cohort study based on chart review. Perioperative glycemic control was characterized by the mean of six capillary glucose measurements taken during the 36-h interval following surgery. The major outcomes studied were infections of leg and chest wounds, pneumonia, and urinary tract infections. RESULTS: Mean postoperative glucose levels ranged from 121 to 352 mg/dl and were divided into quartiles: quartile 1 (121-206 mg/dl), quartile 2 (207-229 mg/dl), quartile 3 (230-252 mg/dl), and quartile 4 (253352 mg/dl). After simultaneous adjustment for age, sex, race, underlying comorbidity, acute severity of illness, and the length of the stay in the surgical intensive care unit, patients with higher mean capillary glucose readings were at increased risk of developing infections. Compared with people in the lowest quartile of postoperative glucose, those in quartiles 2 (relative odds of infection [95% CI] = 1.17 [0.57-2.40]), 3 (1.86 [0.94-3.68]), and 4 (1.78 [0.86-3.47]) were at progressively higher risk for infection (P = 0.05 for trend). CONCLUSIONS: In patients with diabetes who undergo coronary artery surgery, postoperative hyperglycemia is an independent predictor of short-term infectious complications. Physicians should consider a glucose concentration target of < or =200 mg/dl to reduce the risk of infection.     

Exercise and glycemic control in diabetes: benefits, challenges, and adjustments to pharmacotherapy

Exercise, along with dietary intervention, represents first-line therapy for diabetes mellitus. Aerobic exercise is recommended for its beneficial effects on glucose control as well as its abilities to retard the progression of other comorbidities common in patients with diabetes, such as cardiovascular disease. The capability of aerobic exercise to improve glycemic control in diabetes is well documented, although adherence to exercise regimens is problematic. More recently, the glucose-lowering effects of resistance training have also been documented; this form of exercise has additional benefits, such as the capability to counteract sarcopenia, which is common in older people with type 2 diabetes. Exercise in people with diabetes, however, also can present significant challenges to glycemic control. Excessive glucose lowering can occur under certain conditions, enhancing the threat of hypoglycemia; in other situations, hyperglycemia can be accentuated. An understanding of the interactions between specific antidiabetic medications and various forms and intensities of exercise is essential to optimizing glycemic control while minimizing the potential for acute derangements in plasma glucose levels. Exogenous forms of insulin and agents that stimulate insulin secretion in a glucose-independent manner (such as sulfonylureas and glinides) increase the propensity for hypoglycemia during low- to moderate-intensity aerobic exercise. In contrast, exercise protocols characterized by high intensity are more likely to result in episodes of hyperglycemia. Strategies to minimize inappropriate swings in glycemic control are reviewed.     

Association between parental history of type 2 diabetes and glycemic control in urban African Americans

OBJECTIVE—The purpose of this study was to examine the association between parental history of type 2 diabetes and glycemic control among diabetic urban African Americans.RESEARCH DESIGN AND METHODS—Study participants included 359 African Americans with type 2 diabetes from Baltimore, Maryland, enrolled in Project Sugar 2. Participants underwent an interview-administrated questionnaire that asked about family history, sociodemographics, clinical characteristics, and knowledge and perception of adequate glycemic control. Regression analysis was used to determine the association between parental history of diabetes and glycemic control, as measured by A1C.RESULTS—In the comparisons between participants with and without a parental history of diabetes, those with a positive parental history tended to be younger, have higher glucose levels, and have higher blood glucose levels before calling a doctor (all P < 0.05). After adjustments for age, sex, and BMI, there was a significant association (P = 0.02) between A1C and parental history with the mean A1C difference between those with a positive and a negative parental history being 0.58%. However, after adjustment for duration of diabetes, the association was no longer significant (P = 0.11). However, there was a tendency for individuals with two diabetic parents to have higher A1C (P = 0.011).CONCLUSIONS—From these results, we conclude that among the urban African American participants who were aware of their parental history of diabetes, a positive parental history was associated with worse glycemic control, partly due to longer duration of diabetes. Parental history did not appear to be associated with better knowledge or perception of adequate glycemic control.Many studies have investigated risk factors for type 2 diabetes (1). For instance, it has been well established that family history of type 2 diabetes has been found to be associated with an increased risk of developing the disease (2,3). However, few studies have evaluated the effects of family history on poor glycemic control, which has been found to be associated with many serious complications among individuals living with type 2 diabetes (4,5). Consequently, family history continues to be underutilized in disease prevention (6,7) and not often considered after the initial disease diagnosis.Family history could have effects on glycemic control via genetic or behavioral mechanisms. For example, individuals with diabetes who have a parental history of type 2 diabetes may have worse glycemic control, in part due to the genetic risk factors of the disease, which may then influence the severity or duration of the condition. Alternatively, they could have better glycemic control, in part due to improved knowledge of the disease or health behaviors as a result of having affected family members. We conducted a study to quantify these effects and determine their overall effect on glycemic control.This study has important clinical practice implications. If glycemic control is associated with family history, it is possible that given a patient''s family history, clinicians will have insight into not only their risk of developing type 2 diabetes but also its severity.     

Diabetes pattern management: the key to diabetes self-management and glycemic control

Technological advances in home blood glucose monitors have no practical value unless the test results are recorded and used for pattern management. This systematic approach is central to the plan of care for patients with diabetes. Pattern management helps patients, caregivers, and referring physicians identify patterns in blood glucose readings, so treatment and/or lifestyle changes can be made without delay.