Symptoms of depression in patients with type II diabetes mellitus

Patients with type II diabetes mellitus were assessed for symptoms of depression using the Zung Self-Rated Depression Scale (Zung SDS) and the Beck Depression Inventory (BDI). The patients were classified according to the presence or absence of diabetic complications, and they were compared with a group of demographically matched, nonmedically ill control subjects. The patients with diabetic complications scored significantly higher on the depression inventories than did the patients without complications and the control subjects. Factor analysis of BDI responses revealed that cognitive symptoms of depression were prominent in the diabetic patients with complications. In this group, 74% of patients scored within the range of clinical depression on the BDI; 35% scored within the range of severe depression. Symptoms of sexual dysfunction were significantly correlated with symptoms of depression in diabetic women but not in diabetic men. The findings are discussed within the context of other research in the behavioral aspects of diabetes mellitus.     

A "family-based" approach to the treatment of obese type II diabetic patients

Forty-nine obese diabetic patients with obese spouses (diabetic or nondiabetic) were randomly assigned to an alone or together condition. Patients in the alone group participated by themselves in a 20-week behavioral weight control program; their spouses attended assessment sessions only. Patients in the together group attended the program with their spouses; both were targeted for weight loss and taught social support strategies. Weight losses of patients treated alone and together did not differ significantly at posttreatment (19.9 vs. 19.1 lb) or 1-year follow-up (11.6 vs. 7.0 lb). However, there was a significant interaction of treatment and gender; women did better when treated with their spouses, whereas men did better when treated alone. A "family-based" approach was not effective for these obese Type II diabetic patients as a whole but may be helpful for women.     

Cognitive-behavior modification: A conceptual review

Conceptual issues regarding cognitive-behavior modification are presented, beginning with an analysis of the basic terms of cognition, behavior modification, and behaviorism. Five controversies in the relevant literature that stimulated increased interest in cognitive factors among behavior therapists are reviewed: (a) symbolic control in classical and operant conditioning; (b) Breger and McGaugh's (1965) critique of behavior therapy; (c) cognitive factors in systematic desensitization; (d) the debate regarding cognition in the first issue of Behavior Therapy (1970); and (e) Ledwidge's (1978) Psychological Bulletin critique of cognitive-behavior modification. An analysis of several conceptual issues emerging from the literature results in the following conclusions: cognitive-behavior modification is a “revolutionary” development only insofar as it extends beyond mediational behaviorism to a truly cognitive view that includes internal cognitive structures; cognitions are not behaviors, but can be studied in their effects on behaviors as is done with drugs and genetics; a unifiedinteractive approach that incorporates cognition, behavior, and affect represents the logical future development in psychotherapy research and practice.     

The Role of Body Dissatisfaction and Bingeing in the Self-Esteem of Women with Type II Diabetes

This study investigated the impact of body dissatisfaction and binge eating on self-esteem in women with Type II diabetes. The relationship of body dissatisfaction and bingeing to perceived blood glucose control was also assessed. Questionnaires were completed by a total of 215 women: 125 women with Type II diabetes and 90 comparison women, who were roughly matched for age, education, and ethnicity. When actual weight (BMI) was statistically controlled, there was no difference between the groups in body dissatisfaction or bingeing behavior. The women with diabetes, however, had significantly lower self-esteem. Further, bingeing made a significant contribution to their self-esteem, in contrast to the women without diabetes. For the women with diabetes, body dissatisfaction and bingeing were also related to perceived blood glucose control, although only bingeing remained significant when both variables were entered into the regression equation. It was concluded that diabetes broadens the domains of body dissatisfaction which are related to self-esteem.     

Improving self-care among older patients with type II diabetes: the "Sixty Something..." Study.

A 10-session, self-management training program was designed specifically for persons over 60 years of age having Type II diabetes. It targeted social learning variables, especially problem-solving skills and self-efficacy, found to be related to diabetes self-care in earlier correlational research. One hundred two adults were randomized to immediate or delayed intervention conditions. At posttest, subjects in the immediate intervention condition showed significantly greater reductions in caloric intake and percent of calories from fat than control subjects. The intervention also produced greater weight reductions and increases in the frequency of glucose testing than did the control condition. Improvements among immediate intervention subjects were generally maintained at a 6-month follow-up. Intervention results from subjects receiving delayed intervention closely replicated those for immediate intervention subjects. We conclude that a relatively short-term program can improve self-management skills of older diabetic adults, and that there is an important need for such interventions.     

Insulin-like growth factors. Studies in diabetics with and without retinopathy

To determine whether two insulin-like growth factors (IGF I and IGF II) influence the course of diabetic retinopathy, we measured the concentrations of these factors in 80 adult patients with diabetes and in 62 control subjects. In seven patients with Type I diabetes and rapidly deteriorating vision as a result of proliferative and exudative retinopathy, the serum concentration of IGF I was 722 +/- 41 ng per milliliter (mean +/- S.E.M.), as compared with 381 +/- 48 ng per milliliter in 26 patients who had Type I diabetes without retinopathy or with less severe forms of it, and 302 +/- 15 ng per milliliter in the controls (P less than 0.001 for both comparisons). Serum concentrations of IGF II were normal in subjects with Type I diabetes but were somewhat depressed in those with Type II disease. Whether elevated serum concentrations of IGF I cause the accelerated development of retinopathy in some patients remains to be determined. Such levels do appear to identify patients at high risk for rapid deterioration of vision, and hence may be useful in selecting patients for more intensive or alternative forms of therapy.     

Coronary-Prone Behavior Pattern and Cardiovascular Response

Two studies were carried out examining the relationship between coronary-prone behavior pattern and cardiovascular responses to an experimental stressor. Among 52 subjects of the Type A (coronary-prone) and Type B (non-coronary-prone) behavior patterns in Study I, Type A males showed greater elevations of systolic blood pressure than Type B males on exposure to a difficult cognitive task; no reliable differences were found for Type A and B females. Due to a conceptual similarity of the coronary-prone behavior pattern and the personality dimension of Internal External locus of control, 48 male subjects in Study II were selected with respect to four subject groups: Type A-Internals, Type A-Externals, Type B-Internals, and Type B-Externals. Again, Type As showed a more pronounced systolic response than subjects of the Type B pattern, though diastolic blood pressure and heart rate responses did not vary by coronary-prone behavior pattern. While locus of control-Internals tended to show greater task-related systolic elevations than Externals, this effect was not significant. Self-reports of anxiety increased during the period of the task, but revealed no differences among Type A and B subjects of either study. It was concluded that for male subjects the Type A-Type B dimension constitutes a salient variable of individual differences mediating the systolic pressor response.     

Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance

BACKGROUND: Type 2 diabetes mellitus is increasingly common, primarily because of increases in the prevalence of a sedentary lifestyle and obesity. Whether type 2 diabetes can be prevented by interventions that affect the lifestyles of subjects at high risk for the disease is not known. METHODS: We randomly assigned 522 middle-aged, overweight subjects (172 men and 350 women; mean age, 55 years; mean body-mass index [weight in kilograms divided by the square of the height in meters], 31) with impaired glucose tolerance to either the intervention group or the control group. Each subject in the intervention group received individualized counseling aimed at reducing weight, total intake of fat, and intake of saturated fat and increasing intake of fiber and physical activity. An oral glucose-tolerance test was performed annually; the diagnosis of diabetes was confirmed by a second test. The mean duration of follow-up was 3.2 years. RESULTS: The mean (+/-SD) amount of weight lost between base line and the end of year 1 was 4.2+/-5.1 kg in the intervention group and 0.8+/-3.7 kg in the control group; the net loss by the end of year 2 was 3.5+/-5.5 kg in the intervention group and 0.8+/-4.4 kg in the control group (P<0.001 for both comparisons between the groups). The cumulative incidence of diabetes after four years was 11 percent (95 percent confidence interval, 6 to 15 percent) in the intervention group and 23 percent (95 percent confidence interval, 17 to 29 percent) in the control group. During the trial, the risk of diabetes was reduced by 58 percent (P<0.001) in the intervention group. The reduction in the incidence of diabetes was directly associated with changes in lifestyle. CONCLUSIONS: Type 2 diabetes can be prevented by changes in the lifestyles of high-risk subjects.     

A controlled study of weight reduction in type 2 diabetics treated by two reinforcers

The aim of this clinical study was to evaluate a practicable method to improve metabolic control and body weight in obese patients suffering from Type 2 diabetes. Eighteen overweight Type 2 diabetic patients received an outpatient psychoeducational group program over 1 year, which was centered on aspects of metabolic control in diabetes. This group was compared with 18 control patients who did not obtain any special psychoeducational training. There was a significant reduction of glycosylated hemoglobin and body weight over 1 year in the treatment group compared with the controls. In conclusion, 1 year of psychoeducational training of obese Type 2 diabetic patients significantly improved body weight and glycosylated hemoglobin. Implications are described for professional health care management of the disorder and aspects of the learning theory.     

Low risk of coronary heart disease in female type II diabetic subjects with diabetic relatives

Possible risk factors for cardiovascular disease were studied in 52 type II diabetic subjects, 19 with and 33 without a history of coronary heart disease (CHD). None of the recognized risk factors, such as hypertension, hyperlipidaemia, smoking and blood glucose imbalance, could be related to CHD. However, all female patients with CHD were lacking a family history of diabetes, while seven of nine female diabetic subjects without a history of CHD had diabetes in the family (p less than 0.02). This was confirmed in a second study of 150 type II diabetic subjects; CHD was more common among female patients without compared to those with diabetes in the family; 9/38 and 1/28, respectively (p less than 0.03). Diabetes increases the risk of CHD, and it does so for women more than it does for men. The finding of a possible low CHD risk in female diabetic subjects with diabetes in the family supports the hypothesis of genetic factors being important for the pathogenesis of cardiovascular disease in diabetes mellitus.     

Avoidance responding in mice with diabetes mellitus

In order to examine the behavioral concomitants of the neuroendocrine state of diabetes mellitus, the behavior of diabetic and normal male mice was compared in two behavioral paradigms. Diabetic mice were found to display significantly more passive avoidance to shock and significantly more submissive social behavior as compared to control mice. Furthermore, within the group of diabetic mice, mice showing the most passive avoidance also displayed the most submissive behavior. These findings suggest that diabetes mellitus may have effects on the neuroendocrine system that are manifested as changes in behavior.     

Macroscopic placental changes associated with fetal and maternal events in diabetes mellitus

OBJECTIVES:

The current study sought to identify macroscopic placental changes associated with clinical conditions in women with or without diabetes and their newborns.

METHODS:

The study population consisted of 62 pregnant women clinically diagnosed with diabetes and 62 healthy women (control group).

RESULTS:

Among the subjects with diabetes, 43 women (69.3%) were diagnosed with gestational diabetes mellitus, 15 had diabetes mellitus I (24.2%), and four had diabetes mellitus II (6.5%). The mean age of the women studied was 28.5±5.71 years, and the mean gestational age of the diabetic women was 38.51 weeks. Of the 62 placentas from diabetic pregnancies, 49 (79%) maternal surfaces and 59 (95.2%) fetal surfaces showed abnormalities, including calcium and fibrin deposits, placental infarction, hematoma, and fibrosis. A statistical association was found between newborn gender and fetal and maternal placental changes (p = 0.002). The mean weight of the newborns studied was 3,287±563 g for women with diabetes mellitus, 3,205±544 g for those with gestational diabetes mellitus, 3,563±696 g for those with diabetes mellitus II, and 3,095±451 g for those with diabetes mellitus I.

CONCLUSIONS:

Infarction, hematoma, calcification, and fibrin were found on the maternal and fetal placental surfaces in women with diabetes. Women with gestational diabetes and post-term infants had more calcium deposits on the maternal placental surface as compared to those with type I and type II diabetes.     

Relation of Diabetic Patients' Health-Related Control Appraisals and Physician–Patient Interpersonal Impacts to Patients' Metabolic Control and Satisfaction with Treatment

Desire for healthcare control, health locus of control, perceived control over diabetes, satisfaction with diabetes treatment, and general personality traits were assessed in 54 Type 1 and Type 2 diabetic patients of the same male endocrinologist during a regularly scheduled office visit. At the end of the consultation, both patients and the physician completed a measure describing the interpersonal impacts produced in each by the other's control and affiliation behaviors. Patient success at diabetes control was assessed via glycosylated hemoglobin A_1C (HA_1C) level on the day of the visit and variability in HA_1C levels across several visits. Patients' satisfaction with treatment was unrelated to diabetes control measures. Patients' desire for behavioral involvement in their own healthcare and NEO Agreeableness scores were positively associated with diabetes control. Better diabetes control also resulted when the physician perceived patients to be more controlling and less submissive, and when there was more reciprocity in patient and physician's perceptions of the other's controlling interpersonal behavior. Findings support the conclusion that both a patient's self-reported desire for involvement in his or her healthcare and the transactional fit of patient–physician interpersonal behaviors are potentially important contributors to better diabetes outcomes.     

A closer look at teaching and contingency contracting with type II diabetes

The purpose of this study was to determine which of two interventions was more effective in assisting Type II non-insulin dependent diabetics to achieve control. Subjects were considered to have their disease under control if their blood glucose was within normal limits and they either maintained or lost a prescribed amount of weight. In a 2 × 2 × 8 repeated measures analysis of variance design, 60 overweight subjects (30 treated with diet alone and 30 treated with diet and oral hypoglycemics) were randomly assigned to one of two interventions, teaching alone or teaching with contingency contracting. The interventions were carried out weekly for 8 weeks in the home setting. Findings revealed a significant weight loss and an increase in knowledge across subjects with no differences between groups. No significant differences were noted for fasting blood glucose or glycosylated hemoglobin measurements either across or between groups. These results support the need to individualize interventions directed toward behavior change and provide insight into contingency contracting as one approach.     

Coronary-Prone Behavior Pattern, Task Incentive, and Cardiovascular Response

In this experiment it was predicted that the presence or absence of a performance-contingent incentive (monetary reward) would mediate effects of the coronary-prone behavior pattern on behavioral and cardiovascular responses to a difficult cognitive task. Accordingly, 44 subjects of the Type A (coronary-prone) and Type B (non-coronary-prone) behavior patterns were assigned to one of two task conditions, labelled Incentive and No Incentive. Results indicated that under No Incentive Type As performed better at the experimental task and reported less state anxiety than Type Bs, whereas in the Incentive condition, Type A and B subjects showed no differences in task performance or self-report of anxiety. Concerning cardiovascular measures, analysis of variance revealed significantly greater systolic blood pressure and pulse pressure elevations for Type A than Type B subjects, but showed no reliable interactions of the Type A, B and Incentive factors nor any related effects regarding heart rate or diastolic blood pressure. Individual differences in subjects' scores on the inventory for coronary-prone behavior pattern, however, correlated positively with heart rate accelerations in the No Incentive condition, but did not covary with heart rate changes under Incentive. With respect to subjects' perceptions of the task, self-report data suggested that Type As responded in a more active and involved manner and resisted feelings of helplessness to a greater extent than their Type B counterparts.     

Time perspective and weight management behaviors in newly diagnosed Type 2 diabetes: a mediational analysis

The primary objective of the current study was to examine the extent to which domain-specific time perspective predicts weight management behaviors (dietary behavior and physical activity) among those newly diagnosed with Type 2 diabetes. A secondary objective was to test potential mediators of the hypothesized effect (behavioral intention, self-efficacy and control beliefs). A total of 204 adults newly diagnosed (≤6?months) with Type 2 diabetes participated in the study, which included a baseline assessment of domain-general and domain-specific time perspective, as well as strength of intention to perform two weight-management behaviors (dietary choice and physical activity); both weight-management behaviors were assessed again at 6?month follow-up. Hierarchical multiple regression analyses revealed a prospective association between domain-specific time perspective and uptake of weight management behaviors. Individuals with newly diagnosed T2DM possessing a future-oriented time perspective reported making less frequent fatty food choices and greater increases in physical activity over the 6-month follow-up interval. These effects were selectively mediated by intention strength, and not competing social cognitive variables. For both behaviors, the total effects and meditational models were robust to adjustments for demographics, body composition and disease variables. A future-oriented time perspective is prospectively associated with superior uptake of weight management behaviors among those with newly diagnosed Type 2 diabetes. The facilitating effect of future-oriented thinking appears to occur via enhanced strength of intentions to perform weight management behaviors.     

Reactions to Health-Related Social Control in Young Adults with Type 1 Diabetes

Health-related social control refers to individuals’ attempts to influence another’s health behavior. We describe social control experienced by 109 adults aged 18–35 with Type 1 diabetes, and examine the influence of different types of social control on behavioral and psychological outcomes. Using a self-administered questionnaire, telephone interview, and chart review, we assessed individuals’ social control experiences, behavioral and psychological reactions, psychological adjustment, metabolic control, socio-demographics, and clinical factors at baseline, and psychological adjustment and metabolic control at 6-months follow-up. Most participants (85%) reported experiencing social control. Regression analyses revealed that more frequent negative control predicted less behavior change and more negative cognitive reactions concurrently, and decreases in psychological adjustment over time. More frequent reinforcement/modeling and structural changes predicted more positive emotional reactions, but were not associated with behavior change, psychological adjustment, or metabolic control. Use of direct persuasion was associated with more pretending of behavior change. These results suggest that negative social control attempts by social network members may be counter-productive.     

Diabetes mellitus and brain atrophy: A computed tomography study in an elderly population

Previous studies have suggested that noninsulin dependent diabetes mellitus (NIDDM) could lead to learning and memory deficits. We studied cognitive performance and computed tomography (CT) findings of the brain in elderly subjects with drug treated NIDDM (n = 12), with diet treated NIDDM (n = 13), and in nondiabetic individuals (ND, n = 59). The cognitive performance (orientation and uptodate knowledge, praxic functions, understanding of speech, expressive speech, memory, general reasoning) did not differ between the groups. The drug treated diabetics had more pronounced central temporal atrophy compared to that in the ND subjects as evidenced by wider right temporal horn (ANCOVA adjusted for age, p = 0.011). The drug treated diabetics (all women) also had wider frontal horns than did the ND women. The CT measures of diet treated diabetics were comparable with those of the ND group. The fasting glucose level was positively correlated with the width of the right temporal horn but not with other CT measures in diabetic subjects. The results suggest that NIDDM and poor glucose control may carry a risk for accelarated brain atrophy in the elderly.     

Association of a microsatellite in FASL to type II diabetes and of the FAS-670G>A genotype to insulin resistance

Type II diabetes is caused by a failure of the pancreatic beta-cells to compensate for insulin resistance leading to hyperglycaemia. There is evidence for an essential role of an increased beta-cell apoptosis in type II diabetes. High glucose concentrations induce IL-1beta production in human beta-cells, Fas expression and concomitant apoptosis owing to a constitutive expression of FasL. FASL and FAS map to loci linked to type II diabetes and estimates of insulin resistance, respectively. We have tested two functional promoter polymorphisms, FAS-670 G>A and FASL-844C>T as well as a microsatellite in the 3' UTR of FASL for association to type II diabetes in 549 type II diabetic patients and 525 normal-glucose-tolerant (NGT) control subjects. Furthermore, we have tested these polymorphisms for association to estimates of beta-cell function and insulin resistance in NGT subjects. We found significant association to type II diabetes for the allele distribution of the FASL microsatellite (P-value 0.02, Bonferroni corrected). The FAS-670G>A was associated with homeostasis model assessment insulin resistance index and body mass index (P-values 0.02 and 0.02). We conclude that polymorphisms of FASL and FAS associate with type II diabetes and estimates of insulin resistance in Danish white subjects.     

Cognitive and Behavioral Treatment of Impulsivity in Children: A Meta-Analytic Review of the Outcome Literature

Reviewed 36 outcome studies that used cognitive and/or behavioral treatment to reduce impulsivity in children. Treatments included self-statement modification, reinforcement contingencies, modeling, strategy training, problem-solving training, and numerous treatment combinations. Subjects were all described as impulsive but varied in clinical diagnosis, including attention-deficit hyperactivity disorder, conduct disorder, behavior disorder, and learning disability. Other subjects were labeled as non-self-controlled, or behavior problem. Meta-analytic techniques showed that interventions for impulsivity were associated with improvements of approximately one third to three quarters of a standard deviation relative to untreated control subjects. Treated subjects fell close to normative group means both before and after treatment.