Self-Care and Glycemic Control in Adolescents With Type I Diabetes

This study assesses the concurrence of adolescent- and parent-reported adherence to the medical regimen among youth with type 1 diabetes. Relationships between diabetes self-care and metabolic control were also examined. Adolescents' (n = 111) and their mothers' reports of adolescents' self-management of the diabetes regimen were examined for prediction to glycosylated hemoglobin (HgbA1c) levels obtained at concurrent and subsequent clinic visits. Adolescents' and parents' reports were correlated with each other, and correlations with HgbA_1c were as high as .41. Self- and parent-reported adherence to more complex aspects of the regimen (i.e., keeping blood glucose at appropriate levels) was the strongest correlate of HgbA_1c. In multivariate analyses, adolescent report predicted 30% and parent report explained 19% of the variance in concurrent HgbA1c. Self- and parent report of the adolescents' self-management may be show reliable indicators of the adolescents' self-care behaviors. As such they may be useful as indices for assessing the effectiveness of interventions to improve the management of the diabetic regimen among adolescents. In addition, aspects of diabetes management that involve higher level cognitive skills appear to be more effective in maintaining good HgbA_1c than variables that involve simply complying with physician directives. These findings emphasize the importance of education and graded practice with complex tasks and decision making in relation to diabetes management.     

Adolescents With Diabetes: Gender Differences in Psychosocial Functioning and Glycemic Control

This study evaluated gender differences in glycemic control among adolescents with insulin-dependent diabetes mellitus (IDDM). Drawing upon a conceptual model, the role of diabetes-specific and psychological variables in predicting gender differences in adolescents' glycemic control was examined. Following routine appointments for medical care, 42 adolescents with IDDM completed several measures: Test of Diabetes Knowledge and Problem Solving-Revised; Self-Care Inventory; Beck Depression Inventory; and the State-Trait Anxiety Inventory. Metabolic control was assessed via HbA[sub 1c] assays. Findings revealed that girls were in worse metabolic control than boys and reported more symptoms of depression and anxiety. Furthermore, gender differences in metabolic control could be explained by the greater depressive symptomatology reported by adolescent girls. Possible reasons for the linkage between depression and poor metabolic control are discussed, as well as directions for future research and clinical implications.     

Self-Care and Glycemic Control in Adolescents With Type I Diabetes

This study assesses the concurrence of adolescent- and parent-reported adherence to the medical regimen among youth with type 1 diabetes. Relationships between diabetes self-care and metabolic control were also examined. Adolescents' (n = 111) and their mothers' reports of adolescents' self-management of the diabetes regimen were examined for prediction to glycosylated hemoglobin (HgbA1c) levels obtained at concurrent and subsequent clinic visits. Adolescents' and parents' reports were correlated with each other, and correlations with HgbA_1c were as high as .41. Self- and parent-reported adherence to more complex aspects of the regimen (i.e., keeping blood glucose at appropriate levels) was the strongest correlate of HgbA_1c. In multivariate analyses, adolescent report predicted 30% and parent report explained 19% of the variance in concurrent HgbA1c. Self- and parent report of the adolescents' self-management may be show reliable indicators of the adolescents' self-care behaviors. As such they may be useful as indices for assessing the effectiveness of interventions to improve the management of the diabetic regimen among adolescents. In addition, aspects of diabetes management that involve higher level cognitive skills appear to be more effective in maintaining good HgbA_1c than variables that involve simply complying with physician directives. These findings emphasize the importance of education and graded practice with complex tasks and decision making in relation to diabetes management.     

Smoking Is Associated With Abdominal Obesity,Not Overall Obesity,in Men With Type 2 Diabetes

Objectives

Abdominal obesity increases mortality and morbidity from cardiovascular disease and there is a possibility that smoking effects obesity. However, previous studies concerning the effects of smoking on obesity are inconsistent. The objective of this study was to examine whether smoking is positively related to abdominal obesity in men with type 2 diabetes.

Methods

Subjects consisted of 2197 type 2 diabetic patients who visited Huh''s Diabetes Center from 2003 to 2009. Indices of abdominal obesity were defined as visceral fat thickness (VFT) measured by ultrasonography and waist circumference (WC). Overall obesity was defined as body mass index (BMI).

Results

Statistically significant differences in WC and VFT by smoking status were identified. However, there was no statistical difference in BMI according to smoking status. Means of WC and VFT were not significantly higher in heavy smokers and lower in mild smokers. Compared to nonsmokers, the BMI confounder adjusted odds ratio and 95% confidence interval for VFT in ex-smokers and current-smokers were 1.70 (1.21 to 2.39) and 1.86 (1.27 to 2.73), respectively.

Conclusions

Smoking status was positively associated with abdominal obesity in type 2 diabetic patients.     

Greater Glycemic Burden Is Associated with Further Poorer Glycemic Control in Newly-Diagnosed Type 2 Diabetes Mellitus Patients

Aims: hyperglycemia impairs pancreatic β-cell function instantly, also known as glucotoxicity. It is unknown whether this insult is temporary or sustained, and little real-world evidence needs to reflect the relationship between hyperglycemic burden, per se, and glycemic durability. Materials and Methods: a retrospective observational cohort study was conducted to recruit newly-diagnosed type 2 diabetes mellitus (T2DM) patients. Durability was defined as the episode from first glycated hemoglobin A1c (HbA1c) below 7.0% to where it exceed 8.0% (with treatment failure) or where study ended (without treatment failure). Glycemic burden was defined with the area above a burden value line (HbA1c = 6.5%) but under the HbA1c curve (AUC), and it was then divided into two compartments with the demarcation timepoint once HbA1c was treated below or equal to 7.0%; the former AUC’ represented the initial insult; the latter AUC” represented the residual part. Multivariable regression models assessed factors associated with durability in whole participants and two distinct subgroups: patients with baseline HbA1c > 7.0% or ≤7.0%. Results: 1048 eligible participants were recruited and analyzed: 291 patients with treatment failure (durability 26.8 ± 21.1 months); 757 patients without treatment failure (durability 45.1 ± 31.8 months). Besides age, glycemic burden was the only constant determinant in the two subgroups. AUC’ or AUC” increased treatment failure, respectively, in baseline HbA1c > 7.0% or ≤7.0% subgroup [per 1%/90 days hazard ratio (95% confidence interval): 1.026 (1.018–1.034) and 1.128 (1.016–1.253)]. Other determinants include baseline HbA1c, initial OAD, and education level. Conclusions: in patients with newly-diagnosed T2DM, glycemic durability was negatively associated with greater glycemic burden.     

Peer Reviewed: Factors Predicting Glycemic Control in Middle-Aged and Older Adults With Type 2 Diabetes

Introduction

Few studies have prospectively assessed the explanatory effects of demographics, clinical conditions, treatment modality, and general lifestyle behaviors on glycemic control in large heterogeneous samples of middle-aged and older adults with type 2 diabetes. We hierarchically examined these factors, focused especially on the effects of modifiable factors (ie, general lifestyle behaviors), and compared predictive patterns between middle-aged and older adults.

Methods

We used nationally representative data from the 1998 and 2000 Health and Retirement Study (HRS) and the HRS 2003 Diabetes Study. We analyzed data from 379 middle-aged adults (aged 51-64 y) and 430 older adults (aged ≥65 y) who self-reported having type 2 diabetes at baseline.

Results

Among middle-aged adults, demographic factors and clinical conditions were the strongest predictors of hemoglobin A1c (HbA1c) levels. However, among older adults, treatment modality (diet only, oral medication, or insulin only or in combination with other regimens) significantly affected HbA1c levels. Lifestyle (physical activity, smoking, drinking, and body weight control), independent of the effects of demographics, clinical conditions, and treatment modality, significantly affected HbA1c levels. An increase of 1 healthy behavior was associated with a decrease in HbA1c levels of more than 1 percentage point.

Conclusion

Our findings provide support for current diabetes guidelines that recommend a lifestyle regimen across the entire span of diabetes care and highlight the need to help both sociodemographically and clinically disadvantaged middle-aged adults with type 2 diabetes as well as older adults who exhibit poor adherence to medication recommendations to achieve better glycemic control.     

Higher Iron Intake Is Independently Associated with Obesity in Younger Japanese Type-2 Diabetes Mellitus Patients

We aimed to analyze the association between dietary iron intake and obesity assessed by BMI after adjustment for nutrient intake (macronutrients and fiber) and food groups. The study design was cross-sectional. Patients with type-2 diabetes (n = 1567; 63.1% males; mean age 62.3 ± 11.6 years) were included in the study. To assess diet, consumption of typical food groups was determined by a food frequency questionnaire. Obesity was defined as BMI ≥ 25 kg/m². We performed a binary regression analysis between quartiles of iron intake and obesity by quartiles of age group. A direct linear association was found for the highest quartile of iron intake and obesity in the younger age group of 30 to 54 years (OR = 3.641, 95% CI = 1.020–12.990; p trend = 0.011). Multivariate analysis using food groups as opposed to nutrients revealed a positive trend for obesity in the younger age group after adjusting for lifestyle factors, energy intake and bean and vegetable intake (p trend = 0.023). In all participants, an inverse association was observed before adjustment by vegetable intake (OR = 0.453, 95% CI = 0.300–0.684; p trend = 0.001). Higher iron intake was associated with obesity independent of macronutrient and fiber intake but only in the youngest quartile of age group examined.     

Impact of Peer Health Coaching on Glycemic Control in Low-Income Patients With Diabetes: A Randomized Controlled Trial

PURPOSE

Peer health coaches offer a potential model for extending the capacity of primary care practices to provide self-management support for patients with diabetes. We conducted a randomized controlled trial to test whether clinic-based peer health coaching, compared with usual care, improves glycemic control for low-income patients who have poorly controlled diabetes.

METHOD

We undertook a randomized controlled trial enrolling patients from 6 public health clinics in San Francisco. Twenty-three patients with a glycated hemoglobin (HbA_1C) level of less than 8.5%, who completed a 36-hour health coach training class, acted as peer coaches. Patients from the same clinics with HbA_1C levels of 8.0% or more were recruited and randomized to receive health coaching (n = 148) or usual care (n = 151). The primary outcome was the difference in change in HbA_1C levels at 6 months. Secondary outcomes were proportion of patients with a decrease in HbA_1C level of 1.0% or more and proportion of patients with an HbA_1C level of less than 7.5% at 6 months. Data were analyzed using a linear mixed model with and without adjustment for differences in baseline variables.

RESULTS

At 6 months, HbA_1C levels had decreased by 1.07% in the coached group and 0.3% in the usual care group, a difference of 0.77% in favor of coaching (P = .01, adjusted). HbA_1C levels decreased 1.0% or more in 49.6% of coached patients vs 31.5% of usual care patients (P = .001, adjusted), and levels at 6 months were less than 7.5% for 22.0% of coached vs 14.9% of usual care patients (P = .04, adjusted).

CONCLUSIONS

Peer health coaching significantly improved diabetes control in this group of low-income primary care patients.Key words: peer coach, diabetes mellitus type 2, self care, primary health care, self-management support     

Family Functioning and Adherence in Youth With Type 1 Diabetes: A Latent Growth Model of Glycemic Control

The objective of this research is to determine the direct impact of family variables on initial status of a glycosylated hemoglobin A1c test (HbA1c) and HbA1c rate of change, and to determine the indirect effects of family variables on HbA1c through adherence. Study participants were 224 children and their parents who completed baseline measures of diabetes-specific family functioning and separate parent- and child-structured adherence interviews. HbA1c assays were performed at baseline, Year 1, and Year 2. Latent growth curve modeling indicated that, together, disagreement about responsibility for diabetes regimen, critical parenting, parental guidance, and parental warmth predicted initial status of HbA1c through adherence. Individually, critical parenting indirectly predicted initial status of HbA1c. Family variables did not directly predict initial status or rate of change in HbA1c, and did not indirectly predict rate of change in HbA1c over 2 years. Risk for high HbA1c remains elevated over time for children reporting critical parents, but their trajectory does not indicate compounding risk over time.     

Glycemic Control and Insulin Improve Muscle Mass and Gait Speed in Type 2 Diabetes: The MUSCLES-DM Study

ObjectivesType 2 diabetes is a risk factor for sarcopenia. Evidence on the prevention of sarcopenia using blood glucose–lowering therapy is limited. We aimed to examine the relationship between changes in glycemic control and sarcopenia and the effect of antidiabetic agents against sarcopenia in patients with type 2 diabetes.DesignWe conducted an observational longitudinal study.Setting and ParticipantsIn total, 588 Japanese patients with diabetes of an ongoing multicenter study completed 1-year follow-up measurements for sarcopenia and clinical data.MethodsThe data set of the Multicenter Study for Clarifying Evidence for Sarcopenia in patients with Diabetes Mellitus (the MUSCLES-DM study) was analyzed.ResultsDuring the follow-up period, the frequency of sarcopenia marginally increased, and the means of skeletal muscle mass index (SMI), handgrip strength, and gait speed did not show any changes. However, on dividing into 5 groups depending on the degree of changes in glycated hemoglobin (HbA_1c) value, the patients with a decrease of ≥1% in HbA_1c exhibited a significant increase in SMI. Our analysis revealed similar results for gait speed but not handgrip strength. Using the multiple linear regression model, we identified that a ≥1% decrease in HbA_1c value was an independent determinant of the changes in SMI and gait speed. We also determined that insulin use at baseline was an independent factor for the changes in SMI.Conclusions and ImplicationsCorrection of poor glycemic control and use of insulin were significantly associated with the increase in skeletal muscle mass or gait speed in Japanese patients with type 2 diabetes. The current finding increases our understanding of the importance of glycemic control for the prevention of cardiovascular diseases and sarcopenia.     

Resistant Starch Consumption Effects on Glycemic Control and Glycemic Variability in Patients with Type 2 Diabetes: A Randomized Crossover Study

We previously observed beneficial effects of native banana starch (NBS) with a high resistant starch (RS) content on glycemic response in lean and obese participants. Here, we aimed to determine the effects of NBS and high-amylose maize starch (HMS) on glycemic control (GC) and glycemic variability (GV) in patients with type 2 diabetes (T2D) when treatments were matched for digestible starch content. In a randomized, crossover study, continuous glucose monitoring (CGM) was performed in 17 participants (aged 28–65 years, BMI ≥ 25 kg/m², both genders) consuming HMS, NBS, or digestible maize starch (DMS) for 4 days. HMS and NBS induced an increase in 24 h mean blood glucose during days 2 to 4 (p < 0.05). CONGA, GRADE, and J-index values were higher in HMS compared with DMS only at day 4 (p < 0.05). Yet, NBS intake provoked a reduction in fasting glycemia changes from baseline compared with DMS (p = 0.0074). In conclusion, under the experimental conditions, RS from two sources did not improve GC or GV. Future longer studies are needed to determine whether these findings were affected by a different baseline microbiota or other environmental factors.     

Factors Associated With Psychological Distress in a Community-Dwelling Japanese Population: The Ohsaki Cohort 2006 Study

Background

In Asia, there has been no population-based epidemiological study using the K6, a 6-item instrument that assesses nonspecific psychological distress.

Methods

Using cross-sectional data from 2006, we studied 43 716 (20 168 men and 23 548 women) community-dwelling people aged 40 years or older living in Japan. We examined the association between psychological distress and demographic, medical, lifestyle, and social factors by using the K6, with psychological distress defined as 13 or more points out of a total of 24 points.

Results

The following variables were significantly associated with psychological distress among the population: female sex, young and old age, a history of serious disease (hypertension, diabetes mellitus, stroke, myocardial infarction, or cancer), current smoking, former alcohol drinking, low body mass index, shorter daily walking time, lack of social support (4 of 5 components), and lack of participation in community activities (4 of 5 components). Among men aged 40 to 64 years, only “lack of social support for consultation when in trouble” and a history of diabetes mellitus remained significant on multivariate analysis. Among men aged 65 years or older, age was not significantly associated with psychological distress, and the significant association with current smoking disappeared on multivariate analysis. Among women aged 40 to 64 years, a history of stroke was not associated with psychological distress. Among women aged 65 years or older, the significant association with current smoking disappeared on multivariate analysis.

Conclusions

A number of factors were significantly associated with psychological distress, as assessed by the K6. These factors differed between men and women, and also between middle-aged and elderly people.Key words: cross-sectional, K6, population-based, psychological distress     

2型糖尿病患者生存质量影响因素的研究

目的 为改善2型糖尿病患者生存质量制订合理措施提供科学依据。方法 采用模糊聚类和累积比数logistic回归模型相结合的方法，探讨2型糖尿病患者生存质量的影响因素。结果 离退休、生活事件、病程、并发症、健康教育和体力活动量6个因素影响2型糖尿病患者的生存质量。离退休、刺激性生活事件多、病程长以及合并并发症的患者，生存质量较差；接受过糖尿病健康教育和经常参加体力活动的患者，生存质量相对较好。结论 保持乐观开朗的处世态度、经常参加糖尿病知识讲座以及适当增加体力活动量，是改善2型糖尿病患者生存质量的重要措施。     

西格列汀联合格列美脲治疗2型糖尿病合并肥胖患者的效果

目的探究磷酸西格列汀联合格列美脲治疗2型糖尿病合并肥胖患者的临床效果。方法选取了2018年5月-2019年5月期间医院收治的2型糖尿病合并肥胖患者根据治疗方法分为对照组(单纯给予磷酸西格列汀)与观察组(给予磷酸西格列汀联合格列美脲)。结果观察组患者的治疗总有效率为96.0%,显著高于对照组的70.0%;同时,在治疗后,观察组FPG(空腹血糖)、2 h PG(餐后2 h血糖)、HbAlc(糖化血红蛋白)对比对照组更优,以上指标经统计学分析结果提示具备显著差异(P<0.05)。结论在2型糖尿病合并肥胖患者的临床治疗中采用磷酸西格列汀联合格列美脲治疗的方法能够有效改善患者的血糖水平。     

Patterns of Food Consumption are Associated with Obesity,Self-Reported Diabetes and Cardiovascular Disease in Five American Indian Communities

The relationship between dietary patterns and chronic disease is underexplored in indigenous populations. We assessed diets of 424 American Indian (AI) adults living in 5 rural AI communities. We identified four food patterns. Increased prevalence for cardiovascular disease was highly associated with the consumption of unhealthy snacks and high fat–food patterns (OR 3.6, CI = 1.06, 12.3; and OR 6.0, CI = 1.63, 22.1), respectively. Moreover, the food-consumption pattern appeared to be different by community setting (p < .05). We recommend culturally appropriate community-intervention programs to promote healthy behavior and to prevent diet-related chronic diseases in this high-risk population.     

Differences in Obesity Rates Between People With and Without Disabilities and the Association of Disability and Obesity: A Nationwide Population Study in South Korea

Objectives

The objective of this study was to identify the differences in obesity rates among people with and without disabilities, and evaluate the relationship between obesity rates and the existence of disabilities or characteristics of disabilities.

Methods

Mass screening data from 2008 from the National Disability Registry and National Health Insurance (NHI) are used. For analysis, we classified physical disability into three subtypes: upper limb disability, lower limb disability, and spinal cord injury. For a control group, we extracted people without disabilities by each subtype. To adjust for the participation rate in the NHI mass screening, we calculated and adopted the weight stratified by sex, age, and grade of disability. Differences in obesity rates between people with and without disabilities were examined by a chi-squared test. In addition, the effect of the existence of disabilities and grade of disabilities on obesity was examined by multiple logistic regression analysis.

Results

People with disabilities were found to have a higher obesity rate than those without disabilities. The obesity rates were 35.2% and 35.0% (people with disabilities vs. without disabilities) in the upper limb disability, 44.5% and 34.8% in the lower limb disability, 43.4% and 34.6% in the spinal cord injury. The odds for existence of physical disability and grade of disability are higher than the non-disabilities.

Conclusions

These results show that people with physical disability have a higher vulnerability to obesity.