Weight control practices and disordered eating behaviors among adolescent females and males with type 1 diabetes: associations with sociodemographics,weight concerns,familial factors,and metabolic outcomes

OBJECTIVE: This study examines the prevalence of specific weight control practices/disordered eating behaviors and associations with sociodemographic characteristics, BMI and weight perceptions, family functioning, and metabolic control among adolescent females and males with type 1 diabetes. RESEARCH DESIGN AND METHODS: The study population included 70 adolescent females and 73 adolescent males with type 1 diabetes who completed the AHEAD (Assessing Health and Eating among Adolescents with Diabetes) survey. Data on BMI and glycosylated hemoglobin (HbA(1c)) were drawn from medical records. RESULTS: Unhealthy weight control practices were reported by 37.9% of the females and by 15.9% of the males. Among the females, 10.3% reported skipping insulin and 7.4% reported taking less insulin to control their weight. Only one male reported doing either of these behaviors. Weight control/disordered eating behaviors were not associated with age, parental level of education, family structure, or race/ethnicity. Higher levels of weight dissatisfaction tended to be associated with unhealthy weight control/disordered eating; associations with BMI were inconsistent. Family cohesion was negatively associated with disordered eating among females (r = -0.52; P < 0.001) and males (r = -0.41; P < 0.001), but correlations with other measures of family environment (control, independence, and responsibility for diabetes management) were not significant. Correlations between disordered eating and HbA(1c) levels were significant among females (r = 0.33; P < 0.01) and males (r = 0.26; P < 0.05). CONCLUSIONS: Special attention is needed for youth with weight concerns and those from less cohesive families to assist in the development of healthy diabetes management behaviors.     

Disordered eating, body mass, and glycemic control in adolescents with type 1 diabetes

OBJECTIVE: To examine the relationship between disordered eating attitudes and behaviors, BMI, and glycemic control in adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODS: In a cross-sectional design, 152 adolescents (ages 11-19 years) completed three scales from the Eating Disorders Inventory (EDI): Body Dissatisfaction, Drive for Thinness, and Bulimia. All subjects had diabetes for > 1 year. Glycemic control was assessed by glycosylated hemoglobin (HbA1c). Height and weight were measured to assess BMI. RESULTS: Adolescents with type 1 diabetes did not report more disordered eating attitudes and behaviors than the normative comparison sample. Male subjects with type 1 diabetes reported fewer symptoms of bulimia and female subjects with type 1 diabetes reported greater body satisfaction than the normative group. A higher BMI was a significant predictor of greater body dissatisfaction, more so for female than male subjects. Symptoms of bulimia were associated with older adolescence and female sex. Those with more symptoms of bulimia were also more likely to have a higher BMI. Sex (female) and body dissatisfaction (more dissatisfied) predicted a stronger desire to be thin. Longer duration of disease, more symptoms of bulimia, and obesity all predicted poorer glycemic control. CONCLUSIONS: Female patients aged 13-14 years seem to be at greatest risk for developing disordered eating patterns. Using the clinical cutoff score (> or = 5) of the EDI Bulimia subscale as a screener in diabetes clinics may help identify adolescents whose disordered eating patterns are likely to compromise their glycemic control.     

Body‐related comments experienced by Chinese young women: A cross‐sectional study

Within Chinese culture, one way that family and friends demonstrate that they care about one‐another is by making body‐related comments. How such comments are experienced by young women, in particular, including how they relate to their psychological disposition and/or use of unhealthy weight control behaviors, is unknown. The purposes of this study were to understand the frequency and type of body‐related comments Chinese college women received, from whom, and their associations with body mass index (BMI), body satisfaction, body change motivations, and unhealthy weight control behaviors. Women from a comprehensive university in Southwest China (N = 236) participated in this cross‐sectional study. Results showed that female Chinese college students received body‐related comments most frequently from their friends, followed by parents, and romantic partners. While the frequency of receiving body‐related comments was not associated with BMI, higher frequencies were associated with stronger motivation to lose weight/fat and to practice unhealthy weight control behaviors. Additionally, positive body‐related comments from romantic partners were associated with higher motivation to gain weight/muscle and/or to maintain weight. Furthermore, positive body‐related comments from friends were associated with higher body satisfaction. Educational programs are needed to help female Chinese college students and members of their social networks recognize and understand the potential impact associated with giving body‐related comments. Screening protocols for unhealthy weight control behaviors and appropriate counseling services should also be developed and made available.     

Behavioral and clinical factors associated with depression among individuals with diabetes

OBJECTIVE: The goal of this study was to determine the behavioral and clinical characteristics of diabetes that are associated with depression after controlling for potentially confounding variables. RESEARCH DESIGN AND METHODS: A population-based mail survey was sent to patients with diabetes from nine primary care clinics of a health maintenance organization. The Patient Health Questionnaire was used to diagnose depression, and automated diagnostic, pharmacy, and laboratory data were used to measure diabetes treatment intensity, HbA(1c) levels, and diabetes complications. RESULTS: Independent factors that were associated with a significantly higher likelihood of meeting criteria for major depression included younger age, female sex, less education, being unmarried, BMI > or = >30 kg/m(2), smoking, higher nondiabetic medical comorbidity, higher numbers of diabetes complications in men, treatment with insulin, and higher HbA(1c) levels in patients <65 years of age. Independent factors associated with a significantly higher likelihood of meeting criteria for minor depression included younger age, less education, non-Caucasian status, BMI > or = 30 kg/m(2), smoking, longer duration of diabetes, and a higher number of complications in older (> or = 65 years) patients. CONCLUSIONS: Smoking and obesity were associated with a higher likelihood of meeting criteria for major and minor depression. Diabetes complications and elevated HbA(1c) were associated with major depression among demographic subgroups: complications among men and HbA(1c) among individuals <65 years of age. Older patients with a higher number of complications had an increased likelihood of minor depression.     

Adolescents with type 1 diabetes: family functioning and metabolic control

Families play central roles in the care of their adolescents with chronic illnesses. This study examined the relationship between family functioning and metabolic control in adolescents with Type 1 diabetes. The McMaster Family Assessment Device (FAD) measured family functioning; the Youth Self-Report Form (YSR) measured adolescent behavior. Older adolescents reported increased family dysfunction. Adolescents who reported family dysfunction on affective responsiveness had HbA(1c) levels greater than 9. Older adolescents, males, and adolescents who reported a greater number of behavior problems were significantly more likely to have HbA(1c) levels greater than 9. Considered together, older age and greater attention problems were most significantly associated with higher HbA(1c) levels. These findings suggest the importance of the relationship between the adolescent's perception of family functioning and metabolic control in the adolescents with Type 1 diabetes.     

Good metabolic control is associated with better quality of life in 2,101 adolescents with type 1 diabetes.

OBJECTIVE: It is unclear whether the demands of good metabolic control or the consequences of poor control have a greater influence on quality of life (QOL) for adolescents with diabetes. This study aimed to assess these relations in a large international cohort of adolescents with diabetes and their families. RESEARCH DESIGN AND METHODS: The study involved 2,101 adolescents, aged 10-18 years, from 21 centers in 17 countries in Europe, Japan, and North America. Clinical and demographic data were collected from March through August 1998. HbA(1c) was analyzed centrally (normal range 4.4-6.3%; mean 5.4%). Adolescent QOL was assessed by a previously developed Diabetes Quality of Life (DQOL) questionnaire for adolescents, measuring the impact of diabetes, worries about diabetes, satisfaction with life, and health perception. Parents and health professionals assessed family burden using newly constructed questionnaires. RESULTS: Mean HbA(1c) was 8.7% (range 4.8-17.4). Lower HbA(1c) was associated with lower impact (P < 0.0001), fewer worries (P < 0.05), greater satisfaction (P < 0.0001), and better health perception (P < 0.0001) for adolescents. Girls showed increased worries (P < 0.01), less satisfaction, and poorer health perception (P < 0.01) earlier than boys. Parent and health professional perceptions of burden decreased with age of adolescent (P < 0.0001). Patients from ethnic minorities had poorer scores for impact (P < 0.0001), worries (P < 0.05), and health perception (P < 0.01). There was no correlation between adolescent and parent or between adolescent and professional scores. CONCLUSIONS: In a multiple regression model, lower HbA(1c) was significantly associated with better adolescent-rated QOL on all four subscales and with lower perceived family burden as assessed by parents and health professionals.     

不同血糖水平的2型糖尿病患者的人体测量指标和血脂比较研究

目的对不同血糖控制水平的2型糖尿病患者的人体测量及血脂生化指标进行比较分析。方法选择2型糖尿病患者179例,取空腹血测定血糖、糖化血红蛋白(HbA1c)、糖化血清蛋白、三酰甘油(TG)、总胆固醇(TC)、高密度及低密度脂蛋白胆固醇(HDL-C、LDL-C)等指标,并进行身高、体质量、腰围、臀围、瘦体质量、体脂肪含量等人体测量,计算体质量指数(BMI)、腰臀比、腰围身高比、体脂肪百分比,按HbA1c<6.5%和HbA1c≥6.5%将研究对象分为HbA1c控制组和HbA1c控制不良组,比较两组人群上述人体测量及血脂生化指标的差异。结果HbA1c控制不良组人群的BMI、臀围、腰围身高比、体脂肪含量及百分比显著大于HbA1c控制组(P<0.05),TC、LDL-C亦显著高于HbA1c控制组(P<0.05)。结论2型糖尿病患者的血糖控制水平与BMI、体脂及血脂密切相关,在代谢控制中应兼顾。     

Discordance between physician and adolescent assessments of adherence to treatment: influence of HbA1c level. The PEDIAB Collaborative Group.

OBJECTIVE: To compare the subjective assessments (perceptions) of physicians and adolescent diabetic patients on the adolescents' adherence to treatment and to test the hypothesis that the HbA1c level influences physicians' perceptions. RESEARCH DESIGN AND METHODS: In a multicenter cross-sectional survey, 143 adolescents with diabetes (mean age 14.6 years) auto-assessed, while their pediatricians independently assessed, the level of adherence to treatment on a four-point scale. Scores of adherence given by a validated scale and metabolic control (HbA1c) were compared according to those assessments. RESULTS: Agreement between the adherence perceptions from adolescents and physicians was low (kappa = 0.23), and adolescents scored significantly higher (P < 0.001). Mean adherence score to diabetes treatment was significantly higher when the adolescents' perception of their self-care behaviors was good than when it was poor (P = 0.01), but did not significantly differ according to physicians' perception. Mean HbA1c level was significantly lower when the self-care behavior perception was good than when it was poor, both for the adolescents (P = 0.02) and for the physicians (P < 0.001). Multivariate analyses showed that only the adherence scale score was significantly associated with the adolescents' perception (P = 0.015), whereas only HbA1c level was significantly associated with the physicians' perception (P = 0.0008). CONCLUSIONS: By identifying the possible discrepancy between their own assessment of adherence and that of adolescents, and by avoiding the systematic attribution of poor metabolic control to poor adherence, physicians could generate a more confident and collaborative relationship with diabetic adolescents and therefore facilitate adolescents' self-management.     

Assessment of group versus individual diabetes education: a randomized study

OBJECTIVES: The current study was conducted to compare the effectiveness of delivering diabetes education in either a group or individual setting using a consistent, evidence-based curriculum. RESEARCH DESIGN AND METHODS: A total of 170 subjects with type 2 diabetes were randomly assigned to either group (n = 87) or individual (n = 83) educational settings. Subjects received education in four sequential sessions delivered at consistent time intervals over a 6-month period. Outcomes included changes in knowledge, self-management behaviors, weight, BMI, HbA(1c), health-related quality of life, patient attitudes, and medication regimen. Changes were assessed at baseline and after the 2-week, 3-month, and 6-month education sessions. RESULTS: Both educational settings had similar improvements in knowledge, BMI, health-related quality of life, attitudes, and all other measured indicators. HbA(1c) decreased from 8.5 +/- 1.8% at baseline to 6.5 +/- 0.8% at 6 months (P < 0.01) in the study population as a whole. Subjects assigned to the individual setting had a 1.7 +/- 1.9% reduction in HbA(1c) (P < 0.01), whereas subjects assigned to the group setting had a 2.5 +/- 1.8% reduction in HbA(1c) (P < 0.01). The difference in HbA(1c) improvement was marginally greater in subjects assigned to group education versus individualized education (P = 0.05). CONCLUSIONS: This study demonstrates that diabetes education delivered in a group setting, when compared with an individual setting, was equally effective at providing equivalent or slightly greater improvements in glycemic control. Group diabetes education was similarly effective in delivering key educational components and may allow for more efficient and cost-effective methods in the delivery of diabetes education programs.     

An outbreak of body weight dissatisfaction associated with self-perceived BMI and dieting among female pharmacy students

Some reports indicate that in various groups of society living in the highly developed countries a body weight perception and weight satisfaction tend to be inappropriate when compared with body mass index (BMI) calculated from estimated actual weight and height. Thus in present studies a relationship between body weight perceptions, measured actual BMI, gender, and dieting practices in a sample population of pharmacy students in Poland were examined to verify hypothesis that their incorrect self-perception would provoke occasional, seasonal and permanent eating disorders. Height and weight data of 178 pharmacy students (mean age 22.6 ± 2.4 years) in Bydgoszcz, Poland, were collected and validated by completed self-reported questionnaire assessing their self-perceived body weight, desired body weight and past/current dieting practices. Only 34.4% of female and 37.1% of male pharmacy students was satisfied with their current body weight. Statistical analyses revealed significant differences in estimated BMI status (χ² = 28.5; p = 0.0001), desired body weight (χ² = 15.6; p = 0.0004) and past dieting (χ² = 7.6; p = 0.0050) by gender. In the male sub-group of students (n = 27) unclear association (χ² = 6.1; p = 0.046) between measured actual BMI status and self-perceived body weight have been presented. Moreover, in male students a significant relationship (χ² = 4.9; p = 0.0261) between actual BMI status and both past as well as current weight control behavior in the form of dieting practices was exhibited. In case of a sub-group of female students (n = 151) a diffuse association of actual BMI and self-perception of their body weight (χ² = 69.5; p = 0.0001) was obtained. However, a close relation (χ² = 16.9; p = 0.0007) between actual BMI and only past dieting practices was observed in females. Furthermore, in this last sub-group of students the significant relationship (χ² = 53.9; p = 0.0001) between measured actual BMI and desired body weight was also demonstrated. The study showed an evidence of distorted self-perception of body weight in both sub-groups of considered pharmacy students. There was a tendency to overestimate of body weight in female students, and to underestimate in male students. These results suggest common dissatisfaction of body weight, especially among females, who were more often engaged in dieting, despite not being overweight or obese according to measured actual BMI status.     

Clinical and psychological course of diabetes from adolescence to young adulthood: a longitudinal cohort study

OBJECTIVE: To determine the clinical and psychological course of diabetes through adolescence and the relationship with glycemic control in young adulthood. RESEARCH DESIGN AND METHODS: A longitudinal cohort study of adolescents recruited from the register of the outpatient pediatric diabetes clinic. A total of 76 individuals (43 male patients, 33 female patients) aged 11-18 years completed baseline assessments, and 65 individuals (86%) were reinterviewed as young adults (20-28 years of age). Longitudinal assessments were made of glycemic control (HbA(1c)), weight gain (BMI), and development of complications. Adolescents completed self-report questionnaires to assess emotional and behavioral problems as well as self-esteem. As young adults, psychological state was assessed by the Revised Clinical Interview Schedule and the self-report Brief Symptom Inventory. RESULTS: Mean HbA(1c) levels peaked in late adolescence and were worse in female participants (average 11.1% at 18-19 years of age). The proportion of individuals who were overweight (BMI >25.0 kg/m(2)) increased during the 8-year period from 21 to 54% in female patients and from 2 to 28% in male patients. Serious diabetes-related events included death in one patient and cognitive impairment in two patients. Individuals in whom diabetic complications developed (25% of male patients and 38% of female patients) had significantly higher mean HbA(1c) levels than those without complications (difference 1.9%, 95% CI 1.1-2.7, P < 0.0001). Behavioral problems at baseline were related to higher mean HbA(1c) during the subsequent 8 years (beta = 0.15, SEM (beta) 0.04, P < 0.001, 95% CI 0.07-0.24). CONCLUSIONS: The outcome for this cohort was generally poor. Behavioral problems in adolescence seem to be important in influencing later glycemic control.     

A simple meal plan emphasizing healthy food choices is as effective as an exchange-based meal plan for urban African Americans with type 2 diabetes

OBJECTIVE: To compare a simple meal plan emphasizing healthy food choices with a traditional exchange-based meal plan in reducing HbA(1c) levels in urban African Americans with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 648 patients with type 2 diabetes were randomized to receive instruction in either a healthy food choices meal plan (HFC) or an exchange-based meal plan (EXCH) to compare the impact on glycemic control, weight loss, serum lipids, and blood pressure at 6 months of follow-up. Dietary practices were assessed with food frequency questionnaires. RESULTS: At presentation, the HFC and EXCH groups were comparable in age (52 years), sex (65% women), weight (94 kg), BMI (33.5), duration of diabetes (4.8 years), fasting plasma glucose (10.5 mmol/l), and HbA(1c) (9.4%). Improvements in glycemic control over 6 months were significant (P < 0.0001) but similar in both groups: HbA(1c) decreased from 9.7 to 7.8% with the HFC and from 9.6 to 7.7% with the EXCH. Improvements in HDL cholesterol and triglycerides were comparable in both groups, whereas other lipids and blood pressure were not altered. The HFC and EXCH groups exhibited similar improvement in dietary practices with respect to intake of fats and sugar sweetened foods. Among obese patients, average weight change, the percentage of patients losing weight, and the distribution of weight lost were comparable with the two approaches. CONCLUSIONS: Medical nutrition therapy is effective in urban African Americans with type 2 diabetes. Either a meal plan emphasizing guidelines for healthy food choices or a low literacy exchange method is equally effective as a meal planning approach. Because the HFC meal plan may be easier to teach and easier for patients to understand, it may be preferable for low-literacy patient populations.     

Sexual dysfunction in women with type 1 diabetes: a controlled study

OBJECTIVE: This study aimed to 1) examine the prevalence of sexual problems in women with type 1 diabetes, 2) compare this prevalence rate with that of an age-matched control group, 3) study the influence of diabetes-related somatic factors on female sexuality, and 4) study the influence of psychological variables on the sexual functioning of both groups. RESEARCH DESIGN AND METHODS: A total of 120 women with diabetes visiting the outpatient diabetes clinic completed questionnaires evaluating psychological adjustment to diabetes, marital satisfaction, depression, and sexual functioning. Medical records were used to obtain data on HbA(1c), use of medication, BMI, and early-onset microvascular complications. An age-matched control group of 180 healthy women attending an outpatient gynecological clinic for preventive routine gynecological assessment also completed the non-diabetes-related questionnaires. RESULTS: More women with diabetes than control subjects reported sexual dysfunction (27 vs. 15%; P = 0.04), but a significant difference was found only for decreased lubrication. No association was found between sexual dysfunction and age, BMI, duration of diabetes, HbA(1c), use of medication, menopausal status, or complications. Women with more complications, however, reported significantly more sexual dysfunctions, and the presence of complications altered treatment satisfaction. Both diabetic and control women with sexual dysfunction mentioned lower overall quality of the marital relation and more depressive symptoms than their respective counterparts without sexual problems. Depression was a significant predictor for sexual dysfunction in both women with diabetes and control subjects. CONCLUSIONS: Sexual problems are frequent in women with diabetes. They affect the overall quality of life and deserve more attention in clinical practice and research.     

Effect of smoking on hemoglobin A1c and body mass index in patients with type 2 diabetes mellitus.

BACKGROUND: Smoking is associated with a decrease in body weight in patients without diabetes mellitus and an increase in insulin resistance and hemoglobin A1c (HbA1c) levels in patients with type 1 diabetes mellitus. Whether smoking is associated with an increase in HbA1c and/or a decrease in body mass index (BMI) in type 2 diabetes mellitus is unresolved, however. Therefore, the objective of this study was to determine the effect of smoking on HbA1c levels and BMI in a cross-section of outpatients with type 2 diabetes mellitus. METHODS: A questionnaire was completed by 102 sequential outpatients (32 men, 70 women) with type 2 diabetes mellitus to assess age, sex, duration of diabetes mellitus, medications, exposure to nicotine, medical complications as a result of type 2 diabetes mellitus, and BMI In addition, a urine sample was obtained from each patient to assess the microalbumin-creatinine and cotinine-creatinine ratios. HbA1c level were also obtained from each volunteer as a measure of glucose control. RESULTS: Smokers had significantly higher cotinine-creatinine ratios than nonsmokers. Smokers and nonsmokers did not differ significantly with regard to HbA1c level, BMI, or duration of diabetes mellitus. Smokers were younger than nonsmokers. Smokers and nonsmokers did not differ significantly in terms of microalbumin-creatinine ratio, amount of diabetic medications, or medical complications. CONCLUSION: The results of this study suggest that smoking does not have a significant direct effect on BMI or HbA1c in patients with type 2 diabetes mellitus. This conclusion suggests that the relationship between these factors is much more complex than in people without diabetes or in patients with type 1 diabetes mellitus.     

A longitudinal study of the effects of a gluten-free diet on glycemic control and weight gain in subjects with type 1 diabetes and celiac disease

OBJECTIVE: To describe the longitudinal growth characteristics and glycemic control in type 1 diabetic children diagnosed with celiac disease and started on a gluten-free diet (GFD). RESEARCH DESIGN AND METHODS: Data on growth and glycemic control for 11 case subjects diagnosed with celiac disease (cd(+) group) and started on a GFD were collected prospectively, and two control subjects without celiac disease matched for age, sex, and duration of diabetes (cd(-) group) were selected for comparison. RESULTS: In the period between diagnosis of type 1 diabetes and start of a GFD in the cd(+) compared with the cd(-) group, BMI standard deviation score (SDS) was lower (-0.2 vs. 0.7, P = 0.015), as was HbA(1c) (8.9 vs. 9.8%, P = 0.002). In a regression model the cd(+) group had lower BMI SDS (P < 0.001) and lower HbA(1c) (P = 0.04), independent of other variables. On a GFD, BMI SDS increased by 12 months in the cd(+) group and then was no different than the cd(-) group (1.1 vs. 1.0, P = 0.11), whereas HbA(1c) improved further within case subjects compared with pre-GFD (8.9 vs. 8.3%, P = 0.002). On a GFD, case subjects in contrast to control subjects showed no deterioration in HbA(1c) during the years of puberty (8.3 vs. 10.0%, P = 0.022) CONCLUSIONS: In children with type 1 diabetes, untreated celiac disease resulted in lower BMI SDS and lower HbA(1c). Recovery of BMI SDS with a GFD was associated with further improvement in HbA(1c) as compared with pre-GFD, with no expected deterioration in glycemic control during puberty. These apparent clinical benefits need confirming by larger studies.     

The National Diabetes Register in Sweden: an implementation of the St. Vincent Declaration for Quality Improvement in Diabetes Care

OBJECTIVE: To monitor glycemic control, treatable risk factors, and treatment profile for quality assessment of diabetes care on a national scale. RESEARCH DESIGN AND METHODS: Four samples of 23,546, 32,903, 30,311, and 29,769 patients with diabetes (1996-1999) were studied based on a repeated national screening and quality assessment of diabetes care by the National Diabetes Register, Sweden, with participation of both hospitals and primary health care. Clinical characteristics included were age, sex, diabetes duration and treatment, glycemic control (HbA(1c)), office blood pressure (BP), BMI, smoking habits, and use of lipid-lowering drugs in patients with type 1 or type 2 diabetes. RESULTS: Favorable decreases of mean HbA(1c) and BP values were registered during the 4-year study period for both type 1 (HbA(1c) 7.5-7.3% and BP 130/75-130/74 mmHg) and type 2 diabetic patients (HbA(1c) 7.0-6.7% and BP 151/82-147/80 mmHg). Treatment aims of HbA(1c) and BP levels were also achieved in increasing proportions for type 1 (HbA(1c) <7.5%: 50-58% and BP 相似文献   

Metformin as an adjunct therapy in adolescents with type 1 diabetes and insulin resistance: a randomized controlled trial

OBJECTIVE: To evaluate whether, in adolescents with type 1 diabetes, the addition of metformin to insulin and standard diabetes management results in 1) higher insulin sensitivity and 2) lower HbA1c, fasting glucose, insulin dosage (units per kilogram per day) and BMI. RESEARCH DESIGN AND METHODS: This was a randomized, placebo-controlled 3-month trial of metformin therapy in 27 adolescents with type 1 diabetes, high insulin dosage (>1 unit. kg(-1). day(-1)), and HbA1c >8%, with measurements of insulin sensitivity (by frequently sampled intravenous glucose tolerance test [FSIGT]), HbA1c, insulin dosage, and BMI at the onset and end of treatment. RESULTS: At t = 0, HbA1c was 9.2 +/- 0.9%, insulin dosage was 1.2 +/- 0.2 units. kg(-1). day(-1), fasting glucose was 10.6 +/- 2.4 mmol/l, and BMI was 24.2 +/- 3.9 kg/m2 (means +/- SD), with no difference between the metformin and placebo groups. At the end of the study, HbA1c was 0.6% lower in the metformin group than in the placebo group (P < 0.05). This was achieved at lower daily insulin dosages (metformin group -0.14 +/- 0.1 vs. placebo group 0.02 +/- 0.2 units. kg(-1). day(-1); P < 0.05), with no significant change in BMI. Fasting glucose levels improved significantly in the metformin group (P < 0.05). Change in insulin sensitivity, measured by FSIGT, was not significantly different between the two groups at study end. Mild hypoglycemia occurred more frequently in the metformin-treated than in the placebo subjects (1.75 +/- 0.8 vs. 0.9 +/- 0.4 events. patient(-1). week(-1); P = 0.03). There were no differences in frequency of severe hypoglycemic episodes or gastrointestinal complaints between the two groups. CONCLUSIONS: Metformin treatment lowered HbA1c and decreased insulin dosage with no weight gain in teens with type 1 diabetes in poor metabolic control. Changes in insulin sensitivity were not documented in this study using the FSIGT. Long-term studies will determine whether these improvements are sustained and whether certain subgroups accrue greater benefit from this therapy.     

Factors affecting the efficacy of starting insulin treatment in Type 2 diabetic patients. A retrospective evaluation

OBJECTIVE: To assess the efficacy and practices of insulin treatment in Type 2 diabetes mellitus in primary health care. SETTING: Primary health care in southwest Finland (population 250,000). DESIGN: Cases in the target area with insulin treatment initiated in 1991-1997 were identified and the patient records were analysed retrospectively for up to 5 years from treatment. PATIENTS: A total of 883 patients with Type 2 diabetes (aged 40-91 years) were identified. MAIN OUTCOME MEASURES: HbA1c and body weight. RESULTS: HbA1c declined by 2.0 percentage points from 10.0% to 8.0% (p < 0.001) at 12 months from the initiation of insulin, irrespective of age. The decrease was smaller in obese patients (BMI > 34 kg/m2). A slightly better glycaemic control was achieved when the treatment was initiated by a specialist rather than by a general practitioner. The improvement in HbA1c was essentially unchanged at 4 years. The decrease in HbA1c was largely independent of the type of the insulin regimen (insulin alone, combined insulin and oral therapy). The daily insulin dose increased markedly and the proportion of patients on combination therapy decreased from 57% to 38% at 4 years. The mean body weight of the patients increased (3.7 kg at 12 months, 5.7 kg at 4 years). The weight increase was highest in patients treated with insulin alone. CONCLUSIONS: Introducing insulin therapy in poorly controlled Type 2 diabetic patients results in a marked decrease in HbA1c. Insulin therapy can be initiated in all age groups with equal results. Insulin treatment can be initiated and improved metabolic control maintained in primary health care.     

Weight-loss practices and weight-related issues among youth with type 1 or type 2 diabetes

OBJECTIVE—The purpose of this study was to describe the weight-loss practices and weight-related issues reported by youth with diabetes, according to sex and diabetes type.RESEARCH DESIGN AND METHODS—A total of 1,742 female and 1,615 male youth aged 10–21 years with type 1 or type 2 diabetes completed a SEARCH for Diabetes in Youth study visit during which height, weight, and A1C were measured. A survey assessed weight-related issues and weight-loss practices.RESULTS—Although more common in youth with type 2 diabetes, youth with type 1 diabetes also reported weight-related concerns and had elevated BMI. Among youth who had ever tried to lose weight (n = 1,646), healthy weight-loss practices (diet [76.5%] and exercise [94.8%]) were the most common, whereas unhealthy practices (fasting [8.6%], using diet aids [7.5%], vomiting or laxative use [2.3%], and skipping insulin doses [4.2%]) were less common. In sex-specific multivariable models including age, race/ethnicity, diabetes type, BMI category, and glycemic control, obese females and overweight/obese males were more likely to report ever practicing any unhealthy weight-loss practice than normal-weight youth. These practices were associated with poor glycemic control for female but not male subjects. All unhealthy weight-loss practices except fasting were more common in female than in male subjects. Dieting, fasting, and using diet aids were all more common in youth with type 2 diabetes than in those with type 1 diabetes.CONCLUSIONS—Given the prevalence of overweight and obesity among youth with type 1 or type 2 diabetes, health care professionals caring for youth with diabetes need to pay particular attention to identifying youth, particularly females, with unhealthy weight-loss practices.Diabetes is one of the three most prevalent chronic diseases of youth (1), with the majority of affected youth having type 1 diabetes (2). However, type 2 diabetes is being diagnosed more frequently in youth than has been reported in previous decades (2–4). Although youth with type 2 diabetes are likely to be overweight or obese, the increase in overweight in the U.S. population is mirrored among youth with type 1 diabetes (5,6). Strategies used to lose or manage weight include those that are healthy, such as regular physical activity and consuming a healthy diet, as well as those that are unhealthy, such as using over-the-counter diet aids without physician''s advice, fasting, taking laxatives or diuretics, and vomiting. In 2005, 12.3% of 9th to 12th graders went without eating for at least 24 hours, 6.3% used diet pills, powders, or liquids, and 4.5% vomited or took laxatives to maintain or lose weight (7). Females were significantly more likely than males to use these unhealthy strategies; some racial/ethnic differences were observed.Certain features of diabetes and its management, including weight gain after the initiation of insulin treatment, dietary restraint, and the knowledge that withholding insulin can cause weight loss, may trigger eating disturbances in youth with type 1 diabetes (8). Eating disorders have been associated with poor metabolic control and microvascular complications in type 1 diabetic youth (9–12). There is limited information about weight-related concerns among youth with type 2 diabetes. The American Diabetes Association recommends that youth with type 2 diabetes implement lifestyle modifications to reduce their intake of high-fat, high-energy foods and to increase physical activity to optimize glycemic control as well as their cardiovascular risk profile, including their lipid levels and blood pressure (13). At the same time, medical nutrition therapy must take in to account the nutritional needs required to support normal growth and development during childhood and adolescence (13,14). In this article, we describe the approaches to healthy and unhealthy weight-loss practices reported by youth with type 1 or type 2 diabetes by sex. In addition, we explore the associations between any unhealthy weight-loss practice, body weight perception, weight management goal, and worry about weight and glycemic control among youth with type 1 or type 2 diabetes by sex.     

Combined insulin-glibenclamide therapy of NIDDM patients in primary health care. A follow-up study of its compliance and efficacy and a review of the literature

Twenty non-insulin-dependent diabetic (NIDDM) patients with secondary failure to sulphonylureas were given combined insulin-glibenclamide therapy. After discharge they were followed for the following 12 months at different primary care centres. In the 19 patients who completed the combined therapy, the mean glycosylated haemoglobin A1c (HbA1c) level decreased from 11.2 +/- 0.5% to 9.1 +/- 0.3% at 2 months (p less than 0.001), and remained at 9.1 +/- 0.4% at 12 months. The reduction of HbA1c was positively correlated with the HbA1c value and inversely with the initial body weight (both p less than 0.05). There was a slight rise in the body mass index (BMI) from 26.9 +/- 0.9 to 28.2 +/- 0.7 at 12 months (p less than 0.001), which was inversely correlated with the BMI value at 0 month (p less than 0.05). The insulin doses were similar at 2 and 12 months. A review of the literature since 1985 identified ten double-blind, controlled studies on combined insulin-sulphonylurea therapy, comprising 156 NIDDM patients followed for 8-52 weeks. Improved glycaemic control and endogenous insulin secretion were documented in nine of these studies in parallel with a decrease of insulin requirement in six studies. We conclude from our own experience and the literature that combined insulin-glibenclamide therapy is an efficient and compliant therapeutic regimen.