The Impact of Managing School-aged Children’s Diabetes: The Role of Child Behavior Problems and Parental Discipline Strategies

Models of diabetes management in children emphasize family relationships, particularly parent–child interactions. In adolescents, parental involvement in disease-specific management relates to better health and adherence. However, information about parental involvement in disease management for young children is limited and mixed. This study investigated behavior problems of school-aged children with Type 1 Diabetes Mellitus (T1DM) in association with parent discipline strategies and parents’ perceptions of (1) time spent managing diabetes and (2) the impact their child’s diabetes has on their discipline strategies. Parents of children ages 5–12 with T1DM completed standardized measures of child misbehavior, parent discipline strategies, and responded to questions regarding perceived time spent managing diabetes, and perceived impact of diabetes on ability to discipline. Results showed child mealtime misbehavior was common and associated with overreactive parental discipline. Further, overreactive discipline was also associated with reports of less time spent managing child’s illness. Child misbehavior was positively associated with parents’ perceived amount of time spent managing diabetes and with the impact of child diabetes on discipline. Findings suggest the importance of considering parent discipline strategies and child misbehavior when working with young children with diabetes.     

这一次沃森的“猜想”对吗？——糖尿病是一种氧化还原性疾病

2型糖尿病发病机制的氧化应激学说被广泛地接受,可是大量的证据表明,服用抗氧化剂并不能增加胰岛素的敏感性,相反,体育锻炼能够增加氧化应激,却是治疗糖尿病的首选方案。分子机制的研究也表明,细胞内氧化应激不足时,会导致内质网无法合成二硫键,导致胰岛素生成不足。由此沃森推测,糖尿病是由于氧化应激不足所致。同理,氧化应激不足可能也是阿尔茨海默病、肿瘤等疾病的发病机制之一。沃森的呼声让现在普遍认为氧化应激有害理论的人们开始重新审视氧化应激在机体中的有益作用。     

What Diagnostic Devices Do: The Case of Blood Sugar Measurement

Diagnostic devices do more than just passively register facts. They intervene in the situations in which they are put to use. The question addressed here is what this general remark may imply in specific cases. To answer this question a specific case is being analysed: that of the blood sugar measurement device that people with diabetes may use to monitor their own blood sugar levels. This device not only allows the patients concerned to better approach normal blood sugar levels, but alters what counts as normal in the first place. Using the device may shift people's attention away from their physical sensations towards the numbers measured, but it may also help them to increase their own physical self-awareness. Self-monitoring finally (something that the devices have made possible) makes patients less dependent on professionals, but it requires them to engage in self-disciplining and binds them to the outcomes of their measurement activities: their own blood sugar levels.     

The impact of diabetes on psychological well being and quality of life. The role of patient education

People with diabetes live in a society that does not understand their condition. The overall perception that people with serious diabetes inject insulin and that Type 2 diabetes is relatively mild remains rife within the general population and even with some health care professionals. To make the situation worse, only few people understand that diabetes is a condition that cannot be simply controlled by medications and that the presence of diabetes markedly alters the lives of individuals and their families. Consequently, in this article we will be reviewing the scientific evidence of the effects of impaired psychological well being and poor perception of life quality on patients with diabetes. We will be enlightening the importance of patient education and self-empowerment on this aspect of management, which is crucial for the improvement in the physical, psychological and social well being of every patient suffering from this disease.     

运用比较治疗学的方法促进T2DM胰岛素治疗决策的最优化

2型糖尿病（T2DM）为内分泌科常见疾病,胰岛素是最主要的治疗药物之一,但胰岛素治疗方法诸多,各种方案的疗效参差不齐。为了促进2型糖尿病治疗决策的最优化,本文通过利用检索国内报道的相关文献,对文献中2型糖尿病的胰岛素治疗方法进行归纳总结,并且运用比较治疗学的研究方法进行比较分析,旨在寻求最有效的治疗方案。     

Physical activity and psychological well-being in children with Type 1 diabetes

Physical activity and psychological well-being contribute to positive lifestyle and well-being in youngsters who have Type 1 diabetes. The aims of this study were to objectively assess the physical activity levels of children with Type 1 diabetes, and investigate associations between physical activity levels, psychological well-being and HbA(1c). Thirty-six children, mean age 12.8 years, participated in the investigation. Physical activity was assessed using heart rate monitoring over four days. Children further completed the Diabetes Quality of Life for Youths Questionnaire, the Physical Self-Perception Profile for Children and the Self-Efficacy for Diabetes Scale. Routine outpatient HbA(1c) measurements were recorded. There were no significant associations between psychological well-being and physical activity, or HbA(1c) and physical activity, thus suggesting physical activity does not directly relate to psychological well-being in children with Type 1 diabetes. It may be that the effect of physical activity differs from that in children without Type 1 diabetes because of the place of physical activity within diabetes management and the need to balance this with insulin dosage and dietary intake to maintain blood glucose levels.     

多因素强化干预对2型糖尿病患者低脂联素血症的影响

探讨多因素强化干预对2型糖尿病患者低脂联素血症的影响。89例2型糖尿病患者实施血糖、血脂、血压强化控制,随诊1年并检测相关指标变化,统计学分析显示多因素强化干预可改善低脂联素血症,糖化血红蛋白和甘油三酯的变化值是影响血清脂联素水平变化的主要因素。因此,多因素强化干预可以有效改善低脂联素血症,可能减低糖尿病并发症发生的风险。     

The effect of diabetes knowledge and attitudes on self-management and quality of life among people with type 2 diabetes

We examined the effect of diabetes knowledge and attitudes on self-management and quality of life (QoL) of people with type 2 diabetes mellitus (T2DM). We employed a cross-sectional study design. A total of 137 female and 129 male participants with T2DM completed the diabetes knowledge scale (DKN), Diabetes Integration Scale-19 (ATT19), Summary of Diabetes Self-care Activities (SDSCA) scale, and Diabetes Quality of Life (DQoL) scale, measuring diabetes knowledge, attitudes, self-management, and QoL respectively. The SDSCA scale measures diet, exercise, blood glucose monitoring, and foot care. The DQoL scale measures satisfaction and impact of QoL. An initial path model that tested the inter-relationships of the study variables was first identified based on previous research. Then, the path model was tested using Mplus 7.3. In the final model, diabetes knowledge was a significant predictor of attitudes and self-management in terms of blood glucose monitoring and foot care. Attitudes was a significant predictor of impact of QoL. Self-management in terms of blood glucose monitoring was a significant predictor of impact of QoL and diet was a significant predictor of satisfaction and impact of QoL. Exercise and foot care aspects of Self-management were significant predictors of satisfaction and impact of QoL respectively. The final model showed a good fit to the data: RMSEA = .045 (90% CI: .009, .071; Clfit = .601), CFI = .950, SRMR = .058. The findings suggest a theoretical basis to direct the development of appropriate health programs and interventions for improving QoL in people with T2DM and warrant replication in diverse samples.     

肺结核患者的血糖控制

肺结核与糖尿病是两种严重危害人类健康的疾病。越来越多的研究证明,发生结核病的一个重要的危险因素为糖尿病,而且可能会影响肺结核患者的表现和治疗反应。另外,结核病可能会导致糖耐量异常,并使糖尿病患者的血糖控制不良。糖尿病引起肺结核发病增加,可能是因为持续的高血糖损害了针对结核杆菌的机体免疫。对结核病患者合并糖尿病者,药物治疗需考虑到药物动力学,监测血糖,谨慎用药。     

Diabetes mellitus as a model of psychosomatic and somatopsychic interrelationships

The article reviews research on the problem of interrelationship between different physical and psychosocial factors in type 1 diabetes mellitus (DM1). The authors consider methodological principles of health-related quality of life (HRQoL) assessment in DM1 patients and stress the need for an integrated biopsychosocial approach to the management of the disease. DM1 is a chronic metabolic disease with an absolute requirement for insulin replacement therapy. The stress-inducing nature of DM1 is associated with its unexpected and dramatic manifestation in juvenile years, life-threatening nature of severe hypo-/hyperglycaemias and long-term complications, with the burden of diabetes self-management, threat of work disability, employment and career problems etc. These features of DM1 increase the likelihood of the development of anxiety and depressive disorders, which, in turn, may negatively influence the course of diabetes and in particular, diabetes self-care. This necessitates early diagnosis of emotional and behavioral disturbances in DM1 using self-report instruments as well as clinical assessment. Evidence suggests that active problem-focused coping behavior and adequate social support promote adherence to diabetes regimes and may act as a buffer against negative effects of the disease on HRQoL in DM1 patients. The core element in the HRQoL structure is personal disease picture (as opposed by objective clinical picture)--the cognitive-affective-behavioral complex reflecting the patient's personal perception of the disease. Examination of the personal disease picture and attitude towards the ailment in DM1 patients may help to improve understanding of the mechanisms of poor adjustment. Problems in disease adjustment can be detected also by diabetes-specific HRQoL assessment. The measures of HRQoL can be applied as screening instruments useful in increasing the effectiveness of patient-provider interactions and diabetes care.     

Pediatric Parenting Stress and Its Relation to Depressive Symptoms and Fear of Hypoglycemia in Parents of Young Children with Type 1 Diabetes Mellitus

Parents of young children with type 1 diabetes (T1DM) maintain full responsibility for their child’s daily diabetes self-care and thus may be vulnerable to experiencing parenting stress. This study examined several psychological correlates of pediatric parenting stress in parents of young children with T1DM. Parents of 39 young children with T1DM (ages 2–7 years) completed measures of pediatric parenting stress, mealtime behavior problems, depressive symptoms, and fear of hypoglycemia. For parents of young children, higher stress frequency and difficulty were associated with higher parental depressive symptoms and fear. Regression analyses identified that 58% of the variance in stress frequency was associated with parental depressive symptoms. For stress difficulty, 68% of the variance was associated with parental depressive symptoms and fear. Pediatric parenting stress is common in parents of young children with T1DM. Stress and the psychological correlates measured in this study are amenable to intervention and should be regularly assessed in parents of young children with T1DM.     

Life stories managing chronic illness: Young adults’ lived experiences with type 1 diabetes

This study aimed to characterise diabetes management experiences of South African young adults living with well-controlled type 1 diabetes (n = 8, female = 5, male = 3, age range = 20–25). The young adults told life stories managing their type 1 diabetes. Thematic analysis revealed the young adults to construct personal identities as people living with type 1 diabetes, to mostly utilise emotion-focused management strategies and social support for successful living with type 1 diabetes. Behavioural health strategies appear important for living well with this chronic insulin deficiency condition.     

Partners’ representations of diabetes as mediators between patients’ representations and adherence to self-care behaviors,in type 2 diabetes

The purpose of this study was to analyze partners’ representations of diabetes as mediators between patients’ illness representations and adherence to all self-care behaviors, in recently diagnosed type 2 diabetes (T2DM) patients. The sample included 340 patients and their respective partners. The instruments used were: Revised Summary of Diabetes Self-Care Activities (RSDSCA); Medication Adherence Report Scale (MARS); and the Brief Illness Perception Questionnaire (Brief-IPQ). A mediational effect of partners’ representation of diabetes consequences was found between the same patients’ representations and exercise, foot care, and self-monitoring of blood glucose. Partners’ representations of personal and treatment control, were mediators between the same partners’ representations and self-monitoring of blood glucose. No partners’ representations mediated patients’ representation and adherence to medication or diet . This study emphasized partners’ representations on patient’s adherence to exercise, foot care and monitoring of blood glucose, in recent diagnosed T2DM patients. Interventions to promote adherence in T2DM should promote convergence between patients and partners’ diabetes representations. This study provides some evidence for the need to treat T2DM within the dyad to improve adherence, starting after the diagnosis.     

糖尿病“达标”教育对控制2型糖尿病的影响

为评价"达标"教育对新诊断2型糖尿病(T2DM)监测及控制水平的影响,选取新诊断T2DM患者90例,随机分为两组,实验组进行"控制目标"认知教育,对照组不进行。治疗6个月后,比较两组控制水平。结果实验组与对照组相比,血糖、血压、体重监测及主动拜访专业医生的频次显著为高,血糖、血压、胆固醇控制显著为好。提示对新诊T2DM患者进行"达标"教育可提高DM监测频次及控制水平。     

Illness perceptions and self-care behaviours in the first years of living with type 2 diabetes; does the presence of complications matter?

Objective: To assess illness perceptions, self-care behaviours and their relationship in recently diagnosed type 2 diabetes mellitus (T2DM) patients with and without diabetes-related complications.

Design: Cross-sectional survey among 192 recently diagnosed T2DM patients of whom 23% reported the presence of diabetes-related complications. Illness perceptions and self-care were assessed by the Revised Illness Perception Questionnaire (IPQ-R) and the revised Summary of Diabetes Self-Care Activities (SDSCA) measure.

Results: Generally, participating patients perceived T2DM as a chronic, but relatively controllable condition with minor consequences. In the presence of complications, however, T2DM was perceived as more unpredictable with more (serious) consequences and less controllable by self-care or medical treatment. Furthermore, engagement in exercise and foot care was reported more often by patients with complications. Self-care was related to certain illness perception dimensions, and interactions between perceptions and complications were found.

Conclusion: T2DM patients in the first years of their illness are often recommended to make lifestyle changes in the absence of noticeable diabetes-related symptoms or complaints. As many T2DM patients do not seem to perceive their condition to be serious and postpone lifestyle changes until diabetes-related complications appear, a major challenge for professionals is to convince asymptomatic patients of the importance of self-care.     

强化控制2型糖尿病患者血糖、血压＼血脂可降低尿白蛋白／肌酐比率

探讨2型糖尿病（T2DM）患者尿白蛋白／肌酐比率（UACR）的主要影响因素。89例T2DM患者实施血糖、血脂、血压强化控制,随诊1年并检测相关指标变化,统计学分析显示强化治疗后UACR降低,糖化血红蛋白和收缩压的变化值是影响UACR变化的主要因素。强化控制血糖、血脂、血压,尤其是严格控制糖化血红蛋白及收缩压,能减低糖尿病肾病发生的风险。     

Are exercise social-cognitive factors and behaviours different for adults with diabetes? A randomized community sample

Exercise plays a key role in the prevention and delay of the onset of Type 2 diabetes and in the management of this disorder. To determine if there are differences in key social-cognitive determinants of exercise and self-reported physical activity levels between adults with diabetes and those without the condition, a random selected sample of adults was surveyed. A telephone interview assessed physical activity behaviour and key social-cognitive constructs from major health behaviour change theories/models. The mean energy expenditure was not significantly different between the diabetes (n?=?46) and the non-diabetes (n?=?1556) groups. The diabetes group reported significantly lower scores for self-efficacy and perceived behavioural control, but higher for fear of, and vulnerability to, general health and cardiovascular disease threat. The data suggest that it may not be necessary to promote health threat messages, as threat is already high for this diabetes population and studies have shown that excess threat does not promote recommended exercise and health behaviours. Instead, the low levels of self-efficacy and perceived behavioural control among those with diabetes emphasize the importance of designing specific strategies (e.g., skills, incremental success) to increase their self-confidence in undertaking physical activity.     

Getting one's thoughts straight: a dialogical analysis of women's accounts of poorly controlled type 2 diabetes

Type 2 diabetes is a metabolic disorder characterised by chronically elevated blood glucose and a high risk of cardiovascular and other complications. Self-management is central to diabetes care and includes taking regular exercise, low-fat/sugar diet and blood glucose monitoring. However, little is understood about how people with diabetes make sense of self-management. Our aim, therefore, is to explore the process of 'getting one's thoughts straight' in relation to illness self-management for women with poorly controlled type 2 diabetes. Eight women were recruited from two hospitals in the North of England. Each was interviewed using a biographic-narrative method. Narratives were analysed using a dialogical approach. We use Bakhtin's concepts of voice, official and unofficial truth, and internally persuasive discourse to explore how participants considered, struggled with, and, sometimes, acted upon self-management. We demonstrate how the truth by which participants lived shifted as they encountered new perspectives and experiences. The accounts revealed tension between official, authoritative voices, typically concerned with optimal illness control and unofficial voices that speak at a lived, embodied level. In conclusion, we suggest moving beyond the notion of self-management towards a conceptualisation of life with chronic illness that includes personal goals, values and embodied experience in context.     

Authoritative Parenting, Parenting Stress, and Self-Care in Pre-Adolescents with Type 1 Diabetes

Parent involvement in type 1 diabetes (T1DM) care leads to improved adherence; however, the manner in which parents approach illness management interactions with children must also be considered. It was hypothesized that greater use of an authoritative parenting style and less parenting stress would be associated with greater behavioral adherence and better metabolic control. Ninety-five primary caregivers of preadolescents (ages 8-11) with T1DM completed questionnaires assessing parenting style, pediatric parenting stress, and child behavioral adherence. Caregivers primarily self-identified as using an authoritative parenting style. Greater authoritative parenting was associated with greater behavioral adherence and less difficulty with pediatric parenting stress; no differences in metabolic control were observed. Greater engagement in authoritative parenting behaviors may contribute to increased age-appropriate child behavioral adherence and less pediatric parenting stress. Interventions highlighting diabetes-specific authoritative parenting techniques may enhance health outcomes and improve overall family functioning.     

糖尿病的免疫抑制治疗

淡化糖尿病的分型为我们提供了一个全新的思维空间。即传统的1型和至少部分2型糖尿病可能都是一种自身免疫性疾病,而目前流行的炎症学说可能是对认可免疫损伤是糖尿病发病理论的一个过渡,我们应该重新审视糖尿病的早期治疗和研究其慢性并发症的发病机理。我们则采用小别量、长时间的治疗理念,早期接受这种免疫治疗的患者出现低血糖的症状,遂减少胰岛素的剂量;再次出现低血糖,我们就继续减少胰岛素的剂量。结果,有部分患者完全摆脱了胰岛素。我们对糖尿病的再认识是建立在对多脏器活检的基础之上。我们的活检结果表明,糖尿病肾病存在着免疫损伤。糖尿病眼底病变是使患者致盲的主要病因,糖尿病患者的眼底病变是一种自身免疫损伤的结果。我们尝试用小剂量的免疫抑制剂环孢菌素A（25mgbid）治疗糖尿病眼底出血,取得了不错的疗效,也证实糖尿病眼底病变是一种血管炎,与自身免疫病变有关。其他的器官还包括垂体、大脑的血管、糖尿病足、冠心病、皮肤的病变和肌肉活检的免疫组化也均有证据表明,免疫损伤是导致多种慢性并发症的罪魁祸首,是一种多器官免疫损伤的结果无论是1型糖尿病,还是2型糖尿病,肌细胞表面或多或少均有免疫复合物沉积。这些免疫复合物的存在势必会影响胰岛素与肌肉细胞表面的胰岛素受体结合,即胰岛素抵抗的存在。为此,我们在临床上广泛采用了免疫抑制治疗的理念治疗糖尿病。应用小剂量胰岛素和小剂量环孢素A治疗早期发现的糖尿病取得了不错的疗效。唯一担心的副作用发生在肝脏,即部分糖尿病患者会出现总胆红素升高,而也有一部分患者总胆红素不升高。