The impact of a laryngectomy on the spouse: Who is better off?

Background: Diabetes self-care is a key element in the overall management of diabetes. However, the importance of psychosocial factors for successful disease management is under investigated. This study aimed at exploring the role of coping styles and social support in the relationship between self-care activities and glycated haemoglobin in patients with type 2 diabetes.

Methods: One hundred adults (60% female, aged 40–70 years) with type 2 diabetes completed questionnaires assessing self-care activities, coping styles and social support. In addition, a blood test was performed to obtain glycated haemoglobin levels.

Results: Result showed significant relationships of glycated haemoglobin with self-care activities, coping styles and social support. Regression analysis indicated that social support had a moderating role on the relationship between self-care activities and glycated haemoglobin, such that, at very high levels of social support the association, between Self-Care and HbA1c disappears.

Conclusions: Findings indicate that health care providers, within the context of the Iranian social and cultural situation, should pay more attention to psychosocial factors when addressing self-care activities. Delineation of the role of coping styles and social support might be useful for identifying patients in need of particular counselling and support for improving self-care activities and HbA1c levels.     

Reducing obstacles to the provision of quality diabetic care

Abstract

High quality diabetic care is seen as influenced by the organisation of care, health care workers' involvement in diabetes-specific areas, co-operation among staff members, the availability of resources, and the competence of medical staff (including both physicians and nurses). In a prospective study we have tested a programme for improvements of the quality of diabetes services which combined organisational development and continuing medical education (CME) measures. The study involved 34 primary health care centres over an 18 month period and was based on the responses to questionnaires answered by 123 general practitioners and 247 registered nurses at the 34 PHCCs.

The combined programme had a considerable influence on inter-group co-operation, staff members' perceptions of resources available, and nurses' involvement in diabetic care (54 versus 30% seeing diabetic patients for regular check-ups).

The results show that, in order to diminish obstacles to high quality care, organisation of care as well as care workers' theoretical knowledge has to be focused.     

The use of diabetes-specific perceived control and health belief measures to predict treatment choice and efficacy in a feasibility study of continuous subcutaneous insulin infusion pumps

Abstract

In the course of a feasibility study of continuous subcutaneous insulin infusion pumps, 382 insulin-requiring diabetic patients were offered a choice of CSII, intensified conventional treatment or conventional treatment. Two hundred and eighty-six (75%) patients completed newly developed diabetes-specific measures of health beliefs and attributions before any change of treatment regimen. The scales were useful predictors of patients' choice of treatment. Furthermore, they were useful in predicting efficacy of treatment in terms of glycosylated haemoglobin measures of diabetes control after one year of treatment in the study. The implications of the findings for introducing patients to new forms of treatment are discussed.     

A Contextual Model of Control Beliefs,Behavior, and Health: Latino and European Americans with Type 2 Diabetes

Sense of control is frequently found to be related to health. A model of control beliefs, disease-management behaviors, and health indicators was tested in a sample of 74 Latino Americans and 115 European Americans with Type 2 diabetes. Two measures of control beliefs, one diabetes-specific (diabetes self-efficacy) and one global (mastery), were examined for their effects on management behaviors (diet and exercise) and on health (Hb_A1C and general health). Results indicated that the relationship between control and management behaviors varied by measure of control and by group. For Latino participants, global mastery was related to management behaviors; whereas, self-efficacy was related to such behaviors among European Americans. The relationship between control and health did not appear to be mediated by management behaviors. This study provides support for a diversified approach to control, behavior, and health.     

将糖化血红蛋白控制在7．0％以下是否更安全

2008年一项针对2型糖尿痛强化血糖控制对心血管病变研究（ACCORD）发现,对于病程在10年左右,30％存在心血管疾病的2型糖尿病人群,利用现有手段努力实现血糖“正常化”,即糖化血红蛋白（A1C）〈6．0％并没有减少糖尿病全因死亡。人们开始重新思考对2型糖尿病是否还需要强调强化血糖控制、血糖控制的目标多少为宜。中华医学会糖尿病学分会也在今年重新修订了其《中国2型糖尿病防治指南》的A1C控制目标,A1C目标由原来的6．5％提高到7．0％。那么这一改变对2型糖尿病患者来讲到底有多大意义呢？ACCORD强化降糖治疗终止后的随访研究发现强化组患者在血糖控制目标与标准治疗组相似的情况下,全因死亡率并没有随之减少。因此,需要重新检视2型糖尿病防治策略。     

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。     

西藏老年病房2型糖尿病患者的血糖管理

西藏老年2型糖尿病患者有着知晓率低、病程长、慢性并发症多、其他相关疾病多等特点。加强糖尿病教育、控制饮食、合理用药、注意相关疾病的处理和个体化治疗是血糖管理的有效方案。     

Feasibility of a pilot intervention targeting self-care behaviors in adults with diabetes mellitus

Diabetes has reached epidemic proportions and is widely encountered by clinicians in medical settings. National Standards for diabetes education recommend utilization of an interdisciplinary team, setting individual lifestyle goals and managing barriers. However, typical diabetes education programs lack integration of strategies for translating recommendations into behavioral actions. The present intervention was developed to assess the feasibility and efficacy of a short-term cognitive-behavioral intervention aimed at optimizing self-care behaviors in adults with diabetes in a “real world” medical setting. Participants were 20 adults who had completed medical model outpatient diabetes education. The intervention consisted of 6 weekly sessions that addressed the role of behavior in diabetes including self-care barriers, cognitions and self-regulation. Pre-post intervention data indicated greater specificity in goal-setting. Participants who kept activity records had the greatest lifestyle activity behavior change. Findings suggest that a brief intervention addressing realistic goal-setting is feasible and can promote meaningful health behavior changes. Clinical psychology can provide a bridge between current diabetes care recommendations and available medical resources by providing training in and delivery of empirically supported behavior change strategies and evaluation of diabetes care treatment approaches.     

2型糖尿病胰岛素治疗探讨

过去,人们(包括医护人员)对2型糖尿病的胰岛素治疗存在许多误区。通过糖尿病的流行病学,2型糖尿病的发病机制,早期胰岛素治疗对2型糖尿病的意义,及胰岛素的种类、剂型,和使用方法(包括补充疗法和替代疗法),以及2型糖尿病的治疗现状,来阐述胰岛素治疗对2型糖尿病的必要性。     

Association of Depression with Complications of Diabetic Pregnancy: A Retrospective Analysis

The goal of this study was to determine whether an association between histories of depression and adverse pregnancy outcome could be established using a retrospective analysis. Participants were a convenience sample of 152 pregnant diabetic women for whom prior pregnancy data were available. Prior pregnancy outcome, depression history, and other clinical characteristics were determined from chart review and medical history questionnaires. Logistic regression was used to determine which of the measured clinical factors, including history of depression, had a significant association with history of pregnancy complications. Thirty-nine patients (26%) had a past history of depression. Three pregnancy complications (preterm labor, pre-eclampsia, fetal prematurity) were more common in the group having a history of depression as was the proportion of participants requiring Caesarean section p( < .05 for each comparison). A history of depression was associated with prior pregnancy complications independent of the effects of parity, prepregnancy BMI, tobacco use history, diabetes type, and presence of diabetes complications (OR = 3.6; 95% CI = 1.5–9.0, p = .006). These retrospective data indicate that depression is linked to complications of diabetic pregnancy and support the need for prospective studies to clarify the effects of depression and its treatment on diabetic pregnancy.