Diabetes distress,illness perceptions and glycaemic control in adults with type 2 diabetes

The emotional distress associated with adjusting to and living with diabetes has been termed diabetes distress. Diabetes distress is associated with glycaemic control but interventions to reduce diabetes distress have failed to consistently improve diabetes control. Various illness perceptions have previously been linked with both diabetes distress and glycaemic control but interrelationships between these features have not been previously investigated. We hypothesised that illness perceptions mediate the relationship between diabetes distress and glycaemia. Participants with type 2 diabetes attending diabetes outpatient clinics (n = 84) provided demographic and clinical information and completed the Diabetes Distress Scale-17 and the Brief Illness Perceptions Questionnaire. Using regression analysis we demonstrated that the illness perceptions of personal control, regimen-related distress, socioeconomic status and insulin use were significant contributors in the final model predicting HbA_1c. Higher levels of personal control were associated with better glycaemic control. Conversely, regimen-related distress was associated with hyperglycaemia. Mediation analyses showed that the relationship between regimen-related distress and HbA_1c was mediated by personal control. Our work suggests that psychological interventions designed to reduce diabetes distress may be more efficacious in improving glycaemic control if they address an individual’s perception of personal control.     

Explanatory style differences in health literacy: a survey among young adults in Taiwan

Explanatory styles are related to individuals’ positive health management. Everyone interprets and thinks about issues differently; therefore, medical information is understood in different ways. This study explored the relationship of optimistic and positive views on health literacy. A survey method was used to collect information from 342 university students. This study used PLS2.0 and SPSS 18.0 for data analysis. The results indicated that optimists had more accurate self-reported health status and medication-taking and nutritional knowledge than pessimists did. Females had higher scores on health knowledge and medication-taking and nutritional knowledge than males. In addition, female optimists had better performance on self-reported health status and health and medication-taking knowledge than female pessimists did. The major contribution of this study is the confirmation of the effect of explanatory style on health literacy.     

A study of mild cognitive impairment in veterans: role of hypertension and other confounding factors

Introduction: Hypertension has shown to be an important risk factor for the decline in cognitive function. Aim of our study is to investigate the presence of cognitive impairment of the elders with hypertension and other confounding factors.

Methods: This study was conducted on 400 veterans who were matched one-to-one with the confounding factors for assessing the presence of mild cognitive impairment using both MMSE and Montreal Cognitive Assessment (MoCA). The 13 related factors of patient data were studied.

Results: The prevalence rate of cognitive impairment was 29.25%. Age (OR 2.679, 95%CI 1.663–6.875), sleep impairment (OR 1.117, 95%CI 1.754–7.422), uncontrolled hypertension (OR 1.522, 95%CI 1.968–4.454), type 2 diabetes (OR 2.464, 95%CI 1.232–4.931), and hyperlipidaemia (OR 1.411, 95%CI 1.221–8.988) are the risk factors for the cognitive deterioration, while the protective factors are high level of education (OR 0.032, 95%CI 0.007–0.149) and regular exercise (OR 0.307, 95%CI 0.115–0.818).

Discussion: Because some vascular disease risk factors, such as hypertension, can be treated effectively, cognitive decline related to these risk factors, and vascular disease per se, may be prevented or its course modified through more aggressive treatment and improved compliance.     

Text‐message reminders plus incentives increase adherence to antidiabetic medication in adults with type 2 diabetes

Some adults with Type 2 diabetes mellitus have difficulty adhering to their oral medication regimens. The current study used a multiple baseline design with 3 adults with Type 2 diabetes. Medication taking was monitored remotely in real time via an electronic pill bottle. During the intervention, monetary incentives were delivered contingent on evidence of adherence to taking medication at specified times. Text‐message reminders were also sent if medication was not taken. Adherence increased for all participants. Future studies should separate the relative contributions of text‐message and incentive components of the intervention.     

How patients’ representations of cystic fibrosis-related diabetes inform their health behaviours

Background: Although diabetes is a frequent complication of cystic fibrosis (CF), patients’ behaviours tend not to comply with best practice recommendations. Using Leventhal’s Common-Sense Model, we address this issue by exploring patients’ representations of CF-related diabetes (CFRD) to better understand the discrepancy between patients’ expected and observed health behaviours.

Methods: Semi-structured individual interviews were conducted with patients (n = 39) in six CF clinics in Quebec, Canada. These interviews were part of a larger research project on screening and management practices for CFRD.

Results: Illness representations differed between two groups of interviewed patients: (1) one group had either CF without dysglycemia or CF with impaired glucose tolerance; and (2) the other group had CFRD. Both representations were internally consistent and encompassed Leventhal’s five dimensions of illness representation: illness identity, cause, timeline, consequences and control.

Conclusions: Patients require specific information on CFRD. The screening phase could be a crucial time to help patients adjust their representations to fit the reality of CFRD.     

Head and Trunk Control While Walking in Older Adults with Diabetes: Effects of Balance Confidence

Investigations of gait in older adults with diabetes mellitus (DM) have been primarily focused on lower limb biomechanical parameters. Yet, the upper body accounts for two thirds of the body's mass, and head and trunk control are critical for balance. The authors examined head and trunk control during self-selected comfortable, fast, and dual-task walking and the relationship between balance confidence and potential head-trunk stiffening strategies in older adults with DM without diagnosed diabetic peripheral neuropathy (DPN). Twelve older adults with DM without diagnosed DPN (DM group) and 12 without DM (no-DM group) were recruited. Walking speed, peak-to-peak head and trunk roll displacement, head and trunk roll velocity, and head-trunk correlation were measured while walking at a self-selected comfortable or fastest possible speed with or without a secondary cognitive task. The Activities-specific Balance Confidence scale measured balance confidence. Subtle group differences in axial segmental control (lower trunk roll velocity; higher head-trunk correlation) were apparent in older adults with DM even in the absence of DPN. Balance confidence was 19% lower in the DM group than in the no-DM group, and partially explained (34%) the group difference in head-trunk stiffening. These results emphasize the need for proactive monitoring of postural control and balance confidence before the onset of DPN.     

关于胰岛移植治疗1型糖尿病的思考

糖尿病是一种严重影响人类健康的疾病,胰岛移植作为一项新兴技术,对于1型糖尿病而言是一种很有前景的治疗方法。通过总结和回顾该疗法的产生原因、研究现状及发展方向,揭示了认识论和系统论这些哲学基本原理在此过程中的指导作用,并以此为例阐述临床辩证思维对临床医学的促进作用。     

中国糖尿病教育者的重任

糖尿病教育是一种治疗性的干预措施,也是一项有计划的教育课程,糖尿病教育者是糖尿病管理队伍中的一个整合部分,一名专业糖尿病教育工作者对于促进糖尿病医疗护理、实践及服务等方面都将起到很大的贡献,其中,糖尿病专科护士扮演着重要角色。要促进我国糖尿病教育的快速发展,急需一支专业化的糖尿病教育者队伍来发挥主力军的作用。     

Adult Attachment: Toward a Rapprochement of Methodological Cultures

ABSTRACT— Attachment security in adulthood is not profitably conceptualized as a single, monolithic construct. It is reflected both in adults' confidence in themselves and others in close relationships (as noted by social-personality psychologists) and in their ability to successfully construct a coherent life narrative about childhood experiences with primary attachment figures (as emphasized by developmental psychologists). Evidence suggests that measures tapping these forms of attachment-related variation represent the underlying structure of adult attachment similarly, in that both may be best captured by two continuously distributed, albeit correlated dimensions tapping anxiety and avoidance. Nonetheless, differing approaches to measuring adult security demonstrate weak empirical overlap, and emerging evidence suggests that each is associated with personal and interpersonal outcomes central to attachment theory in empirically distinct ways. Discussion focuses on how recent insights—in combination with needed experimental and longitudinal data—can help reconcile the developmental- and social-psychological literatures on adult attachment.     

防治血管剩留风险的决策探讨

针对冠心病和（或）2型糖尿病患者,已有许多有效的防治措施。然而,尽管接受了当前的标准治疗,这类患者仍会反复发生许多大血管和微血管事件,这种现象称之为血管剩留风险。有许多因素影响血管剩留风险的存在,其中最为重要的是致动脉粥样硬化性血脂异常。因此,采取积极的全面干预措施如改善生活方式、联合降脂以改善所有的脂质异常指标,是最大程度降低血管剩留风险的动向。