Cognitive-behavioural interventions in a patient with an anxiety disorder related to diabetes

This study extends the data on the efficacy of cognitive interventions for patients with chronic medical problems and describes the case of a 37-year-old woman with an anxiety disorder related to diabetes. The effects on panic frequency, use of safety behaviour and related beliefs were investigated after the introduction of two main cognitive-behavioral interventions. The results are consistent with predictions from the cognitive model of panic. This case demonstrates the usefulness of directly challenging the 'meaning' of the feared situation in order to produce clinically significant improvements in the management of physical disease.     

Maternal distress in the context of their child’s type 1 diabetes: exploring the role of adaptive maternal emotion regulation on child outcomes

Parents of children with Type 1 diabetes (T1D) experience high levels of distress, which may negatively impact child functioning. However, little is known about mechanisms that may buffer the adverse impact of parental distress. The current study explored the possible buffering role of maternal adaptive cognitive emotion regulation (CER) for the relationship between maternal distress and child psychological functioning. Forty-three children with T1D (8–15 years) completed measures assessing trait anxiety and depressive symptoms. Their mothers reported on general distress, illness-related parenting stress, and adaptive CER. Maternal illness-related parenting stress (but not general distress) was significantly associated with child psychological functioning. No buffering role for maternal adaptive CER was observed. As the current study is rather preliminary, future research using other methods to examine maternal adaptive CER, and examining other parental variables that may buffer against the negative impact of parental distress is warranted.     

Increased forefoot loading is associated with an increased plantar flexion moment

The aim of this study was to identify the cascade of effects leading from alterations in force generation around the ankle joint to increased plantar pressures under the forefoot. Gait analysis including plantar pressure measurement was performed at an individually preferred and a standardized, imposed gait velocity in diabetic subjects with polyneuropathy (n = 94), without polyneuropathy (n = 39) and healthy elderly (n = 19). The plantar flexion moment at 40% of the stance phase was negatively correlated with the displacement rate of center of pressure (r = ?.749, p < .001 at the imposed, and r = ?.693, p < .001 at the preferred gait velocity). Displacement rate of center of pressure was strongly correlated with forefoot loading (r = ?.837, p < .001 at the imposed, and r = ?.731, p < .001 at the preferred gait velocity). People with a relatively high plantar flexion moment at 40% of the stance phase, have a faster forward transfer of center of pressure and consequently higher loading of the forefoot. This indicates that interventions aimed at increasing the control of the roll-off of the foot may contribute to a better plantar pressure distribution.     

Effect of the Healthy MOMs Lifestyle Intervention on Reducing Depressive Symptoms Among Pregnant Latinas

Depression during the prenatal and postpartum periods is associated with poor maternal, perinatal and child outcomes. This study examines the effectiveness of a culturally and linguistically tailored, social support-based, healthy lifestyle intervention led by trained community health workers in reducing depressive symptoms among pregnant and early postpartum Latinas. A sample of 275 pregnant Latinas was randomized to the Healthy MOMs Healthy Lifestyle Intervention (MOMs) or the Healthy Pregnancy Education (control) group. More than one-third of participants were at risk for depression at baseline. MOMs participants were less likely than control group participants to be at risk for depression at follow-up. Between baseline and 6 weeks postpartum, MOMs participants experienced a significant decline in depressive symptoms; control participants experienced a marginally significant decline. For MOMs participants, most of this decline occurred during the pregnancy intervention period, a time when no change occurred for control participants. The change in depressive symptoms during this period was greater among MOMs than control participants (“intervention effect”). From baseline to postpartum, there was a significant intervention effect among non-English-speaking women only. These findings provide evidence that a community-planned, culturally tailored healthy lifestyle intervention led by community health workers can reduce depressive symptoms among pregnant, Spanish-speaking Latinas.     

Representing diabetes: ‘Brightside’ and ‘chaos’ in autobiography

This paper examines six autobiographical sources written by people with type 1 diabetes. In seeking to improve the understanding of diabetic lifeworlds; some of the autobiographies present heroic stories of ‘overcoming’ diabetes while others present a more ‘chaotic’ narrative. Regardless of their form, all the autobiographies highlight how the everyday problems and concerns associated with diabetes can be hidden and silenced. Therefore, I ask the question of how to use autobiographies as sources of evidence, being aware of the power constructs that may have directed their form. Despite this question, I argue that autobiographies remain crucial sources for exploring the experience of everyday life and much of the silencing in the texts reflects spatial and emotional challenges faced by the authors. I also consider the limitations of representation in the autobiographies calling for an understanding that the experience of diabetes carries with it feelings, emotions and affects that are non-representable and so never entirely knowable. Thus, this paper builds on recent geographical research on emotion and ‘contested’ illnesses, especially those that are not obviously visible or are easily hidden.     

Illness perception clusters and relationship quality are associated with diabetes distress in adults with Type 2 diabetes

This report aims to augment what is already known about emotional distress in Type 2 diabetes, by assessing the predictive value of illness perception clusters and relationship quality on four subcategories of Diabetes Distress.162 individuals with Type 2 diabetes responded to a postal questionnaire assessing demographics, depression, diabetes distress, illness perceptions and relationship quality. Long-term blood glucose was retrieved from participants’ General Practitioner. Three illness perception clusters emerged from the data, capturing three subgroups of participants sharing similar illness perception schemas. Regression analyses were performed across each diabetes distress subscale, with demographics, illness perception clusters, and relationship variables entered into three blocks. Covariates explained 51.1% of the variance in emotional burden, 41% of the variance in regimen-related distress, 20% of the variance in interpersonal distress, and 8.6% of the variance in physician-related distress. Cluster membership was strongly associated with emotional burden, regimen-related distress, and to a lesser degree interpersonal distress, but was not associated with physician-related distress. Relationship quality most strongly predicted regimen-related distress. Illness perception schemas and interpersonal issues influence emotional adjustment in diabetes. This study provides direction for the content of a novel approach to identifying and reducing diabetes distress in people with Type 2 diabetes.     

糖尿病教育在2型糖尿病防控工作中的重要性

近年来,由于糖尿病的高患病率、高致残率和高死亡率带来沉重的社会和经济负担。预防糖尿病发生、改善糖尿病患者现况等均提示推广普及糖尿病教育具有重要意义。通过糖尿病教育可以全面改善患者临床控制指标、知识水平、自我管理水平和自我效能水平,且从卫生经济学角度分析显示其投入相对较小的成本即可达到良好的效果和效用,因而在糖尿病防控体...     

OSAHS在2型糖尿病发病中的作用与对策

阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea hypopnea syndrome,OSAHS）是一种常见的睡眠呼吸紊乱性疾病,以睡眠时反复发作的上气道部分或完全阻塞为特征。近年发现OSAHS与2型糖尿病之间有着明显的相关性,二者均为心血管疾病的高危因素,合并存在能够严重影响生命质量与预期寿命...     

老年糖代谢异常患者血浆NT—proBNP与血管内皮功能早期监测意义

通过检测老年糖代谢异常患者的血浆N末端血清脑钠肽前体（NT—proBNP）水平与肱动脉血管内皮依赖性舒张功能（FMD）,探讨其早期监测意义。共77例观察对象,其中12例血糖正常的健康老人为对照组,65例老年糖代谢异常组患者根据空腹血糖（FBG）和糖耐量2小时（0GTT2h）血糖水平分为空腹血糖受损组（IFG）14例、糖耐量受损组（IGT）23例和2型糖尿病组（DM）28例。各组均检测血浆NT—proBNP水平和无创超声监测FMD。随着血糖代谢异常程度加重,比较正常组,糖代谢异常组的血浆NT—proBNP水平升高（P〈0．01）,FMD调节下降（P〈0．01）;糖代谢异常发展过程中,IFG阶段FMD即出现舒张失调（P〈0．05）;IGT阶段血浆NT-proBNP水平升高有意义并达到无症状心衰诊断标准（P〈0．01）,且FMD出现舒张过度调节,提示收缩和舒张功能双向调节不良。空腹血糖升高增加血管内皮依赖性舒张功能损害,当FBG合并（或）餐后血糖升高,血浆NT—proBNP水平升高可以成为早期预测慢性无症状心功能不全的危险因素。因此,关注老年糖代谢异常早期阶段进程,并联合血浆NT—proBNP水平和血管内皮依赖性舒张功能监测,不仅对靶器官保护具有早期预警意义,而且是临床控制血糖管理的重要而简易的方法之一。     

初探健康管理与我国糖尿病的预防与控制

近年来,我国糖尿病发展的势头迅速,成为糖尿病患病率增长最快的国家之一,给社会和经济带来了巨大的负担。文章针对我国的糖尿病的流行现状及其带来的经济负担,分析了实施糖尿病健康管理的现实意义,并借鉴美国健康管理的经验,构思了我国社区的促进糖尿病防制的健康管理模式。