Diabetes mellitus and psychological well-being. Change between 1984-1986 and 1995-1997. Results of the Nord-Trøndelag Health Study

Effectiveness of Gratitude Therapy in Diabetes Management: A Qualitative Study

The present study involves a Qualitative research design. The study intends to assess the effectiveness of interventions on the diabetic participants. In the present study, four participants screened with high perceived stress, moderate depression, poor sense of gratitude, were selected. The study consisted of three successive phases such as baseline assessment, intervention, and follow-up. Pre-test and Post-test design were adopted. Qualitative data were expressed as percentages, and Schwartz and Blanchard's technique was administered. Participants have shown improvement in positive dimension scores and there is reduction in negative dimension scores. Blood glucose level readings are also marked before, during, and after the intervention. Participants are found to control their blood glucose level, but the change in the glucose level is not clinically significant.

Psychological well-being and adjustment among type 2 diabetes patients: the role of psychological flexibility

Elevated rates of psychological disorders are reported among those with type 2 diabetes (T2D). Thus, research into factors enhancing psychological aspects of well-being is critical in T2D. We examine the association between a multifaceted measure of Psychological Flexibility (PF), and its relationship to adjustment and well-being, among this population. Adults with T2D (N = 102) completed an online battery of self-reported questionnaires and were asked for demographics, general T2D features, treatment adherence, PF, adjustment, and well-being. We examined the association between PF (Psychological Flexibility Questionnaire, PFQ), adjustment to diabetes (ATT-39) and well-being (Mental Health Inventory), among adults with T2D. Greater PF was significantly associated with greater well-being, but unrelated to adjustment, which was positively associated with well-being. In a hierarchical regression analysis, perception of change as positive (one of the five PFQ factors) significantly contributed to the explained variance in well-being, beyond the contribution of adjustment. These findings indicate that positive perception of change may enhance well-being independently from adjustment to diabetes since these two constructs are distinct and independent. Such an association between PF and well-being may apply to other medical conditions. Implications for psychological intervention are discussed.

The Impact of Promotoras on Social Support and Glycemic Control Among Members of a Farmworker Community on the US-Mexico Border

PURPOSE

The purpose of this study is to describe the effect of a promotora-driven intervention to build social support as a means to affect self-management behaviors and clinical outcomes in a farmworker community on the US-Mexico border.

METHODS

Promotoras implemented a community-based intervention that included support groups, home/hospital visits, telephone support, and advocacy to people with diabetes. A 12-month pre/post study design was used to investigate the relationship between promotora contact, perceived support, and clinical outcomes. Clinical data were gathered from 70 participants during routine physician visits. A pre/post questionnaire was used to measure perceived support and self-management practices.

RESULTS

Glycosylated hemoglobin (HbA1c) levels decreased 1% among high-risk participants. Improved HbA1c level was associated with promotora advocacy and participation in promotora-led support groups. Participants reported increased support from family and friends and more comfort speaking about diabetes (la enfermedad) with family and friends.

CONCLUSIONS

These findings document improvement in both clinical and social health indicators for Mexican Americans in a farmworker community when a promotora model is used to provide and facilitate culturally relevant support for diabetes self-management practices.

Body mass index and health status in diabetic and non-diabetic individuals

Background/Objectives:

There is controversy regarding the existence of a body mass index (BMI) mortality paradox in diabetes, whereby the optimal BMI category is higher than it is in non-diabetic persons. To explore possible pathways to a mortality paradox, we examined the relationship of BMI with physical and mental health status in diabetic and non-diabetic persons.

Subjects/Methods:

We examined adjusted SF-12 Physical and Mental Component Summary (PCS-12 and MCS-12) scores by BMI (kg m⁻²) category (underweight, <20; normal weight, 20 to <25; overweight, 25 to <30; obese, 30 to <35; severely obese ⩾35) in adult diabetic and non-diabetic respondents to the 2000–2011 United States national Medical Expenditure Panel Surveys (N=119 161). Adjustors were age, sex, race/ethnicity, income, health insurance, education, smoking, comorbidity, urbanicity, geographic region and survey year.

Results:

In non-diabetic persons the adjusted mean PCS-12 score was highest (that is, most optimal) in the normal-weight category, whereas for diabetic persons the optimal adjusted mean PCS-12 score was in the overweight category (adjusted difference between non-diabetic and diabetic persons in the difference in PCS-12 means for overweight versus normal-weight category=0.8 points, 95% confidence interval; CI 0.1, 1.6; P=0.03). This paradoxical pattern was not evident for the MCS-12, and the adjusted difference between non-diabetic and diabetic persons in the difference in MCS-12 means for overweight versus obese persons was not significant (−0.3 points, 95% CI −0.9, 0.4; P=0.43). The findings were not significantly moderated by smoking status, cancer diagnosis or time period.

Conclusions:

The optimal BMI category for physical health status (but not mental health status) was higher among diabetic than non-diabetic persons. The findings are consistent with a BMI physical health status paradox in diabetes and, in turn, a mortality paradox.

Impact of Diabetic Foot Related Complications on the Health Related Quality of Life (HRQol) of Patients - A Regional Study in Spain

The diabetic foot reduces the health-related quality of life (HRQoL) in patients with diabetes mellitus. This study aims at ascertaining the impact of the etiological factors of the diabetic foot on the various aspects of HRQoL. This is a comparative study involving type 1 or type 2 (n = 421) diabetic patients divided into 2 groups. Group 1 (n = 258) includes diabetic patients without foot lesions and group 2 (n = 163) includes patients suffering from a diabetic foot ulcer. The HRQoL of the sample was assessed by using the SF-36 Health Questionnaire. The overall HRQoL score was 68.58 ± 18.24 in group 1 and 50.99 ± 18.98 in group 2 ( P < .001). The diabetic foot—related etiological factors that significantly reduce these patients’ HRQoL are neuropathy, amputation history, and poor metabolic control ( P < .001). Quality of life was lower in women with diabetic foot than in men. Neuropathy—regarded as the main etiological factor in the diabetic foot—also proved to be a variable that reduces the HRQoL. Paradoxically, peripheral vascular disease did not prove to have a negative impact on the quality of life.

The association between diabetes mellitus, glucose, and chronic musculoskeletal complaints. Results from the Nord-Trøndelag Health Study

Background

The relationship between diabetes mellitus (DM) and chronic musculoskeletal complaints (MSCs) is unclear. The aim of this study was to investigate the association between DM, non-fasting glucose and chronic MSCs defined as pain and/or stiffness ≥ 3 months during the past year in the general adult population.

Methods

The results were based on cross-sectional data from 64,785 men and women (aged ≥ 20 years) who participated in the Nord-Trøndelag Health Survey, which included 1,940 individuals with known DM. Associations were assessed using multiple logistic regression, estimating prevalence odds ratio (OR) with 95% confidence intervals (CIs).

Results

High non-fasting glucose was associated with a lower prevalence of chronic MSCs compared to a low glucose level. DM was associated with higher prevalence of chronic MSCs, in particular chronic widespread MSCs. In the multivariate analysis, adjusting for glucose level, BMI, age, gender and physical activity, chronic widespread MSCs was 1.6 times more likely (OR = 1.6, 95% CI 1.2–2.2) among individuals < 60 years of age with DM than among those without DM. The association between chronic widespread MSCs and DM was most evident among the group of individuals aged < 60 years with either type 2 DM or unclassified DM (OR = 1.8, 95% CI 1.3–2.5).

Conclusion

In this cross-sectional study a high non-fasting glucose was associated with lower prevalence of chronic MSCs. Among individuals with known DM chronic widespread MSCs were more likely.

The relation of chronic cardiovascular diseases and diabetes mellitus to perceived health, and the moderating effects of sex and age

This study investigates the relation of five chronic cardiovascular diseases and diabetes mellitus (DM) to perceived health, and the moderating effects of sex and age. In a community-based cross-sectional telephone survey in Hong Kong, 7730 Chinese aged 25-74 were interviewed in 1994-1996. The odds ratio for poor perceived health associated with each condition was calculated adjusting for age, sex and education. Subjects free from the six conditions were treated as the comparison group. Hypertension, angina, DM, coronary heart disease (CHD) and stroke were significantly associated with poor perceived health. The odds ratio of poor perceived health was significantly greater in men than in women for having more than one condition among DM, CHD and stroke (p=0.02), and insignificantly greater for stroke, CHD and angina. The odds ratios were significantly greater in the young (25-39) versus the old (60-74) for DM (p=0.008) in men and women combined, and for having either DM, CHD or stroke in men (p=0.02). These findings suggest that the relation of DM, CHD and stroke with poor perceived health tends to be stronger in men and younger adults. These findings have implications for health care workers and home carers who need to appreciate that the same condition may have a different perceived impact on persons of different sex and age, and be sensitive to their varying needs.