Diabetes Questionnaires Research Articles

Prevalence of Chronic Kidney Disease in Type 1 Diabetes Among Adults in the U.S.

The prevalence of chronic kidney disease (CKD) in adults ≥18 years of age with type 1 diabetes in the U.S. was determined using National Health and Nutrition Examination Survey (NHANES) data. A modified treatment-based algorithm applying a subset of NHANES diabetes questionnaires was used. The number of respondents with CKD and type 1 diabetes was weighted (extrapolated) to the U.S. population. Based on data between 2015 and 2018, type 1 diabetes was identified in 47 out of 19,225 adults with evaluable kidney function data. CKD was present in 20 out of 47 people identified with type 1 diabetes. The weighted estimate of CKD in type 1 diabetes was 21.5%, corresponding to 258,196 (95% CI 71,189-445,203) people in the U.S. Applying a conservative approach in our study indicates that CKD is common in adults with type 1 diabetes in the U.S.

Abstract P400: Trajectories of Psychological Well-Being Are Associated With High Cardiovascular Health Late in Life: Findings From the Women’s Health Initiative

Introduction: Psychological well-being (PWB) may influence cardiovascular health (CVH) through what the American Heart Association has called the “mind-heart-body connection”. However, few studies have examined longitudinal relationships between positive PWB and CVH. We estimated associations between trajectories of PWB and Life’s Essential 8 (LE8) achievement. Hypothesis: We hypothesized that women who maintained high levels of PWB over time would have higher LE8 scores later in life. Methods: We conducted group-based trajectory modelling in the Women’s Health Initiative (WHI) to identify latent trajectories of PWB among those with ≥3 measurements of purpose in life (PIL, N=29,717) and personal growth (PG, N=12,148). PIL and PG scores were calculated according to participants’ responses to the FACIT-Sp Meaning Subscale and Ryff’s Scales of PWB, collected between 2000-2021. The selection of trajectory models was informed by statistical criteria and prior literature. Late life CVH (2018-2021) was summarized by LE8, with scoring adapted based on available data: self-reported treatment for hypertension, diabetes, and hypercholesterolemia, and historical food frequency questionnaires were used. Logistic regression was performed to estimate associations between PIL and PG trajectory group membership and high CVH (LE8≥80), summarized by odds ratios (OR) and 95% confidence intervals (CI). Logistic models adjusted for baseline age, WHI study arm, race, marital status, income, and education in those with complete data (PIL N=28,033; PG N=11,495). Results: On average, PIL trajectories spanned 17 years (age 66-83) and three latent groups were identified: high/decreasing (n=12,073; 47.4%), moderate/decreasing (n=12,096; 44.1%), and low/stable (n=2,548; 8.6%). Compared to those in the low/stable group, women in the moderate/decreasing and high/decreasing PIL groups had significantly higher odds of having high CVH (OR 1.47 [1.35, 1.61] and OR 2.09 [1.92, 2.28], respectively). These associations were robust to adjustment for demographics and social determinants of health: moderate/decreasing (aOR 1.40 [1.27, 1.53]), high/decreasing (aOR 1.88 [1.71, 2.07]). PG trajectories spanned 9 years (age 74-83) and high/stable (n=3,832, 31.5%), moderate/stable (n=5,692, 46.9%), and low/stable (n=2,624, 21.6%) latent groups were identified. Membership in moderate/stable (OR 1.53 [1.40, 1.69] and high/stable (OR 1.95 [1.75, 2.16]) PG trajectory groups was also significantly associated with odds of having high CVH. These associations remained significant after adjustment (moderate/stable aOR 1.40 [1.27, 1.55]; high/stable aOR 1.64 [1.46, 1.84]). Conclusions: Maintaining high levels of PIL and PG may contribute to better CVH late in life. Further research is needed to investigate how strategies to improve PWB may be integrated within cardiovascular care among older adults.

Assessing the relationship between low-calorie sweetener use and quality of life measures in adults with type 1 diabetes

BackgroundTo evaluate use of low-calorie sweeteners (LCS) among adults with type 1 diabetes (T1D) and its impact on quality of life (QOL).MethodsIn this single center, cross-sectional survey study with 532 adults with T1D, Food related QOL (FRQOL), LCS specific questionnaire (LCSSQ), Diabetes Self-Management Questionnaire (DSMQ), Food Frequency Questionnaire (FFQ), Audit of Diabetes-Dependent QOL (AddQOL), Type 1 Diabetes and Life (T1DAL) questionnaires were administered through RedCAP, a secure, HIPAA-compliant web-based application. Demographics and scores of adults who used LCS in last month (recent users) and others (non-users) were compared. Results were adjusted for age, sex, diabetes duration and other parameters.ResultsOf 532 participants (mean age 36 ± 13, 69% female), 99% heard LCS before, 68% used them in the last month, 73% reported better glucose control with LCS use and 63% reported no health concerns about LCS use. Recent LCS users were older and had a longer diabetes duration and more complications (hypertension, or any complication) than non-users. However, A1c, AddQOL, T1DAL, FRQOL scores did not differ significantly between recent LCS users and non-users. DSMQ scores, DSMQ management, diet, health care scores did not differ between two groups; however, recent LCS users had lower physical activity score than non-users (p = 0.001).ConclusionsMost of the adults with T1D have used LCS and perceived that LCS use improved their QOL and glycemic control; however, these were not verified with questionnaires. There was no difference in QOL questionnaires except DSMQ physical activity between recent LCS users and not users with T1D. However, more patients in need to increase their QOL may be using LCS; therefore, associations between the exposure and outcome can be bi-directional.

The Effect of the Innovative Healthcare Program "My Color Health" on Knowledge, Behavior, and Perception of Disease Severity in Patients with Diabetes and Hypertension

Motivational program as a form of mutual aid could offer great benefits to promote healthy eating among Thai elderly with Diabetes and Hypertension. The purpose of this study is to examine the average, knowledge, practice recommendations, and patients' perceptions of the severity of their diseases before and after receiving the My Color Health Innovation. This quasi-experimental research used a one-group pretest-posttest design that aimed to examine the effects of the innovation "My color health" on knowledge, behavior, and the perception of disease severity in patients with diabetes and hypertension. This study used the concept of the 7-Color Ball. The sample consisted of 20 elderly people and was selected through purposive sampling. The research instruments consisted of the innovation "My color health" knowledge test behavior, and perception of the severity of diabetes and hypertension questionnaires. The questionnaire in Google Forms was used to collect data. The data were analyzed using descriptive statistics and paired t-tests. The results revealed that after using "My color health", the differences in the mean scores of knowledge, guidelines for practice, and perceived severity of diabetes and hypertension were statistically significant (P< 0.05). This research shows that the innovation of "My color health" can increase knowledge, behavior, and perception of the severity of diabetes and hypertension. It can be used as a guideline for the care of patients with uncontrolled diabetes and hypertension.

Test–retest reliability and measurement error of the WHO-5 Well-being Index and the Problem Areas in Diabetes questionnaire (PAID) used in telehealth among patients with type 1 diabetes

BackgroundPatient-reported outcome (PRO) measures may be used in telehealth for the clinical assessment of mental health and diabetes distress, which are important aspects in diabetes care, but valid and reliable instruments on these topics are necessary. We aimed to evaluate the test–retest reliability and measurement error of the Danish versions of the WHO-Five Well-being Index (WHO-5) and Problem Areas in Diabetes (PAID) questionnaires used in a PRO-based telehealth intervention among patients with type 1 diabetes. A further aim was to evaluate the test–retest reliability of single items concerning patients’ symptom burden and general health status.MethodsOutpatients with type 1 diabetes from the Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark, were enrolled from April 2019 to June 2020. Patients aged ≥ 18 who had type 1 diabetes for > 1 year, internet access, and the ability to understand, read, and write Danish were included. Intraclass correlation coefficients (ICC) and weighted Kappa values were used to assess test–retest reliability, and measurement error was assessed by estimating the minimal detectable change (MDC).ResultsA total of 146/255 (57%) patients completed the web questionnaire twice. The median response time between the two-time points was five days. The ICC of the WHO-5 scale was 0.87 (95% CI 0.82–0.90), and MDC was 18.56 points (95% CI 16.65–20.99). The ICC of the PAID scale was 0.89 (95% CI 0.84–0.92), and MDC was 11.86 points (95% CI 10.46–13.70). Overall, test–retest reliability of single symptoms and general health status items was substantial.ConclusionsThe WHO-5 and PAID questionnaires, and single symptoms and general health status items showed substantial test–retest reliability among patients with type 1 diabetes. Measurement error of the PAID questionnaire was considered acceptable; however, a larger measurement error of the WHO-5 questionnaire was observed. Further research is recommended to explore these findings.

Improved patient-reported outcomes with iGlarLixi versus premix BIAsp 30 in people with type 2 diabetes in the SoliMix trial.

To assess patient-reported outcomes (PROs) in the SoliMix trial, which compared the efficacy and safety of iGlarLixi versus BIAsp 30 in people with type 2 diabetes (T2D). SoliMix (EudraCT: 2017-003370-13), a 26-week, open-label study, randomized (1:1) 887 adults with T2D and HbA1c≥7.5%-≤10.0% (≥58-≤86 mmol/mol) on basal insulin plus oral antihyperglycaemic drugs (OADs) to once-daily iGlarLixi or twice-daily premix insulin, BIAsp 30. PROs were assessed using the Treatment-Related Impact Measure Diabetes (TRIM-D) and Global Treatment Effectiveness Evaluation (GTEE) questionnaires. Over 26 weeks, iGlarLixi showed greater improvement from baseline versus BIAsp 30 in total TRIM-D score (least squares mean difference [95% confidence interval]: 5.08 [3.69, 6.47]; effect size: 0.32) and in each TRIM-D domain, with the greatest differences seen in diabetes management (8.47 [6.11, 10.84]) and treatment burden (6.95 [4.83, 9.07]). GTEE scores showed a greater proportion of participants and physicians rated a complete or marked improvement of diabetes control with iGlarLixi (80.5%, 82.8%) versus BIAsp 30 (63.3%, 65.1%) at week 26. Post hoc analyses showed that after adjusting for HbA1c, body weight and hypoglycaemia outcomes, iGlarLixi continued to show greater improvements in TRIM-D total scores versus BIAsp 30. In addition to better glycaemic control, weight benefit and less hypoglycaemia, once-daily iGlarLixi provided improved diabetes management, treatment burden and perceived effectiveness versus twice-daily premix BIAsp 30, further supporting iGlarLixi as an advanced treatment option in people with suboptimally controlled T2D on basal insulin plus OADs.

906-P: Parents Experience Diabetes Distress Too: Parental Reports and Association with Quality of Life and Teen A1C

Background: Diabetes distress (DD) is a negative emotional response commonly associated with type 1 diabetes (T1D). Similar to youth, parents may experience their own DD resulting from the burdens associated with supporting their child with T1D. Parental DD can have a negative impact on quality of life (QoL), and disruptive factors, such as family conflict, may exacerbate parental DD. Clinical and psychosocial outcomes associated with DD have been previously examined in teens, yet less is known about the association among parental DD, QoL, and diabetes outcomes in parents of teens experiencing DD. Methods: 60 parent-teen dyads have enrolled thus far in the ongoing THR1VE! study, a positive psychology texting-based intervention. Teens (M age 16.2 ± 1.5, 68% female, M T1D duration 7.7 ± 3.9) were eligible if they reported experiencing moderate or higher DD. Parents (83% female; 78% married/partnered; 78% white) completed the Parents - Problem Areas in Diabetes, Revised Diabetes-Related Family Conflict, and Type 1 Diabetes and Life questionnaires at baseline. A1c data were gathered at routine diabetes clinic appointments or through at-home A1c kits. Associations among parental reports of DD, diabetes-related family conflict, parental QoL, and A1c were examined. Results: Higher parental DD was positively associated with higher parent-reported family conflict (r= 0.54), lower parental QoL (r=0.63), and higher teen A1c (r=0.31). Higher parent-reported family conflict was also associated with lower QoL (r=0.40) and higher A1c (r= 0.35), all p <0.05. Conclusion: Similar to prior findings for teens with DD, results suggest that for parents of distressed teens, parents’ own experience of DD is also related to psychosocial variables including family conflict and QoL. Importantly, parental DD is related to children’s glycemic control, suggesting that increased psychological support for parents with teens with DD is warranted. Disclosure H. Inverso: None. H. R. Moore: None. T. Morrow: None. S. S. Jaser: None. R. Streisand: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK121316)

Diabetes distress and HbA1c in racially/ethnically and socioeconomically diverse youth with type 1 diabetes.

Diabetes distress, the emotional burden of caring for the chronic demands of diabetes, has not been well described in children and preadolescents with type 1 diabetes (T1D). This gap is particularly evident among youth of lower socioeconomic status (SES) and/or racial/ethnic minorities. Since these groups are more likely to have disparities in health outcomes and healthcare related to their diabetes, factors that could potentially improve glycemic and other diabetes-related outcomes should be studied closely. We hypothesized that (a) diabetes distress levels would be elevated in children with markers of lower SES and those of racial/ethnic minorities, and (b) higher HbA1c would be predicted by higher diabetes distress levels, when controlling for race/ethnicity, SES, and clinical covariates. One hundred and eighty-seven youth age 9 to 13 with T1D completed age-appropriate Problem Areas in Diabetes (PAID) questionnaires using a web-based portal during routine diabetes care visits. PAID scores were significantly elevated in youth who had surrogate markers of lower SES and who were from racial/ethnic minority backgrounds. In multivariate models including race/ethnicity or the SES variables and controlling for clinical covariates, the factor most predictive of higher HbA1c was elevated PAID score. Diabetes distress is elevated in a younger population of children with T1D who are from racial/ethnic minority backgrounds or have markers of lower SES. Interventions that target distress and/or expand the safety net in these populations could potentially improve glycemic outcomes.

Impact of insulin pump therapy on key parameters of diabetes management and diabetes related emotional distress in the first 12 months

AimsTo evaluate the effect of continuous subcutaneous insulin infusion (CSII) on glycaemic control, hypoglycaemia and emotional distress in adults with type 1 diabetes (T1D) during the first 12 months. Methods47 patients were started on CSII as per NICE guidelines. Anthropometric, clinical and biochemical parameters, hypoglycaemia rates and emotional distress measured by Problem Areas in Diabetes questionnaires (PAID) were recorded at baseline and during follow up at 3–6 months and 6–12 months. ResultsMean HbA1c dropped by 1.1% (11.8 mmol/mol; p < 0.0001) at 3–6 months and by 0.8% (8.6 mmol/mol; p = 0.008) at 6–12 months. Most patients had improved HbA1c between 6.5 and 8.5% (48–69 mmol/mol) during these follow ups (68.3% and 71.5% respectively). Frequency of hypoglycaemia reduced from 338.2 to 187.2 and 155.3 per 100 patient years during follow ups. Severe hypoglycaemia also decreased from 48.9 to 8.5 and 6.3 per 100 patient years respectively. PAID scores improved from 29.8 ± 18.5 to 17.2 ± 14.0 (p = 0.0002) at 3–6 months and to 12.8 ± 11.7 (p < 0.00001) at 6–12 months. Reduction in HbA1c, insulin dose and PAID scores was more significant in group with HbA1c > 8.5% (69 mmol/mol) at baseline whereas improvement in episodes of hypoglycaemia and severe hypoglycaemic was more in patients who had HbA1c ≤ 8.5% before commencement of CSII therapy. ConclusionsCSII therapy led to early improvement in glycaemic control, rates of hypoglycaemia and diabetes specific emotional distress. As beneficial effects are recorded within the first few months, CSII therapy should be started more proactively in T1D.

The Precision of Screening Questionnaires for Diabetes Mellitus Type 2 and Hypertension Compared with the Gold Standard in Primary Care

Background: Diabetes mellitus (DM) and hypertension are health issues that are the focus of the Indonesian government, especially in the era of Universal Health Coverage/Jaminan Kesehatan Nasional (JKN). The prevalences have been steadily increasing daily. Special Region of Yogyakarta (DIY) has the highest prevalence of DM in Indonesia, while hypertension prevalence is 25.7% according to data from Riskesdas 2013. Complications from diabetes and hypertension lead to decreased quality of life and premature death, therefore it is necessary to have a better management strategy to reduce the risks. Nowadays, there are no diabetes and hypertension screening questionnaires which have been validated and implemented in the district of Bantul. Therefore, it is important to develop screening questionnaires for early detection of diabetes and hypertension as a tool for primary care physicians to perform tasks at the preventive level.Objective: This study aimed to measure the accuracy of screening questionnaires to detect diabetes mellitus and hypertension in primary care in Bantul DIY.Methods: This study used a cross-sectional method. The subjects of the study were a group of individuals aged 40-60 years in Bantul who met the criteria inclusion and the criteria exclusion. The study subjects were asked to complete the screening questionnaires of diabetes and hypertension. The results were then compared with the gold standard of fasting blood sugar and blood pressure check. The data were analyzed by using multivariate regression tests.Results: The results of multivariate analysis showed that the risk factors were a history of baby born weight ≥ 4 kg or gestational diabetes mellitus and the abdominal circumference was an independent risk factor for the incidence of diabetes in general population. Being a baby born with weight ≥ 4 kg and abdominal circumference had p = 0.001: RR 2.75 (CI 95%: 1.5 to 5.0) and p = 0.036: RR of 8.08 (CI 95%: 1.15 to 56.8), respectively. The risk factor of age was an independent risk factor for hypertension with p = 0.003: RR of 3.1 (CI 95%: 1.4 to 6.6).Conclusion: History of a baby born with weight ≥ 4 kg and abdominal circumference were appropriate for screening DM, meanwhile the age was appropriate for screening hypertension.

The impact of self-efficacy education based on the health belief model in Iranian patients with type 2 diabetes: a randomised controlled intervention study.

Type 2 diabetes is a chronic illness which can be managed by patients' commitment to self-care and self-efficacy behaviors. A randomized controlled intervention study was carried out to determine the impact of self-efficacy education based on the Health Belief Model (HBM) in 240 patients with type 2 diabetes at the Golestan Hospital, Ahvaz, Iran between October 2014 and August 2015. The education duration was three months followed by a 24-week follow-up visit to determine the progress of the subjects. In this study, reliable and validated diabetes educational booklet and questionnaires based on knowledge, health beliefs and quality of life were used. The participants were randomly allocated to either the intervention group (n=120) or to the conventional dietary counseling group as controls (n=120), and assessed at the baseline, week 12 and week 36. The study was divided into primary outcome measurements consisting of glycated hemoglobin A1c (HbA1c), fasting blood glucose, lipid profile, and anthropometric levels. Secondary outcome measures were related to nutrition knowledge, health beliefs and quality of life. The results showed that subjects in the intervention group had significantly better metabolic and glycemic profiles compared with those in the control group. It also showed that knowledge, health belief and quality of life significantly increased in the intervention group. Findings indicate that through tailored self-efficacy education, the quality of life and metabolic profile of diabetes patients can be improved.

A study of a pre-operative intervention in patients with diabetes undergoing cardiac surgery

Coronary heart disease is common in Type 2 diabetes and often requires cardiac surgery. However poorer outcomes have been reported including increased rates of post-operative infection and prolonged hospital stay. The aim of the study was to determine the feasibility and acceptability of a specialist consultation model (pre-operative medical and educational intervention) for type 2 diabetes in the cardiac surgery setting. Twenty four patients were assigned usual care or to the intervention group. The intervention group were assessed by a diabetes clinical nurse consultant, dietitian, and endocrinologist during a pre-operative visit. Specific diabetes questionnaires were administered, education was delivered, and protocol-driven changes to the medical regimen were instituted. Length of stay, incidence of post-operative complications, and number of post-operative inpatient review endocrinology visits required were recorded. Twenty four patients with a pre-operative HbA(1c) greater than 6.5% (48 mmol/mol) were studied (17 males and 7 females). In the usual care group (n = 15), HbA(1c) pre-operatively was 7.2% (55.2 mmol/mol) compared to 10.1% (86.9 mmol/mol) in the intervention group (n = 9). Six weeks post-operatively HbA(1c) fell significantly in the intervention group by 1.9% (to 8.2% [66.1 mmol/mol]) compared to a reduction of 1.2% (to 7.0% [53 mmol/mol]) in the usual care group (p < 0.05). No significant differences were observed in length of stay in intensive care or in total hospital stay between the groups: length of ICU stay 54 h for intervention versus 47 h for usual care, total hospital stay (mean 8 days for both); or in rates of post-operative infection. Differences were seen between in the diabetes questionnaires: in the Problem Areas in Diabetes questionnaire and in the Diabetes Treatment Satisfaction Questionnaire (p = 0.048). This small pilot feasibility study suggests there is potential benefit in the acute optimisation of diabetes treatment before elective cardiac surgery.

Screening for depression and diabetes‐related distress in a diabetes outpatient clinic

To investigate: (1) the willingness of patients with diabetes to participate in a screening programme; (2) the extent to which patients with diabetes who screen positive endorse need for psychosocial care; (3) the rate of referral to psychosocial care during screening vs. usual care. Four hundred and ninety-nine patients with diabetes were invited to complete the Center for Epidemiologic Studies Depression and the Problem Areas in Diabetes questionnaires. Patients screening positive on either instrument were invited for an interview. One year after screening was withdrawn, rates of referral to psychosocial care were assessed from physician reports of patient referrals. In total, 349/499 (70%) patients with diabetes completed the questionnaire. Patients who did not take up the screening were younger, smoked more often and had higher HbA(1c) values. 'No-shows' for clinical appointments accounted for 74% of non-participation. Of the 104 (30% of 349) patients screening positive, 45 accepted an invitation for an interview. Finally, 36/104 (35%) would like a referral for psychological care. Seven per cent of patients were referred to psychological care during screening compared with 1% when screening was withdrawn. Results raise questions as to whether screening is the most efficient way to identify patients with psychological problems. Many patients did not take up the screening, especially those with low adherence to diabetes care in general. Furthermore, few patients screening positive wanted to be referred. Screening should be evaluated in the context of consideration of alternative ways to identify at-risk patients, including providing resources to deal with patients with already known adjustment and adherence problems.

Interactions With Parents and Friends Among Chronically Ill Children: Examining Social Networks

Children with medical conditions often experience a combination of positive and negative social interactions with parents and friends. Adult research examining cross-domain buffering effects has documented that supportive social ties can make up for shortcomings in other social relationships. This study examined whether negative effects of strained relationships with loved ones can be buffered when children feel supported by individuals in different support networks (i.e., cross-domain buffering effects). Children with Type I diabetes (n = 56), chronic asthma (n = 54), and cystic fibrosis (n = 17) completed questionnaires during an outpatient hospital visit that assessed perceptions of support and strain from parents and friends, quality of life, self-concept, and emotional/behavioral difficulties. Parental strain was conceptualized as parental overprotection and parental rejection. Hierarchical regression analyses showed that friend support buffered the adverse effects of parental strain on child quality of life, self-concept, and emotional/behavioral difficulties. Interestingly, parental support did not buffer the negative effects of experiencing strained relationships with friends; only main effects on outcome were found. These findings partially support our hypotheses of cross-domain buffering. In this study, friendships were a protective factor for children who experienced strained relationships with parents. In contrast, although parent support had a direct impact on child outcome, it did not make up for feeling rejected by friends. Because close relationships are often strained during medical stressors, findings underscore the importance of promoting social connectedness in chronically ill children to maximize opportunities for experiencing positive social relationships.

How does anger coping style affect glycemic control in diabetes patients?

Although various forms of anger have been found to influence the psychological and physical health in many chronic illness populations, little is known about the effects of anger in diabetes patients. Associations between anger coping style, diabetes-related psychological distress, and glycosylated hemoglobin (HbA1c) were examined in 100 diabetes patients. Participants completed the Problem Areas in Diabetes and Coping Styles questionnaires, and had HbA1c assessments at study entry (Time 1 = T1), six months (T2), and 12 months after T1 (T3). Linear regression analyses revealed T1 anger coping associated with T3 HbA1c (beta = .22, p < .05), but T1 HbA1c did not associate with T3 anger coping (beta = .13, p = NS). After controlling for significant covariates (of gender, age, education, type and duration of diabetes), regression analyses revealed that T2 diabetes-related psychological distress partially mediated this association. These results suggested that higher levels of anger coping may promote poorer glycemic control in diabetes patients by provoking greater diabetes-related distress. Areas of future research on this topic are discussed.

Diabetes in children and adolescents from ethnic minorities: barriers to education, treatment and good metabolic control

This paper reports an investigation to establish whether metabolic control is different in children and adolescents from ethnic minorities with type 1 diabetes compared with young Danish patients, and to learn about factors affecting their opportunities to achieve good metabolic control. The prevalence of diabetes in children and adolescents from ethnic minorities in Denmark is increasing. Having a different ethnic background has frequently been described as a risk factor for poor metabolic control, but whether the risk is represented by the ethnicity and immigration itself or in combination with other factors is unclear. The study included data (gender, age, diabetes duration HbA(1c), number of incidents of severe hypoglycaemia and ketoacidosis) from a national register including 919 Danish and 58 children and adolescents from ethnic minorities, questionnaires to all 20 Danish paediatric diabetes centres and questionnaires to 38 families of other ethnic backgrounds completed by professional interpreters. The study was conducted in 2001-2002. HbA(1c) was significantly higher in children and adolescents from ethnic minorities (mean 9.05 +/- 1.4%) compared with Danish patients (mean 8.62 +/- 1.3%; P = 0.018). There was no significant difference in HbA(1c) among the different ethnic groups, nor in the prevalence of severe hypoglycaemia or ketoacidosis. Patients from different ethnic minorities were unevenly distributed throughout the country, and generally the centres provided limited specialized knowledge and support. The questionnaires completed by the parents revealed limited schooling, lack of professional education and a major need for interpreters; these characteristics were especially prevalent among the mothers. Young patients from ethnic minorities have significantly poorer metabolic control compared with Danish patients, and patients with an immigrant background are seen as a vulnerable group with different needs and probably fewer chances of achieving good control. Special education for health care professionals as well as projects to improve methods, quality and knowledge should be encouraged in order to provide tailored support to members of individual ethnic groups. We recommend that the use of professional interpreters should become the gold standard in health care provision to all immigrant families.

Sense of coherence and power among people with blindness caused by diabetes

The aim of the present study was to analyze whether strong sense of coherence (SOC) or power or the combination of strong SOC and power was related to blind diabetic patients’ self-perceived health, burden of diabetes, glycaemic control and self-care among blind people. In some variables we wanted to compare subjects with diabetes-related blindness with people who were blind for other reasons than diabetes. The present descriptive study included 39 blind subjects from three ophthalmic outpatient clinics who agreed to participate; 23 were blind due to diabetes and 16 were blind for other reasons. Power was explored during semi-structured interviews, SOC was measured with the SOC-scale and burden of diabetes with semantic differential in diabetes (SDD) questionnaires. A single Likert scale (EVGFP) was used to measure self-perceived health. Participants with the combination of strong SOC and power perceived better health, experienced less burden of diabetes and had better glycaemic control than those with the combination of weak SOC and non-power. Nearly all participants with diabetes experienced problems with self-care, especially with the insulin treatment. The results highlight the importance of education that increases SOC and power as well as developing visual aids that assist blind people with diabetes in different self-care situations.

Vitamin E consumption and the risk of coronary heart disease in men.

The oxidative modification of low-density lipoproteins increases their incorporation into the arterial intima, an essential step in atherogenesis. Although dietary antioxidants, such as vitamin C, carotene, and vitamin E, have been hypothesized to prevent coronary heart disease, prospective epidemiologic data are sparse. In 1986, 39,910 U.S. male health professionals 40 to 75 years of age who were free of diagnosed coronary heart disease, diabetes, and hypercholesterolemia completed detailed dietary questionnaires that assessed their usual intake of vitamin C, carotene, and vitamin E in addition to other nutrients. During four years of follow-up, we documented 667 cases of coronary disease. After controlling for age and several coronary risk factors, we observed a lower risk of coronary disease among men with higher intakes of vitamin E (P for trend = 0.003). For men consuming more than 60 IU per day of vitamin E, the multivariate relative risk was 0.64 (95 percent confidence interval, 0.49 to 0.83) as compared with those consuming less than 7.5 IU per day. As compared with men who did not take vitamin E supplements, men who took at least 100 IU per day for at least two years had a multivariate relative risk of coronary disease of 0.63 (95 percent confidence interval, 0.47 to 0.84). Carotene intake was not associated with a lower risk of coronary disease among those who had never smoked, but it was inversely associated with the risk among current smokers (relative risk, 0.30; 95 percent confidence interval, 0.11 to 0.82) and former smokers (relative risk, 0.60; 95 percent confidence interval, 0.38 to 0.94). In contrast, a high intake of vitamin C was not associated with a lower risk of coronary disease. These data do not prove a causal relation, but they provide evidence of an association between a high intake of vitamin E and a lower risk of coronary heart disease in men. Public policy recommendations with regard to the use of vitamin E supplements should await the results of additional studies.

Mothers' and fathers' coping with chronic childhood disease

Abstract Mothers and fathers with a child with diabetes, asthma, cardiac conditions, epilepsy or leukaemia completed questionnaires to investigate their appraisal of disease-related difficulties and patterns of coping. There were differences both in appraised difficulties and coping patterns as a function of diagnostic group. In general, mothers who perceived more difficulties reported that it was helpful to cope by gaining disease-related knowledge. Fathers who perceived more difficulties reported it was more helpful to adopt strategies to enhance their own personal autonomy. Fathers who perceived more difficulties also reported that contact with medical staff was less helpful. Implications are discussed in terms of the differential implications of coping with chronic childhood diseases for mothers and fathers. Theoretical models need to take into account the differential demands of specific diseases in accounting for parents' stress appraisal and coping patterns.

The relationship between psychological factors and blood glucose regulation in insulin-dependent diabetic adolescents.

Fifty-two insulin-dependent diabetic, white, rural, middle-class adolescent subjects who had diabetes 5 or more years participated in a project comparing psychological and personality variables to the degree of altered blood glucose regulation as measured by hemoglobin A1c (HbA1c) levels. An HbA1c level of 9.5% was arbitrarily chosen as a cutoff score to divide subjects into two groups: those having "adequate" (N = 25) and those having "inadequate" (N = 27) blood glucose regulation. There were no significant differences between high and low HbA1c groups for all psychological variables tested, i.e., anxiety, locus of control, self-concept, and various personality traits measured by the High School Personality Questionnaire (HSPQ). Female subjects scored significantly higher on the anxiety scale and had significantly higher HbA1c values and weight percentiles compared with male subjects. Six self-report diabetes questionnaires dealing with various aspects of diabetes care and adjustment were completed by mothers and five similar questionnaires were completed by the adolescents. There were no significant differences in the mean scores of the 11 diabetes questionnaires between the high and low HbA1c groups. Girls scored significantly higher than boys in "self-care" and on individual items pertaining to dysphoric feelings about diabetes. Our findings may have resulted from the homogeneity of the sample, but underlying metabolic and genetic factors need to be considered in differentiating subjects according to the level of blood glucose regulation.