Diabetes-related Symptoms Research Articles

Diabetes-Related Symptom Distress in Association With Glucose Metabolism and Comorbidity

OBJECTIVE—The purpose of this study was to determine the associations between diabetes-related symptom distress, glucose metabolism status, and comorbidities of type 2 diabetes.RESEARCH DESIGN AND METHODS—This was a cross-sectional sample of 281 individuals with normal glucose metabolism (NGM), 181 individuals with impaired glucose metabolism (IGM), and 107 subjects with type 2 diabetes. We used the revised type 2 Diabetes Symptom Checklist (DSC-R) to assess diabetes-related symptom distress.RESULTS—The total symptom distress score (range 0–100) was relatively low for diabetic subjects (mean ± SD 8.4 ± 9.4), although it was significantly different from that for subjects with IGM (6.5 ± 7.1) and NGM (6.1 ± 7.9) (F = 3.1, 2 d.f., P = 0.046). Ischemic heart disease was associated with elevated DSC-R scores on three subscales, whereas depression showed higher symptom distress levels across all DSC-R domains.CONCLUSIONS—Worsening glucose metabolism is associated with increasing diabetes-related symptom distress. This relationship is attenuated by ischemic heart disease and particularly by depression.

β‐Blocker use and diabetes symptom score: results from the GEMINI study

The Glycemic Effect in Diabetes Mellitus: Carvedilol-Metoprolol Comparison in Hypertensives (GEMINI) trial compared the metabolic effects of two beta-blockers in people with type 2 diabetes and hypertension treated with renin-angiotensin system (RAS) blockade and found differences in metabolic outcomes. In this paper, we report the results of a prespecified secondary analysis of GEMINI that sought to determine the effect of these two beta-blockers on commonly reported symptoms. The Diabetes Symptom Checklist (DSC), a self-report questionnaire measuring the occurrence and perceived burden of diabetes-related symptoms, was completed by GEMINI participants at baseline and at the end of the study (maintenance month 5). The DSC assessed symptoms in eight domains: psychology (fatigue), psychology (cognitive), neuropathy (pain), neuropathy (sensory), cardiology, ophthalmology, hyperglycaemia and hypoglycaemia. Comparison of the mean change in self-reported diabetes-related symptoms indicated a significant treatment difference favouring carvedilol over metoprolol tartrate in overall symptom score (-0.08; 95% CI -0.15, -0.01; p = 0.02) and in the domains for hypoglycaemia symptoms (-0.12; 95% CI -0.23, -0.02; p = 0.02) and hyperglycaemia symptoms (-0.16; 95% CI -0.27, -0.05; p = 0.005). Carvedilol resulted in fewer perceived diabetes-related symptoms in patients with diabetes and hypertension. Carvedilol resulted in a lower perceived burden of diabetes-related symptoms in patients with type 2 diabetes and hypertension. The addition of a well-tolerated beta-blocker to RAS blockade may improve hypertension treatment and quality of life in patients with diabetes.

Adherence, body mass index, and depression in adults with type 2 diabetes: The mediational role of diabetes symptoms and self-efficacy.

Evidence indicates that depression is linked to the development and worsening of diabetes, but the mechanisms underlying this link are not well understood. The authors examined the hypothesis that diabetes-related symptoms mediate the effect of both behavioral adherence and body mass index (BMI) on depression. In addition, they examined whether a prior finding that self-efficacy mediates the effect of behavioral adherence and BMI on depression would replicate with a larger sample size (W. P. Sacco, K. J. Wells, C. A. Vaughan, A. Friedman, S. Perez, & R. Morales, 2005). Also, the relative contributions of diabetes-related symptoms and self-efficacy to depression were evaluated. Cross-sectional design involving adults diagnosed with Type 2 diabetes (N = 99). The primary outcome measure was depression (Patient Health Questionnaire: Nine Symptom Depression Checklist). Predictors of depression were diet and exercise adherence (Summary of Diabetes Self-Care Activities Questionnaire), diet and exercise self-efficacy (Multidimensional Diabetes Questionnaire), diabetes symptoms (Diabetes Symptom Checklist), and BMI (based on height and weight data from medical records). Path and mediation analyses indicated that adherence and BMI each contributed to depression indirectly, via their effects on self-efficacy and diabetes-related medical symptoms. Results provide evidence consistent with two independent pathways by which BMI and adherence could increase depression in people with Type 2 diabetes. The first pathway indicates that the effects of higher BMI and poor adherence on depression are mediated by lower self-efficacy perceptions. The second pathway indicates that the effect of higher BMI on depression is mediated by increased diabetes symptoms.

Diabetes and Depression: The Role of Social Support and Medical Symptoms

Depression in people with diabetes is linked to poor physical health. Social support and physical health have been linked to each other and to depression. The present study examined three possible models of the interrelationship among depression, social support, and diabetes-related medical symptoms. Eighty-six diabetes patients completed measures of diabetes symptoms, depression, and diabetes-related social support. Depression, social support, and diabetes-related medical symptoms were significantly related to each other. Mediation analysis indicated that the effect of social support on diabetes-related medical symptoms was fully accounted for by social support's adverse effect on depression. Consistent with theory and research on interpersonal aspects of depression, a bi-directional relationship between depression and social support was suggested. That is, while both diabetes-related medical symptoms and social support independently contributed to depression, depression also contributed to lower social support. Findings underscore the potential importance of interpersonal factors in the physical health of individuals with diabetes.

Medical Benefits of Using Natural Compounds and Their Derivatives Having Multiple Pharmacological Actions

The multiple pharmacological actions of a unique compound are a prerequisite for classifying drugs as highly efficacious, because the multiple pharmacological actions offer the possibility of treating various symptoms of chronic diseases as described below. 1) Sustained hyperglycemia induces macrovascular and microvascular complications in type 2 diabetes mellitus. Antihyperglycemic medication and the control of postprandial hyperglycemia are essentially important for normalizing plasma glucose level. Gymnemic acid IV isolated from Gymnema sylvestre (Asclepiadaceae) leaves has antisweet, antihyperglycemic, glucose uptake inhibitory, and gut glycosidase inhibitory effects. Most of these pharmacological effects may synergistically contribute to alleviating type 2 diabetes-related symptoms. 2) Diabetic skeletal and vascular smooth muscles are hypersensitive to chemical transmitters, cytokines and autacoids. The sensitivity of neuromuscular synapses is enhanced in diabetes, which seems to be closely associated with neuropathy as one of the diabetic complications. beta-Eudesmol found in Atractylodes lancea rhizome has a desensitizing channel blocking action to nicotinic acetylcholine receptors, anti-angiogenic action in vascular endothelium, and neuronal differentiation actions. These multiple pharmacological actions are favorable for treating angiogenic diseases possibly including the complications of diabetes, namely, retinopathy and nephropathy, and cancer. 3) Nipradilol is clinically utilized as a topical antiglaucoma drug. The ocular hypotensive effects of this compound are brought about by its alpha1 and beta-adrenergic receptor blocking actions, and nitric oxide (NO) releasing action. NO directly activates cyclooxygenases. All these pharmacologic effects are beneficial for treating glaucoma. The selectivity and specificity of drug action are required for treating acute diseases, infections or for acting as useful reagents. The pleiotropic actions of natural compounds and their derivatives serve as important clues for developing new drugs for various chronic diseases.

The psychological impact of screening for type 2 diabetes

Until recently, there was little empirical data regarding the psychological impact of screening for type 2 diabetes. There is now some progress in this area, as evidenced by emerging population based studies reporting on the effects of screening for type 2 diabetes on perceived health status and well-being. Recent studies from our own and other groups show that the diagnosis type 2 diabetes has no substantial adverse or positive effect on the participants' perceived health status and well-being after notification of the test result. Importantly, screening-detected type 2 diabetes patients beforehand perceive their risk for type 2 diabetes to be low, despite the presence of risk factors, such as obesity, hypertension and a family history, and overall report low levels of diabetes-related symptom distress. Yet, screening-detected type 2 diabetes patients were bothered more by symptoms of hyperglycaemia and fatigue in the first year following diagnosis type 2 diabetes than non-diabetics. On the basis of research to date, we conclude that screening for type 2 diabetes in the general population has no serious psychological side effects. Whether lack of emotional response to screening, is because of unawareness or indifference, needs further investigation. Future studies should be aiming towards a better understanding of how to raise the awareness and understanding of type 2 diabetes and its risk factors in high-risk individuals, while avoiding or minimizing negative effects, such as emotional distress and denial. The growing number of younger people developing type 2 diabetes warrants further research into labeling effects of an early diagnosis.

Reliability of AOFAS Diabetic Foot Questionnaire in Charcot Arthropathy: Stability, Internal Consistency, and Measurable Difference

The development of Charcot changes is known to be associated with a high rate of recurrent ulceration and amputation. Unfortunately, the effect of Charcot arthropathy on quality of life in diabetic patients has not been systematically studied because of a lack of a disease-specific instrument. The purpose of this study was to develop and test an instrument to evaluate the health-related quality of life of diabetic foot disease. Subjects diagnosed with Charcot arthropathy completed a patient self-administered questionnaire, and clinicians completed an accompanying observational survey. The patient self-administered questionnaire was organized into five general sections: demographics, general health, diabetes-related symptoms, comorbidities, and satisfaction. The scales measured the effect in six health domains: 1) general health, 2) care, 3) worry, 4) sleep, 5) emotion, and 6) physicality. The psychometric properties of the scales were evaluated and the summary scores for the Short-Form Health Survey (SF-36) were compared to published norms for other major medical illnesses. Of the 89 enrolled patients, 57 who completed the questionnaire on enrollment returned a second completed form at 3-month followup. Over the 3-month followup period most of the patients showed an improvement in the Eichenholtz staging. The internal consistency of most was moderate to high and, in general, the scale scores were stable over 3 months. However, several of the scales suffered from low-ceiling or high-floor effects. Patients with Charcot arthropathy had a much lower physical component score on enrollment than the reported norms for other disease conditions, including diabetes. Quality of life represents an important set of outcomes when evaluating the effectiveness of treatment for patients with Charcot arthropathy. This study represents an initial attempt to develop a standardized survey for use with this patient population. Further studies need to be done with larger groups of patients to refine the tool and to begin the validation process. The instrument developed could be used for comparing treatment strategies for Charcot arthropathy.

Diabetes-related symptoms and negative mood in participants of a targeted population-screening program for type 2 diabetes: The Hoorn Screening study

To determine the level of diabetes-related symptom distress and its association with negative mood in subjects participating in a targeted population-screening program, comparing those identified as having type 2 diabetes vs. those who did not. This study was conducted within the framework of a targeted screening project for type 2 diabetes in a general Dutch population (age 50-75 years). The study sample consisted of 246 subjects, pre-selected on the basis of a high-risk profile; 116 of whom were subsequently identified as having type 2 diabetes, and 130 who were non-diabetic subjects. Diabetes-related symptom distress and negative mood was assessed approximately 2 weeks, 6 months, and 12 months after the diagnosis of type 2 diabetes, with the Type 2 Diabetes Symptom Checklist and the Negative well-being sub scale of the Well-being Questionnaire (W-BQ12), respectively. Screening-detected diabetic patients reported significantly greater burden of hyperglycemic (F = 6.0, df = 1, p = 0.015) and of fatigue (F = 5.3, df = 1, p = 0.023) symptoms in the first year following diagnosis type 2 diabetes compared to non-diabetic subjects. These outcomes did not change over time. The total symptom distress (range 0-4) was relatively low for both screening-detected diabetic patients (median at approximately 2 weeks, 6 months, and 12 months; 0.24, 0.24, 0.29) and non-diabetic subjects (0.15, 0.15, 0.18), and not significantly different. No average difference and change over time in negative well-being was found between screening-detected diabetic patients and non-diabetic subjects. Negative well-being was significantly positive related with the total symptom distress score (regression coefficient beta = 2.86, 95% CI 2.15-3.58). The screening-detected diabetic patients were bothered more by symptoms of hyperglycemia and fatigue in the first year following diagnosis type 2 diabetes than non-diabetic subjects. More symptom distress is associated with increased negative mood in both screening-detected diabetic patients and non-diabetic subjects.

Symptom Prevalence and Treatments Among Mexican Americans With Type 2 Diabetes

The purpose of this study was to examine the prevalence of diabetes-related symptoms among Mexican Americans with type 2 diabetes, their perceptions of symptom seriousness, treatments used to self-manage the symptoms, and ratings of treatment effectiveness. As part of a larger descriptive correlational study conducted with 87 Mexican American adults in a southwest metropolitan area, data were collected during one-on-one interviews during outpatient visits using the Diabetes Symptom Self-care Inventory and analyzed with descriptive methods, t tests, and chi(2)s. Participants experienced 4.9 diabetes-related symptoms in a 30-day period and used a variety of treatments to self-manage the symptoms. Many of the self-management strategies were not appropriate for the most common causes of the symptoms. Few people tested their blood glucose levels in response to symptoms even though most owned glucometers. Most people who experience diabetes symptoms used self-care to treat the symptoms, did not verify the cause of the symptom, and perceived their treatments as effective. The appropriateness of the treatments used cannot be evaluated without knowing the etiology of the symptom for a particular person and time. Clinicians must assess symptoms and their treatments to best develop effective individualized treatments.

Depression increases diabetes symptoms by complicating patients' self-care adherence.

This study evaluated whether diabetes patients with depressive symptoms are more likely than other diabetes patients to report symptoms of glucose dysregulation, and whether this relationship is mediated by the impact of depressive symptoms on patients' adherence to their diabetes self-care regimen. Participants were English- and Spanish-speaking adults with type 2 diabetes. Interviewers assessed participants' depressive symptoms and diabetes-related symptoms at baseline. Self-care behaviors and diabetes symptoms were measured at a 1-year follow-up. Structural equation models were used to determine whether depression affected diabetes symptoms by limiting patients' ability to adhere to self-care recommendations. An initial model identified direct effects of baseline depressive symptoms on self-care and diabetes symptoms at follow-up. The relationship between self-care behaviors and physical symptoms of poor glycemic control were assessed using a second model. Results explained the relationship between depressive symptoms at baseline and diabetes symptoms at 1 year. Depressive symptoms impact subsequent physical symptoms of poor glucose control by influencing patients' ability to adhere to their self-care regimen. More aggressive management of depression among patients with diabetes may improve their physical health as well as their mental health.

A Danish diabetes risk score for targeted screening: the Inter99 study.

To develop a simple self-administered questionnaire identifying individuals with undiagnosed diabetes with a sensitivity of 75% and minimizing the high-risk group needing subsequent testing. A population-based sample (Inter99 study) of 6,784 individuals aged 30-60 years completed a questionnaire on diabetes-related symptoms and risk factors. The participants underwent an oral glucose tolerance test. The risk score was derived from the first half and validated on the second half of the study population. External validation was performed based on the Danish Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen Detected Diabetes in Primary Care (ADDITION) pilot study. The risk score was developed by stepwise backward multiple logistic regression. The final risk score included age, sex, BMI, known hypertension, physical activity at leisure time, and family history of diabetes, items independently and significantly (P<0.05) associated with the presence of previously undiagnosed diabetes. The area under the receiver operating curve was 0.804 (95% CI 0.765-0.838) for the first half of the Inter99 population, 0.761 (0.720-0.803) for the second half of the Inter99 population, and 0.803 (0.721-0.876) for the ADDITION pilot study. The sensitivity, specificity, and percentage that needed subsequent testing were 76, 72, and 29%, respectively. The false-negative individuals in the risk score had a lower absolute risk of ischemic heart disease compared with the true-positive individuals (11.3 vs. 20.4%; P<0.0001). We developed a questionnaire to be used in a stepwise screening strategy for type 2 diabetes, decreasing the numbers of subsequent tests and thereby possibly minimizing the economical and personal costs of the screening strategy.

Irish diabetes detection programme in general practice.

To assess the prevalence of undiagnosed diabetes, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) in patients over the age of 40 years attending their general practitioner (GP) in Ireland, through opportunistic screening, using a three-step screening tool involving self-determined high-risk groups, random venous plasma glucose (RVPG) measurement and oral glucose tolerance tests. In participating general practices, 100 consecutive patients > 40 years, completed a screening questionnaire relating to diabetes-related symptoms and risk factors. Patients with previously diagnosed diabetes were not excluded from the study and the screening instrument included a question about known diabetes. Patients without known diabetes mellitus (DM) and with at least two risk factors and/or symptoms underwent a RVPG test. Those with an RVPG above 5.5 mmol/l underwent an oral glucose tolerance test. Forty-one practices returned 3821 questionnaires. The prevalence of Type 2 diabetes mellitus in the study population was 9.2% (353), of whom 23.5% (83) were previously undiagnosed. DM was detected on the basis of an RVPG >11.1 mmol/l in 0.8% (32) of the studied population. DM was detected on the basis of the oral glucose tolerance test in 1.3% (51) of the population. One per cent (39) had a fasting plasma glucose (FPG) > or = 7.0 mmol/l, 0.6% (24) had a 2-h >11.0 mmol/l and 0.3% (12) had both. Diabetes would not have been detected in 12 people had the 2-h test been omitted. The prevalence rate for IFG and/or IGT was 3.9% (148). Of the 103 patients with IGT, 83 (81%) would have been missed had the GTT been omitted. Opportunistic diabetes screening in general practice using a screening questionnaire followed by RVPG testing and GTT for those above 5.5 mmol/l is feasible, with a high participation rate. The use of GTTs rather than fasting glucose testing alone improves patient identification, in particular those with IGT who are at higher cardiovascular risk.

Fatigue in employees with diabetes: its relation with work characteristics and diabetes related burden

Aims: To examine the relations between work characteristics as defined by the Job Demand-Control-Support model (JDCS) (that is, job demands, decision latitude, and social support), diabetes related burden (symptoms, seriousness...

Examination of the Neuroticism-Symptom Reporting Relationship in Individuals with Type 2 Diabetes

The current study utilized a within-subject, experience sampling methodology (ESM) to examine the relationship between neuroticism (N) and physical symptom reports. Individuals with type 2 diabetes monitored diabetes-related symptoms, rated negative and positive affect (NA and PA), estimated their blood glucose (BG) levels, and tested their actual BG levels with a glucometer four times per day for 7 days. Multilevel modeling analyses indicated that N, NA, and PA were related to reported symptom frequency. Neuroticism moderated the relation between PA and symptom reports: Lower PA was more strongly related to symptom reports among high-N individuals. In addition, there was evidence that symptoms mediated the relationship between N and state NA. Finally, N was related to overestimation of BG, beyond that accounted for by state NA. Results are discussed with respect to potential effects of N on the processing of negative self-relevant information and on self-regulatory behavior in health contexts.

Risk assessment for developing type 1 diabetes: intentions of behavioural changes prior to risk notification.

Recent progress in predictive techniques allows people at risk of developing type 1 diabetes to be identified in a pre-symptomatic stage and prevention trials to be implemented. The present study examined prospectively whether participants in a screening programme anticipated behavioural changes in the event of having a high risk. Four hundred and three first-degree relatives of people with type 1 diabetes completed a self-administered questionnaire about their views on screening and diabetes, and questionnaires on well-being and locus of control. Prior to risk notification, 73% reported that they intended to introduce lifestyle changes if at high risk. The vast majority of the respondents (87%) reported that eating habits would be the main changes made. Those anticipating changes believed they could take actions to reduce their risk of type 1 diabetes (p<0.001) and to have personal control over diabetes onset (p<0.001). They were also more worried about developing diabetes (p<0.01) and preoccupied with diabetes-related symptoms (p<0.01). Prior to risk notification, the process of being screened raised concerns and expectations about future changes. Despite the lack of any evidence, people believed lifestyle changes would be effective in reducing their risk. Since the impact of lifestyle in the development of type 1 diabetes is not yet established, accurate information about the role of health behaviour in the progression to overt diabetes is needed to avoid unrealistic expectations on the benefit of these changes and unnecessary impairment to quality of life. Personally initiated changes should be monitored since they could importantly influence the progress and outcome of prevention trials.

The Child Health Questionnaire in children with diabetes: cross‐sectional survey of parent and adolescent‐reported functional health status

To study parent and adolescent-reported physical, psychosocial and family wellbeing in children aged 5-18 years with diabetes. 5-18-year-olds attending a diabetes clinic at a tertiary children's hospital. (1) Child Health Questionnaire (CHQ) PF-50, a functional heath status measure for children aged 5-18 years (parents); (2) CHQ CF-80, a similar self-report measure (adolescents aged 12-18 years); (3) 11 study-designed questions related to diabetes-specific concerns (parents); (4) global ratings of physical and psychosocial health (clinicians); (5) HbA1c level (all subjects). CHQ data were compared with Australian normative data collected six months earlier. Reports were obtained from 128 parents and 71 adolescents (90 and 92% response). The CHQ demonstrated good psychometric properties in this sample of children with diabetes. Parents reported children with diabetes to have generally poorer health than children in the normative sample, especially on psychosocial and parent/family scales. Psychosocial health was markedly lower in 5-11-year-olds with HbA1c > 8.8%, but not in 12-18-year-olds. Presence of diabetes-related symptoms and concerns correlated with lower physical and psychosocial functioning. Parents and clinicians concurred in their ratings of health for 12-18-year-olds but not 5-11-year-olds. Adolescents reported their own health similarly to adolescents in the normative sample. Parents report children aged 5-18 years with diabetes to have poorer health than children in the normative sample across all domains. Clinicians may underrate the impact of diabetes for younger children, with possible therapeutic implications. In providing an overall description of health, instruments like the CHQ may add another dimension to the care of children with diabetes and can feasibly be used within clinical settings.

The quality of life of patients with type 2 diabetes mellitus in general practice

Background: Improving patients' duration and quality of life (QoL) is the long-term goal in treatment of diabetes mellitus.Aim: To estimate the QoL of patients with type 2 diabetes followed in primary care, using the newly developed and validated 'Well-being Enquiry for Diabetes' (WED) questionnaire. The questionnaire evaluates four subscales of QoL: diabetes-related somatic symptoms (Symptoms); diabetes-related worries (Discomfort); mental health (Serenity); familiar relationship and social network (Impact). Patients and methods: We randomly selected 100 patients with type 2 diabetes mellitus in our practice, of whom 98 completed the questionnaire (mean age ±SD: 64.6±9.5; 44 males, 54 females; duration of disease 8.3±6.0 years; 23.5% on diet only, 67.3% on oral hypoglycaemic agents, 5.1% on both oral hypoglycaemic agents and insulin, and 4.1% on insulin monothe-rapy). Micro- or macroangiopathy was present in 33 patients (33.7%, 15 males, 18 females). In each patient we considered the following variables: age, gender, duration of disease, type of treatment in use, presence of complications. Mann-Whitney test, Kruskal-Wallis test and multiple regression analysis were used for statistical analysis (p<0.05 as significant). Results: Females had lower total WED scores than males (p=0.0001) and lower scores in each of the four subscales. Patients with chronic complications had lower scores than patients without complications (p=0.19). Patients on insulin showed lower total WED scores than patients treated with oral hypoglycaemic agents or diet only. Multivariate analysis showed a correlation between WED scores and gender (p=0.0001) or complications (p=0.049), but not with duration of disease (p=0.28) or age (p=0.15). Conclusion: The WED questionnaire appears to be a simple, reliable measure of diabetes-related QoL in primary care. Females had significantly lower scores than males, with the greatest difference in the area of Serenity. This is in accordance with general data showing higher psychiatric morbidity (anxiety, depression, eating disorders) among females. The WED provides GPs with a tool for auditing care of patients with diabetes and to identify type 2 diabetes patients in whom interventions may be needed to improve their QoL. Eur J Gen Pract 2000;6:93–7.

Type 2 diabetes: symptoms and impact on daily life. An eight year follow-up study of psychosocial situation and disease development

A group of 174 patients with type 2 diabetes mellitus (DM), recruited at diagnosis in 1988–1989, was followed up eight years later in a questionnaire study and subjects were asked to provide a blood sample for measurement of HbA1c. Forty-three (24.7%) had died during the follow-up period and 88 of the remaining 131 survivors (67.2%) responded to the questionnaire and 86% of these provided a blood sample for HbA1c analysis. The mean age of the patient group at diagnosis was 61.2 years (SD12.5) for men and women. Patients who died had been significantly older (P<0.001 for men; P<0.05 for women) and had had higher HbA1c levels at diagnosis (8.3% vs 7.0%; P<0.01). Patients complained of a mean of 1.9 symptoms of diabetes each in 1990 and less than one symptom each in 1998. In 1990, 82% of the patients was on dietary treatment alone, while in 1998 only 18% were still only receiving dietary treatment. The number of patients on oral treatment and insulin increased from 13 and 5, respectively, at diagnosis to 46 and 14%, respectively; and 20% of the patients were on a combination of oral agents and insulin. As the patient group became older, fewer were still employed at follow-up and more had become pensioners. There was a trend towards fewer still being married. Survivors reported fewer diabetes-related symptom and little impact of their diabetes on daily living, with little gender difference. The majority of patients found living with diabetes to be easy and did not dominate their lives. The proportion of patients who were concerned or very concerned about their health in 1998 decreased from 44.9% in 1988–1989 to 36.4% in 1998. Men tended to be less concerned about their perceived state of health (71% men vs 48% women) but while 70% of men still claimed not be worried in 1998, slightly more women had stated that they were not at all concerned about their health in 1998 (48% vs 55%). Thus type 2 DM appears to have little impact on patients' psychosocial situation or self-assessed perception of health. Degree of glycaemic control, measured by HbA1c, improved over the follow-up period and number of symptoms decreased. Copyright © 2000 John Wiley & Sons, Ltd.

Performance of a predictive model to identify undiagnosed diabetes in a health care setting.

To develop a predictive model to identify individuals with an increased risk for undiagnosed diabetes, allowing for the availability of information within the health care system. A sample of participants from the Rotterdam Study (n = 1,016), aged 55-75 years, not known to have diabetes completed a questionnaire on diabetes-related symptoms and risk factors and underwent a glucose tolerance test. Predictive models were developed using stepwise logistic regression analyses with the absence or presence of newly diagnosed diabetes as the dependent variable and various items with a plausible connection to diabetes as the independent variables. The models were evaluated in another Dutch population-based study, the Hoorn Study (n = 2,364), in which the participants were aged 50-74 years. Performances of the predictive models were compared by using receiver-operator characteristics (ROC) curves. We developed three predictive models (PMs), PM1 contained information routinely collected by the general practitioner, while PM2 also contained variables obtainable by additional questions. The third predictive model, PM3, included variables that had to be obtained from a physical examination. These latter variables did not have additive predictive value, resulting in a PM3 similar to PM2. The area under the ROC curve was higher for PM2 than for PM1, but the 95% Cls overlapped (0.74 [0.70-0.78] and 0.68 [0.64-0.72], respectively). Using only information normally present in the files of a general practitioner, a predictive model was developed that performed similarly to one supplemented by information obtained from additional questions. The simplicity of PM1 makes it easy to implement in the current health care setting.

Symptom-related self-care of Mexican Americans with type 2 diabetes: preliminary findings of the Starr County Diabetes Education Study.

Starr County, Texas, a Texas-Mexico border community, was the site of a study involving culturally-appropriate education and group support for Mexican Americans with type 2 diabetes. Data were collected from 63 subjects on frequency of diabetes-related symptoms during the previous month and on self-care symptom treatments. On average, subjects were 57-year-old females, diagnosed with diabetes for 10 years, and exhibiting HbA1c levels of 12.5%. Almost 50% experienced excessive urination, excessive thirst, shakiness/nervousness, and numbness and/or tingling in their extremities. More than 50% of those who experienced symptoms did not view them as serious. Only one subject checked blood sugar levels when symptoms occurred. Significantly higher mean glycosylated hemoglobin levels were found for individuals who experienced dizziness and/or chest pain compared with those who did not. A variety of self-care treatments were employed, including over-the-counter medications and home remedies.