Negative Impact Of Diabetes Research Articles

The Impact of Type 1 Diabetes on the Family and Related Factors

Objective: This study was conducted to determine the impact of Type 1 diabetes mellitus and related factors on children and families. Methods: The descriptive study was conducted with the parents of 175 children aged 6-18 years with Type 1 diabetes mellitus. The data were collected using the "Child and Family Information Form" and the "Diabetes Family Impact Scale (DFIS)." pResults:It was determined that the parents' total median DFIS score was 21.42 (9.52-35.71) and the highest median score was 33.33 (11.11-66.66) in the "finances" sub-dimension score. There was a significant difference between the child's school success and the parents' "school" sub-dimension median scores, the mother's employment status and the "work" sub-dimension median scores, and the family's income level and the DFIS total median scores (pConclusions and Recommendations:It was concluded that diabetes mostly adversely affected the family in terms of "finances." It was also determined that the negative impact of diabetes on the family was higher in children with poor school success and in families where mothers were unemployed and whose income was less than their expenses. The negative impact of diabetes on the family increased as the ages of the child, mother, and father and the duration of diagnosis decreased and the HbA1c level increased. In line with the research findings, one should be aware of the factors (child's age, child's school success, parental age, parental employment status, family income level, duration of diagnosis, HbA1c level) that affect the negative effects of diabetes on the family. In addition, it is recommended to plan and implement the necessary initiatives to prevent the negative effects of diabetes on the family (especially in the financial field) since the child's diagnosis of diabetes.

Quality of life and other patient-reported outcomes in adult Lebanese patients with type 2 diabetes during COVID-19 pandemic.

IntroductionSeveral studies have shown that COVID-19 pandemic has a negative impact on type 2 diabetic mellitus (T2DM) patients’ quality of life (QoL). However, very few studies were performed in Middle Eastern countries.AimThe aim of the current study was to assess, the QoL and diabetes-specific QoL, treatment satisfaction and psychological distress of Lebanese patients with T2DMs using: the Audit of Diabetes-Dependent Quality of Life (ADDQoL), Diabetes Treatment Satisfaction Questionnaire status version (DTSQs) and Kessler 10 (K10) questionnaires and to compare results to those obtained during the pre-COVID-19 period.Results461 patients with T2DM participated in the study; 52.6% men, 47.4% women; median age 59 years old. The respective median ADDQoL and DTSQs scores were − 2.2 (interval interquartile range (IQR) − 3.9, − 0.8) (range from − 9 maximum negative impact to + 3 maximum positive impact) and 30(IQR22-36) (range from 0 maximum dissatisfaction to 36 maximum satisfaction). K10 median score was 26(IQR18-35) (range from minimum score of 10 indicating no distress to maximum score of 50 indicating severe distress). Rural dwelling, lack of exercise, current smoking, diabetic complications, injectable diabetes treatment, and previous COVID-19 infection were all associated with significantly worse ADDQoL, DTSQs, and K10 score indicating greater distress. A significant worsening of ADDQoL scores followed onset of the pandemic with no significant change in DTSQs scores.ConclusionDuring the COVID-19 pandemic, T2DM Lebanese patients experienced more negative impact of diabetes on QoL and mental health. Those infected with COVID-19 also reported worse QoL, treatment satisfaction and mental health. This highlights the need for community and individual support.

Diabetes Mellitus and Women's Health

Diabetes mellitus leads to high blood glucose due to disturbance in insulin secretion or sensitivity. Diabetes mellitus type 1 results from insufficient insulin release. Diabetes mellitus type 2 and gestational diabetes occur mainly due to insulin resistance which is associated with obesity and pregnancy. Diabetes is a chronic disease that needs three approaches for successive treatment which are food regimen (diet), exercise, and medication (either by insulin or pills). These three treatment strategies should occur together. Insulin treatment is typically used to treat type 1 diabetes, and on the occasion, that type 2 patients don't react to different drugs. Medications that don't contain insulin are given either as oral pills or by infusion. The most distinguished of these medications and the first to be utilized to treat diabetes is metformin. Doing a pancreas transplant is especially valuable for type 1 patients. There is no negative impact of diabetes on the marital relationship because high blood glucose level doesn't affect the menstrual cycle and ovulation happens normally. There is no issue with the wedding a woman with diabetes as diabetes doesn't influence the productivity of the patient, as this woman can manage her sugar level appropriately. Some diabetic women have little sexual desire but unlike diabetic men, they have no difficulties during or after sex. Controlling the blood glucose level during pregnancy is very important for the security of both the mother and the baby. Women with gestational diabetes could begin breastfeeding as non-diabetic women, however, the time of breastfeeding in women with gestational diabetes was two months not as much as that of uninfected women.

Diabetes Mellitus and Women's Health

Diabetes mellitus leads to high blood glucose due to disturbance in insulin secretion or sensitivity. Diabetes mellitus type 1 results from insufficient insulin release. Diabetes mellitus type 2 and gestational diabetes occur mainly due to insulin resistance which is associated with obesity and pregnancy. Diabetes is a chronic disease that needs three approaches for successive treatment which are food regimen (diet), exercise, and medication (either by insulin or pills). These three treatment strategies should occur together. Insulin treatment is typically used to treat type 1 diabetes, and on the occasion, that type 2 patients don't react to different drugs. Medications that don't contain insulin are given either as oral pills or by infusion. The most distinguished of these medications and the first to be utilized to treat diabetes is metformin. Doing a pancreas transplant is especially valuable for type 1 patients. There is no negative impact of diabetes on the marital relationship because high blood glucose level doesn't affect the menstrual cycle and ovulation happens normally. There is no issue with the wedding a woman with diabetes as diabetes doesn't influence the productivity of the patient, as this woman can manage her sugar level appropriately. Some diabetic women have little sexual desire but unlike diabetic men, they have no difficulties during or after sex. Controlling the blood glucose level during pregnancy is very important for the security of both the mother and the baby. Women with gestational diabetes could begin breastfeeding as non-diabetic women, however, the time of breastfeeding in women with gestational diabetes was two months not as much as that of uninfected women.

Diabetes and periprocedural outcomes in patients treated with rotablation during percutaneous coronary interventions.

This study is to assess differences in periprocedural outcomes among diabetic and non-diabetic patients treated with percutaneous coronary intervention (PCI) and rotational atherectomy (RA). Under assessment were 221,187 patients from the Polish Cardiovascular Intervention Society national registry (ORPKI) including all PCIs performed in Poland in 2015 and 2016. Data was extracted of 975 patients treated with RA - 336 (34.5%) diabetics and 639 (65.5%) non-diabetics. Periprocedural complications were defined as overall rate or particular complications such as deaths, no-reflows, perforations, dissections, cerebral strokes or bleedings.. Multivariate analysis was performed to assess predictors of periprocedural complications. The mean age was similar in diabetics and non-diabetics (70.9 ± 9.0 vs. 72.1 ± 9.9; p = 0.06). Diabetics were more often females (p < 0.01), with arterial hypertension (p < 0.01), kidney failure (p < 0.01) and prior myocardial infarction (p = 0.01). No significant differences were observed in overall or individual periprocedural complications and angiographic success was expressed as thrombolysis in myocardial infarction grade 3 flow after PCI. At baseline, de-novo lesions accounted for 96.5% in diabetics and 99% in non-diabetics (p < 0.01), while overall rate of restenosis was 3.5% and 1%, respectively (p < 0.01). Diabetes was an independent predictor of periprocedural complications in the overall group of patients treated with PCI (OR 1.11, 95% CI 1.04-1.194; p < 0.001). The negative impact of diabetes on the incidence of periprocedural complications and angiographic effectiveness in the group of patients treated with RA is mitigated in the comparison to the non-RA group.

Obesity and dental implant treatment: a review

Aim Success of dental implants depends mainly on osseointegration between bone and titanium surface. Since osseointegration relies on balanced bone turnover, it can be assumed that any conditions that interfere with homeostasis of bone modelling/remodeling might be detrimental to survival of dental implants. Obesity has become a serious public health problem, and has been shown to be closely linked to a wide array of pathophysiologic consequences, including insulin resistance or pre-diabetes. Obese-insulin resistance or pre-diabetic condition is characterized by hyperinsulinemia with euglycemia. The impacts of type 2 diabetes mellitus (T2DM) on the success of dental implants and the factors to improve osseointegration in diabetic condition have been thoroughly investigated. Much evidence demonstrated that T2DM impaired the bone healing around dental implants, possibly due to hyperglycemic condition. However, the effect of obese-insulin resistant condition or pre-diabetes on survival of dental implants has not been investigated. This review aims to summarize the current findings of effect of obesity toward bone health and osseointegration of dental implants.Conclusion The studies favor the relatively negative impact of diabetes on osseointegration, but more scientific studies are necessary.

Three-years outcomes of diabetic patients treated with coronary bioresorbable scaffolds

BackgroundDiabetes is among the strongest predictors of outcome after coronary artery stenting and the incidence of negative outcomes is still high in this specific group. Data of long-term outcomes comparing diabetic patients with non-diabetic patients treated with bioresorbable scaffolds are still incomplete. This work evaluates the long-term outcomes after implantation of a coronary bioresorbable scaffold (BRS) in diabetic patients compared to non-diabetics.MethodsPatients who received at least one Absorb BRS in the time of May 2012 to December 2014 were enrolled into this single-center registry. Quantitative coronary angiography (QCA) was performed.ResultsSix hundred fifty seven patients including 138 patients (21%, mean age 65 ± 11, 78% male) with diabetes were enrolled.Patients in the diabetic group were significantly older, were more likely to suffer from hypertension and hyperlipidemia and had more often a prior stroke or TIA as well as a reduced renal function (all P < 0.05). The initial stenosis was less severe in the diabetic group (74.8% vs. 79.6%, P = 0.036), but the residual stenosis after BRS implantation exceeded that of the control group (16.7% vs. 13.8%, P = 0.006).History of diabetes had no impact on the incidence of events within one year after BRS implantation. Beyond 1 year, diabetic patients had a higher incidence of cardiovascular death (6.9 vs. 1.4%, HR:5.37 [1.33–21.71], P = 0.001), scaffold restenosis (17.6 vs. 7.8%, HR:3.56 [1.40–9.05], P < 0.0001) and target lesion revascularization (P = 0.016). These results were confirmed in the propensity score analysis.In both diabetics and non-diabetics, there was a strong association (HR:18.6 [4.7–73.3]) between the risk of restenosis and the technique used at implantation; in contrast, the impact of vessel size was more manifest in non-diabetics than in diabetic patients, and an increased risk of restenosis was demonstrated for both large and small vessels.ConclusionAs for metal stents, beyond one year after implantation, diabetes was associated with an increased incidence of scaffold restenosis and related outcomes. This negative impact of diabetes was reset when an optimal implantation technique was used.

A cross-sectional study on the quality of life of patients with peripheral diabetic neuropathy pain in Hospital Tegku Ampaun Afzan, Kuantan, Malaysia

Purpose: To evaluate the quality of life of patients with peripheral diabetic neuropathy pain (PDNP) in Hospital Tegku Ampaun Afzan (HTAA), Kuantan, Malaysia.Methods: Ninety (90) participants were selected from the Medical Outpatient Department (MOPD) clinic of HTAA. The study adopted a cross-sectional design, and the self-administered Douleur Neuropathy 4 (DN4) and Audit of Diabetes-Dependent Quality of Life (ADDQoL) questionnaires were used for data collection.Results: The negative impact of diabetes on QoL was clearly reflected in the fact that every domain had a negative mean value. Overall, 27.8 % of the participants reported that DM negatively affected their QoL and 37.8 % expressed the opinion that their QoL would have been higher if they were not diabetic. QoL correlated with marital status and age, with married participants and participants in the age range 50 - 59 years old showing QoL negatively affected (p &lt; 0.05) by DM with PDNP. Apart from diabetes type, all other characteristics significantly affected participants QoL as reflected by the various related domains (p &lt; 0.05).Conclusion: Based on the findings of this study, it seems that individuals with diabetes and PDNP have a low QoL, with regard to “freedom to eat”, “freedom to drink”, “physical health”, “family life”, and “living condition”.Keywords: Quality of life, Diabetes, Peripheral neuropathy pain

Assessment of health-related quality of life in Egyptian adolescents with type 1 diabetes: DEMPU survey.

Type 1 diabetes (T1D) is a serious chronic illness that imposes significant morbidity and mortality with a major impact on the quality of life (QoL) that became a core issue in diabetes care. Understanding the effect of diabetes on QoL is important for day-to-day clinical management and also for public health policy initiatives aiming at improving health outcomes for those with diabetes. The objective of the study was to assess the QoL in adolescents with T1D and assess the applicability of the use of the "Quality of Life for Youth" questionnaire at the Diabetes, Endocrine and Metabolism Pediatric Unit (DEMPU) clinic. One hundred and fifty adolescents (82 males and 68 females) (10-18 years), with T1D of at least 1 years' duration, completed the questionnaire that evaluated symptoms related to diabetes, treatment, activities, parent issues, worries about diabetes and health perception. Higher scores indicated a more negative impact of diabetes and poorer QoL. Males showed a significantly better mean QoL score than females (p=0.004). Different age groups showed different QoL scores (p=0.047). Urban adolescents had a better QoL than rural counterparts (p=0.02). Adolescents with poor QoL had generally lower educational level (p=0.02). Better metabolic control was associated with a better QoL (p=0.01). However, duration of diabetes and body mass index (BMI) had no statistically significant effect on QoL. QoL had a variable significant association with certain socio-demographic and clinical characteristics of diabetics (sex, residence, educational level as well as metabolic control).

PATIENTS WITH DIABETES AND MYOCARDIAL REVASCULARIZATION FROM EVIDENCE-BASED MEDICINE POSITIONS: CARDIOLOGIST’S OPINION. PART 1

The review presents current data on the prevalence of diabetes in the cohort of patients undergoing coronary artery bypass grafting and percutaneous coronary intervention. The expediency of a proactive approach to identifying diabetes and pre-diabetes in patients with coronary heart disease before coronary revascularization is reviewed. The current information about the negative impact of diabetes on the prognosis of myocardial revascularization is provided, and the main mechanisms responsible for the development of adverse outcomes of interventions in these patients are highlighted. Target values of perioperative glycemia recommended by the leading communities of the study of diabetes are compared, and shown the role of other carbohydrate metabolism markers (glycated hemoglobin, fructosamine, 1,5-anhydroglucitol) in patients with diabetes mellitus in terms of their impact on cardiovascular prognosis, including with coronary intervention.

Parenchymal and Stromal Cells Contribute to Pro-Inflammatory Myocardial Environment at Early Stages of Diabetes: Protective Role of Resveratrol.

Background: Little information is currently available concerning the relative contribution of cardiac parenchymal and stromal cells in the activation of the pro-inflammatory signal cascade, at the initial stages of diabetes. Similarly, the effects of early resveratrol (RSV) treatment on the negative impact of diabetes on the different myocardial cell compartments remain to be defined. Methods: In vitro challenge of neonatal cardiomyocytes and fibroblasts to high glucose and in vivo/ex vivo experiments on a rat model of Streptozotocin-induced diabetes were used to specifically address these issues. Results: In vitro data indicated that, besides cardiomyocytes, neonatal fibroblasts contribute to generating initial changes in the myocardial environment, in terms of pro-inflammatory cytokine expression. These findings were mostly confirmed at the myocardial tissue level in diabetic rats, after three weeks of hyperglycemia. Specifically, monocyte chemoattractant protein-1 and Fractalkine were up-regulated and initial abnormalities in cardiomyocyte contractility occurred. At later stages of diabetes, a selective enhancement of pro-inflammatory macrophage M1 phenotype and a parallel reduction of anti-inflammatory macrophage M2 phenotype were associated with a marked disorganization of cardiomyocyte ultrastructural properties. RSV treatment inhibited pro-inflammatory cytokine production, leading to a recovery of cardiomyocyte contractile efficiency and a reduced inflammatory cell recruitment. Conclusion: Early RSV administration could inhibit the pro-inflammatory diabetic milieu sustained by different cardiac cell types.

Association between diabetes and prevalence and growth rate of abdominal aortic aneurysms: A meta-analysis

BackgroundAlthough the prevalence of abdominal aortic aneurysm (AAA) was lower in diabetes, the relationship between diabetes and AAA prevalence remains unclear. In this meta-analysis, we sought to clarify the effect of diabetes on prevalence and growth rate (GR) of AAA. MethodsWe searched PubMed, Web of Science, Scopus and Cochrane databases. Articles reporting the AAA prevalence in diabetic patients and diabetic effects in GR of AAA were included. ResultsForty-nine studies on AAA prevalence in diabetics and thirteen studies on effect of diabetes in GR of AAA were included for meta-analysis. A strongly negative association was found between diabetes and AAA prevalence in population based screening (odds ratio [OR]adjusted: 0.66; 95% confidence interval [CI]: 0.58–0.75) and prospective studies (ORadjusted: 0.52; 95% CI: 0.43–0.63), but not in case–control studies (ORadjusted: 0.48; 95% CI: 0.20–1.15). Similar association was found in North American (ORadjusted: 0.62; 95% CI 0.54–0.71) and European (ORadjusted: 0.45; 95% CI 0.33–0.62) studies. The strongly negative association remained consistent after stratification by time of data collection (up to -1995 [ORadjusted: 0.65; 95% CI: 0.53–0.80], 1996–2005 [ORadjusted: 0.61; 95% CI: 0.47–0.78], 2006 and beyond- [ORadjusted: 0.67; 95% CI: 0.53–0.85], and data collection time >10years [ORadjusted: OR: 0.44; 95% CI 0.34–0.58]). The annual mean diabetic effect on AAA GR was −0.60mm/y (95% CI: −0.76 — −0.43). ConclusionDiabetes was strongly and negatively associated with AAA prevalence regardless of study type, geography and time of data collection, as well as negative impact of diabetes on GR of AAA.

Health-related Quality of Life among Diabetics visiting RajaRajeswari Medical College and Hospital, Bengaluru

ABSTRACTIntroductionDiabetes mellitus is independently associated with lower levels of health-related quality of life (HRQoL). Quality of life (QoL) is an important aspect in diabetes because poor QoL leads to diminished self-care, which in turn leads to worsened glycemic control, increased risks for complications, and exacerbation of diabetes overwhelming in both the short run and the long run.ObjectiveTo assess the HRQoL among diabetics aged 18 years and above visiting the Medicine Outpatient Department at RajaRajeswari Medical College and Hospital, Bengaluru.Materials and methodsWe conducted a hospital-based study using a generic instrument, Audit of Diabetes Dependent Quality of Life 18 (ADDQoL 18) to measure the QoL of diabetic subjects aged ≥18 years. One hundred and forty diabetics, including 68 males and 72 females, were selected from the Medicine Outpatient Department at RajaRajeswari Medical College and Hospital. Data was analyzed using Statistical Package for the Social Sciences for Windows, version 22.ResultsThe mean age of the participants was 55.7 ±12.5 years. Majority of them (75.7%) were Hindu by religion and most of the study participants (60%) had received formal education. Majority (48.6%) belonged to grade 3 socioeconomic status. Diabetic patients who were employed constituted 52.9%. On the type of diabetes, 91.4% of the participants had type 2 diabetes, while 8.6% had type 1 diabetes. The mean duration of diabetes since diagnosis was 8.2 ±6.5 years.With regard to presence or absence of complications, 38.6% of the participants suffered from complications of diabetes, while 61.4% did not. With regard to treatment, 59.3% of them were consuming only oral hypoglycemic, whereas 40.7% were on insulin. It was observed that diabetes had a negative impact on the present QoL with a mean negative impact of –0.45 and a mean negative average weighted impact of –5.16 on the individual life domains. The negative impact of diabetes on the QoL was greater among those receiving insulin ±oral hypoglycemic agents and among those who had complications. The domains “freedom to eat,” “freedom to drink,” “enjoyment of food,” and “working life” had the greatest negative impact in all patient subgroups. It was observed that male diabetics had a poorer QoL as compared with female diabetics, but this was found to be not statistically significant.ConclusionDiabetes had an adverse effect on the QoL of these study subjects.How to cite this articleKomal SS, Srividya V. Health-related Quality of Life among Diabetics visiting RajaRajeswari Medical College and Hospital, Bengaluru. J Med Sci 2016;2(2):31-35.

Assessment of satisfaction, impact and emotional stress in elderly diabetics without satisfactory control of disease

Materials and methods We performed a historical case-control study of diabetic patients in the Endocrinology Department of a Brazilian tertiary hospital who were treated between June and December 2014. We include patients over 60 yrs. of age, of both sexes, with HbA1c ≥ 8.5% using oral hypoglycemic agents and insulin. Patients were submitted to BPAID (Problems Ares in Diabetes – Brazil) and DQOL (Diabetes Quality of Life) questionnaires, both validated in Portuguese. The first evaluates emotional stress related to DM in 20 questions. On the second, we use the variables “impact” and “satisfaction” to evaluate quality of life. There were 33 issues. We divided the patients into two groups, according the mean of score BPAID (39.45). There are no pre-defined cutoff point for this BPAID questionnaire. The higher the final score, the greater the stress related to DM. Results Forty-five patients were included. There were no differences between the groups for age, gender, education, race, religion, smoking and alcohol. There was no difference in HbA1c (10.75% vs. 9.98%, p=0.09) in the moment of interview. However, the HbA1c levels was greater in the year preceding study in patients with the worst stress scores (10.87% vs. 9.31%, p=0.023). Number of medicines used, dose of Insulin UI/kg, number of daily insulin injections or use of Regular insulin, weight, presence of hypoglycemia, blood pressure levels, or presence of chronic complications associated were not different. Patients with higher levels of stress presented greater negative impact of diabetes on quality of life compared to patients with lower levels of stress (p<0.001). Results were similar with respect to the degree of satisfaction (p<0.001).

Sugar-sweetened beverages and Type 2 diabetes: will a reduction in consumption reduce the risk of developing diabetes?

Context The number of people with Type 2 diabetes (T2D) is increasing across the globe. By 2035 it is estimated that there will be 592 million people with diabetes worldwide, increasing from 382 million in 2013 [1]. The negative impact of diabetes on the individual’s quality of life has long been established [2] and the impact on economic and health resources is a substantial and growing burden [3]. There is high-quality evidence from intervention trials that healthier lifestyles can prevent or delay the onset of T2D [4]. A shift from a nutrient-based approach to one based on foods has been proposed for dietary guidelines [5], with emerging evidence for roles of certain foods in the development of T2D [6–8]. A ‘food’ item of particular interest is sugar-sweetened beverages (SSBs) [9,10], which, if found to be causally related to T2D, would offer the potential for T2D prevention by reducing or eliminating them from the diet. SSB is a collective term for soft drinks, fruit juice drinks, cordials, iced teas, sports drinks and other similar beverages, which are sweetened with caloric sugars. It has been estimated that the global consumption of soft drinks has increased from 9.5 gallons per person per year in 1997 to 11.4 gallons in 2010 [11]. Although national surveys from both the USA [12] and UK [13] have reported small decreases in SSB consumption (with the exception of a small increase in men aged ≥19 years in the UK) the contribution of SSBs to free sugar intakes is still high and concerning, as for example, SSBs are listed as the highest individual food contributor to energy intakes (5.3%) in the USA [14] and as one of the major sources of non-milk extrinsic sugar in the UK [13].

Cystic fibrosis-related diabetes

Cystic fibrosis-related diabetes is an entity distinct from diabetes mellitus type 1 and 2, but with symptoms characteristic to them. Along with the extension of the life expectancy, the prevalence of diabetes increased in association with a more severe decline of the lung function and a poorer nutritional status in comparison to that of people with cystic fibrosis but without diabetes. The authors present current data regarding the prevalence and physiopathology of the disease, the clinical picture, and the useful examinations in establishing the diagnosis, the therapeutic possibilities and disease prognostic. We conclude that the early diagnosis and appropriate therapeutic interventions may diminish the negative impact of diabetes on the lung function and the nutritional status in cystic fibrosis.

Abnormalities of the cardiac stem and progenitor cell compartment in experimental and human diabetes

Diabetic cardiomyopathy consists of a series of structural and functional changes. Accumulating evidence supports the concept that a “cardiac stem cell compartment disease” plays an important role in the pathophysiology of diabetic cardiomyopathy. In diabetic hearts, human cardiac stem/progenitor cells (CSPC) are reduced and manifest defective proliferative capacity. Hyperglycaemia, hyperlipidemia, inflammation, and the consequent oxidative stress are enhanced in diabetes: these conditions can induce defects in both growth and survival of these cells with an imbalance between cell death and cell replacement, thus favouring the onset of diabetic cardiomyopathy and its progression towards heart failure. The preservation of CSPC compartment can contribute to counteract the negative impact of diabetes on the myocardium. The recent studies summarized in this review have improved our understanding of the development and stem cell biology within the cardiovascular system. However, several issues remain unsolved before cell therapy can become a clinical therapeutically relevant strategy.

The transition to young adulthood in youth with type 1 diabetes on intensive treatment

We sought to examine prospectively patterns of clinical and psychosocial outcomes during the transition from adolescence to young adulthood in a cohort initiating intensive therapy after the Diabetes Control and Complications Trial. We conducted a prospective, descriptive analysis of data from a randomized intervention study with 117 adolescents (45 males and 72 females, mean age at entry = 14.4 +/- 2.0 yr, mean diabetes duration at entry = 5.7 +/- 3.7 yr) recruited from a large pediatric diabetes clinic. Data were collected for each subject over periods of up to 5 yr at 6-month intervals using measures of depressive symptoms, quality of life, and metabolic control, with chart review for prevalence of diabetes complications. Metabolic control worsens during adolescence but returns to early adolescent levels in young adulthood. The negative impact of diabetes on quality of life, disease-related worries, and life satisfaction did not change significantly with age. These results did not vary with treatment group or gender. Participants who showed high levels of depressive symptoms as adolescents were somewhat more likely to be depressed when older. Despite relatively long duration of diabetes, relatively few complications were observed in young adulthood. These data suggest that youth who begin intensive treatment as adolescents generally have good metabolic and psychosocial outcomes as young adults. However, those who have high levels of depressive symptoms in adolescence tend to continue to have such symptoms in early adulthood.

¿Cómo influye el tratamiento intensivo de los factores de riesgo cardiovascular en la calidad de vida relacionada con la salud de los pacientes diabéticos?

To assess the health-related quality of life (HRQoL) in diabetic patients who have followed a protocol of intensive treatment of cardiovascular risks (CVR). Clinical trial randomised by cluster. A convenience sample of 65 primary care practitioners, randomly assigned to a control or intervention group. Patients were selected by systematic sampling from diabetic lists. The follow-up for the control group was by normal practice and the intervention group by using the intensive control of cardiovascular risk factors (CVRF) protocol. Seventeen health-centres in the Valencia Community, Spain. One hundred and eighty-four patients, 93 in the control group and 91 in the intervention group. patients diagnosed with diabetes mellitus (DM) type 2, aged between 45-75 years, DM for more than 2 years and less than 20 years and a cardiovascular risk (CVR) >20% after 10 years (Framingham equation). The exclusion criteria were: history of ischaemic heart disease, terminal illness, hepatic cirrhosis, renal failure, grade III-IV cardiac failure, and mental disorders. The patients self-completed the Spanish versions of the COOP/WONCA charts and a diabetes-specific tool (ADDQol questionnaire) at the start, and after 6 months and 12 months. Means of COOP/WONCA charts and ADDQol. Comparison between groups using Mann-Whitney U test, and the group follow ups using the Wilcoxon test. No significant differences were found in the COOP/WONCA charts. At 12 months the only significant difference was in the feelings chart (P=.024; control group 1.86+/-1.03: intervention group 2.23+/-1.11). A negative impact of diabetes was seen in all the dimensions of ADDQoL. The most negative impact of diabetes was related to diet. There were no significant differences between groups in the ADDQoL throughout the study. The HRQoL in diabetic patients is not affected by intensive therapy of cardiovascular risk factors. Diabetes has a negative impact on HRQoL in the patients studied.

Coping skills training for youths with diabetes on intensive therapy

The purpose of this study was to determine if a behavioral intervention (coping skills training [CST]) combined with intensive diabetes management can improve the metabolic control and quality of life in adolescents who are implementing intensive therapy. A total of 77 youths (age range, 12.5-20 years) who were beginning intensive insulin therapy were randomly assigned to one of two groups: intensive management with CST or without CST. CST consists of a series of small group efforts designed to teach problem solving skills and communication. Data were collected preintervention and at 3 and 6 months post-intervention by using established clinical and psychosocial indicators. Randomization produced equivalent groups. After 6 months, subjects who received CST had better metabolic control (F = 3.89, p = .02) and better general self-efficacy (F = 4.54, p = 0.01). They reported less negative impact of diabetes on their quality of life (F = 4.55, p = .01) and had fewer worries about diabetes (F = 3.82, p = .02). Thus, nurses may find CST useful in assisting youths with diabetes to achieve metabolic and quality of life goals.