Diabetes management

About: Diabetes management is a research topic. Over the lifetime, 6060 publications have been published within this topic receiving 164670 citations.

Nutrition principles for the management of diabetes and related complications.

Abstract: Health professionals and people with diabetes recognize nutrition therapy as one of the most challenging aspects of diabetes care and education (1). Adherence to meal planning principles requires the person with diabetes to learn specific nutrition recommendations. It may require altering previous patterns of eating and implementing new eating behaviors, which requires motivation for a healthy lifestyle and may also require participation in exercise programs. Finally, individuals must be able to evaluate the effectiveness of these lifestyle changes. Despite these challenges, nutrition is an essential component of successful diabetes management.

Healthy Coping, Negative Emotions, and Diabetes Management A Systematic Review and Appraisal

Abstract: Purpose The purpose of this systematic review is to assess the literature pertinent to healthy coping in diabetes management and to identify effective or promising interventions and areas needing further investigation. Methods A PubMed search identified 186 articles in English published between January 1, 1990, and July 31, 2006, addressing diabetes and emotion, quality of life, depression, adjustment, anxiety, coping, family therapy, behavior therapy, psychotherapy, problem solving, couples therapy, or marital therapy. Results Connections among psychological variables, behavioral factors, coping, metabolic control, and quality of life are appreciable and multidirectional. Interventions for which well-controlled studies indicate benefits for quality of life and/or metabolic control include general self-management, coping/problem-solving interventions, stress management, support groups, cognitive-behavioral therapy, behavioral family systems therapy, cognitive-analytic therapy, multisystemic therapy, medications for depression, and the Pathways intervention integrating case management, support of medication, and problem-solving counseling. Conclusions Psychological, emotional, related behavioral factors, and quality of life are important in diabetes management, are worthy of attention in their own right, and influence metabolic control. A range of interventions that achieve benefits in these areas provide a base for developing versatile programs to promote healthy coping.

Diabetes and behavioral medicine: the second decade.

Abstract: Diabetes management depends almost entirely on behavioral self-regulation. Behavioral scientists have continued a collaboration with other health systems researchers to develop a holistic approach to this disease. The authors summarized the literature in 4 major areas: self-management of diabetes, psychosocial adjustment and quality of life, neuropsychological impact, and psychobehavioral intervention development. Progress made in each of these areas over the past decade is highlighted, as are important issues that have not yet received sufficient scientific attention. Emerging areas likely to become central in behavioral research, such as diabetes prevention, are introduced. The future of behavioral medicine in diabetes is also discussed, including topics such as the changing role of psychologists in diabetes care, the urgent need for more and better intervention research, the growing importance of incorporating a health system–public health perspective, and obstacles to the integration of psychobehavioral approaches into routine health care delivery. A profound event in diabetes management during the past decade was the release of the 1993 report of the National Institutes of Health (NIH) funded Diabetes Control and Complications Trial (DCCT; DCCT Research Group, 1993), which radically altered both the goals and the philosophy of treatment of this disease. The DCCT was a controlled, prospective trial following more than 1,400 adults and adolescents with Type 1 diabetes (T1DM) over an average of 6.5 years. The results provided strong evidence that the use of intensive treatment regimens to maintain tighter glucose control can delay or prevent the development of at least some of the devastating long-term complications of diabetes, including retinopathy and nephropathy. Subsequent studies replicated these findings and demonstrated the benefits of maintaining tighter metabolic control for patients with Type 2 diabetes (T2DM; Ohkubo et al., 1995; Reichard, Nilsson, & Rosenqvist, 1993; Turner, Cull, & Holman, 1996). It is almost impossible to overestimate the impact of the DCCT on diabetes treatment and research. Seemingly overnight, large numbers of patients were expected to follow a demanding, intensive treatment regimen that previously had been recommended only for those who were most highly motivated and diligent in their diabetes self-management. Health care practitioners were also expected to know how to help patients achieve these lofty treatment goals. In addition to problems in implementing intensive treatment, questions arose concerning the effects of these regimens on quality of life (QOL) for patients. Intensive regimens also posed new dilemmas for health care practitioners and patients, not the least of which was the dramatic increase in risk for episodes of severe hypoglycemia when patients attempted to lower blood glucose (BG) levels. It quickly became clear that the greatest challenge to contemporary diabetes treatment was overcoming the many psychobehavioral and social– environmental barriers to optimal self-management. Not surprisingly, the medical establishment turned to behavioral scientists for assistance, and new and stronger partnerships emerged between psychology and diabetes health care. Following the DCCT, there was an enormous effort to summarize and disseminate relevant findings from psychobehavioral research to assist health care practitioners and patients in adapting to these new treatment goals. In 1994, The Handbook of Psychology and Diabetes(Bradley, 1994b) described diabetes-specific psychological instruments, with demonstrated reliability and validity, that are available for clinical and research use. In 1996, the American Diabetes Association (ADA) published Practical Psychology for

Peer Mentoring and Financial Incentives to Improve Glucose Control in African American Veterans: A Randomized Trial

Abstract: Management of Diabetes Mellitus has proven difficult because many of the most critical elements of disease management occur outside of clinical encounters. Intensive clinic based programs have proven effective in improving diabetes management, but such programs are resource intensive with declining effectiveness over time. Support from families and friends is often not a viable alternative because many patients are socially isolated, others may not want to engage relatives or friends in discussions about their medical problems, and family and friends may be unable to assume a caretaker role (1). Disease-specific social support has been shown to improve diabetes self-management behaviors and may be particularly beneficial when the support comes from a peer with the same chronic condition (2-6). In interventions with diabetics, peer support has been shown to be effective in improving medication adherence, diet, exercise, blood glucose monitoring, and most recently glucose control (7-11). Prior interventions have introduced peer support through group visits or nurse phone calls or home visits from community health workers; however, these require expensive professional or semi-professional support staff (12-18). A more informal, flexible means of providing one-on-one peer support through volunteer peer coaches or mentors could potentially provide similar benefits at lower cost. Financial incentives could enhance diabetes self-care. Financial incentives show promise in domains of behavior such as medication adherence (19), diet and exercise (20), and smoking (21), where people’s short time horizons lead them to favor immediate benefits at the expense of delayed costs (22-24). As far as we know, financial incentives have not been tested as a means to improving diabetes control. To test the efficacy of these emerging means to promote health behaviors, we performed a randomized controlled trial of peer mentoring and financial incentives aimed at improving glucose control in African American veterans with persistently poor diabetes control.