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Results for “Glycemic Control”

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PubMedDate not supplied

Effects of nortriptyline on depression and glycemic control in diabetes: results of a double-blind, placebo-controlled trial.

OBJECTIVE: Depression is a prevalent and chronic condition in diabetes and is associated with poor glucose regulation and poor compliance with diabetes treatment. This investigation evaluated the effects of nortriptyline on depression and glycemic control to see whether depression in diabetes is treatable and whether restoring mental health contributes to improved medical outcome. METHOD: Sixty-eight diabetic patients with poor glycemic control, 28 of whom had active major depression (DSM-IIIR), completed a randomized, placebo-controlled, double-blind trial involving 8 weeks of treatment with nortriptyline targeted to therapeutic plasma levels (50-150 ng/ml). Depression improvement was determined with the Beck Depression Inventory; glucose control was measured by glycated hemoglobin levels. Compliance behavior was assessed using medication dispensing devices and glucometers equipped with electronic memory. RESULTS: The reduction in depression symptoms was significantly greater in depressed patients treated with nortriptyline compared with those receiving placebo (-10.2 vs -5.8, p = .03). Nortriptyline was not statistically superior to placebo in reducing glycated hemoglobin of the depressed subjects (p = .5). However, path analysis indicated that the direct effect of nortriptyline was to worsen glycemic control whereas depression improvement had an independent beneficial effect on glycated hemoglobin. These findings were not explained by the relationships of nortriptyline treatment to weight change (r = -0.21, p = .31) or depression improvement to compliance with the protocol for self-monitoring of blood glucose (r = 0.01, p = .97). CONCLUSIONS: Major depression in diabetic patients can be effectively treated with nortriptyline at the expense of a direct hyperglycemic effect. Path analysis demonstrated a treatment-independent effect of depression improvement on glycemic control, suggesting that a more ideal antidepressant agent may both restore mental health and improve medical outcome.

Adult↗

PubMed2004

Glycemic control with metformin or insulin therapy in adolescents with type 2 diabetes mellitus.

BACKGROUND: Only metformin and insulin are approved by the FDA for adolescents. OBJECTIVE: To study the efficacy of insulin versus metformin in adolescents with type 2 diabetes mellitus (DM2) and examine whether psychosocial factors affect therapeutic efficacy. METHODS: Phase I involved a retrospective examination of the medical records of 18 adolescents with DM2. Glycemic control was evaluated by mean HbA1c. We tested for relationships between glycemic control and BMI, number of outpatient visits per year, and self-reported compliance. Phase II employed a pilot questionnaire. RESULTS: Glycemic control deteriorated when therapy was changed from insulin (HbA1c, 5.0+/-2.6% [SD]) to metformin (8.4+/-2.9%; p <0.05). Self-reported compliance positively predicted glycemic control (p <0.005) and inversely correlated with degree of weight loss (p <0.05). Pilot questionnaire data suggested that patients may perceive their DM as less serious when treated with metformin. CONCLUSIONS: Metformin was often ineffective in our adolescents with DM2 and compliance was a major factor. Altered perception of the seriousness of their DM may have influenced adherence to therapy.

Adolescent↗

PubMed2000

Improved glycemic control and platelet function abnormalities in diabetic patients with microvascular disease.

Patients with diabetes mellitus have a variety of platelet and coagulation system dysfunctions. At least theoretically, these can contribute to microvascular complications. Intensive glycemic control has been demonstrated to decrease microvascular complications in type 1 diabetics. We studied 16 patients with type 1 diabetes mellitus (11 men and five women; mean age, 39 years) with albuminuria greater than 0.1 g/d and/or proteinuria greater than 0.3 g/d and a creatinine clearance rate higher than 30 mL/min. They received a regimen including three to four injections of insulin per day with or without a weekly infusion of intravenous insulin, and were evaluated for 6 months. We compared the plasma level of von Willebrand factor, platelet aggregation responses to adenosine diphosphate (ADP), epinephrine, and collagen, and platelet adhesion at the beginning of the study and at follow-up intervals. Glycemic control improved significantly. There were no significant differences in the platelet aggregation responses to ADP (1.59 +/- 0.34 v 1.88 +/- 0.23 mmol/L, P = .3; normal, 4.6 +/- 0.2), epinephrine (0.50 +/- 0.20 v 1.11 +/- 0.31 mmol/L, P = .06; normal, 7.6 +/- 1.5), or collagen (92.4 +/- 6.61 v 82.60 +/- 3.78 seconds, P = .6; normal, 79.1 +/- 3.1) or in platelet adhesion (126.31 +/- 16.95 v 195.08 +/- 30.2 platelets, P = .34; normal, 68.6 +/- 1.4). Baseline von Willebrand factor increased, but not significantly (166.38% +/- 10.6% v 142.72% +/- 14.73%, P = .21; normal, 102.0% +/- 6.0%). In type 1 diabetic patients with established microvascular complications of nephropathy, a statistically significant improvement in glycemic control did not improve the in vitro platelet function abnormalities. Improved glycemic control delays the progression of microvascular disease through mechanisms not measured by tests of platelet function.

Adenosine Diphosphate↗

PubMed1994

[Health and factors associated with glycemic control in 165 children with insulin-dependent diabetes, aged 7-23 year].

BACKGROUND: A multicenter cross-sectional study was the first step of a project aimed at performing an educational diagnosis for IDDM children in France. POPULATION AND METHODS: Inclusion criteria were age 7 to 13 years, IDDM duration > 6 months and to be followed in a university pediatric department. One hundred and seventy-three children, followed in six centers, were eligible. One hundred and sixty-five of them (age 10.2 +/- 1.9 years and IDDM duration 3.1 +/- 2.7 years) agreed to participate. Standardized questionnaires were completed by the parents and children. Clinical examination was performed and a medical questionnaire was completed by the usual diabetologist of children. HbA1c was measured using a single HPLC method (normal levels +/- 2 sd = 4.5 to 5.7%). RESULTS: Mean HbA1c was 8.3 +/- 1.6% (range 5-13.2%) and values were distributed as follows: < or = 7% for 24.5%, < or = 8% for 46.6% and > 10% for 14% of the children. Age (r = 0.33, P < 0.001), duration of diabetes (r = 0.29, P < 0.001), number of biochemical hypoglycemias (r = -0.21, P < 0.01) and cholesterol level (r = 0.31, P < 0.001) were correlated with HbA1c levels and accounted for 30% of the variance in predicting HbA1c. The difference of HbA1c levels between prepubertal and pubertal children was significant (P < 0.02). Other usual clinical parameters as well as indexes for diabetes monitoring were not significantly correlated with HbA1c. In addition, four subgroups were associated with a significant deterioration (delta > or = 1%) in mean HbA1c levels: 1) age > 10 years (n = 82, P < 0.01); 2) pubertal stage in girls (Tanner stages III vs I, P < 0.05); 3) IDDM duration > or = 2 years (n = 106, P < 0.001); 4) a non French native mother (n = 27, P < 0.001). CONCLUSIONS: Only 50% of this group under specialized care had an acceptable level of glycemic control (HbA1c < or = 8%). Factors related to glycemic control were identified, as well as subgroups of children at particular risk for bad glycemic control which requires specifically targeted interventions. The analyse of sociodemographic, psychological, familial and cognitive factors is currently being conducted in this population, in order to find other explicative variables of glycemic control and to develop specifically targeted educational programs.

Adolescent↗

PubMed2001

Glycemic control is a predictor of survival for diabetic patients on hemodialysis.

OBJECTIVE: To investigate the impact of glycemic control on the survival of diabetic subjects with end-stage renal disease (ESRD) starting hemodialysis treatment. RESEARCH DESIGN AND METHODS: This single-center prospective observational study enrolled 150 diabetic ESRD subjects (109 men and 41 women; age at hemodialysis initiation, 60.5 +/- 10.2 years) at start of hemodialysis between January 1989 and December 1997. The subjects were divided into groups according to their glycemic control level at inclusion as follows: good HbA1c <7.5%, n = 93 (group G), and poor HbA1c > or = 7.5%, n = 57 (group P); and survival was followed until December 1999, with a mean follow-up period of 2.7 years. RESULTS: Group G had better survival than group P (the control group) (P = 0.008). At inclusion, there was no significant difference in age, sex, systolic blood pressure (SBP), BMI, cardio-to-thoracic ratio (CTR) on chest X-ray, and serum creatinine (Cre) or hemoglobin (Hb) levels between the two groups. After adjustment for age and sex, HbA1c was a significant predictor of survival (hazard ratio 1. 133 per 1.0% increment of HbA1c, 95% CI 1.028-1.249, P = 0.012), as were Cre and CTR. CONCLUSIONS: Good glycemic control (HbA1c <7.5%) predicts better survival of diabetic ESRD patients starting hemodialysis treatment.

Blood Glucose↗

PubMed2003

Decrease of collagen deposition in wound repair in type 1 diabetes independent of glycemic control.

HYPOTHESIS: Type 1 and type 2 diabetes mellitus and glycemic control influence wound healing in humans. DESIGN: Experimental study using a human wound-healing model. SETTING: Collaboration among a multidisciplinary wound-healing department, department of medicine, and research laboratories. PATIENTS, CONTROL SUBJECTS, AND METHODS: In 34 patients with type 1 (insulin-dependent) and 25 with type 2 (non-insulin-dependent) diabetes and 5 nondiabetic control subjects matched with the type 2 diabetic patients, wound-healing capacity was determined as subcutaneous accumulation of collagen measured as hydroxyproline. Two expanded polytetrafluoroethylene tubes were implanted and removed 10 days later. The hydroxyproline level was determined by means of high-performance liquid chromatography; the collagenase activity, by using a radiolabeled collagen substrate. Proliferation of fibroblasts cultured from the wounds was studied in patient groups. RESULTS: The deposition of hydroxyproline decreased by 40% (P =.03) in type 1 compared with type 2 diabetes (median, 0.70 vs 1.16 nmol/mg; interquartile range, 0.48-1.04 vs 0.56-1.63 nmol/mg), which in turn did not differ significantly from that of controls (median, 1.35 nmol/mg; interquartile range, 0.72-1.88 nmol/mg). The decreased collagen deposition in type 1 diabetes was not caused by increased collagenase activity. The deposition of hydroxyproline did not correlate significantly (r(s) = 0.07; P =.63) with glycosylated hemoglobin levels in either diabetic group. Fibroblast growth was also decreased in type 1 compared with type 2 diabetic patients and controls. CONCLUSIONS: Collagen deposition in acute wounds is impaired in type 1 diabetes, possibly due to a decreased fibroblast proliferation. In type 2 diabetes, collagen deposition is normal. Glycemic control does not influence collagen deposition in acute wound repair in type 1 or in type 2 diabetes mellitus.

Adult↗

PubMedDate not supplied

Patient safety and inpatient glycemic control: translating concepts into action.

OBJECTIVE: (1) To summarize current knowledge regarding patient safety issues and their impact on inpatient glycemic control and (2) to provide a systematic and practical approach to improving patient safety in this area. METHODS: Insulin delivery in inpatient settings is examined, as are the barriers to safe insulin therapy. A distinction is made between safety strategies of proven value and those that are less useful. Characteristics of safer insulin algorithms are discussed. RESULTS: Errors in insulin administration remain a common cause of injuries. Despite strong evidence of the dangers of sliding-scale insulin regimens in inpatient settings, sliding-scale insulin regimens remain a widely used but ineffective (and occasionally dangerous) method. To correctly analyze inpatient processes of care, a systems approach is needed, and the relationship between quality of care, latent medical errors, injurious patient errors, and patient safety must be understood. In complex systems such as hospitals, catastrophic error has complex roots involving many individuals, and the design of the system often has latent flaws that make human error likely, even predictable. The concept of the scope of awareness is useful in understanding why it is ineffective to focus only on those at the point of care, and how improvement is more apt to occur with a team approach and the evaluation of systemic factors, at the "blunt end" of care. Error-prone organizations are often very unsafe, and certain practices tend to be common among them. Data are now available showing the negative impact of poorly supervised trainees and the extent of the problem worldwide on patient safety. CONCLUSION: Redesign of patient care provided in hospitals regarding glucose control is long overdue. Practical strategies are given that focus on improving patient safety for the patient needing inpatient glycemic control. Such techniques now have a sufficient evidentiary base. Therefore, hospitals should move rapidly to make euglycemia a goal for all inpatients, and to make patient safety in glycemic control a reality, not just for a few, but for all patients in our care.

Humans↗

PubMed2005

Monitoring glycemic control: the importance of self-monitoring of blood glucose.

Several methods, each with differing utility and limitations, exist for monitoring glycemic control. Hemoglobin A1c (HbA1c) is considered the standard measure of long-term glycemic control, and HbA1c levels are strongly associated with complications of diabetes. However, HbA1c does not provide "real-time" information about individual hyperglycemic or hypoglycemic excursions. Urine glucose testing is noninvasive and inexpensive, but it is dependent on the patient's individual renal threshold and can only detect glucose concentrations above this threshold. As such, urine testing cannot be recommended for diabetes management that aims for near-normoglycemia. Self-monitoring of blood glucose (SMBG) complements HbA1c by providing real-time blood glucose data. It is an educational tool for both patients and their healthcare providers to understand the effects of diet, exercise, and medications on day-to-day glycemic control. However, guidelines from various international diabetes organizations vary in their level of specificity regarding the frequency and timing of self-monitoring. SMBG should be implemented for all patients as part of an overall diabetes management plan that includes specific instruction on how, when, and why to test.

Blood Glucose↗

PubMed1982

Short term improvement in glycemic control utilizing continuous subcutaneous insulin infusion: the effect on 24-hour integrated concentrations of counterregulatory hormones and plasma lipids in insulin-dependent diabetes mellitus.

Eight patients with established insulin-dependent diabetes mellitus were studied before and 2 weeks after the initiation of pumped continuous sc insulin infusion in order to investigate the effect of short term improvement of glycemic control on hormonal and lipid levels. Glycemic control was improved in all patients. Using a constant blood withdrawal pump, accurate 24-h average concentrations, denoted integrated concentrations, were obtained. The mean 24-h integrated concentrations of GH, cortisol, norepinephrine, and epinephrine did not change significantly. The mean fasting triglyceride concentration dropped from 119.1 to 83.4 mg/dl (P less than 0.05). The mean 24-h integrated concentration of plasma triglycerides fell from 132.1 to 101.5 mg/dl (P less than 0.02). Both mean fasting and mean 24-h integrated concentrations of plasma cholesterol were lower after improved control. Short term improvement in glycemic control was associated with a reduction in plasma lipid concentrations, but failed to alter mean 24-h integrated concentrations of the measured counterregulatory hormones.

Adolescent↗

PubMed1996

Glycemic control and the risk for coronary heart disease in patients with non-insulin-dependent diabetes mellitus. The Finnish studies.

PURPOSE: To review population-based studies that investigated the association and nature of association between glycemic control and the risk for coronary heart disease in patients with non-insulin-dependent diabetes mellitus (NIDDM). DATA SOURCES: Study 1 included 133 newly diagnosed patients with NIDDM from eastern Finland, who were 45 to 64 years of age at baseline. These patients were followed up to 10 years for cardiovascular mortality. Study 2 included 229 newly or previously diagnosed patients with NIDDM from eastern Finland, aged 65 to 74 years at baseline. These patients were followed up to 3.5 years for coronary heart disease mortality and all coronary heart disease events (mortality or nonfatal myocardial infarction). STUDY SELECTION: Prospective, population-based studies that included indicators of glycemic control and the evaluation of coronary heart disease and cardiovascular risk. RESULTS: Study 1: 10-year cardiovascular mortality was significantly and linearly associated with glycemic control (fasting blood glucose and glycated hemoglobin A1 levels) independently of the mode of treatment. A high fasting blood glucose level significantly predicted cardiovascular mortality in multiple logistic regression analysis independently of other risk factors. Study 2: Glycated hemoglobin A1c was the most important single risk factor associated with coronary heart disease death or all coronary heart disease events. In multiple logistic regression analysis, glycated hemoglobin A1c was significantly associated with coronary heart disease death after adjustment for other cardiovascular risk factors. CONCLUSIONS: Two prospective, population-based studies from Finland give evidence for the linear association of glycemic control with the risk for coronary heart disease in middle-aged and elderly patients with NIDDM.

Aged↗

PubMed2001

A double-blind trial on the effects of atorvastatin on glycemic control in Japanese diabetic patients with hypercholesterolemia.

A double-blind, placebo-controlled, parallel-group study was performed to determine whether atorvastatin, a new HMG-CoA reductase inhibitor, could effectively and safely reduce plasma LDL-cholesterol concentrations in Japanese patients with type-2 diabetes without influencing glycemic control. The subjects were patients with hypercholesterolemia (serum cholesterol concentration > or =5.7 mmol/l (220 mg/dl)) and stable glycemic control. The fasting concentrations of hemoglobin A(1C) (HbA(1C)), fructosamine, and 1,5-anhydroglucitol (1,5-AG) were measured as indices of glycemic control. Plasma lipid concentrations and the safety of the drug were also examined. Forty eligible patients in two groups of 20 each were administered atorvastatin (10 mg/day) or placebo. Neither atorvastatin nor placebo caused a significant change in HbA(1C), fructosamine, or 1,5-AG concentrations. Atorvastatin significantly reduced total cholesterol and LDL-cholesterol concentrations from baseline by 29.7% (p<0.0001) and 41.6% (p<0.0001), respectively. The incidence of clinical adverse events and that of abnormal changes in laboratory test values did not differ between the two groups. In this trial, atorvastatin effectively and safely reduced LDL-cholesterol concentrations in diabetic patients with hypercholesterolemia without influencing glycemic control. These findings are clinically important because there are many diabetic patients with hypercholesterolemia and such patients have a high risk of developing arteriosclerotic disease.

Adult↗

PubMed1993

Poor glycemic control and antepartum obstetric complications in women with insulin-dependent diabetes.

OBJECTIVE: The purpose of this study was to test the hypothesis that the rate of complications of pregnancy in women with insulin-dependent diabetes is higher than in nondiabetic women and is associated with poor glycemic control and microvascular disease. METHOD: Women who enrolled in a multidisciplinary program of diabetes in pregnancy prior to 20 weeks' gestation were included in the study and matched 1:2 by age, race and parity to a control group of nondiabetic women. Complications of pregnancy were retrospectively analyzed and compared between groups. The association of complications with glycemic control and microvascular disease was analyzed within the diabetic group. RESULT: Women with diabetes had significantly higher rates of pregnancy-induced hypertension (PIH), polyhydramnios, pyelonephritis, preterm delivery and meconium-stained amniotic fluid. Poor glycemic control, particularly during the first and second trimesters of pregnancy, was associated with all complications, except pyelonephritis. Microvascular disease was associated with PIH and preterm delivery prior to 34 weeks. CONCLUSION: Women with insulin-dependent diabetes are at high risk for complications of pregnancy. Glycemic control during the first and second trimesters may affect events later in pregnancy.

Blood Glucose↗

PubMed2006

Poor glycemic control in diabetic patients seeking care in the ED.

We hypothesized that diabetic patients in the emergency department (ED) have poorer glycemic control than patients seeking care at primary care clinics. A convenience sample of hemoglobin A1c (HbA1c) values was gathered retrospectively from the ED, Endocrinology, and Family Medicine Clinics. Results were divided into controlled, poorly controlled, and extremely poorly controlled. The only differing pattern of patients (*P < .01) was in the extremely poorly controlled group consisting of 36% of the ED patients (confidence interval [CI], 29.23-42.69; n = 74) vs 18% of the Endocrinology patients (CI, 13.76-22.53; n = 56) and 19% of the Family Medicine patients (CI, 15.98-22.75; n = 105). A frequency distribution of the ED HbA1c values was bimodal. The first peak represents well-controlled diabetic patients. The second, higher peak comprises a larger number of patients (approximate n = 134, 73% of all 207 ED patients) who have poorer glycemic control. We conclude that a large number of ED diabetic patients have poorer glycemic control than the other clinics.

Blood Glucose↗

PubMed1996

Effect of improved glycemic control on blood pressure and albuminuria of insulin-dependent diabetes without nephropathy.

To assess the effect of glycemic control on blood pressure (BP) and albumin excretion rate (AER) in insulin-dependent diabetes, 35 patients (age 12.6 +/- 2.7 years) and 45 matched control subjects (11.9 +/- 1.8 years) were studied at an educational camp (Study I). They were evaluated at the beginning and at the end of a 9-day program of adequate diet and exercise twice daily, which induced statistically significant reductions in urinary glucose (18 +/- 21 to 5 +/- 7 g/12 h, P < 0.01) and in insulin requirement (42 +/- 20 to 31 +/- 12 U/day, P < 0.01) in the diabetic group. The mean BP and AER of the diabetic patients fell from 74 +/- 11 to 69 +/- 11 mmHg, P < 0.001, and from 4.9 +/- 6.0 to 2.1 +/- 2.0 micrograms/min, P < 0.01, and a correlation was found between AER and urinary glucose. In contrast, controls showed a lower reduction in BP and no change in AER. To evaluate the mechanisms involved in BP fall another group of 39 diabetics (age 12.7 +/- 2.1 years) was submitted to the same 9-day program and also to improved glycemic control (Study II). Changes in BP (79 +/- 11 to 76 +/- 11 mmHg, P < 0.05) were slighter than in the previous study. Initial creatinine clearance was high and fell to the normal range at the end of the study (159 +/- 99 to 127 +/- 42 ml min-1 (1.73 m2)-1, P < 0.05). Urinary aldosterone decreased from 5.3 +/- 3.9 to 3.4 +/- 2.4 micrograms/24 h (P < 0.05), and fractional Na+ excretion tended to increase. Initial and final metanephrine values did not differ. Changes in mean BP did not correlate with changes in aldosterone, insulin requirement or urinary glucose. The decreases in hyperfiltration and AER may have been due to the improved glycemic control induced by this educational program. Exercise may be responsible for BP reduction in diabetics and controls. BP changes particularly in diabetics could be attributed to the inhibition of the renin-angiotensin-aldosterone system and/or to decreased insulin requirement. The contribution of a negative Na+ balance consequent to decreased plasma insulin levels to the BP fall cannot be excluded.

Adolescent↗

PubMed2006

Improvement in glycemic control over 11 years in patients monitored for diabetes in one county.

BACKGROUND: Hemoglobin A(1c) (HbA(1c)) has been used in controlled trials for the last 10 years but has never been evaluated in clinical practice as an effective parameter for clinical outcome. We investigated the trend for glycemic control over 11 years in one county of 350,000 citizens. METHODS: We studied 226,382 HbA(1c-DCCT-aligned) from 39,455 patients in whom routine monitoring for diabetes was initiated in 1993, 1996, or 2001. The trend in glycemic control was investigated in groups by probit plots, and in individual patients by target plots. RESULTS: From 1993 to 2001, the number of HbA(1c) measurements increased three-fold. The number of new monitoring series increased from 0.22% to 0.27% of the county population, and the number of patients monitored using HbA(1c) as a proxy for diabetes increased from 0.5% to 1.5%. A proportional reduction in high HbA(1c) concentrations of 5% was identified in the 1993 group, compared to 15% in the 1996 group, and 20% in the 2001 group. The percentage of patients with diabetic first HbA(1c) experiencing normalization increased from 8% to 30% for males and from 9% to 24% for females (1993-2001). The percentage of HbA(1c) concentrations that were not normalized decreased from 78% to 53% for males and from 83% to 59% for females (1993-2001). The median HbA(1c) at initiation of monitoring decreased from 8.7% in 1993 to 7.5% in 2001 (p < 10(-5)). The number of normal first HbA(1c) results in monitoring series increased from 7% to 17% for males and from 8% to 22% for females. Up to 10% of subjects developed diabetic concentrations during monitoring. CONCLUSION: On average, patients with diabetic first HbA(1c) concentrations (> or =6.62%) showed an improvement in glycemic control from 5% in 1993 to 20% in 2001. High concentrations were easiest to reduce. In patients with originally diabetic HbA(1c) levels, 66% on average showed improved glycemic control in the 2001 series compared to 50% in the 1993 series. An average of 6% (1993) vs. 9% (2001) with originally normal HbA(1c) levels showed an upward trend inHbA(1c) levels. Median HbA(1c) at initiation of monitoring decreased from 8.7% in 1993 to 7.5% in 2001 (p < 10(-5)). The incidence of new cases was constant.

Adolescent↗

PubMedDate not supplied

Pre-existing diabetics: relationship between glycemic control and emotional status in pregnancy.

Due to the paucity of information regarding the emotional status of pregnant diabetic women, we sought to determine the impact of pre-existing diabetes on the relation between the level of glycemic control and emotional well-being during pregnancy. English-speaking women with pre-existing diabetes mellitus (N = 100) and nondiabetic controls (N = 132) were compared for maternal characteristics and test results on the Profile of Mood States-Bipolar form. It is a 72-item, self-administered Likert scale measuring six bipolar subjective mood states representing both positive and negative aspects. Patients were stratified according to level of glycemic control. The number of glucose determinations were categorized as: mild and severe hypoglycemia and hyperglycemia, and normoglycemia. An Average Mood Disturbance score was calculated to measure the level of association between the total psychological profile and categories of glucose determinations. In two of the six subscales (hostility and anxiety) of the Profile of Mood States, significantly lower scores indicating greater hostility and anxiety were found in the diabetic group. The level of glycemic control was not adversely associated with the emotional state of pre-existing diabetic pregnant women. The psychological profile was not associated with the severity of the disease as reflected by the diabetes classification. Pregnant women with pre-existing diabetes display greater anxiety and hostility in comparison to nondiabetic women with no association to level of glycemic control. This issue should be addressed in the medical and psychosocial health assessment of these women.

Affect↗

PubMed1994

Stimulus specificity of defects in counterregulatory hormone secretion in insulin-dependent diabetes mellitus: effect of glycemic control.

Counterregulatory hormone responses to hypoglycemia are impaired in subjects with insulin-dependent diabetes mellitus (IDDM) in strict glycemic control. To determine whether these defects are specific for hypoglycemia, we examined counterregulatory hormone responses during a 3-h hypoglycemic hyperinsulinemic clamp (14.4 pmol/kg.min) that lowered plasma glucose from 5.0 to 2.2 mmol/L in 9 well controlled IDDM patients (hemoglobin-A1, 7.5 +/- 0.8%), 9 poorly controlled patients (hemoglobin-A1, 12.5 +/- 1.5%), and 10 healthy volunteers. Counterregulatory hormone secretion was compared with responses to non-glucose secretagogues for epinephrine and norepinephrine (cold pressor test), ACTH (overnight metyrapone test), and GH (L-arginine infusion). During hypoglycemia, epinephrine and cortisol responses were lower in the IDDM group in strict glycemic control than those in the poorly controlled IDDM group or healthy volunteers (P < 0.05). In response to the cold pressor test, the areas under the curve for epinephrine and norepinephrine were also reduced in the well controlled IDDM group (P < 0.05 vs. healthy volunteers). The ACTH response to hypoglycemia was not significantly reduced in the well controlled IDDM, whereas the response to metyrapone was actually greater in this group (P < 0.05 vs. poorly controlled IDDM). GH responses to both hypoglycemia and arginine were highest in the well controlled diabetic patients. These data suggest that 1) the reduced epinephrine responses in well controlled IDDM may not be specific for the hypoglycemic stimulus alone, but may also occur in response to other nonhypoglycemic stimuli; 2) cortisol responses to hypoglycemia are reduced in well controlled IDDM, whereas the ACTH response to a non-hypoglycemic stimulus remains intact; and 3) GH responses to both hypoglycemic and nonhypoglycemic stimuli are preserved in well controlled IDDM. The preservation of ACTH and GH responses to metyrapone and arginine, respectively, suggests adequate pituitary functional reserve in IDDM patients in strict glycemic control in response to nonhypoglycemic stimuli.

Adolescent↗

PubMed1992

Stress buffering and glycemic control. The role of coping styles.

OBJECTIVE: To test the hypotheses that chronic psychosocial stress is associated with worse glycemic control and that coping moderates (buffers) this effect. RESEARCH DESIGN AND METHODS: Subjects consisted of 105 insulin-treated adults from the Diabetes Division of Henry Ford Hospital who filled out questionnaires on stress and coping and received an HbA1 test at a clinic appointment. Six coping styles were examined, including both emotion- and problem-focused styles. Two standardized stress inventories were administered. Ineffective coping was defined as scoring below the median for stress-dampening coping styles and above the median for stress-exacerbating styles. RESULTS: Stress was significantly (P less than 0.05) correlated with higher HbA1 in all but one ineffective coping subgroup. Conversely, none of 12 correlations between stress and glycemic control was significant in the effective coping subgroups. CONCLUSIONS: Chronic psychosocial stress is associated with worse glycemic control among those who do not cope effectively with stress. Effective coping can protect individuals from the deleterious effects of stress.

Adaptation, Psychological↗