Subclinical biobehavioral factors, adherence to diabetes self-care, and glycemic control in Type 1 diabetes mellitus

Achieving glycemic control due to insulin treatment consequent to strict adherence to diabetes self-care behaviors greatly reduces the risk of long-term complications of Type 1 diabetes mellitus (DM-1). The primary purpose of this dissertation was to develop a conceptual model in adult men and women with DM-1 that includes psychosocial functioning, adherence to diabetes self-care behaviors, and glycemic control. The assessment of these interrelationships in persons with DM-1 without a history of major diabetes related complications, who have had the disease for a period of time but have had fairly good glycemic control would permit an understanding of these factors impacting glycemic control before potentially confounding disease complications and pathophysiology complicate their investigation. Therefore, in this study subjects were enrolled if their diagnosed DM-1 was established for a duration of at least 8 years but their glycemic control was at least in the fair to good range (i.e., HbA1c was 4 to 11%) and upon clinical examination were free of diabetes-related complications and neuropathies, although subjects who displayed minimal evidence of sensory neuropathy were included. Subjects were recruited from the Miami-Dade community as part of a study assessing the integrity of autonomic mediation of cardiovascular function in DM-1. The subjects were 45 Non-Hispanic White (53%), Hispanic (30%), and Black (17%) men (n = 21) and women (n = 24) and ranged in age from 18 to 55 years (mean +/- SD 34 +/- 8), with a mean +/- SD diabetes duration of 18 +/- 7 years, and mean +/- SD glycemic control of 7.5 +/- 2%. Psychosocial measures assessed depressive symptoms, adherence to DM-1 self-care behaviors, coping with DM-l, and both diabetes-specific and general perceived stress. Glycosylated hemoglobin and general health status were obtained as well.This study used hierarchical regression to test two theoretical mediation models suggested by prior research. Planned mediational analyses using a total adherence score did not indicate that adherence mediates the associations between either diabetes-specific stress or dysphoria with glycemic control. However, post-hoc exploratory analyses revealed that certain diabetes self-care behaviors may be mediators of these relationships. Specifically, greater diabetes-stress and dysphoria may be associated with diminished adherence to blood glucose testing and eating meals on time which, in turn, is negatively related with glycemic control. (Abstract shortened by UMI.

Randomized Clinical Trial of Telephone-Administered Cognitive-Behavioral Therapy to Reduce Post-Traumatic Stress Disorder and Distress Symptoms After Hematopoietic Stem-Cell Transplantation

Purpose A significant number of survivors of hematopoietic stem-cell transplantation (HSCT) report enduring adverse effects of treatment, including illness-related post-traumatic stress disorder (PTSD) symptoms and general distress. We report results of a randomized clinical trial that tested the effects of a 10-session, telephone-administered cognitive-behavioral therapy (CBT) intervention on PTSD, depression, and distress symptoms. Methods Survivors who had undergone HSCT 1 to 3 years earlier (N = 408) were assessed for study eligibility. Those who met study eligibility criteria (n = 89) completed a baseline assessment that included a clinical interview and self-report measures of PTSD symptoms (the primary outcome) and depression and general distress (the secondary outcomes). Next, they were randomly assigned to CBT or an assessment-only condition. Survivors in the CBT group completed 10 individual telephone-based CBT sessions (T-CBT) that included strategies to reduce PTSD symptoms, depression, and general distress. Follow-up assessments occurred at 6, 9, and 12 months after the baseline assessment. Results Linear mixed-model analyses revealed that, compared with HSCT survivors in the assessment-only condition, survivors who completed T-CBT reported fewer illness-related PTSD symptoms, including less avoidance (P < .001) and fewer intrusive thoughts (P < .05) as well as less general distress and fewer depressive symptoms (P < .05) even after controlling for potential demographic and medical covariates. These results were consistent across the three follow-up assessments. Conclusion A brief, telephone-administered CBT intervention developed for HSCT survivors is an efficacious treatment for reducing illness-related PTSD symptoms and general distress