Psychological Care as an Interdisciplinary Approach in the Management of Diabetes: A Narrative Review of Literature

Objective: Diabetes, a serious chronic disease, demands a lot of patients in terms of daily self-care and often complicated treatment. Psychological problems are prevalent among people with diabetes. Burden with daily restrictions to diet and activity, risks of the treatment, fear of losing metabolic control and disease progression may furthermore reduce quality of life and aggravate psychological condition. This paper provides a current overview of prevalence, screening and general psychological managements in diabetes according to the worldwide recommendations. In addiction it updates the medical literature refer to Poland. Materials and methods: The search was conducted in Google Scholar, PubMed, Scopus, Web of Science, and ScienceDirect. The final set of 75 articles, include 33 papers that refer to psychological condition assessmenttools. Results: The analysis for this review has been packaged into themes in order to generate a very useful and practical tool for all health professionals. It summarized in systematic and comprehensive way all psychological states that can appear in patients with diabetes. The most prevalent and important problems are: diabetes distress, depression, anxiety disorders, disordered eating behavior, and cognitive impairment/dementia. Conclusions: All worldwide guidelines strongly recommendpsychological and social care as integrated part of the management of the diabetes. Healthy psychological state with proper screening, monitoring and the management could help in reaching therapeutic success and better quality of life

sICAM-1 w surowicy chorych na alergiczny nieżyt nosa leczonych feksofenadyną lub flutykazonem

The aim of the study was to examine the level of sICAM-1in serum of patients suffering from allergic rhinitis treated with fexofenadine or fluticasone. The study was performed after two weeks duration of the pollen season. Thirty -eight patients sensitized to grass pollen were participated in this study: 15 patients were treated for 10 days with oral fexofenadine (dose: 120 mg/d), 13 patients were treated with intranasal fluticasone (dose:200mcg/d), 10 patients were given oral placebo. Blood sample were collected both in the first and the last day of the treatment. The efficacy was evaluated with the use of symptom score. sICAM-1l level in serum was measured with ELISA method. The results: Mean sICAM-1 level in serum was: in group treated with fexofenadine- 224,5 ng/ml before treatment, 228 ng/ml – after treatment; in group treated with fluticasone-212ng/ml before treatment, 214ng/ml– after treatment; in placebo group- 226 ng/ml before treatment, 229 ng/ml– after treatment. There was no difference in statistical analysis between sICAM-1 values. (p>0,05). In 7 patients treated with fexofenadine serum levels of sICAM-1 significantly decreased from 212ng/ml to 185ng/ml(

Inflammatory Markers: Exhaled Nitric Oxide and Carbon Monoxide During the Ovarian Cycle

Nitric oxide (NO) production and carbon monoxide (CO) production are increased in inflammatory lung diseases. Although there are some pieces of evidence for hormonal modulation by estrogen, little is known about exhaled NO and CO during the ovarian cycle. In 23 subjects, we measured exhaled NO and CO by an online analyzer. Significantly higher levels of exhaled NO were found at the midcycle compared with those in the premenstrual period or during menstruation. Higher levels of CO were after ovulation and reached a peak in the premenstrual phase. The lowest levels of CO were observed in the first days of the estrogen phase. In males, there was no significant variation in exhaled NO and CO. Exhaled NO and CO levels vary during the ovarian cycle in women, and this fact should be taken into account during serial measurements of these markers in the female population

Ocena stanu psychoemocjonalnego pacjentek z nadmierną masą ciała w okresie okołomenopauzalnym po zastosowaniu diety redukcyjnej

INTRODUCTION: Particular predisposition to obesity and overweight occurs in perimenopausal women. Dietetic treatment of hyperalimentation syndrome in this group can have multidimensional effects. The aim of this study was to evaluate the psychoemotional state in overweight and obese perimenopausal women after performing three-month reducing diet. MATERIAL AND METHODS: The study involved women aged 55 ± 4,75 years: group I ― 33 overweight women and group II ― 32 obese women. Dietetic questionnaire, Beck Depression Inventory and Hamilton Anxiety Scale were performed before and after three months in every group. Reducing diet was applied in both groups. Statistical data analysis was performed. RESULTS: After three-month reducing diet it was noticed that levels of depression and anxiety states were decreased (which was statistically significant). CONCLUSIONS: Application of appropriate reducing diet in perimenopausal overweight and obese women may cause the change of psychoemotional state. Perimenopausal overweight and obese women should aim to weight reduction in the context of relaxation of psychological negative menopausal symptoms.WSTĘP: Szczególną skłonność do otyłości i nadwagi przejawiają kobiety w okresie okołomenopauzalnym. Dietetyczne leczenie zespołów hiperalimentacji w tej grupie może mieć skutki wielowymiarowe. Celem pracy była ocena stanu psychoemocjonalnego kobiet w okresie menopauzy z nadwagą i otyłością po zastosowaniu trzymiesięcznej diety redukcyjnej. MATERIAŁ I METODY: Do badań zakwalifikowano kobiety w wieku 55 ± 4,75 roku. Wyodrębniono dwie grupy: I ― 33 osoby z nadwagą, II ― 32 osoby otyłe. W każdej grupie wykonano pomiary masy ciała i wzrostu, kwestionariusze: żywieniowy, Skalę Becka, Skalę Lęku Hamiltona na początku i po 3 miesiącach. Zastosowano w tym czasie dietę redukcyjną. Uzyskane wyniki badań poddano analizie statystycznej. WYNIKI: Po zastosowaniu diety redukcyjnej u kobiet z nadwagą i otyłością zaobserwowano istotnie statystycznie poprawę stanu psychoemocjonalnego. WNIOSKI: Zastosowanie odpowiedniej diety redukcyjnej u kobiet z nadwagą i otyłością w okresie okołomenopauzalnym wpływa korzystnie na poprawę nastroju i obniżenie uczucia lęku. Kobiety w okresie okołomenopauzalnym z nadmiarem masy ciała powinny dążyć do jej normalizacji w celu złagodzenia niekorzystnych psychicznych objawów wypadowych menopauzy

Bi-directional interaction between hypoglycaemia and cognitive impairment in elderly patients treated with glucose-lowering agents: a systematic review and meta-analysis

Aims: To examine the bi-directional relationship, whereby hypoglycaemia is a risk factor for dementia, and where dementia increases risk of hypoglycaemia in older patients with diabetes mellitus treated with glucose-lowering agents.  Methods: We searched MEDLINE and EMBASE over a 10-year span from 2005 to 2015 (with automated PubMed updates to August 2015) for observational studies of the association between hypoglycaemia and cognitive impairment or dementia in participants aged >55 years. Assessment of study validity was based on ascertainment of hypoglycaemia, dementia and risk of confounding. We conducted random effects inverse variance meta-analyses, and assessed heterogeneity using the I2 statistic.  Results: We screened 1177 citations, and selected 12 studies, of which nine were suitable for meta-analysis. There were a total of 1 439 818 participants, with a mean age of 75 years. Meta-analysis of five studies showed a significantly increased risk of dementia in patients who had hypoglycaemic episodes: pooled odds ratio 1.68 [95% confidence interval (CI) 1.45, 1.95]. We also found a significantly increased risk of hypoglycaemia in patients with dementia: pooled odds ratio from five studies 1.61 (95% CI 1.25, 2.06). Limitations of the study were heterogeneity in the meta-analysis, and uncertain ascertainment of dementia and hypoglycaemic outcomes and temporal relationships. Publication bias may have favoured the reporting of more significant findings.  Conclusions: Our meta-analysis shows a bi-directional relationship between cognitive impairment and hypoglycaemia in older patients. Glucose-lowering therapy should be carefully tailored and monitored in older patients who are susceptible to cognitive decline

Glycaemic control in type 2 diabetes patients and its predictors: a retrospective database study at a tertiary care diabetes centre in Ningbo, China

Objectives: The objectives of the study were to assess glycaemic control in patients with type 2 diabetes (T2DM) at a tertiary care diabetes centre in Ningbo, China and to determine factors that independently predict their glycaemic control. Design: Retrospective cross-sectional study using an existing database, the Diabetes Information Management System. Setting: Tertiary care diabetes centre in Ningbo, China. Participants: The study included adult patients with T2DM, registered and received treatment at the diabetes centre for at least six consecutive months. The study inclusion criteria were satisfied by 1387 patients, from 1 July 2012 to 30 June 2017. Primary outcome measure: Glycaemic control (poor was defined as glycated haemoglobin (HbA1c)>=7% or fasting blood glucose (FBG)>7.0 mmol/L). Results: In terms of HbA1c and FBG, the 5-year period prevalence of poor glycaemic control was 50.3% and 57.3%, respectively. In terms of HbA1c and FBG, the odds of poor glycaemic control increased with the duration of T2DM (>1 to 2 years: OR 1.84, 95% CI 1.06 to 3.19; >2 to 4 years: 3.32, 1.88 to 5.85 and >4 years: 5.98, 4.09 to 8.75 and >1 to 2 years: 2.10, 1.22 to 3.62; >2 to 4 years: 2.48, 1.42 to 4.34 and >4 years: 3.34, 2.32 to 4.80) and were higher in patients residing in rural areas (1.68, 1.24 to 2.28 and 1.42, 1.06 to 1.91), with hyperlipidaemia (1.57, 1.12 to 2.19 and 1.68, 1.21 to 2.33), on diet, physical activity and oral hypoglycaemic drug (OHD) as part of their T2DM therapeutic regimen (1.80, 1.01 to 3.23 and 2.40, 1.36 to 4.26) and on diet, physical activity, OHD and insulin (2.47, 1.38 to 4.41 and 2.78, 1.58 to 4.92), respectively. Conclusions: More than half of patients with T2DM at the diabetes centre in Ningbo, China have poor glycaemic control, and the predictors of glycaemic control were identified. The study findings could be taken into consideration in future interventional studies aimed at improving glycaemic control in these patients