Eating behavior affects quality of life in type 2 diabetes mellitus

We evaluated the prevalence of disordered eating behavior in 168 unselected outpatients with type 2 diabetes and the effects on the health related quality of life (HRQL). Subjects in generally good glycemic control, treated by diet or oral hypoglycemic agents (58% M; 63.8 \ub1 SD 10.1 years; BMI, 29.7 \ub1 5.9 kg/m2) completed self-administered questionnaires for HRQL (SF-36) and eating behavior (Three-Factor Eating Questionnaire (TFEQ); Binge Eating Scale (BES)). Data on HRQL were computed as effect-sizes in comparison to population norm. The prevalence of altered TFEQ scales was not different between genders, and varied between 22.1% (disinhibition) and 41.4% (restriction), but only 6.7% had a positive BES score. Age (OR, 0.58 for decade; 95% CI, 0.39 \u2013 0.87), duration of diabetes (OR, 1.33 for 5 years; 1.01 \u2013 1.74) and BMI (OR, 1.11; 1.04 \u2013 1.18) were predictive for the presence of disinhibition. BMI also predicted hunger (OR, 1.16; 1.08 \u2013 1.25). SF36 domains were not different in relation to positive BES. Disinhibition at TFEQ was significantly associated with poor Social Functioning (P = 0.018) and Role-Emotional (P = 0.022), whereas hunger was associated with poor Physical Functioning (P = 0.010), Role-Physical (P = 0.0014), Social Functioning (P = 0.015) and Role-Emotional (P = 0.0001). Metabolic control, duration of diabetes, and the presence of complications were not associated with HRQL. A disordered eating behavior may be present in type 2 diabetes patients, and is associated with poor HRQL. This condition must be considered for an olistic approach to weight control

Quanto mangio veramente?

Riassunto Ogni tentativo di misurare l\u2019apporto calorico \ue8 necessariamente approssimativo, qualora non si giunga alla registrazione e pesatura meticolosa degli alimenti, peraltro gravata da errori. Abbiamo sviluppato un questionario autosomministrato, basato su 20 gruppi di alimenti. Per ognuno, il paziente deve indicare la frequenza settimanale e la porzione su una scala a 5 punti. Le calorie delle porzioni sono conteggiate per multipli di 50. Attraverso un semplice calcolo si giunge alla definizione delle calorie medie giornaliere su base settimanale. Dopo un periodo di taratura, per approssimazioni successive, siamo giunti ad una versione definitiva, testata su 123 soggetti consecutivi nei confronti dell\u2019intervista semistrutturata condotta dalla dietista. L\u2019apporto calorico stimato dal questionario (2388 \ub1 SD 798 kcal/die in 100 questionari validi per l\u2019analisi) non risulta significativamente diverso da quello misurato nell\u2019inchiesta (2317 \ub1 676; P = 0.191; t appaiata) ed esiste tra le due misurazioni una buona correlazione (r 2 = 0.585; P< 0.0001), in un range calorico misurato dall\u2019intervista compreso tra 946 e 5080 kcal/die. Il questionario sovrastima l\u2019apporto calorico nel primo quintile dell\u2019intervista (range 900 \u2013 1833 kcal/die; ? = +163 \ub1 SD 343 kcal/die; P = 0.047), ma mantiene una buona correlazione tra 1500 e 3000 kcal/die (? = 65 kcal/die), nel quale si colloca l\u201983% dei casi analizzati. Lo strumento pu\uf2 essere utile per indagini epidemiologiche in soggetti motivati a perdere peso, o come ausilio ai medici di medicina generale in assenza di dietisti in una politica di controllo dell\u2019obesit\ue0. English Summary Any attempt to measure calorie intake is approximate when foods are not registered and weighted, and several biases may be introduced. We developed a self-administered questionnaire, based on 20 items, their weekly intake and the average portion on a Likert scale. Portions are given a score as multiple of 50 calories, allowing a simple calculation of the daily intake on a weekly basis. The test was adjusted during the years and its final version was tested in 123 consecutive subjects against a semi-structured interview carried out by a dietitian. Calorie intake measured by the questionnaire (2388 \ub1 SD 798 kcal/day in 100 questionnaires valid for analysis) does not differ from values calculated by interview (2317 \ub1 676; P = 0.191; paired t), and a good correlation exists between the two measurements (r 2 = 0.585; P< 0.0001) in a calorie range measured by the interview between 946 and 5080 kcal/day. The questionnaire overestimates calorie intake in the first quintile of interview (range, 900 \u2013 1833 kcal/day; ? = +163 \ub1 SD 343 kcal/die; P = 0.047), but maintains a good correlation between 1500 and 3000 kcal/day (? = 65 kcal/day), a range comprising 83% of tested cases. The self-administered instrument may be useful in epidemiological surveys in subjects seeking a weight-losing treatment, or as support to general practitioner in the absence of dietitians

Comparison of WHO and ATPIII proposals for the definition of the metabolic syndrome in patients with Type 2 diabetes

Summary Aims Different criteria have been proposed by the World Health Organization (WHO) and the Third Report of the National Cholesterol Education Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATPIII) for the diagnosis of the metabolic syndrome. Its identification is of primary importance for coronary risk assessment. Methods The prevalence of the metabolic syndrome was determined according to the 2 different proposals in 1,569 consecutive subjects with type 2 diabetes. Results By WHO proposal, 81% of cases (95% confidence interval, 79 – 83) were labelled as metabolic syndrome. Microalbuminuria had the highest specificity (99%), visceral obesity the highest sensitivity (93%). 78% of patients (95% CI, 76 – 80) fulfilled the ATPIII criteria for metabolic syndrome, low HDL-cholesterol having the highest specificity (95%), elevated blood pressure having the highest sensitivity. 1,113 patients were positive according to both proposals; 183 were concordantly negative, indicative of a fairly good agreement (k statistics, 0.464). Subjects only positive for WHO proposal were more frequently males, had a lower BMI and a higher arterial pressure. Only subjects identified by ATPIII proposal had a significantly higher prevalence of previously detected coronary heart disease. Conclusions Minimum criteria for the metabolic syndrome are met in most patients with type 2 diabetes. A correct identification of the syndrome is mandatory for an integrated approach to reduce the high costs and the associated disabilities. The ATPII proposal more clearly identifies the burden of coronary heart disease associated with the metabolic syndrome

Metabolic syndrome in subjects at high risk for type 2 diabetes: the genetic, physiopathology and evolution of type 2 diabetes (GENFIEV) study.

BACKGROUND AND AIM: We evaluated the relationship between insulin resistance (IR) and insulin secretion with the metabolic syndrome (MS) in 885 subjects (377 men/508 women, age 49\ub111 years, BMI 29\ub15.2kgm(-2)) at risk of diabetes enrolled in the genetics, pathophysiology and evolution of type 2 diabetes (GENFIEV) study. METHODS AND RESULTS: All subjects underwent a 75-g oral glucose tolerance test (OGTT) for the estimation of plasma levels of glucose and C-peptide, as well as fasting insulin and lipid profile. IR was arbitrarily defined as HOMA-IR value above the 75th centile of normal glucose tolerance (NGT) subjects. Overall MS prevalence (National Cholesterol Treatment Panel-Adult Treatment Panel (NCEP-ATPIII) criteria) was 33%, 19% in subjects with NGT, 42% in impaired fasting glucose (IFG), 34% in impaired glucose tolerance (IGT), 74% in IFG+IGT subjects, and 56% in newly diagnosed diabetic patients. Prevalence was slightly higher with IDF criteria. MS prevalence was >50% in subjects with 2h glucose >7.8mmoll(-1), independently of fasting plasma glucose. IR prevalence was higher in subjects with MS than in those without (63% vs. 23%; p<0.0001) and increased from 54% to 73% and 88% in the presence of three, four or five traits, respectively. IR occurred in 42% of subjects with non-diabetic alterations of glucose homeostasis, being the highest in those with IFG+IGT (IFG+IGT 53%, IFG 45%, IGT 38%; p<0.0001). Individuals with MS were more IR irrespective of glucose tolerance (p<0.0001) with no difference in insulinogenic index. Hypertriglyceridaemia (OR: 3.38; Confidence Interval, CI: 2.294.99), abdominal obesity (3.26; CI: 2.18-4.89), hyperglycaemia (3.02; CI: 1.80-5.07) and hypertension (1.69; CI: 1.12-2.55) were all associated with IR. CONCLUSIONS: These results show that in subjects with altered glucose tolerance (in particular IFG+IGT) MS prevalence is high and is generally associated to IR. Some combinations of traits of MS may significantly contribute to identify subjects with IR