Behavioral medicine of type-2-diabetes

In einer randomisierten, prospektiven Studie wurde untersucht, welche Form der Diabetesschulung für nicht insulinpflichtige Typ-2-Diabetiker im mittleren Lebensalter am effektivsten ist: (1) ein 12 stündiges Schulungsprogramm, das sich an den Prinzipien des Selbstmanagements orientiert (MEDIAS 2), (2) ein ebenfalls 12 stündiges Schulungsprogramm, das aus einer Kombination aus Gruppen- (6) und Einzelterminen (6) besteht (Kombination) und einem 4-stündigen, konventionellen Schulungsprogramm, das vor allem auf die Vermittlung von Wissen über die Erkrankung und die Therapiemaßnahmen abzielt (Standard). Die Hauptfragestellung bezog sich auf die Wirksamkeit der drei Schulungsprogramme auf die metabolischen Faktoren glykämische Kontrolle und Körpergewicht 1 Jahr nach Abschluss der Interventionen. Die weiteren abhängigen Variablen waren: physiologische Messparameter (z.B. Triglyceride), Verhaltensfaktoren (z.B. körperliche Aktivität), Prozessvariablen (z.B.Wissenstest), psychologisches Faktoren (z.B. Depression) und gesundheitsökonomische Variablen (z.B. Medikamentenkosten). 193 Typ-2-Diabetiker wurden randomsiert. Zu t1 gab es zwischen den drei Gruppen keine signifikanten Unterschiede in den Hauptvariablen. Entsprechend der intention to treat Auswertung konnten zum entscheidenden Katamnesezeitpunkt (1 Jahr nach Beendigung der Behandlungsgruppen) 176 Personen (Alter 55.8 ±6.2 Jahre; HbA1c 7.8 ± 1.6%, BMI 32.2 ± 3.7 kg/m²) untersucht werden (dropout-rate 8,8%). Die medikamentöse Diabetestherapie wurde in allen drei Gruppen nicht systematisch verändert und war vergleichbar. In Bezug auf die glykämische Kontrolle war MEDIAS 2 (ΔHbA1c -0.7 ±1.4%) sowohl der Kombinationsgruppe (ΔHbA1c -0,2 ±1,6%), als auch der Standardgruppe (ΔHbA1c 0.1 ±1.5%) signifikant (p=.005) überlegen. Das Körpergewicht (ΔBMI -0.9 ±1.5 kg/m²) wurde ebenfalls im Vergleich zu der Standardgruppe (ΔBMI -0.4 ±1.6 kg/m²) und der Kombinationsgruppe (ΔBMI -0.9 ±1.5 kg/m²) signifikant (p=.025) reduziert. Die Verbesserungen waren nicht auf den Einfluss der medikamentösen Behandlung zurückzuführen. Insgesamt erreichte das an den Prinzipien des Selbstmanagement orientierte Gruppenprogramm die besten Effekte in Bezug auf die für nichtinsulinpflichtige Typ-2-Diabetiker im mittleren Lebensalter wichtigen metabolischen Faktoren glykämische Kontrolle und Übergewicht. Darüber hinaus zeigte MEDIAS 2 auch eine Reihe von positiven Effekten bezüglich der anderen physiologischen, psychologischen, behavioralen, prozessualen und sozioökonomischen Variablen. Der mehr individualisierte Ansatz (Kombination) erbrachte im Vergleich zu MEDIAS 2 keinen zusätzlichen Vorteil.This randomized, prospective study looks at the efficacy of three different outpatient-education-programs for middle-aged non-insulin-dependent type-2-diabetic persons: (1) self-management-oriented-program, performed in group lessons (MEDIAS 2, 12 sessions); (2) combination-treatment with group lessons (6 sessions) and individual counseling (6 session) (combination, 12 sessions); (3) conventionally structured education-programs aiming at knowledge-transfer (standard, 4 sessions). The key outcome variables were glycemic control and body weight 12 months after the end of the treatments. The additional dependent variables were: Physiological measures (e.g. triglycerides), behavioral parameters (e.g. physical activity), process-variables (e.g. knowledge test), psychological well-being (e.g. depression) and economic measures (e.g. diabetes-related costs of medication). 193 type-2-diabetic subjects were randomized. Baseline examinations revealed no relevant differences in the main outcome variables. According to intention-to-treat-analysis 176 subjects (age 55.8 ±6.2 years; HbA1c 7.8 ± 1.6%; BMI 32.2 ± 3.7 kg/m²) could be re-examined at the decisive measurement-point 12 months after the end of the treatments (drop-out rate 8.8%). The oral diabetes medication was not changed systematically and was comparable in all three groups. There was a significant advantage of MEDIAS 2 (p=.005) with respect to glycemic control (ΔHbA1c -0.7 ±1.4%), compared with the combination-treatment (ΔHbA1c -0,2 ±1,6%) and with the standard-treatment (ΔHbA1c 0.1 ±1.5%). Body weight improved most in MEDIAS 2 (ΔBMI -0.9 ±1.5 kg/m²) compared with the standard- treatment (ΔBMI -0.4 ±1.6 kg/m²) and with the combination-treatment (ΔBMI -0.8 ±1.5 kg/m²; p=.025). The improvement was not a consequence of a different treatment with antidiabetic drugs. The self-management-oriented-group-program (MEDIAS 2) achieved the best effects on metabolic control for middle aged non-insulin-dependent type-2-diabetic persons. Moreover, the group-program indicated additional benefits, related to the physiological, psychosocial, behavioral, and economic variables. There were no further advantages of the more individualized approach compared with MEDIAS 2

The Diabetes Self-Management Questionnaire (DSMQ): development and evaluation of an instrument to assess diabetes self-care activities associated with glycaemic control

BACKGROUND: Though several questionnaires on self-care and regimen adherence have been introduced, the evaluations do not always report consistent and substantial correlations with measures of glycaemic control. Small ability to explain variance in HbA(1c) constitutes a significant limitation of an instrument’s use for scientific purposes as well as clinical practice. In order to assess self-care activities which can predict glycaemic control, the Diabetes Self-Management Questionnaire (DSMQ) was designed. METHODS: A 16 item questionnaire to assess self-care activities associated with glycaemic control was developed, based on theoretical considerations and a process of empirical improvements. Four subscales, ‘Glucose Management’ (GM), ‘Dietary Control’ (DC), ‘Physical Activity’ (PA), and ‘Health-Care Use’ (HU), as well as a ‘Sum Scale’ (SS) as a global measure of self-care were derived. To evaluate its psychometric quality, 261 patients with type 1 or 2 diabetes were assessed with the DSMQ and an established analogous scale, the Summary of Diabetes Self-Care Activities Measure (SDSCA). The DSMQ’s item and scale characteristics as well as factorial and convergent validity were analysed, and its convergence with HbA(1c) was compared to the SDSCA. RESULTS: The items showed appropriate characteristics (mean item-total-correlation: 0.46 ± 0.12; mean correlation with HbA(1c): -0.23 ± 0.09). Overall internal consistency (Cronbach’s alpha) was good (0.84), consistencies of the subscales were acceptable (GM: 0.77; DC: 0.77; PA: 0.76; HU: 0.60). Principal component analysis indicated a four factor structure and confirmed the designed scale structure. Confirmatory factor analysis indicated appropriate fit of the four factor model. The DSMQ scales showed significant convergent correlations with their parallel SDSCA scales (GM: 0.57; DC: 0.52; PA: 0.58; HU: n/a; SS: 0.57) and HbA(1c) (GM: -0.39; DC: -0.30; PA: -0.15; HU: -0.22; SS: -0.40). All correlations with HbA(1c) were significantly stronger than those obtained with the SDSCA. CONCLUSIONS: This study provides preliminary evidence that the DSMQ is a reliable and valid instrument and enables an efficient assessment of self-care behaviours associated with glycaemic control. The questionnaire should be valuable for scientific analyses as well as clinical use in both type 1 and type 2 diabetes patients

Local heating at the insulin injection site by the use of the InsuPad is able to reduce post-prandial glucose excursion in daily life

Background and aims: The insulin action profiles of subcutaneously injected short acting insulin analogues are still slow compared to physiologically released human insulin. Thus, postprandial glucose excursions cannot be avoided. InsuPad is a medical device designed to accelerate insulin delivery rate by applying local heat at the insulin injection site. Whenever an insulin injection is given, the skin surface temperature is heated up locally to 38.5 C° for 30 minutes. This pilot-study examines the impact of the InsuPad use on postprandial glucose excursions after breakfast and dinner in daily life conditions. Materials and methods: Insulin resistant diabetic patients were instructed to use the InsuPad when injecting bolus insulin prior to breakfast and dinner for one month and to measure their blood glucose at least five times per day (pre- and post-breakfast, pre-lunch and pre- and post-dinner). In the other study phase patients were instructed to maintain the same blood glucose measurement schedule for one month, without using the InsuPad. The order of the study phases was randomized. All blood glucose data were transmitted to a central computer using the DIASEND System. A valid pre-post-prandial measurement time difference was 75 - 135 minutes. An ANOVA, controlling for order of study phase, patient and meal (breakfast vs. dinner) was used to analyze the effect of the InsuPad on postprandial glucose excursions. In this study 10 diabetic patients took part (30% type 1 diabetes, age: 51.5 ±7.7 yrs., diabetes duration: 15.7 ± 7.7 yrs.; HbA1c: 8.2 ± 0.9%; bolus insulin dose: 51.7 ± 22.2 insulin units per day; total insulin dose 0.92 insulin units per kg). Results: Preprandial blood glucose levels were similar in the phase with (151.7 ±46.8 mg/dl) and without the InsuPad (148.5 ±38.6 mg/dl, p=.385). Postprandial glucose decreased by 0.05 ± 59.1 mg/dl, if InsuPad was used, whereas the postprandial glucose levels increased by 11.3 ± 56.3 mg/dl if the InsuPad was not used (p=.011). The number (283 vs. 257) and proportion of valid measurements (65.5% vs. 64.4%, p=.740) in the phase with and without InsuPad were highly comparable. The time differences between pre- and post-prandial glucose measurements were very similar in both study phases (102.7 ± 19.0 vs. 102.3 ± 15.6 minutes with and without InsuPad, p=.777). The overall glycaemic control (mean total blood glucose values) was significantly lower when using the InsuPad compared to the no-use-phase (149.7 ± 54.5 mg/dl vs. 158.7 ±57.7 mg/dl; p=.016). The percentage of hypoglycaemic (< 60 mg/dl) or hyperglycaemic values (> 300 mg/dl) was slightly decreased when using the InsuPad, but the difference was not statistically significant (% hypoglycaemic values 1.5% vs. 1.8%, p=.496; % hyperglycaemic values 1.6% vs. 2.1%, p=.250). Conclusion: This pilot-study indicates that local heating of the insulin injection site in insulin resistant diabetic patients by using the InsuPad is able to reduce post-prandial blood glucose excursions as well as mean daily glucose values significantly in daily life conditions. Safety parameters like the prevalence of hypoglycaemic and hyperglycaemic glucose measurements were not affected by the use of InsuPad

Self-reported hypoglycaemia: a global study of 24 countries with 27,585 insulin-treated patients with diabetes: the HAT study.

Background and aims: Hypoglycaemia is an important concern for patients with diabetes and physicians when setting glycaemic targets. The Hypoglycaemia Assessment Tool (HAT) study, the largest and most comprehensive of its kind, assessed self-reported hypoglycaemia and associated predictive factors in a global population of patients with insulin-treated diabetes. Materials and methods: HAT was a non-interventional, multicentre, 6-month retrospective and 1-month prospective study of hypoglycaemic events in 24 countries using self-assessment questionnaires and patient diaries (for 28 days) in people aged ≥18 years with type 1 (T1D) or type 2 (T2D) diabetes using insulin for ≥12 months attending routine clinics. Associations between predictive factors and hypoglycaemia were examined using negative binomial regression models adjusted for period and country. Results: 27,585 patients completed the study (Table 1). 83.4% of patients with T1D and 50.8% of patients with T2D experienced ≥1 hypoglycaemic event in the 4 weeks before baseline (51.5 and 16.5 events per patient year). Higher (p < 0.001) incidence rates were reported in the 4 weeks after baseline (73.3 [T1D] and 19.3 [T2D] events per patient year). A greater percentage of patients with T1D vs. T2D reported any (83.0 vs. 46.5%), nocturnal (40.6 vs. 15.9%) or severe (14.4 vs. 8.9) hypoglycaemia in the prospective period. Conclusion: In this large, multinational population of patients (insulin-treated) with T1D or T2D, rates of overall, nocturnal and severe hypoglycaemia were higher than previously published. An increased incidence of overall hypoglycaemia in the prospective study indicated significant under-reporting of hypoglycaemia

Assessing Diabetes Self-Management with the Diabetes Self-Management Questionnaire (DSMQ) Can Help Analyse Behavioural Problems Related to Reduced Glycaemic Control

AIM:To appraise the Diabetes Self-Management Questionnaire (DSMQ)'s measurement of diabetes self-management as a statistical predictor of glycaemic control relative to the widely used SDSCA. METHODS:248 patients with type 1 diabetes and 182 patients with type 2 diabetes were cross-sectionally assessed using the two self-report measures of diabetes self-management DSMQ and SDSCA; the scales were used as competing predictors of HbA1c. We developed a structural equation model of self-management as measured by the DSMQ and analysed the amount of variation explained in HbA1c; an analogue model was developed for the SDSCA. RESULTS:The structural equation models of self-management and glycaemic control showed very good fit to the data. The DSMQ's measurement of self-management showed associations with HbA1c of -0.53 for type 1 and -0.46 for type 2 diabetes (both P < 0.001), explaining 21% and 28% of variation in glycaemic control, respectively. The SDSCA's measurement showed associations with HbA1c of -0.14 (P = 0.030) for type 1 and -0.31 (P = 0.003) for type 2 diabetes, explaining 2% and 10% of glycaemic variation. Predictive power for glycaemic control was significantly higher for the DSMQ (P < 0.001). CONCLUSIONS:This study supports the DSMQ as the preferred tool when analysing self-reported behavioural problems related to reduced glycaemic control. The scale may be useful for clinical assessments of patients with suboptimal diabetes outcomes or research on factors affecting associations between self-management behaviours and glycaemic control

Welche Effekte hat eine Verbesserung der Hypoglykämiewahrnehmung bei Teilnehmern des Hypoglykämiewahrnehmungstrainings „HyPOS“ auf das Wohlbefinden sowie auf das Ausmaß von diabetesbezogene Belastungen und Hypoglykämie-Ängsten?

Fragestellung: Die Studie untersucht die mittelfristigen Auswirkungen einer interventionsbedingten Verbesserung der Hypoglykämiewahrnehmung auf das psychosoziale Wohlbefinden bei Typ-1-Diabetikern. Methodik: Bei 65 Teilnehmern (Alter 46,2 ± 11,8J.; Diabetesdauer 20,7 ± 10,7J.; HbA1c 7,2 ± 0,9%; 50% weiblich) des ambulanten Schulungsprogramms „HyPOS“ (6 UE) wurde mithilfe des HAQ-Fragebogens (Clarke et al., 1995) die Hypoglykämiewahrnehmung zu Beginn (t0) und zum 6-Monats Follow-up (t2) erfasst. Teilnehmer mit einem HAQ-Score (0 – 7) > 3 wurden als „unaware“ kategorisiert. Zum 6-Monats Follow-up wurden „Responder“ (t0: „unaware“, t2: „aware“) und „Non-Responder“ (t0: „unaware“, t2: „unaware“) hinsichtlich des Wohlbefindens (WHO-5), des Ausmaßes diabetesbezogener Belastungen (PAID) sowie Hypoglykämie-Ängsten (HFS) verglichen. Ergebnisse: Zur Baseline zeigte sich eine vergleichbare Qualität der Hypoglykämiewahrnehmung bei Respondern (n = 35) und Non-Respondern (n = 30). Non-Responder wiesen jedoch ein höheres Alter (p < 0,03), eine längere Diabetesdauer (p = 0,003) sowie ein beeinträchtigteres Wohlbefinden (p < 0,02) auf. Zum 6-Monats Follow-up beschrieben Teilnehmer mit einer verbesserten vs. einer weiterhin defizitären Hypoglykämiewahrnehmung ein tendenziell besseres Wohlbefinden (16,9 ± 4,2 vs. 14,6 ± 5,9; p < 0,07). Weiterhin beschrieben Responder ein signifikant geringeres Ausmaß an diabetesbezogenen Belastungen (19,0 ± 13,1 vs. 29,5 ± 14,2; p = 0,003). Die Itemanalyse ergab bei Respondern eine reduzierte Sorge vor Hypoglykämien (PAID Item 9: 1,3 ± 1,2 vs. 2,4 ± 1,1; p < 0,0001), eine geringere Belastung durch unangenehme Situationen (PAID Item 4: 0,6 ± 0,6 vs. 1,3 ± 1,2; p < 0,01) und ein geringer ausgeprägtes Gefühl, mit dem Diabetes alleine zu sein (PAID Item 17: 0,4 ± 0,6 vs. 1,0 ± 1,0; p = 0,005). Im Hinblick auf Hypoglykämie-Ängste beschrieben Responder ein geringeres Ausmaß an Vermeidungs- und Sicherheitsverhalten (HFS-B: 20,1 ± 5,6 vs. 22,8 ± 4,8; p < 0,05) und weniger Sorgen um Unterzuckerungen (HFS-W: 20,1 ± 11,8 vs. 27,8 ± 11,5; p = 0,01). Dabei gaben Responder an, weniger Blutzuckerkontrollen in sozialen Situationen durchzuführen (HFS-B Item 10: 2,4 ± 1,4 vs. 3,2 ± 0,8; p < 0,01). Ebenso beschrieben sie eine geringere Sorge, einen Unfall zu verursachen (HFS-W Item 10: 1,7 ± 1,3 vs. 2,5 ± 1,3; p < 0,03) und hatten weniger Befürchtungen, in verantwortungsvollen Situationen nicht klar denken zu können (HFS-W Item 12: 1,9 ± 1,2 vs. 2,8 ± 1,1; p < 0,003). Schlussfolgerungen: Typ-1-Diabetiker mit einer verbesserten Hypoglykämiewahrnehmung beschrieben nach 6 Monaten ein geringeres Ausmaß an diabetesbezogenen Belastungen. Die Reduktion dieser Belastungen ist insbesondere mit einer signifikanten Reduktion von hypoglykämiebezogenen Ängsten und Befürchtungen assoziiert. Möglicherweise erschweren ein höheres Lebensalter, eine längere Diabetesdauer sowie ein reduziertes Wohlbefinden den Erfolg eines Hypoglykämiewahrnehmungstrainings

Einflussfaktoren auf die gesundheitsbezogene Lebensqualität bei Menschen mit Typ-2-Diabetes

Fragestellung: In dieser Studie wurde untersucht, inwieweit sich Typ-2-Diabetespatienten mit intensivierter (ICT) und nicht-intensivierter Insulintherapie (NIT) hinsichtlich ihrer gesundheitsbezogenen Lebensqualität unterscheiden und welche Faktoren diese beeinflussen. Methodik: Lebensqualität wurde mittels EQ-5D erfasst. Neben univariaten Analysen wurde eine multivariate Regressionsanalyse durchgeführt. Abhängige Variable war die Lebensqualität, unabhängige Variablen waren demographische und diabetesspezifische Parameter. Ergebnisse: Beide Gruppen (N = 356; 52% NIT vs. 48% ICT) wiesen die gleiche Alters- und Geschlechterverteilung (62,8 ± 8,2 Jahre; 45% weiblich) auf. ICT-Patienten zeigten eine signifikant längere Diabetesdauer 11,6 ± 6,9 vs. 13,7 ± 7,6 Jahre (p = 0,005) und Dauer der Insulintherapie 2,7 ± 4,1 vs. 5,4 ± 5,0 Jahre (p = 0,001), höheren BMI 31,5 ± 5,2 vs. 33,3 ± 5,9 kg/m2 (p = 0,003), häufigere BZSK/Tag 2,25 ± 1,49 vs. 3,33 ± 1,37 (p = 0,001) und Insulininjektionen/Tag 2,33 ± 4,15 vs. 3,93 ± 2,44 (p = 0,001) sowie einen höheren HbA1c 7,9 ± 1,2 vs. 8,3 ± 1,4% (p = 0,004) und geringere diabetesbezogene Belastungen 26,77 ± 19,39 vs. 23,61 ± 16,21 (p = 0,097). Gleichzeitig zeigte die ICT-Stichprobe eine signifikant geringere Lebensqualität als die NIT-Stichprobe (0,86 ± 0,16 vs. 0,81 ± 0,21; p = 0,019). In einer multivariaten Analyse hatten diabetesbezogene Belastungen den größten Einfluss auf die Lebensqualität (β=-0,24; p = 0,001), gefolgt von der Anzahl der Folgekomplikationen (β=-0,14; p = 0,005), weiblichem Geschlecht (β=-0,13; p = 0,013), erhöhtem BMI (β=-0,12; p = 0,018). Die Therapieform blieb ein signifikanter Prädiktor (β=-0,12; p = 0,028). Alter, Diabetesdauer, HbA1c und Blutzuckerselbstkontrollen/Tag hatten multivariat keinen signifikanten Einfluss auf die Lebensqualität. Schlussfolgerungen: Patienten mit einer ICT berichten eine signifikant geringere Lebensqualität als Patienten mit einer NIT. Dieser Unterschied bleibt auch multivariat nach Kontrolle demographischer und diabetesspezifischer Variablen bestehen. Aufgrund ihres großen Einflusses sollten diabetesbezogene Belastungen in der Behandlung von Typ-2-Diabetikern größere Beachtung finden. Übergewichtige Patienten mit Folgeerkrankungen scheinen eine Risikogruppe für eine reduzierte Lebensqualität zu bilden

The use of CGM to identify type 1 diabetic patients with hypoglycemia problems and its impact for avoidance of biochemical hypoglycemia.

This cross-over study used a CGM system (DexCom SEVEN PLUS CGM). In a randomized order, participants had either no access (CGM blind) or real time access to current glucose data (CGM open). One objective was to analyze if type 1 diabetic patients with hypoglycemia problems (at least one episode requiring third party assistance) could be identifi ed by the use of the blinded CGM data. We also analyzed the impact of CGM use on biochemical hypoglycemia. Type 1 diabetic patients with hypoglycemia problems had signifi cant longer diabetes duration (17.0 vs. 11.0 yrs.), a higher unawareness score (4.0 vs. 2.0) and lower thresholds for detecting hypoglycemia (50.0 vs. 65.0 mg/dl) than patients without hypoglycemia problems. During the blinded CGM phase patients with hypoglycemic problems had a signifi cant longer duration of low glucose phases 248 vs. 153 minutes per day (p=.037; <70 mg/dl) respectively 173 vs. 96 minutes per day (p=.041; <60 mg/dl). Area under the receiver operating curve (ROC 0.72 p=.03) indicated a suffi cient screening performance of the duration of low glucose periods (< 70 mg/dl) for the identifi cation of patients with hypoglycemia problems. A cut-off of 170 minutes per day of time spend in the low glucose range had a sensitivity of 75% and a specifi city of 70.3%; the positive predictive value was 52.9%, the negative predictive value was 86.4%. A comparison of blind vs. open CGM showed that time spend in a low glucose range could be signifi cantly more reduced in patients with hypoglycemia problems than in patients without hypoglycemia problems during CGM open (< 60 mg/dl; - 67.8 min per day p=.040; < 50 mg/dl; -50.6 min per day, p=.038; < 40 mg/dl; -41.4 min. per day, p=.03). This study shows that CGM has an unused potential for identifying type 1 diabetic patients at risk for hypoglycemia problems in clinical practice as well as for avoidance of biochemical hypoglycemia, which plays a pivotal role for the development of hypoglycemia associated autonomic failure

The Influence of Diabetes-related Distress on Depression

Depressive disorders in diabetic patients are nearly twice as likely compared to the non-diabetic population. There is evidence that patients’ perception of diabetes is a decisive aspect of this association. Therefore this study prospectively investigates the role of patients’ perceived diabetesrelated distress on incidence depression and recovery. 343 patients with type 1 diabetes completed the CES-D and the Problem Areas in Diabetes Scale (PAID) at baseline and at the 6-month follow-up. A CES-D score of ≥16 indicated elevated depressive symptoms. A PAID score of ≥30 indicated elevated diabetes-related distress. Logistic regression analyses were performed with recovery from and incidence of depressive symptoms as dependent variables. Independent variable was diabetesrelated distress adjusted for possible demographic (age, gender, BMI) and medical confounders (diabetes duration, HbA1c, insulin pump therapy, and late complications). At baseline 130 patients (37.9%) reported elevated depressive symptoms and 40 of these patients (30.8%) recovered 6 months later. Of the 213 patients without elevated depressive symptoms, 27 (12.7%) had elevated depressive symptoms 6 months later. Diabetes-related distress at baseline diminished the chance to recover from elevated depressive symptoms by 64% (OR = 0.36, p<.05). In addition, the chance for incident depressive symptoms if diabetes-related distress was present at baseline is 2.5 times more likely in contrast to no diabetes-related distress at baseline (OR=2.5; p<.05). In both analyses, no other variables reached a signifi cant infl uence. It could be demonstrated that preventing diabetes-related distress is a protective factor regarding the incidence of elevated depressive symptoms. Furthermore, preventing diabetes-related distress supports the recovery from already elevated depressive symptoms. This supports the notion that diabetes per se is not a risk factor for depressive disorders but the perceived emotional distress is

The impact of continuous glucose monitoring (CGM) on low interstitial glucose values and low blood glucose values assessed by Point-of-Care glucose meters (POC-GM).

The impact of CGM on the duration of periods with low glucose measured in interstitial fl uid is well known. But studies showing an impact of CGM on low blood glucose values, measured by POC-GM are rare. This crossover study examines the impact of CGM on duration of periods spent in low interstitial glucose range (70 mg/dl) as well as on the proportion of low blood glucose (BG) values measured by POC-GM (Glukometer 3000, Bio Sensor Technology, Germany)and time until detection of low BG by use of POC-GM. 41 type 1 diabetic patients (age 42.0 ±11.3 yrs, diabetes duration 15.3 ±10.1; A1c 8.2 ±1.4%) used the DEXCOM 7 Plus CGM system twice; once participants were blinded against the results and in the other study phase (Open GCM) patients received real-time glucose values and current glucose trends, used the CGM data to determine their insulin dose, and were alerted if hypoglycaemic or hyperglycaemic glucose ranges were approached. In addition, BG was routinely measured 6 times a day by POC-GM. The order of study phases was randomized. The time spent in a hypoglycaemic glucose range (< 70 mg/dl) was reduced by open CGM from 180.6 ±125 to 125 ± 89.2 minutes per day (p=.005). Also time spent in the euglycemic glucose range was increased from 946 ±176 to 1023 ±168 minutes per day (p=.003). Open CGM reduced the proportion of low BG measurements by POC-GM from 10.3 ±7.6% to 7.4 ±5.8% (p=.039), whereas the euglycemic POC readings was increased from 68.3 ±12.1% to 73.7 ±12.1% (p=.007). The time until a hypoglycaemic BG value was detected by POC-GM was signifi cantly (p.028) shortened by 33.1 (95% CI 3.8 -62.3) minutes. These results demonstrate that CGM used for insulin dosing and hypoglycaemia alerts not only diminishes low interstitial glucose values but also reduces the proportion of low BG measured by POC-GM. In addition the time for the detection of a hypoglycaemic episode by POC-GM was signifi cantly shortene