WHICH FACTORS MAY AFFECT THE QUALITY OF LIFE IN PATIENTS WITH TYPE 1 DIABETES MELLITUS USING THE MEDTRONIC VEO CONTINUOUS SUBCUTANEOUS INSULIN INFUSION PUMP?

Continuous Subcutaneous Insulin Infusion (CSII) is considered an effective therapeutic approach to the treatment of patients with Type 1 Diabetes Mellitus (T1DM). Literature offers limited information regarding the quality of life (QoL) in patients using CSII. The aim of the study was to investigate the impact of diabetes related factors on the QoL of patients with T1DM on CSII treatment, in a Greek urban population. A cross-sectional study was conducted on 80 patients with T1DM using CSII. [(Mean±SD) age: 35.9±11.4 years, duration of diabetes: 24.2±10.3 years, BMI: 24.6±3.5kg/m2, duration of Insulin pump use: 7.1±3.9 years, HbA1c: 7.7±1.1%, gender: 37 males-43 females)]. QoL was assessed using the patient self-administered EuroQol EQ 5D validated in Greek. Correlation and regression analyses were performed to examine the relationship between EQ index - EQ VAS scores and diabetes related factors. Hypoglycemia Awareness was measured using Clarke and Gold Score questionnaires, Hypoglycemic Episodes were expressed as number of episodes per week and the Fear of Hypoglycemia was measured using the worry subscale of the Hypoglycemia Fear Survey (HFS-W). Results were as follows: Gold score: 2.8±1.5, Clarke score: 2.8±2.1, Hypoglycemia Fear Score: 20.6±11.2, Number of hypoglycemic Episodes per week: 4.3±2.9, VAS score: 68.7±18.1, EQ index: 0.79±0.24. In univariate analyses QoL was negatively correlated with Hypoglycemic episodes, HbA1c, Hypoglycemia Fear Score and Hypoglycemia Awareness status. After regression analysis, only HbA1c and the number of hypoglycemic episodes per week remained independently related to QoL scores. Prevention of hypoglycemia and glycemic control should be emphasized in order to improve QoL in patients with T1DM with CSII.

Psychometric properties and factor structure of the Greek version of Reflective Functioning Questionnaire.

The ability to mentalize, namely to understand, interpret and effectively communicate the mental state of self and others is considered important in self-organisation and affect regulation. The aim of the present study was to provide data on the validation process of Reflective Functioning Questionnaire (RFQ), a recently developed measure of mentalizing, in order to evaluate its use in research and in clinical practice for Greek populations. A total of 219 participants (102 people with type 1 diabetes and 117 healthy individuals) completed the RFQ. A principal component analysis supported the 2-factor model (RF certainty for mental states and RF uncertainty for mental states) in both samples. Internal consistencies of both subscales were satisfactory (α=0.80 for RF certainty and α=0.79 for RF uncertainty). Relationships with validity measures of psychological distress, empathy and emotional intelligence provided further support for the psychometric properties of the scale. As expected, there were positive associations between the degree of certainty concerning mental states and emotional intelligence (r=0.390, p<0.01), as well as empathy (r=0.292, p<0.01) in general population. Conversely, negative associations were found between the degree of certainty about mental states and psychological distress in the diabetes group (r=-0.470, p<0.01) and in general population (r=0.320, p<0.01). A reverse pattern of associations was observed between the degree of uncertainty about mental states and emotional intelligence (r=-0.265, p<0.01) in general population, as well as psychological distress in both the diabetes group (r=0.590, p<0.01) and in general population (r=0.330, p<0.01). Also, as expected, there were differences across age groups, with older participants reporting a more balanced reflective functioning - with higher certainty levels in the diabetes group (t=-2.133, p>0.05) and the healthy participants (t=-2.738, p>0.05) and lower uncertainty levels in the diabetes group (t=-2.480, p>0.05) and the healthy participants (t=-2.779, p>0.05). The data collected so far support the reliability and validity of the measure that can be used in research to address mentalizing impairments. However, further research is needed to evaluate its consistency thought time with a test-retest analysis, and to evidence its factorial structure with a confirmatory factor analysis. In addition, it is of primary importance to extend the validity testing of RFQ in clinical populations to further support its use in clinical practice.

Internal structure and psychometric properties of Diabetes Distress Scale for Type 1 Diabetes.

Diabetes-related distress (DD) refers to the worries and concerns about the nature and complications of Type 1 diabetes (T1D) and the frustration with the burdens of its management. Research suggests that sources of DD among people with T1D differ from those among Type 2. Many adults with T1D experience difficulties that are often unrecognised, unaddressed and mismanaged. The Diabetes Distress Scale for Type 1 diabetes (T1-DDS), is a newly developed instrument that is used to identify the specific sources of DD, exclusively for adults with T1D. The aim of the study was to examine the factorial structure of T1-DDS in Greek population and to evaluate its psychometric properties for use in research and clinical practice. A sample of 102 adults with type 1 diabetes, aged 38.85 (±10.08) years, females 63%, BMI 21.45 (±5.84) kg/m2, diabetes duration 21.35 (±13.73) years, HbA1c 7.5% (±1.2;58 mmol/mol) completed the translated T1-DDS. Exploratory factor analysis (EFA) and confirmatory (CFA) factor analysis were used to investigate the factor structure of the scale. Reliability was explored by internal consistency. Convergent validity was assessed through correlations with measures of psychological distress and diabetes status variables. Differential validity was assessed on the basis of known-group comparisons, with expected differences in distress for gender and age. Confirmatory factor analysis provided a low fit for the 7-factor model. Exploratory factor analysis supported a conceptually justifiable 5-factor model in the Greek sample. Internal consistencies of all five factors ranged from α=0.76 to 0.89. As expected, all factors were correlated with psychological distress [(r=0.510, p<0.01) for the total scale]. Management distress was positively correlated with HbA1c (r=0.397, p<0.01) and BMI (r=0.296, p<0.01), and Family/Friends distress was negatively correlated with duration of diabetes (r=-0.298, p<0.01). Further analyses showed that men exhibited higher score in relations to the social context of diabetes management (t=2.164, p<0.05 for Negative Social Perceptions), (t=2.572, p<0.05 for Family/Friends distress), and younger participants reported significantly higher distress in relation to reactions from friends and family (t=2.106, p<0.05). The Greek version of T1-DDS is a valid and reliable measure of diabetes-related distress that can be used in clinical practice to address personal needs and direct targeted interventions.

Chromogranin a levels in diagnosis, treatment and follow-up of 42 patients with non-functioning pancreatic endocrine tumours.

BACKGROUND/AIMS: Non-functioning pancreatic endocrine tumours (NFPET) constitute the largest component (35-50%) of pancreatic endocrine tumours. They are characterized by the absence of symptoms of hormone hypersecretion and frequently have clinical manifestations similar to the more common exocrine pancreatic adenocarcinoma. The present studyaims toevaluate the clinical features, diagnostic approach and, in particular, the significance of serum chromogranin A levels (CgA) in the management and outcome of 42 patients with NFPET (from a series of 121 patients with pancreatic endocrine tumours). METHODS: Twenty-five males and 17 females were included, and the mean age at diagnosis was 52.3 years (range: 26-68 years). The diagnosis for each patient was established by histopathological examination and immunohistochemistry. After the histopathological confirmation of diagnosis and during the follow-up period, patients were evaluated clinically and radiologically (including OctreoScan), whilst fasting gut hormones (including CgA) were also estimated. At diagnosis, all patients were checked for the presence of multiple endocrine neoplasia type I syndrome. The follow-up was complete and ranged from 12 to 86 months (mean: 49 months). RESULTS: Dyspepsia (66.5%) and weight loss (47.6%) were the most common symptoms at diagnosis, while in 21.4% of patients tumour lesions were revealed incidentally. Plasma CgA levels were significantly or moderately elevated in all patients with liver metastases at diagnosis (64.3%). The levels also reflected tumour progression or response to treatment during the follow-up period. OctreoScan showed avid uptake in 77.8% of patients with hepatic metastases. Moreover, in 2 patients OctreoScan revealed unexpected metastatic mesenteric deposits, which had not been found by the other studies. However, it was negative in 6 patients with liver metastases, in whom tumours were proved to be poorly differentiated (high-grade). CONCLUSIONS: (1) NFPET may present with clinical manifestations similar to those of an exocrine pancreatic tumour; (2) plasma CgA levels reflect tumour load, and also seem to correlate with tumour progression or response to treatment; (3) surgeryin patients with localized disease at presentation can be curative, while it can also reduce tumour burden in patients with metastases; (4) long-acting somatostatin analogues provide good quality of life and temporary disease stabilization in patients with low-grade tumours; (5) systemic chemotherapy or chemoembolization seem to be beneficial in high-grade and progressive tumours.

Avoiding hypoglycemia: the use of insulin pump combined with continuous glucose monitor in type 1 diabetes crossing a Rocky Gorge.

BACKGROUND: Continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring systems (CGMS) have been proven very effective in diabetes management. AIM: This study evaluated the usefulness of these devices during prolonged, intense physical activity in an uncontrolled natural environment away from the clinical research center. DESIGN: Non-randomized, prospective and observational study. METHODS: During the summer, 38 participants with type 1 diabetes crossed the Samaria gorge, the second largest gorge in Europe (17 km). Twenty subjects on CSII combined with real-time CGMS and 18 on multiple daily injections (MDI) combined with professional (retrospective) CGMS participated in the program. All participants were unsupervised during the event. RESULTS: All 38 participants managed to reach the destination point safely. There were no episodes of severe hypoglycemia. The duration of the exercise (mean ±SD) was 6.4 ± 1.3 h. The CSII group exhibited significantly lower hypoglycemic episodes during exercise (0.1 ± 0.3 vs. 0.4 ± 0.6; P = 0.047) as well as lower AUC below 70 mg/dl compared with the MDI, during the 24 h (0.61 ± 0.78 vs. 1.84 ± 1.55; P = 0.007). Individuals on CSII were significantly less likely to develop a hypoglycemic episode during exercise (P = 0.038). Exercise induced nocturnal hypoglycemia was not prevented effectively in neither group. CONCLUSIONS: CSII combined with CGMS is effective in controlling blood glucose levels in type 1 diabetics who perform prolonged strenuous exercise. The use of insulin pump technology in regions with hot Mediterranean climates is safe and can provide protection against exercise-induced hypoglycemia. Development of precise instructions for T1DM who occasionally get involved in exercise activities, requires further studies.

Leptin and adiponectin responses in overweight inactive elderly following resistance training and detraining are intensity related.

CONTEXT: Adiponectin and leptin are closely related to weight control and energy balance, whereas exercise affects elderly metabolic regulation and functional capacity. OBJECTIVE: The objective of this study was to investigate leptin and adiponectin responses in elderly males after exercise training and detraining. DESIGN: The study design was a 1-yr randomized controlled trial. SETTING: The study was performed at the Laboratory of Physical Education and Sport Science Department. PARTICIPANTS: Fifty inactive men [age, 65-78 yr; body mass index (BMI), 28.7-30.2 kg/m2] were recruited from a volunteer database by word of mouth and fliers sent to medical practitioners, physiotherapists, and nursing homes in the local community. INTERVENTION(S): Participants were randomly assigned to a control (n = 10), low-intensity (n = 14), moderate-intensity (n = 12), or high-intensity training (HI; n = 14) group. Resistance training (6 months, 3 d/wk, 10 exercises/three sets) was followed by 6 months of detraining. MAIN OUTCOME MEASURE(S): Strength, exercise energy cost, skinfold sum, body weight, maximal oxygen consumption, resting metabolic rate (RMR), and plasma leptin and adiponectin were determined at baseline and after training and detraining. RESULTS: Strength, maximal oxygen consumption, RMR, and exercise energy cost increased (P < 0.05) after training in an intensity-dependent manner. Skinfold sum and BMI were reduced by resistance training (P < 0.05), with HI being more effective (P < 0.05) than moderate-intensity/low-intensity training. Leptin was diminished (P < 0.05) by all treatments, whereas adiponectin increased (P < 0.05) only in HI. Detraining maintained training-induced changes only in HI. The percent leptin decrease was associated (P < 0.05) with the percent BMI decrease and the percent RMR increase, whereas the percent adiponectin increase was associated (P < 0.05) with the percent BMI decrease. CONCLUSIONS: Resistance training and detraining may alter leptin and adiponectin responses in an intensity-dependent manner. Leptin and adiponectin changes were strongly associated with RMR and anthropometric changes.

Trends in the management of type 2 diabetes and its prescription drug costs in Greece (1998 & 2006).

AIMS Aim of the present study is to compare control of hyperglycaemia and other diabetes-related cardiovascular risk factors during the years 1998 and 2006 and to estimate the change in the cost of medications prescribed for this purpose. METHODS We compared the medical records of all patients who were regularly followed in three major diabetes centers located in Athens and Piraeus, Greece, during 1998, with those who were examined at the same centers during 2006. The cost of medications was calculated in Euros per patient-year (euroPY), using the 2006 official Greek market prices. RESULTS A total of 1 743 eligible files were included in the study (805 files from 1998 and 938 from 2006). HbA (1c), LDL-cholesterol and blood pressure improved significantly in 2006 as compared to 1998 (7.0% vs. 8.1%, 2.9 mmol/l vs. 3.9 mmol/l and 134.9/77.6 mmHg vs. 139.3/80.9 mmHg respectively, p<0.001 for all comparisons). Treatment of hyperglycaemia was more intense and had a different pattern in 2006. The proportion of patients receiving antihypertensive, hypolipidaemic and antiplatelet drugs increased from 48.8% to 74.4%, from 15.2% to 61.2% and from 17.6% to 51.1% respectively (p<0.001 for all comparisons). A highly significant increase in the cost per patient-year was observed for all classes of medications in 2006. The total cost of all diabetes-related medications increased in 2006 by 221.1% (from 341.3+/-276.0 euroPY to 1095.8+/-634.1 euroPY). CONCLUSIONS Control of cardiovascular risk factors of patients with T2D, regularly followed by diabetes specialists, improved significantly in 2006 as compared to 1998. This improvement, however, was associated with a considerable increase in the cost of medications prescribed for treatment of these parameters.