Effectiveness of Mindfulness-based interventions on physiological and psychological complications in adults with diabetes: A systematic review.

This systematic review aimed to examine the effectiveness of Mindfulness-based interventions in reducing diabetes-related physiological and psychological symptoms in adults with types 1 and 2 diabetes. Five databases were systematically searched. A total of 11 studies satisfied the inclusion criteria. Mindfulness-based intervention effectiveness for physiological outcomes (glycaemic control and blood pressure) was mixed. Mindfulness-based interventions appear to have psychological benefits reducing depression, anxiety and distress symptoms across several studies. Studies' short-term follow-up periods may not allow sufficient time to observe physiological changes or illustrate Mindfulness-based interventions' potential long-term efficacy. More long-term studies that include a consistent, standardised set of outcome measures are required.

Harm/Loss, Threat, and Challenge of Living With Diabetes for Persons From Rural Appalachia: A Qualitative Study.

Living with the stress of diabetes involves suffering with pain, being frightened of the unknown, worrying about threats to family, trying to manage restrictions, taking on activities of living the everyday, and moving forward with confidence. The appraisal of the stress of diabetes indicates a need for development of person-centered interventions.

Influence of educational attainments on long term glucose control and morbid events in patients with type 2 diabetes receiving integrated care from 15 China urban communities: The Beijing Community Diabetes Study 11.

AIM: To investigate the effects of educational attainment on glucose control and morbid events in patients with type 2 diabetes in Beijing communities. METHODS: In this prospective multi-center study, 2866 type 2 diabetes patients receiving integrated care from 15 Beijing urban communities were investigated. Educational attainment was categorized into three levels: low, medium, and high. After a 42-month management, glucose control parameters and morbid events were analyzed. RESULTS: At baseline, the percentages of patients with good glucose control (HbA1c ≤ 7.0%) in the low, medium and high educational groups were 49.09%, 54.82% and 62.59%, respectively (P<0.001). After the 42-month management, fasting plasma glucose and HbA1c values were the highest in the low educational group (7.51 ± 2.05 mmol/l and 7.20 ± 1.27%, respectively). Percentages of patients with good glucose control in the three groups were 49.6%, 55.83% and 67.23%, respectively, and the incidences of combined morbid events were 4.5%, 2.4% and 1.5%, respectively. Cox regression analysis showed that educational level was related to the incidence of combined morbid events (medium level, HR=0.572; high level, HR=0.351; P<0.05). CONCLUSIONS: Educational level was associated with long-term glucose control, and seemed to be related to the incidence of combined morbid events in people with type 2 diabetes.

Brain aging and AD-like pathology in streptozotocin-induced diabetic rats.

OBJECTIVE: Numerous epidemiological studies have linked diabetes mellitus (DM) with an increased risk of developing Alzheimer's disease (AD). However, whether or not diabetic encephalopathy shows AD-like pathology remains unclear. RESEARCH DESIGN AND METHODS: Forebrain and hippocampal volumes were measured using stereology in serial coronal sections of the brain in streptozotocin- (STZ-) induced rats. Neurodegeneration in the frontal cortex, hypothalamus, and hippocampus was evaluated using Fluoro-Jade C (FJC). Aß aggregation in the frontal cortex and hippocampus was tested using immunohistochemistry and ELISA. Dendritic spine density in the frontal cortex and hippocampus was measured using Golgi staining, and western blot was conducted to detect the levels of synaptophysin. Cognitive ability was evaluated through the Morris water maze and inhibitory avoidant box. RESULTS: Rats are characterized by insulin deficiency accompanied with polydipsia, polyphagia, polyuria, and weight loss after STZ injection. The number of FJC-positive cells significantly increased in discrete brain regions of the diabetic rats compared with the age-matched control rats. Hippocampal atrophy, Aß aggregation, and synapse loss were observed in the diabetic rats compared with the control rats. The learning and memory of the diabetic rats decreased compared with those of the age-matched control rats. CONCLUSIONS: Our results suggested that aberrant metabolism induced brain aging as characterized by AD-like pathologies.

Posttraumatic stress disorder and cardiometabolic disease.

The need for addressing posttraumatic stress disorder (PTSD) among combat veterans returning from Afghanistan and Iraq is a growing public health concern. Current PTSD management addresses psychiatric parameters of this condition. However, PTSD is not simply a psychiatric disorder. Traumatic stress increases the risk for inflammation-related somatic diseases and early mortality. The metabolic syndrome reflects the increased health risk associated with combat stress and PTSD. Obesity, dyslipidemia, hypertension, diabetes mellitus, and cardiovascular disease are prevalent among PTSD patients. However, there has been little appreciation for the need to address these somatic PTSD comorbidities. Medical professionals treating this vulnerable population should screen patients for cardiometabolic risk factors and avail themselves of existing preventive diet, exercise, and pharmacologic modalities that will reduce such risk factors and improve overall long-term health outcomes and quality of life. There is the promise that cardiometabolic preventive therapy complementing psychiatric intervention may, in turn, help improve the posttraumatic stress system dysregulation and favorably impact psychiatric and neurologic function. © 2013 S. Karger AG, Basel.

Beneficial effects of Brassica juncea on cognitive functions in rats.

UNLABELLED: CONTEXT. Brassica juncea (BJ; Linnaeus) Czern & Coss (Brassicaceae), commonly known as Indian mustard, are enriched in redox-active polyphenols with antidiabetic activities. Diverse other health benefits of this edible plant have been described in classical Ayurvedic texts. OBJECTIVE: The reported experiments were designed to assess therapeutic potential of a methanol extract of BJ leaves for treatment of cognitive disorders associated with diabetes or caused by central cholinergic dysfunctions. MATERIALS AND METHODS: Elevated plus-maze and active- and passive-avoidance tests were used to assess anti-amnesic potentials of BJ (100, 200 and 400 mg/kg/day, p.o., for 10 days) in alloxan diabetic or scopolamine-challenged rats. Treatment effects on brain acetylcholinesterase (AChE), superoxide dismutase (SOD) and catalase (CAT) activities were quantified in behavioral tested animals. RESULTS: Anti-amnesic efficacy of all three tested BJ doses against scopolamine-induced amnesia was almost equal in all behavioral tests. Such efficacy of the extract in diabetic rats was increased always with its increasing doses. All treatments of BJ dose dependently decreased the elevated level of AChE, and significantly increased the SOD and CAT levels in brain homogenates of scopolamine-challenged and diabetic rats. Minimal effective oral daily doses of BJ in all tests were 100 mg/kg/day for 10 consecutive days. DISCUSSION AND CONCLUSION: Our observation indicates that BJ could be a therapeutic option for treatment of cognitive disorders associated with diabetes, or caused by cholinergic deficit and brain oxidative status. They also indicate that the bioactive constituents or mode of actions involved in observed effects of the extract in scopolamine-challenged or diabetic rats are most probably not the same.

Nursing's role in courage development in patients facing complications of diabetes.

The purpose of this study was to explore the experience of nurses in relation to courage development in patients with disabling complications of diabetes. The phenomenon of courage has been explored in philosophy, theology, literature, and other fields of inquiry rooted in the humanities. Nursing inquiry has not often been directed toward an exploration of courage, although coping, compassion, caring, and other experiences integral to the nurse-patient relationship have been examined. The holistic view of the cascading effect of complications on the individual patient is often overlooked. This qualitative study used phenomenological inquiry and included face-to-face interviews of nurses to explore their experience in assisting patients in the development of courage. The experience of courage is investigated as it relates to a specific group of patients who have complications of diabetes. Four categories representing the unique opportunities for courage development by nurses were generated. These categories included education, advocacy, relationship building, and humanization. Each category described nursing intentions and actions and taken together formed an essential structure of courage development. Conclusions indicated that nurses recognize and are able to describe their role in courage development. Implications for improved health through deliberate caring nursing interventions, aimed at courage development, are presented.

Co-occurrence of diabetes and depression: conceptual considerations for an emerging global health challenge.

BACKGROUND: Considering the relationships between diabetes and depression may enhance programs to reduce their individual and shared disease burden. METHODS: This paper discusses relationships between diabetes and depression, the range of influences on each, conceptual issues central to their definition, and interventions including comprehensive, population approaches to their prevention and management. Foundational and exemplary literature was identified by the writing team according to their areas of expertise. RESULTS: Diabetes and depression influence each other while sharing a broad range of biological, psychological, socioeconomic and cultural determinants. They may be viewed as: (a) distinct but sometimes comorbid entities, (b) dimensions, (c) parts of broader categories, e.g., metabolic/cardiovascular abnormalities or negative emotions, or (d) integrated so that comprehensive treatment of diabetes includes depression or negative emotions, and that of depression routinely considers possible diabetes or other chronic diseases. LIMITATIONS: The choice of literature relied primarily on the authors' knowledge of the issues addressed. Some important perspectives and research may have been overlooked. CONCLUSIONS AND CLINICAL IMPLICATIONS: Collaboration among primary care and specialist clinicians as well as program and public health managers should reflect the commonalities among diabetes, depression, and other chronic mental and physical disorders. Interventions should include integrated clinical care and self-management programs along with population approaches to prevention and management. Self management and problem solving may provide a coherent framework for integrating the diverse tasks and objectives of those living with diabetes and depression or many other varieties of multi-morbidity.

[Experiences of people with diabetes and amputation of members]. / Vivências de pessoas com diabetes e amputação de membros.

This is an exploratory, descriptive, qualitative study, built up on Heidegger's phenomenological perspective. It was developed at the Integrated Health Center Dr. Lineu Araújo and at Basic Health Units of Teresina (PI), with the subjects being twelve diabetic patients that have suffered member's amputation. Phenomenological interview was used, as the technique for producing the data. In an attempt of approaching and appropriation of the meanings they attributed to the phenomena, four units of meaning were built. In this perspective, being-person-with diabetes-and-member amputations means experiencing a quotidian permeated by difficulties, restrictions and limitations imposed by the situation; suffering for dependence on others, loneliness imposed by social isolation, either by personal limitations, economic and / or inadequacy of public policies.

Vivências de pessoas com diabetes e amputação de membros / Experiences of people with diabetes and amputation of members / Vivencias de personas con diabetes y amputación de miembros

Trata-se de um estudo exploratório, descritivo, com abordagem qualitativa, na perspectiva fenomenológica heideggeriana. Foi desenvolvido no Centro Integrado de Saúde Dr. Lineu Araújo e em Unidades Básicas de Saúde, de Teresina (PI), tendo como sujeitos doze pacientes diabéticos e amputados. Utilizou-se como técnica para produção dos dados a entrevista fenomenológica. Na tentativa de aproximação e apropriação dos significados por eles atribuídos, foram construídas quatro Unidades de Significação. Nesta perspectiva, Ser-pessoa-com-diabetes-e-amputações de membros significa vivenciar um cotidiano permeado por dificuldades, limitações e restrições impostas pela situação; sofrer pela dependência de outras pessoas, pela solidão imposta pelo isolamento social, seja por limitações pessoais, econômicas e/ou inadequação das políticas públicas.

This is an exploratory, descriptive, qualitative study, built up on Heidegger's phenomenological perspective. It was developed at the Integrated Health Center Dr. Lineu Araújo and at Basic Health Units of Teresina (PI), with the subjects being twelve diabetic patients that have suffered member's amputation. Phenomenological interview was used, as the technique for producing the data. In an attempt of approaching and appropriation of the meanings they attributed to the phenomena, four units of meaning were built. In this perspective, being-person-with diabetes-and-member amputations means experiencing a quotidian permeated by difficulties, restrictions and limitations imposed by the situation; suffering for dependence on others, loneliness imposed by social isolation, either by personal limitations, economic and / or inadequacy of public policies.

Este es un estudio exploratorio, descriptivo, con enfoque cualitativo, desenvuelto en la perspectiva fenomenológica heideggeriana. Se desarrolló en el Centro Integrado de Salud Dr. Lineu Araújo y en una Unidad Básica de Salud de Teresina (PI), teniendo como sujetos doce pacientes diabéticos sometidos a amputaciones. Como técnica para producir los datos, se utilizó la entrevista fenomenológica. En un intento de acercamiento y apropiación de los significados que ellos atribuyen al fenómeno, se construyeron cuatro unidades de significado. En consecuencia, Ser persona-con diabetes-y- amputación de miembros significa experimentar un cotidiano impregnado por dificultades, restricciones y limitaciones impuestas por la situación; y sufrir por la dependencia de otros, y de la soledad impuesta por el aislamiento social, ya sea por limitaciones personales, económicas y / o por insuficiencia de políticas públicas.

Physicians' role in eye care of patients with diabetes mellitus--are we doing what we need to?

CONTEXT: The American Diabetes Association and the American Academy of Ophthalmology recommend that a dilated eye examination be performed on patients with diabetes mellitus during an initial assessment and at least annually there-after. OBJECTIVES: (1) To determine the extent to which patients with diabetes mellitus are aware that their condition can lead to ocular problems; (2) to determine the percentage of patients with diabetes mellitus who receive annual dilated eye examinations; (3) to discover reasons why patients with diabetes mellitus may not receive annual dilated eye examinations; and (4) to raise awareness among patients with diabetes mellitus of the importance of controlling their condition and of receiving frequent dilated eye examinations. METHODS: A 9-question oral survey of individuals with type 2 diabetes mellitus was administered in 2 clinical medical settings and 1 community setting in Harrison County, West Virginia, between April 7, 2007, and May 15, 2007. Questions covered participant knowledge of diabetes mellitus complications, frequency of receiving eye examinations, and other aspects of diabetes mellitus. Responses were statistically analyzed for correlations between participant knowledge and receiving eye examinations in the past year. RESULTS: A total of 147 individuals with diabetes mellitus participated in the survey. Among the various conditions that diabetes mellitus can lead to, the surveyed individuals were most aware that diabetes mellitus can lead to eye disease, followed by kidney problems, ulcers, and heart problems. Approximately 70% of survey respondents received a dilated eye examination in the past year. The most common reasons given by the 30% of respondents who did not receive an eye examination were-in order of frequency-procrastination, having never been told it was necessary, and financial issues. CONCLUSION: Roughly 1 of every 4 surveyed patients with diabetes mellitus in this West Virginia study who did not receive an annual dilated eye examination was not aware of the need to do so. As osteopathic physicians, we can do more to optimize compliance with current recommendations for good health by continually educating our patients with diabetes mellitus about the need for eye examinations.

Normal cognitive decline or dementia?

Cognitive speed, inhibitory function, and memory decline with age while crystallised, particularly verbal, abilities remain largely intact. Poor health, fewer years of education, lower activity, the presence of the APOE E4 allele, and high BP appear to predict faster cognitive decline. Dementia is diagnosed in the presence of objective cognitive impairment, both long- and short-term memory, plus at least one additional (cortical) cognitive deficit, such as dysphasia, dyspraxia, agnosia, or disturbance in executive functioning. In addition, patients have to show significant impairment in social or occupational functioning and a significant decline from previous levels. Both smoking and diabetes increase the risk of all types of dementia, not smoking or even stopping smoking reduces this risk, but better control of type 2 diabetes does not appear to have a measurable effect. Drinking small to moderate amounts of alcohol appears to confer some benefit in ameliorating cognitive decline. There is some evidence that HRT, DHEA, BP lowering in patients without prior cerebrovascular disease, statins, vitamin B6 and procaine are NOT helpful. There is insufficient evidence to establish or refute a beneficial effect for exercise, treatment of type 2 diabetes, omega-3 fatty acids, folic acid with/without vitamin B12, antioxidant vitamins, or ginkgo biloba. Depressive symptoms are more prevalent than dementia. Clinical (major) depression can present with cognitive deterioration, often associated with subjective complaints. Patients with subjective or objective memory impairment, but without functional deterioration, can be referred to the local memory clinic, while demented patients eligible for acetylcholinesterase inhibitor treatment, patients whose diagnosis is unclear and who may need some specific investigations, as well as patients who may benefit from a combined approach with psychotropic drugs and behavioural support should be referred to the local mental health team.

Psychoneuroimmune implications of type 2 diabetes.

The idea that type 2 diabetes is associated with augmented innate immune function characterized by increased circulating levels of acute phase reactants and altered macrophage biology is fairly well established, even though the mechanisms involved in this complex interaction still are not entirely clear. To date, the majority of studies investigating innate immune function in type 2 diabetes are limited to the context of wound healing, atherosclerosis, stroke, and other commonly identified comorbidities. Several important recurring themes come out of these data. First, type 2 diabetes is associated with a state of chronic, subclinical inflammation. Second, in macrophages, type 2 diabetic conditions enhance proinflammatory reactions and impair anti-inflammatory responses. Third, after acute activation of the innate immune system in type 2 diabetes, recovery or resolution of inflammation is impaired. The consequences of type 2 diabetes-associated inflammatory alterations on PNI processes have been recognized only recently. Given the impact of diminished emotional well-being on the quality of life in patients who have type 2 diabetes, diabetes-induced exacerbation of PNI responses should be considered a serious complication of type 2 diabetes that warrants further clinical attention.

Disease-focused or integrated treatment: diabetes and depression.

This article reviewed the literature on the adverse health outcomes of the coexistence of diabetes and depression, the challenges of treating coexisting diabetes and depression in a fragmented health care system, and the need for integrated care as a strategy to improve the quality of care for patients who have complex medical illnesses (eg, patients who have coexisting diabetes and depression).