Relaxation training significantly reduced blood glucose levels in patients with type 1 diabetes mellitus.

PURPOSE/OBJECTIVE: The present study was designed to test whether adding a relaxation training technique to the medical treatment of patients with type 1 diabetes mellitus could, adjusting for the non-specific factors of therapy, lead to an improvement in the patients' condition. METHOD: Forty-six participants were randomly allocated either to an experimental (intervention) group, receiving weekly sessions of relaxation training, or to a control group (placebo) receiving weekly blood circulation training exercises. Measures included the State and Trait Anxiety Inventory, blood glucose levels, high-density lipoprotein levels, cholesterol levels, body weight, HbA1c levels, the Mood Adjective Checklist (MACL), a diary checklist, and urine glucose levels. Assessment of psychological and physiological parameters was conducted before and upon completion of the intervention (8 weeks). RESULTS: Trait anxiety and the main metabolic measurement of blood glucose levels and HbA1C revealed significant differences over time, predominantly among patients in the intervention group. CONCLUSIONS: Relaxation techniques as an adjunct to medical treatment are a useful tool for patients with type 1 diabetes mellitus.

Inpatient Rehabilitation for Children and Adolescents With Diabetes in Germany Between 2006 and 2013.

INTRODUCTION: In Germany, inpatient rehabilitation is a well-established additive option in the therapeutic concept for children and adolescents with diabetes. However, its contribution in pediatric diabetes care is not known exactly. Our objective was to analyze inpatient rehabilitation in pediatric diabetes over eight years in Germany. METHODS: We requested secondary data from the German Statutory Pension Insurance Scheme to evaluate all completed inpatient rehabilitations for children and adolescents with diabetes (ICD-code E10-14) reimbursed by this institution between 2006 and 2013. For each type of diabetes, we analyzed the distribution of admissions by year, age-group, sex, nationality, and other documented diagnoses. All analyses were conducted via remote computing with IBM SPSS Version 24. RESULTS: Between 2006 and 2013, 5,403 admissions to inpatient rehabilitation for 4,746 children and adolescents with diabetes were documented. For type 1 diabetes (T1D; 88.5% of admissions), the number of yearly admissions increased from 458 in 2006 to 688 in 2013 (p=0.013), especially for age-group>5-10. The increase for type 2 diabetes (T2D) was not significant. Admissions were more frequent for girls (53.6%, p≤0.001), age>10-15 years (42.8%, p=0.001), and German nationality (98.5%). Obesity (T1D: 11.1%; T2D: 87.9%) and mental disorders (T1D: 11.6%; T2D: 27.4%) were the most frequent documented diagnoses in addition to diabetes. CONCLUSION: This study provides a comprehensive overview of inpatient rehabilitation for children and adolescents with diabetes over many years in Germany. Until 2013, inpatient rehabilitation remained important in pediatric diabetes care, especially for children with mental disorders or obesity.

[Combined rehabilitative treatment of children with type 1 diabetes mellitus based at a spa and resort facility].

A program of combined rehabilitative therapy of children and adolescents presenting with type 1 diabetes mellitus has been developed to be used under conditions of a spa and resort treatment. The program includes education in the "Diabetes mellitus management school", insulin therapy, an optimized regime of motor activity, nutritional therapy, thalassotherapy and heliotherapy, drinking of mineral water, balneo- and peloidotherapy, reflex-acupuncture therapy, and psychotherapy, underwater shower massage, enterosorption, and instrumental physiotherapy. The efficiency of the spa and resort rehabilitative treatment of the patients with type 1 diabetes mellitus was estimated at 93.2%.

[Agility in treatment of children with type 1 diabetes--pilot study]. / Wykorzystanie agility jako formy rekreacji w leczeniu dzieci z cukrzyca typu 1 - doniesienie wstepne.

INTRODUCTION: Physical activity is a very important element in treatment of children with type 1 diabetes. However, it is difficult to find suitable exercises for the children due to their specific needs and psychophysiological condition. The aim of this study was to examine the effects of agility as a physical activity used to improve parameters of metabolic control in children with type 1 diabetes. Additionally, we hope that this form of recreation could induce a more health-oriented behavior in children. MATERIAL AND METHODS: The experimental group consisted of seven girls aged 8-10 years, the patients of the Clinic of Pediatrics, Endocrinology, Diabetology, Metabolic Disorders and Cardiology of the Developmental Age in Szczecin. The children were qualified for the study after the prior assessment of their metabolic control under the conditions of the one-day hospital stay program. The physical condition of the patients was controlled with a 6-minute walk test and the test of perceived exertion (Borg scale). All the patients were treated using a personal insulin pump and the basal-bolus therapy. The applied research method used the scheme of physical exercise performed 3 times a week, 45 min each, reaching the intensity of 75% of the maximum heart rate under effort performed by a given patient. Before the exercises and directly after their completion, sugar level was measured in the blood of the patients (Accu-chek Active). During the exercises, the heart rate was measured with a pulsometer Bauer PM 80. The exercises included outdoor games and agility sessions. Especially the latter received a positive response and high involvement. This form includes a dog going through an obstacle course, with a child as a guide. RESULTS AND CONCLUSIONS: After three months of the exercise scheme, the analysis of the collected results showed a statistically significant (p <0.05) decrease in the insulin doses (bolus) during morning hours (7-8 am), and in the evening at 9 pm and 10.30 pm, with an unchanged basal. No such decrease was observed in the control group. This study showed that an interesting physical activity resulted in a more eager and systematic effort among examined diabetic children. Its proper organization in time may help in the metabolic control in children with type 1 diabetes.

Nutrition evidence-based guidelines for treating hyperlipidemia in children with type 1 diabetes: a case presentation.

PURPOSE: The purpose of this case presentation is to review the current nutrition evidence-based guidelines and treatment goals for hyperlipidemia in children with type 1 diabetes. The American Heart Association (AHA) places children with type 1 diabetes in the highest tier for cardiovascular risk. METHODS: Early screening for hyperlipidemia in children with diabetes is recommended to identify those children at risk. If the fasting low-density lipoprotein cholesterol (LDL-C) level is > or = 100 mg/dL (2.6 mmol/L), medical nutrition therapy is recommended as the first line of treatment to reach the desired goal (LDL-C <100 mg/dL). Medical nutrition therapy includes the following: decreasing saturated fat (<7% total calories), avoiding trans fatty acids, decreasing total cholesterol to <200 mg daily, increasing soluble fiber, and adding phytosterols daily. RESULTS: The patient discussed in this case presentation achieved a desired LDL-C level <100 mg/dL (2.6 mmol/L) by following the recommended heart-healthy guidelines. Statin therapy was not considered unless the LDL-C goal, <130 mg/dL (3.38 mmol/L), was not achieved by diet alone. CONCLUSIONS: In this case study, evidence-based nutrition guidelines have been evaluated and reviewed to demonstrate heart-healthy eating for children with hyperlipidemia and type 1 diabetes. It is known that approximately 40% to 50% of children with elevated lipids will continue to have abnormal lipids into adolescence and early adulthood. Therefore, early screening is recommended by the AHA to track lipid changes during childhood and adolescence and to begin treating abnormal LDL-C levels to prevent the development of atherosclerosis.

Nutritional status and behavior in subjects with type 1 diabetes, before and after islet transplantation.

BACKGROUND: To investigate whether changes of nutritional status and behavior are associated with islet transplantation (ITx) and to assess their possible mechanisms. METHODS: In this observational study, 52 subjects with type 1 diabetes, 30 of whom received ITx, underwent nutritional assessments. The study consisted of questionnaires complemented by a dietary intake recording, anthropometric measurements, and body composition analysis. Laboratory tests were also reviewed as part of the follow up. RESULTS: After ITx, significant reductions in body weight (3.7 kg; P<0.0001), body mass index (1.39 kg/m2; P<0.0001), waist circumference (3.96 cm; P=0.006), and fat weight (3.28 kg; P<0.01) were observed. The average consumption of carbohydrate and protein were also lower than pretransplant, together with some micronutrients (vitamins B12 and B6, zinc, and phosphorus). Insulin administration and changes in A1C were not associated with a significant change in anthropometric measurements. Subjects on exenatide after ITx showed significantly lower weight and body mass index than those not taking exenatide. CONCLUSIONS: ITx is associated with modifications in nutritional behavior and status. Drugs and health conditions are likely to be at least in part responsible for these changes, but a voluntary modification of eating habits by the patients also plays a role. Strict monitoring of nutritional parameters, counseling by experts in nutrition, and multivitamin/mineral supplement after ITx could be of benefit to the patients.

Nutrition therapy for overweight children and adolescents with type 2 diabetes.

The increased number of children and adolescents diagnosed with type 2 diabetes presents new challenges to pediatricians, nurses, and dietitians. Treatment with medications and lifestyle changes is similar to that for adults with type 2 diabetes, but must be developmentally appropriate for children and adolescents. Registered dieticians must apply knowledge from treatment for overweight children and adolescents without diabetes with treatment for adults with type 2 diabetes to provide effective nutrition therapy for this population.

[Autogenic training in children and adolescents with type 1 diabetes mellitus]. / Autogenes Training bei Kindern und Jugendlichen mit Diabetes mellitus Typ 1.

This paper discusses psychosocial influences of diabetes mellitus type 1 on children and young patients. A group of 21 patients, age 9 to 14 years with Diabetes mellitus type 1 attended a course in "Autogenic Training" for a period of 11 weeks. From the multidimensional questionnaire for children (PFK 9-14, SETZ U. RAUSCHE 1976) 15 dimensions of personality and 5 second rank factors were extracted at the beginning and at the end of training and 5 months later. Additionally HbA1-scores were assessed at the beginning and at the end at a 2 month and a 5 month-follow-up. At the beginning of the course only on one of the 15 scales a significant difference could be observed between experimental group and age related normal population. After training 5 scales and one second rank factor showed significant changes. Significant reduction was observed in: "need for aggressive forms of dominance behaviour" "feeling of submission with respects to other:", "emotional lability" and "tendency for dependence on adults". A significantly increased score was observed in the scale measuring "self confidence regarding one's own meaning, decisions and planning ability". The second rank faktor "neuroticism" was significantly reduced. Against expectations there was no reduction in HbA1 scores. At the end of training HbA1 scores even had increased significantly. But this might have been related to the high frequency of infections during this course. In subjective ratings of training evaluation most of the course members and their parents described fewer problems with attention, less test-anxiety and less aggression and nervousness. The results of this prospective pilot-study are discussed in terms of the psychodynamic influence on diabetes.

[The dynamic laboratory indices of patients with insulin-dependent diabetes mellitus during health-resort treatment]. / Dinamika nekotorykh laboratornykh pokazatelei u bol'nykh insulinzavisimym sakharnym diabetom pri kurortnom lechenii.

The immunological status was assessed in 100 patients with insulin-dependent diabetes mellitus before and after treatment in sanatorium. The treatment consisted of diet 9a, adequate insulin-therapy, therapeutic exercises, mineral water (drinking and baths), physiotherapy, peloids. Immunological assessment of the treatment effects showed normalization of cellular immunity, enhancement of phagocytosis, positive changes in humoral immunity.

Psychosocial problems of children and adolescents with a chronic disease: coping strategies.

The purpose of this pilot study was to identify the coping strategies used by children, adolescents and youths with insulin dependent diabetes mellitus (IDDM) attending a camp for IDDM patients near Ryosen town, Fukushima Prefecture, Japan. Forty-three IDDM patients (24 females and 19 males) were studied, divided into two age groups. The first group included children (seven males and 10 females). The second group included adolescents and youths (12 males and 14 females). For the child group a projective drawing method was used for study and for the older group, an open questionnaire was used. Ryan-Wenger's taxonomy of children's coping strategies and Band's coding systems and classification were used for the content analysis. 'Instrumental action', 'Emotional expression' and 'Catastrophizing thinking' were the coping strategies, represented in the child group. Gender differences in coping strategies were found in the group of adolescents and youths. The most often represented and most important coping category for the male subgroup was 'Behavioral avoidance'. Next in frequency of representation for the male subgroup were 'Cognitive distraction' and 'Behavioral distraction'. The coping categories 'Seeking social support' and 'Behavioral distraction' were represented with equal frequency in the female subgroup and the next was 'Aggressive activities'. The most important coping strategy for the female group was 'Talking to peers' from the seeking social support category. The study also helped to identify several children and adolescents who might need special psychological support.

Using nontraditional methods to teach pediatric residents about insulin-dependent diabetes mellitus.

The purpose of this study was to examine the effect of a training experience on the attitudes and beliefs of pediatric residents concerning insulin-dependent diabetes mellitus (IDDM), persons with diabetes, and the use of a multidisciplinary team to empower patients/families. The resident training experience consisted of three days of diabetes lifestyle simulation including attending an educational program designed for newly-diagnosed patients and their families. Residents' attitudes, beliefs, and team function attitudes were measured at preinstruction, postinstruction, and 6 months following instruction. There was no significant change in beliefs about diabetes. Attitudes about persons with diabetes became more positive after the training experience, but did not continue after six months. Residents also expressed a change in team attitudes, specifically, in their acceptance of having the certified diabetes educator (CDE) nurse and the patient/family adjust insulin and manage insulin during illness.

[Rehabilitation of the diabetic child in Cuba]. / Rehabilitación del niño diabético en Cuba.

The author describes a series of important steps followed in Cuba for the rehabilitation of the diabetic child, like education of the patient and his relatives, active participation of the child in his treatment (self control), hospital attention advisable for a minimal period exclusively in severe cases, attention in office visits as ambulatory patient, participation in vocational, social and psychological orientation activities of the antidiabetic center, areas for sport and recreation, vocational camping for diabetic children, homes, education through press, television and radio of special programs on diabetes.