Cognitive behavioral treatment to improve psychological adjustment in people recently diagnosed with type 2 diabetes: Psychological treatment in type 2 diabetes.

Type 2 diabetes mellitus (T2DM) is a chronic disease that affects a person's general well-being. Current evidence sets an association between psychological well-being and controlled metabolic parameters. People newly diagnosed with T2DM show higher prevalence of depression and anxiety symptoms. Cognitive behavioral therapy (CBT) has effectively improved psychological adjustment, but most studies do not specifically address recently diagnosed people nor usually include long-term follow-up measures. Objective: We sought to assess changes in psychological variables in people with newly diagnosed diabetes who received a cognitive-behavioral intervention, within a comprehensive care program. Method: 1208 adults with T2DM (≤5 years) who attended a national health institute in Mexico received a cognitive-behavioral intervention aimed at improving quality of life and reducing emotional distress that often interferes with diabetes control, as well as evaluating cognitive and emotional resources and social support. Measures of quality of life, diabetes-related distress, anxiety and depression questionnaires were compared at pre-test, post-test and follow up using Friedman's ANOVAs. Multiple logistic regression models evaluated glycosylated hemoglobin (HbA1c) and triglycerides control at post-test and follow up. Results: Questionnaire measures and metabolic variables significantly decreased symptomatology at post-test and these changes maintained at follow-up. Significant associations were found between quality-of-life scores and HbA1c and triglycerides levels in post-test and follow-up. Diabetes-related distress scores increased the odds of having adequate HbA1c control at post-test. Conclusion: This study contributes to the evidence on the importance of considering psychological factors as part of comprehensive diabetes care to improve quality of life and emotional burden and facilitate the achievement of metabolic goals.

Long-Term Effects of Anxiety on the Metabolic Control of Recently Diagnosed Type 2 Diabetes Patients: Results from the CAIPaDi Cohort Study.

Introduction: Anxiety disorders (AXD) are among the most prevalent mental health conditions in patients with type 2 diabetes (T2D). Previous data have established an association of other psychiatric conditions with poor metabolic control and increased odds of diabetes-related complications. Nonetheless, follow-up information about the effects of AXD on the metabolic control of patients with TD2 is still limited. Objective: Evaluate the effects of AXD on the metabolic parameters of patients with T2D over 12 months of follow-up in a multidisciplinary comprehensive care model. Methods: Prospective study of T2D subjects enrolled in a comprehensive care program with follow-up at 3 and 12 months of treatment. Patients were assessed using the Mini-International Neuropsychiatric Interview and the Hospital Anxiety and Depression Scale (HADS). We registered clinical and metabolic characteristics from each visit. Metabolic parameters over time were analyzed with a mixed model of repeated measures using AXD and time as interaction variables. Results: Our sample included 2703 patients at baseline, and 1161 (43%) subjects continued the follow-up at 12 months. The AXD group had more females, lower age, and fewer years of formal education compared with subjects without AXD at baseline, 3 and 12 months. Patients with AXD also reported higher mean fasting glucose at three months, and higher HbA1c at three and 12 months. Our MMRM for HbA1c reported significant differences over time in subjects with and without AXD. The differences in means between groups increased from 0.17% at three months to 0.31% at 12 months. The variables from the HADS anxiety score, sex, age, years of diagnosis, and insulin treatment were also associated with HbA1c parameters over time. Conclusion: Patients with AXD had the worst glycemic control at 3 and 12 months of follow-up. HbA1c differences in patients with AXD compared with non-AXD subjects increases over time in association with anxiety symptoms.

[Prevalence of psychiatric disorders in patients with severe obesity waiting for bariatric surgery]. / Prevalencia de trastornos psiquiátricos en pacientes con obesidad extrema candidatos a cirugía bariátrica.

INTRODUCTION: Obesity is a chronic condition, in which different systems of the body are affected. There are some previous studies in which the prevalence of psychiatric disorders in extreme obese patients has been reported, but there are some methodological problems. As far as we know this is the first report of the prevalence of psychiatric disorders in obese patients that need to have a surgical treatment for this disorder in Mexico. The main goal of this study was to determine the prevalence and risk factors of psychiatric disorders in extreme obese patients candidates to bariatric surgery. MATERIAL AND METHODS: The Structured Clinical Interview for DSM-IV (SCID) axis I disorders, were performed in 70 obese patients that will undergo for bariatric surgery. Also the medical files were reviewed in order to obtain the main medical conditions related to obesity. RESULTS: There were 25 men and 35 women in this study (average age +/- s.d = 39.0 +/- 10.4). The Body Mass Index (BMI) was 53.8 +/- 11.9. Sixty percent of the patients had some psychiatric disorder in the axis I of DSM-IV. The most frequent psychiatric problem that was observed was anxiety disorders. The main medical problems observed were: arterial hypertension (59%), diabetes mellitus type 2 (29%) and obstructive sleep apnea syndrome (29%). The BMI and diabetes mellitus were associated with a lower risk for presenting a psychiatric disorder (for a BMI of 65.5 +/- 10.3 kg/m2: OR 0.26, CI 0.05-1.15, p = 0.04; for diabetes mellitus: OR 0.20, CI 0.03-1.05, p = 0.02). CONCLUSIONS: More than half of the patients had at least one psychiatric disorder in axis 1 of DSM-IV, related mostly to anxiety and mood disorders. Our findings point out the importance of psychiatric and psychological intervention in this group of patients, in which a follow up and adherence of medical, nutritional and psychological problems could be the difference, between a good or bad prognosis. Follow-up studies with obese patients after bariatric surgery, will be important to support our findings.

[Internal validity and diagnostic utility of the Eating Disorder Inventory in Mexican women]. / Validez interna y utilidad diagnóstica del Eating Disorder Inventory, en mujeres mexicanas.

OBJECTIVE: To assess the diagnostic utility and internal validity of the Eating Disorder Inventory (EDI-2) in Mexican women. MATERIAL AND METHODS: An observational, cross-sectional study was conducted between October 2000 and January 2001. The sample population consisted of two groups of women: patients diagnosed with anorexia nervosa or bulimia, but no other psychiatric pathology, seen by psychiatrists at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (National Institute of Medical Sciences and Nutrition Salvador Zubirán), and a randomly selected sample of women from a school in Mexico City. A structured interview was conducted using SCID/DSM-IV as the gold standard. Finally the EDI-2 was administered. Statistical analysis was performed using Student's t test for independent samples, Cronbach's alpha test, and calculation of sensitivity, specificity, and positive and negative predictive values. RESULTS: No significant differences were found for weight, height, and body mass index. Women with no eating disorders were younger than those with eating disorders (16.7 +/- 2.8 vs. 19.9 +/- 4.3, p = 0.004). The EDI-2 total score was clearly different between the groups (53.8 +/- 32.4 vs. 146.3 +/- 45.6 respectively, p < 0.001). All Cronbach's alpha coefficients for all subscales were over 0.85. For the total score, a sensitive cutoff point of 80 (sensitivity 90.9, 95% confidence interval [CI] 69.4 to 98.4; specificity 80, 95% CI 58.7 to 92.4) and a specific cutoff point of 105 (sensitivity 81.8, 95% CI 59 to 94; specificity 89.3, 95% CI 70.6 to 97.2) are recommended. CONCLUSIONS: The EDI-2 has a high internal validity and should be a useful tool to assess eating disorders.

Validez interna y utilidad diagnóstica del Eating Disorders Inventory en mujeres mexicanas / Internal validity and diagnostic utility of the Eating Disorder Inventory, in Mexican women

OBJETIVO: Determinar la utilidad diagnóstica y la validez interna del Eating Disorder Inventory (EDI-2) en mujeres mexicanas. MATERIAL Y MÉTODOS: De octubre de 2000 a enero de 2001 se invitó a participar a todas las mujeres que a juicio de los psiquiatras de la consulta de anorexia del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, de la Ciudad de México, padecían anorexia nervosa o bulimia, sin otra patología psiquiátrica. Es un estudio observacional, comparativo, transversal y prolectivo de dos grupos de mujeres: pacientes de la Clínica de Anorexia del Instituto y de una escuela de la Ciudad de México. Se realizó una entrevista clínica estructurada como estándar de oro (SCID/Manual Diagnóstico y Estadístico de los Trastornos Mentales) y la aplicación del Eating Disorder Inventory. El análisis estadístico incluyó t de Student para muestras independientes, coeficiente alpha de Cronbach, sensibilidad, especificidad, valor predictivo positivo y negativo. RESULTADOS: No hubo diferencias significativas en peso, talla e índice de masa corporal entre los grupos. La edad de las mujeres sin trastorno alimentario fue menor (16.7±2.8 vs. 19.9±4.3, p=0.004). La calificación total del Eating Disorder Inventory fue claramente diferente (53.8±32.4 mujeres sin trastorno alimentario vs. 146.3±45.6 pacientes, p<0.001). Para todas las subescalas los coeficientes alpha de Cronbach fueron superiores a 0.85. Para la calificación total se sugiere un punto de corte sensible de 80 [sensibilidad 90.9 (IC 95 por ciento 69.4-98.4, especificidad 80 (IC 95 por ciento 58.7-92.4)], y uno específico de 105 [sensibilidad 81.8 (IC 95 por ciento 59-94), especificidad 89.3 (IC 95 por ciento 70.6-97.2)]. CONCLUSIONES: El Eating Disorder Inventory es útil para investigar trastorno alimentario, con coeficientes de validez interna altos en la población estudiada

[Accuracy and diagnostic utility of the Hospital Anxiety and Depression Scale (HAD) in a sample of obese Mexican patients]. / Exactitud y utilidad diagnóstica del Hospital Anxiety and Depression Scale (HAD) en una muestra de sujetos obesos mexicanos.

The Hospital Anxiety and Depression Scale (HAD) have been used in Mexico in drug abusers, burned patients, older people, with renal insufficiency and high-risk pregnant women. The aim of this study was to determine reproducibility and accuracy of the questionnaire in a sample of obese subjects. A group of 75 obese patients (BMI > 27) without diabetes mellitus were invited to participated in the study. Diagnosis of anxiety or depression was made by an structured interview based on the DSM-IV criteria, and they were requested to complete the HAD. All subjects were randomized for the manoeuvre sequence. Sensibility specificity, positive predictive value and negative value, and unweighted kappa coefficient (for concordance) were calculated for the two procedures. The questionnaire reproducibility was assessed buy test-retest with other 25 independent subjects. Internal validity was estimated by alpha Cronbach, Guttman and intraclass correlation coefficients. Mean age was 39.7 +/- 11.5 years and BMI 39.1 +/- 9.6. The best cut off point for anxiety was 8 points (Kappa 0.68) and for depression 7 points (Kappa 0.73). Mean age for test-retest was 39.2 +/- 14.5 years and BMI 45.3 +/- 14.6. The alpha-Cronbach was 0.84 for the first tes. and 0.86 for the second. Intraclass coefficient correlation was 0.946. The HAD is applicable for obese subjects, it is reproducible and concordant with a structured interview.