[Behavioral therapy of diabetes mellitus]
SAL István1, KOHLNÉ Papp Ildikó1
FEBRUARY 12, 2017
Lege Artis Medicinae - 2017;27(01-02)
SAL István1, KOHLNÉ Papp Ildikó1
FEBRUARY 12, 2017
Lege Artis Medicinae - 2017;27(01-02)
[Diabetes is a model disease of behavior therapy. Its treatment is in the hands of patients for the most part, who must make decisions about their treatment every day, which affect their health status, prognosis and risk of developing complications of the disease. This common and complex treatment represents a significant burden for the majority of patients. In practice, a significant number of patients do not follow one or more cornerstones of self-management: physical activity, healthy diet, and use of medication. Based on research results diabetic patients' quality of life and psychological state is significantly worse than those of non-diabetics, which tend to deteriorate the medical collaboration and health status. In addition, certain psychiatric disorders (depression, anxiety, eating disorders), are also more common, which impair the quality of self-treatment as well. Early detection and treatment is of great importance, but in practice, only 10% of patients get psychological treatment, despite the fact that nearly 40% of them experience psychological symptoms. Based on the above, behavior remedial methods are highly recommended to be applied in the field of diabetes care in order upgrade quality of life, although they are not yet considered as commonly accepted in psychoeducation. Our aim is to summarise the practical and proven methods of behavioral remedies in addition to the literature review. In the case study demonstrate the authors the addition of transtheoretical model. The first order condition of self-management is the adoption of the disease and motivation, afterwards comes the teaching of theoretical and practical knowledge, and the ongoing diabetes education. ]
Lege Artis Medicinae
Lege Artis Medicinae
Lege Artis Medicinae
Lege Artis Medicinae
[According to both international and national studies the point prevalence of diagnosed major depression requiring treatment is 6-10 percent in general practice. As untreated depression is the most important risk factor for suicide, early detection and effective management of depression (especially depression which predisposes sui-cide) are critical in prevention. According to international and national studies the re-cognition of major depression in primary care significantly contributes to the decline of suicide mortality. In our article we present two short questionnaires used for re-cognising depression and acute suicide risk and we describe their use in family/ general practice. We aim to raise awareness of the need of a systematic, nationwide sui-cide prevention programme which is supported on government level as well. ]
[INTRODUCTION - Data on bone mineral density (BMD) in diabetes mellitus are contradictory in the literature. Early studies described a decreased bone mineral density in type 1 diabetes mellitus (T1DM), but recent studies report no osteopenia in T1DM.The BMD may depend on the quality of treatment for diabetes mellitus and on the presence of chronic complications. In type 2 diabetes mellitus (T2DM) the BMD is not decreased, occasionally it can even be increased. PATIENTS AND METHODS - Bone mineral density was measured in 122 regularly controlled diabetic patients (T1DM: n=73, mean age: 43.6±11.1 years,T2DM: n=49, mean age: 61.8±9.8 years) by dual energy X-ray absorptiometry at the lumbar spine and at the femur. Results were compared to those of 40 metabolically healthy control persons with a mean age of 47.5±11.9 years.The patients’ carbohydrate metabolism was assessed by the average HbA1c level of the last three years.These values were 7.9±1.4 % in T1DM, and 7.5±1.7 % in T2DM. BMDs were classified based on the T-score and Z-score using the WHO criteria. RESULTS - There was no significant difference in T1DM or in T2DM compared to the reference group in the prevalence of either osteoporosis or of osteoporosis and osteopenia combined. CONCLUSION - BMD was not found to be decreased in patients with well-controlled metabolism compared to healthy controls.]
Hypertension and nephrology
[The importance of hypertension in type 2 diabetes mellitus, the method of continuous blood pressure control and patient’s careas well as the forms of non-drug and drug therapy have been disclosed by presenting therapeutical recommendations from American, European scientific societies and international organizations. It has been established that the principles of care and treatment of hypertonia have basically remained unchanged in diabetes all over the world, despite the recent widespread debate over the interpretation of normal blood pressure and the consideration of the benefits of intensive or standard treatment.]
Hypertension and nephrology
[Authors had found diabetes mellitus type 2 in 30% of 38 886 hypertensive patients (stadium I-III). Diabetes was more frequent in case of women under 30 years. Subsequently all age groups (from 40 to 80 years) incidence was more frequently (p<0.01-0.001) in men, above 80 years again a higher ratio was in women. Presence of diabetes was correlated to rate of BMI value and systolic, diastolic pressure as well. In women - above 140 mmHg systolic pressure - the elevation was exponential. We have found a significant correlation between fasting glucose and waist. Reaching the target blood pressure is not a simply task in hypertensive patients with diabetes. The 140/90 mmHg was reached in 34.2%, 90 mmHg diastolic blood pressure in 62.3%, but the required 80 mmHg only in 16.4% of cases. Achieve the target value was quite different in the different region of our country. The major cardiovascular complications (stroke, renal disease, myocardial infarction, peripheral artery disease) have suffered a higher rate in the hypertensives with diabetes compered to hypertensives without diabetes.]
Lege Artis Medicinae
[The prognosis of patients with diabetes mellitus is mainly influenced by vascular complications which is partly due to the deterioration of the microcirculation. Laser Doppler flowmetry is a suitable method to investigate the complex disturbance that characteristic for diabetic microcirculation. This review gives a summary of the anatomical, physiological and theoretical backgrounds and the possibilities in diagnosis given by Laser Doppler flowmetry.]
Lege Artis Medicinae
[Recently, lixisenatide, a new incretin mimetic GLP-1-receptor agonist with a mainly prandial effect has been registered for the treatment of patients with type 2 diabetes mellitus. The amino acid sequence of lixisenatide and that of human native GLP-1 is 50% identical. Due to its altered amino acid sequence and conformation, lixisenatide is resistant to inactivation by DPP-4. Lixisenatide is a specific agonist of GLP-1- receptors and its binding has a pharmacologic GLP-1-agonist effect. Lixisenatide is used subcutaneously, its normal daily dose is 1×20 μg. It is mostly used in combination with metformin, but it can be also used to supplement sulfanylurea or basal insulin therapy. Clinical efficiency of lixisenatide has been investigated in the phase-III GetGoal trials. In these trials, adequate glycaemic control and a marked decrease in postprandial blood glucose values were observed. During lixisenatide therapy, a decrease in body weight and no substantial increase in the risk of hypoglycaemia were observed, whereas transient gastrointestinal side effects might occur after initiation of treatment. Lixisenatide as an add-on treatment to basal insulin should be considered as a new treatment approach in the management of type 2 diabetes.]
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