[Proposals for comprehensive approach to patient education for the care of type 2 diabetic patients]. / Propositions pour une approche compréhensive de l'éducation thérapeutique du patient diabétique de type 2.

The diagnosis of type 2 diabetes is generally put within the context of a medical check-up at a person more or less predisposed to the disease. From the patient's point of view the reality of the disease is thus at this moment at least abstracted, and can go from banalisation to dramatization. This aspect is going to influence how the patient is going to get involved in the approach of care and thus in the therapeutic educational process. We suggest being interested in this difficulty through three fundamental questions of the experience of the patient: the question of the identical break, the question of the sense and the question of self-efficacy. Because never definitively resolved, these questions will accompany the reflection of the patient and caregiver all along the route of care. By illustrating here a posture of care which legitimizes such a glance on the experience of the carrier of the disease, we defend an approach of the therapeutic education of the patient integrated into the care.

Independent evolution of heart autonomic function and insulin sensitivity during weight loss.

In order to investigate the improvement of insulin resistance and cardiac autonomic function along massive weight loss, 12 obese women were evaluated before, and 3 and 12 months after Roux-en-Y gastric bypass. The 12-month values were compared to those of BMI-matched controls. Insulin sensitivity was assessed by euglycemic clamp and the cardiac autonomic function by the analysis of the Heart Rate Variability (HRV). After surgery, glucose uptake progressively increased from 4.3 +/- 0.5 mg/kg lean body mass (LBM)/min preoperative (pre-op) to 4.9 +/- 0.5 and 7.0 +/- 0.5, 3- and 12-month postoperative (post-op) (P = 0.04 and P = 0.006 vs. pre-op), whereas the cardiac autonomic function showed a biphasic pattern. HRV values increased 3 months post-op, and decreased at 12 months, thus indicating an early sympathetic withdrawal followed by a later reactivation (e.g., the standard deviation of the normal-to-normal intervals was 116 +/- 7 ms in pre-op, 161 +/- 10 at 3 months, P = 0.008 vs. pre-op, and 146 +/- 15 at 12 months, P = 0.03 vs. pre-op and P = 0.02 vs. 3 m). Insulin sensitivity was significantly related to body weight (P = 0.02), whereas the cardiac indexes were significantly linked to the profile of energy intake (e.g., HRV triangular index vs. energy intake P = 0.003). No significant relationship linked insulin sensitivity to the cardiac autonomic indexes. Insulin sensitivity and cardiac parameters of the 12-month post-op patients were similar to their matched controls. During massive weight loss, the cardiac autonomic deregulation and insulin resistance improved concomitantly but independently from each other. Our results suggest that the extent of the improvement is associated with the final body weight.

[Fighting heart attacks and atherosclerosis: a therapeutical challenge]. / Combattre l'infarctus du myocarde et l'athérosclérose: un défi thérapeutique.

Myocardial infarction is a frequent, serious and recurrent complication of a chronic disease: atherosclerosis. Therapeutic advances have improved the clinical outcome of affected patients and have shortened the hospital length of stay. However, to decrease the recurrence of cardiovascular events, it is essential to increase adherence to therapeutic projects by improving information given to coronary patients during the short initial hospitalization. This can be achieved by using tools that have been developed for the management of chronic disease: therapeutic education and motivational interviews. Moreover, these information tools have to perform well and have to be used at appropriate times to ensure a positive effect on patients.

[Representations, behavior and obesity]. / Représentations, comportements et obésité.

Dealing with a long term chronic disease necessarily implies changes of behaviour. In the field of obesity, these behaviours concern habits which are very often firmly fixed in patients' lives. The study of patients' representations is of great interest in the medical field. Representations guide behaviours and therefore build up an important factor which determines the adherence to the treatment. Representations always have a foundation and making them rise up induces a non-judge-mental attitude. The health care provider can help the patient make them evolve. It must be highlighted that health care providers' representations are also important, particularly in the therapeutic relationship. This article proposes a reflection on the obese patients follow-up situation as well as some clinical implications.

Enhancing regular physical activity and relapse prevention through a 1-day therapeutic patient education workshop: A pilot study.

OBJECTIVE: Physical activity (PA) is important for managing chronic diseases, such as diabetes and obesity. Yet over half of patients who adopt PA programs do not maintain them at 6 months. To encourage regular PA among our patients, we developed a 1-day outpatient motivational workshop based on well-known theoretical frameworks. The purpose of this pilot study was to evaluate the effectiveness of the motivational workshop in terms of total and activity-specific energy expenditures (EE) and body mass index (BMI). METHODS: This workshop is an integrative model of multiple theoretical frameworks for therapeutic education and behavior change, alternating individual sessions and group sessions in a multidisciplinary setting. Patients completed a validated, self-administered, quantitative PA frequency questionnaire at baseline and at 1 year. Stages of change and relapse risk were identified at baseline. RESULTS: Twenty-five subjects, mean age 48 years and BMI 34.1kg/m(2), completed pre-/post-evaluations. At baseline, 73% of subjects reported regular activities of daily living and 52% reported regular formal exercise. Using total and activity-specificEE, we identified 69.2% as sedentary. A relapse risk was recognized in 76%. Paired t-tests showed significant (P=0.048) reductions in weight and BMI and a significant (P=0.015) increase in high-intensity exerciseEE. Total EE showed no difference. Among baseline sedentary subjects, 39% became active. CONCLUSION: This workshop may be effective in modifying PA patterns, thereby decreasing sedentarism and fostering PA maintenance. PRACTICE IMPLICATIONS: The theory-based workshop for increasing motivation to maintain optimal PA behavior provides an example of translational intervention from theoretical models to clinical practice.