A biopsychosocial model of glycemic control in diabetes: stress, coping and regimen adherence.

This study examines stress, coping, and regimen adherence as determinants of chronic and transient metabolic control in diabetes. We also examine the interaction of biologic vulnerability and psychosocial risk factors to see if Type 1 (insulin dependent diabetes mellitus) or Type 2 (noninsulin dependent diabetes mellitus) diabetes had greater responsiveness to psychosocial risk factors. Analyses of data from insulin-treated adults with Type 1 (N = 57) and Type 2 (N = 61) diabetes supported the biopsychosocial model. For Type 1 diabetes, self-controlling persons had better glycemic control and emotional persons had worse (because of differences in stress). All of these associations were mediated by regimen compliance. For Type 2 diabetes, self-controlling persons had better glycemic control for reasons other than regimen compliance. There was an interaction between biologic and psychosocial factors, with psychosocial factors accounting for more variance in glycemic control within Type 1 patients. Stable psychosocial resources (i.e., education, being married, and positive coping styles) were associated with better chronic glycemic control, while stress and regimen nonadherence were associated with worse transient glycemic control.

Stress buffering and glycemic control. The role of coping styles.

OBJECTIVE: To test the hypotheses that chronic psychosocial stress is associated with worse glycemic control and that coping moderates (buffers) this effect. RESEARCH DESIGN AND METHODS: Subjects consisted of 105 insulin-treated adults from the Diabetes Division of Henry Ford Hospital who filled out questionnaires on stress and coping and received an HbA1 test at a clinic appointment. Six coping styles were examined, including both emotion- and problem-focused styles. Two standardized stress inventories were administered. Ineffective coping was defined as scoring below the median for stress-dampening coping styles and above the median for stress-exacerbating styles. RESULTS: Stress was significantly (P less than 0.05) correlated with higher HbA1 in all but one ineffective coping subgroup. Conversely, none of 12 correlations between stress and glycemic control was significant in the effective coping subgroups. CONCLUSIONS: Chronic psychosocial stress is associated with worse glycemic control among those who do not cope effectively with stress. Effective coping can protect individuals from the deleterious effects of stress.

Insulin therapy in diabetes. The importance of good glucose control.

Good blood glucose control is desirable to prevent or retard the chronic complications of diabetes mellitus. In diabetics who have a nearly normal hemoglobin A1c (glycohemoglobin) concentration and who can adjust their diet and activities to avoid hypoglycemia, one insulin injection daily may be adequate. In most insulin-dependent diabetics, however, a more complicated insulin regimen, tailored to the patient's needs, is required. The best treatment regimen is one that causes minimal disruption in the patient's life-style, costs little, yet produces good results. Glucose levels should be assessed frequently and therapy adjusted as needed. Although good glucose control is difficult to achieve, new monitoring techniques and insulin delivery systems have made the goal more attainable than ever before. By following the motto "Recheck often and change PRN," physicians can achieve the goal in more patients and thus help reduce the chronic complications of diabetes mellitus.

Psychosocial factors in diabetes control: adjustment of insulin-treated adults.

Twenty insulin-treated diabetic adults were studied to identify psychosocial factors important in diabetic (blood glucose) control. Diabetic control was assessed by glycosylated hemoglobin, a measure of long-term glucose control. Subjects were equally divided between "good" and "poor" glucose control groups with sex balanced in each group. A multifactorial biopsychosocial model was proposed and tested. This model incorporated both direct (psychophysiologic) and indirect (behavioral) components. The behavioral variables investigated included predisposing (orientational), enabling (resource/barrier), and conditioning (inhibiting and motivating) factors. The psychophysiologic variables investigated were stress-response factors (elevating and dampening). Univariate and multivariate analysis demonstrated significant relationships between glucose control and each category of variables, using measures of diabetes knowledge and attitudes, health locus of control, and coping styles. The findings support both the stress-coping-illness and health-belief/illness-behavior models of diabetic adjustment and control.

Addison's disease with adrenal enlargement on computed tomographic scanning. Report on two cases of tuberculosis and review of the literature.

Two patients with Addison's disease related to urogenital tuberculosis had enlargement of one or both adrenal glands detected with computed tomographic scanning. Review of reports of adrenal size on computed tomographic examination suggests that adrenal enlargement in the presence of Addison's disease demands further investigation about the cause of the adrenal insufficiency.

Wound healing with diabetes mellitus. Better glucose control for better wound healing in diabetes.

Wound healing is impaired in diabetic patients with infection or hyperglycemia. Several approaches to glucose management are discussed for patients whose diabetic history has been stable and also for those whose diabetic condition is labile or poorly controlled.

A high-wheat bran diet in insulin-treated diabetes mellitus: assessment with the artificial pancreas.

The acute effects of adding a large amount of wheat bran to a mixed meal was examined with the artificial pancreas in seven insulin-dependent diabetic patients. The timing of the peak blood glucose concentration and its magnitude were similar with both low- and high-wheat fiber meals. The total and net areas under the glucose curve were comparable. After adjusting for individual basal needs, the insulin requirements for the test meals were nearly identical. We observed no beneficial effect of added wheat bran from this study. We could not demonstrate any need for diabetic patients to adjust insulin dosage for occasional differences in meal wheat bran content.

Oskar Hirsch and surgery for exophthalmos.

Despite a better appreciation of the relationship between the eye and the thyroid gland in Graves' disease, the treatment of moderate to severe exophthalmos remains surgical. For many years, standard textbooks recommended a risky, transfrontal approach for exophthalmos that had to be performed by a neurosurgeon. A preferable transantral procedure, which can be performed by a plastic surgeon, was originally described by Oskar Hirsch, a Viennese otorhinolaryngologist, in 1930. Although his technique offers the advantage of causing less morbidity, it was several decades before its merits were widely recognized by practitioners.

Pharmacodynamics of propylthiouracil in normal and hyperthyroid subjects after a single oral dose.

Serum levels of propylthiouracil were measured in 8 normal persons and in 7 patients with hyperthyroidism after a single, 300 mg, oral dose of 6-n-propyl-2-thiouracil (PTU). The patients with hyperthyroidism were restudied after 3, 6, and 9 weeks of individualized treatment with PTU. The serum half-life of the drug in normal subjects was 1.65 h. In patients with hyperthyroidism the serum half-life was similar, and it did not change significantly as the euthyroid state was achieved.