Psychotherapy intervention to reduce depressive symptoms in patients with diabetic foot syndrome.

AIMS: Compared to the population as a whole, patients with diabetes mellitus suffer a significantly higher rate of depressive symptoms, especially when they develop complications. Psychotherapy treatments in diabetes mellitus can lead to improvements in both depressive symptoms and glycaemic control. The objective of this study was to investigate whether depressive symptoms can be reduced by psychotherapy treatment delivered as a joint interdisciplinary service to in-patients with diabetic foot syndrome and comorbid depression. METHODS: Thirty in-patients with diabetic foot syndrome and comorbid depression were randomized to either an intervention group (n = 15) with supportive psychotherapy treatment or a control group (n = 15) that received only standard medical treatment. Patients completed a set of questionnaires at the beginning and end of treatment. These recorded sociodemographic variables, anxiety and depression (Hospital Anxiety and Depression Scale) and diabetes-related problems (Problem Areas in Diabetes Scale). RESULTS: Although the diabetic foot syndrome improved significantly in 75% of patients, the extent of depressive symptoms and anxiety reported by the control group did not decrease by the end of treatment. In contrast, in the intervention group, anxiety, depression and diabetes-related problems were all reduced. The extent of anxiety and depression was not, as had been anticipated, associated with the severity of the physical symptoms. CONCLUSIONS: These results indicate that psychotherapeutic intervention during in-patient treatment can have a positive influence on anxiety, depressive symptoms and diabetes-related problems in patients with diabetic foot syndrome.

Classical conditioning of insulin effects in healthy humans.

OBJECTIVE: Classical conditioning of insulin effects was examined in healthy humans using a placebo-controlled design. This study examined whether subjects who experienced a conditioned stimulus (CS) paired with insulin in the acquisition phase of a conditioning protocol would show a conditioned decrease of blood glucose when receiving the CS with a placebo injection in the test phase. METHODS: Twenty healthy male students were assigned either to group 1, which received insulin (0.035 IU/kg i.v.), or to group 2, which received i.v. saline on 4 consecutive days (acquisition). On day 5 (test), both groups were injected with saline. The CS was an olfactory stimulus. Blood glucose, serum insulin, plasma glucagon, plasma catecholamines, serum cortisol, and symptoms were repeatedly measured during each session. RESULTS: In the test phase, group 1 reacted with a significantly larger decrease of blood glucose after presentation of the CS than group 2. Within group 1, a larger conditioned blood glucose decrease was associated with features that enhance classical conditioning (ie, intensity of the unconditioned response and intensity of the CS). Furthermore, in group 1, there was an increase of baseline insulin from day 1 to day 5 and a tendency for insulin reduction after CS presentation. Groups also tended to differ in cortisol and neuroglycopenic symptoms after CS presentation. CONCLUSIONS: Conditioned effects in blood glucose are in accordance with the predictions. As a result of the exploratory analyses, our data also provide hints about conditioned changes in insulin, counterregulatory hormones, and symptoms.

Cognitive function in elderly non-insulin-dependent diabetic patients before and after inpatient treatment for metabolic control.

Cognitive function was measured before and after inpatient treatment for metabolic control in 20 elderly patients with non-insulin-dependent diabetes mellitus (NIDDM). Another 20 patients still on the waiting list for this treatment, served as a control group. Glycosylated hemoglobin decreased in both groups. Psychomotor speed and concentration improved only after inpatient treatment (p < 0.01; p < 0.05, respectively). Improved performance was maintained and even enhanced 6 weeks after discharge from inpatient treatment. Performance in concentration tasks correlated with glycosylated hemoglobin (p < 0.05). It is concluded that cognitive deficits in elderly NIDDM patients can be reduced by inpatient treatment, although the benefit of glycemic control was not clearly demonstrated in this study.

Comparison of metabolic and psychological parameters during continuous subcutaneous insulin infusion and intensified conventional insulin treatment in type I diabetic patients.

Two methods of insulin treatment--intensified conventional therapy (ICT) of three to four daily injections and continuous s.c. insulin infusion (CSII)--were compared in nine patients with insulin-dependent diabetes mellitus (mean age +/- SD 29.4 +/- 5.6 years; duration of diabetes 14.6 +/- 2.9 years). Patients followed each regimen for 3 to 4 months. Under both regimens hemoglobin A1 (HbA1) levels were lower than those recorded previously, but under CSII the mean HbA1 and glucose levels were significantly lower than under ICT (7.8 +/- 0.1 vs. 8.9 +/- 0.2% for HbA1 and 136 +/- 40 vs. 155 +/- 60 mg/dl for blood glucose, P less than 0.001). There was no difference in the frequency of blood glucose levels less than 60 mg/dl, but under CSII hypoglycemic symptoms appeared at lower glucose levels. There was no marked difference between the two regimens regarding scores for depression and anxiety and other psychological parameters, but patients who chose to continue treatment with CSII following completion of the study had previously manifested a significantly higher degree of distress symptoms, which had been reduced during the study. CSII was preferred by some patients because of the superior metabolic control achieved and the greater flexibility in time and size of meals permitted, but was rejected by others because of technical failures and bulkiness of the device. It is concluded that metabolic control can be improved by either regimen, but external pumps must be further miniaturized and technical failures eliminated before CSIII is acceptable to larger numbers of patients.