Mood changes associated with blood glucose fluctuations in insulin-dependent diabetes mellitus.

Examined relationships between blood glucose (BG) levels and self-reported mood in 34 19–68 yr old insulin-independent diabetes mellitus patients. Four times each day, Ss completed a mood/symptom checklist before a self-measurement of BG until 40 checklists had been completed. Half the items of the checklist described physical symptoms, and half described mood states. Within-S correlations and regressions showed that moods were related to BG for the majority of Ss and that, like physical symptoms, mood–BG relationships were idiosyncratic. Low BG levels were associated with negative mood states; positive mood items were almost always associated with high BG. High BG levels also frequently correlated with negative mood states, although the negative mood items that related to high glucose (anger, sadness) differed from those that tended to relate to low BG. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Environmental stress and blood glucose change in insulin-dependent diabetes mellitus.

Investigated blood glucose (BG) response to psychological stress in 14 22–65 yr old insulin-dependent diabetes mellitus patients. Ss were exposed to 2 sessions (12 wks apart) of 2 20-min standardized stressors (active and passive) and a control condition administered in counterbalanced order. BG response was measured, and mood checklist measures were obtained at prestressor, poststressor, and recovery periods. During the 1st session of testing, the active stressor was associated with significantly more absolute change in BG response than the passive stressor. Ss' BG response to this active stressor was idiosyncratic but significantly reliable over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stochastic model of self-regulation decision making exemplified by decisions concerning hypoglycemia.

The following sequence—internal condition → symptom perception → appraisal → decision—models various symptom-based self-regulation processes. A formal mathematical model describes the first three steps by continuous variables and the decisions at the fourth step by binary variables. The stochastic transitions between the sequential steps are quantified by transition probabilities. The model is illustrated by blood glucose level estimation and detection and treatment of hypoglycemia in 78 patients with insulin-dependent diabetes mellitus. These patients made 50 to 70 data collection trials over 3 to 4 weeks recording perceived symptoms, cognitive-motor performance, subjective estimates of blood glucose, decisions about treatment of hypoglycemia, and driving. A statistical estimation of the model's parameters demonstrates the utility of this approach for understanding the awareness, detection, and treatment of hypoglycemia as a process of symptom-based decision making. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of risk for severe hypoglycemia among adults with IDDM: validation of the low blood glucose index

OBJECTIVE: To evaluate the clinical/research utility of the low blood glucose index (LBGI), a measure of the risk of severe hypoglycemia (SH), based on self-monitoring of blood glucose (SMBG). RESEARCH DESIGN AND METHODS: There were 96 adults with IDDM (mean age 35+/-8 years, duration of diabetes 16+/-10 years, HbA1 8.6+/-1.8%), 43 of whom had a recent history of SH (53 did not), who used memory meters for 135+/-53 SMBG readings over a month, and then for the next 6 months recorded occurrence of SH. The SMBG data were mathematically transformed, and an LBGI was computed for each patient. RESULTS: The two patient groups did not differ with respect to HbA1, insulin units per day, average blood glucose (BG) and BG variability. Patients with history of SH demonstrated a higher LBGI (P < 0.0005) and a trend to be older with longer diabetes duration. Analysis of odds for future SH classified patients into low- (LBGI <2.5), moderate- (LBGI 2.5-5), and high- (LBGI >5) risk groups. Over the following 6 months low-, moderate-, and high-risk patients reported 0.4, 2.3, and 5.2 SH episodes, respectively (P = 0.001). The frequency of future SH was predicted by the LBGI and history of SH (R2 = 40%), while HbA1, age, duration of diabetes, and BG variability were not significant predictors. CONCLUSIONS: LBGI provides an accurate assessment of risk of SH. In the traditional relationship history of SH-to-future SH, LBGI may be the missing link that reflects present risk. Because it is based on SMBG records automatically stored by many reflectance meters, the LBGI is an effective and clinically useful on-line indicator for SH risk.     

Perceived symptoms in the recognition of hypoglycemia

For people with diabetes, detection of hypoglycemic symptoms is a critical tool for the recognition and treatment of hypoglycemia. This is not a simple process involving only the occurrence of a hypoglycemic-relevant physiological event, such as sweating. We propose a four-step biological and psychological model that leads to the accurate recognition of hypoglycemia through symptoms. The model illustrates both the chronic and transient modifiers that can enhance and interfere with recognition of hypoglycemia. Three common methods are used to investigate the occurrence and utility of hypoglycemic symptoms that relate to this model. This article reviews the advantages and disadvantages of these methods, providing previously unpublished illustrative data. The field study hit/false alarm approach was shown to be the most useful method. The relevance of this model and data to the concept of hypoglycemic awareness/unawareness and blood glucose awareness training is discussed.     

Reaction time impairment in insulin-dependent diabetes: Task complexity, blood glucose levels, and individual differences.

The effects of hypoglycemia on cognitive processing speed as measured by reaction time (RT) were evaluated in 25 adults (13 women and 12 men) with insulin-dependent diabetes. Simple, choice, and complex RT tasks were administered in a single-blind repeated measures cross-over design. On the experimental day, participants performed tests at euglycemia (80-120 mg/dl), then at mild (55-70 mg/dl) and moderate (33-50 mg/dl) hypoglycemia, and again at euglycemia. On the control day, participants performed tests 4 times at euglycemia. Three months later, 15 participants repeated the experimental day protocol. Results indicated significant increases in RT at moderate hypoglycemia. Individuals varied greatly in their response to mild and moderate hypoglycemia. Individual differences in hypoglycemia sensitivity were not reliable across time and did not correlate with individual difference variables. Complex and simple RT tasks were equally sensitive to cognitive slowing associated with hypoglycemia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diabetes and behavioral medicine: The second decade.

Diabetes management depends almost entirely on behavioral self-regulation. Behavioral scientists have continued a collaboration with other health systems researchers to develop a holistic approach to this disease. The authors summarized the literature in 4 major areas: self-management of diabetes, psychosocial adjustment and quality of life, neuropsychological impact, and psychobehavioral intervention development. Progress made in each of these areas over the past decade is highlighted, as are important issues that have not yet received sufficient scientific attention. Emerging areas likely to become central in behavioral research, such as diabetes prevention, are introduced. The future of behavioral medicine in diabetes is also discussed, including topics such as the changing role of psychologists in diabetes care, the urgent need for more and better intervention research, the growing importance of incorporating a health system-public health perspective, and obstacles to the integration of psychobehavioral approaches into routine health care delivery. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Internet interventions: In review, in use, and into the future.

The provision of health care over the Internet is a rapidly evolving and potentially beneficial means of delivering treatment otherwise unsought or unobtainable. Internet interventions are typically behavioral treatments operationalized and transformed for Web delivery with the goal of symptom improvement. The literature on the feasibility and utility of Internet interventions is limited, and there are even fewer outcome study findings. This article reviews empirically tested Internet interventions and provides an overview of the issues in developing and/or using them in clinical practice. Future directions and implications are also addressed. Although Internet interventions will not likely replace face-to-face care, there is little doubt that they will grow in importance as a powerful component of successful psychobehavioral treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Blood glucose symptom beliefs of diabetic patients: Accuracy and implications.

Tested the accuracy of blood glucose (BG) symptom beliefs in 16 female and 10 male 16–64 yr old insulin-dependent diabetics. A within-Ss, repeated measures design was used to identify symptoms related to low and high BG levels for individual Ss. At the end of a year, Ss reported which symptoms they believed were related to their own low and high BG levels. Across Ss, the frequency of accurate beliefs (hits and correct rejections) was higher than the frequency of inaccurate beliefs (false alarms and misses). Female Ss' symptom beliefs yielded more hits, as well as more false alarms. Males missed more symptoms, especially low BG symptoms, than females. Symptom belief accuracy was greater if symptom–BG relationships remained stable across time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Major developments in behavioral diabetes research.

Over the past decade, there has been a major increase in behavioral diabetes research. This review focuses on 6 areas: self-treatment, psychosocial impact, diabetes-specific assessment, psychological stress, weight loss intervention, and neuropsychological effects. There has been great progress in identifying factors that predict self-treatment behaviors and psychological adjustment. This research has produced a number of diabetes-specific assessment tools. Psychological stress appears to affect both the etiology and the control of diabetes, but underlying mechanisms remain unclear. Weight loss studies demonstrate the potential benefits of behavioral interventions for diabetes management. Both acute and chronic abnormalities in diabetic blood glucose cause neuropsychological impairments and may cause permanent deficits. The challenge for the next decade is to translate these findings into interventions that improve the quality of life and physical well-being for individuals with diabetes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)