The SA Journal Diabetes & Vascular Disease Vol 11 No 4 (November 2014)

32 / 44

166 VOLUME 11 NUMBER 4 • NOVEMBER 2014
LEARNING FROM PRACTICE SA JOURNAL OF DIABETES & VASCULAR DISEASE
psychological factors relating to self blood glucose monitoring with
the finger-prick method. In those who cited forgetfulness, laziness
or time pressure and technical issues, further diabetes education
strategies could have a defined focus.
Increasedawareness of theproblemplusmore specific assessment
tools should identify those who might benefit from psychological
treatments including cognitive behavioural therapy techniques. In
extreme cases identification and referral for specialist psychological
input may be warranted. These strategies may improve the
glycaemic control, and general wellbeing of those individuals.
Conflict of interest None
Funding sources None
Key messages
• A third of diabetes out-patients report some anxiety to the
finger-prick method of glucose testing and also general
anxiety.
• Females report greater anxiety to the finger-prick method
as well as general anxiety and older individuals have less
general anxiety.
• This highlights two separate management strategies such
as practical/educational and psychological intervention
strategies, for example cognitive behavioural therapy.
References
1. Harris MI, Cowie CC, Howie LJ. Self-monitoring of blood glucose by adults with
diabetes in the United States population. Diabetes Care 1993; 16: 1116–1123.
2. Zambanini A, Newson RB, Maisey M, Feher MD. Injection related anxiety in insulin
– treated diabetes. Diabetes Res Clin Pract1999; 46: 239–246. .
org/10.1016/S0168-8227(99)00099-6
3. Green L, Feher MD, Catalan J. Fears and phobia in people with diabetes.
Diabetes/Metab Res Rev 2000; 16: 287–293.
7560(2000)9999:9999<::AID-DMRR123>3.0.CO;2-T
4. Anderson RJ, De Groot M, Grigsby AB, et al. Anxiety and poor glycaemic control:
A meta-analytic review of the literature. Int J Psych Med 2002; 32: 235–247.
5. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr
Scand 1983; 67: 361–370.
6. Allsup SJ, Gosney MA. Anxiety and depression in an older research population
and their impact on clinical outcomes in a randomised controlled trial. Postgrad
Med J 2002; 78: 674–677.
7. Mollema ED, Snoek FJ, Heine RJ, Van der Ploeg HM. Phobia of self-injecting and
self-testing in insulin-treated diabetes patients: opportunities for screening. Diabet
Med 2001; 18: 671–674. j.1464-5491.2001.00547.x
8. Nir Y, Paz A, Sabo E, Potasman I. Fear of Injection in young adults: prevalence and
associations. Tropl Med Hygiene 2003; 68: 341–344.
9. Thomas J, Jones G, Scarinci I, Brantley P. A Descriptive and comparative study of
the prevalence of depressive and anxiety disorders in low-in-come adults with
type 2 diabetes and other chronic illnesses. Diabetes Care 2003; 26: 2311–2317.
10. Kohen D, Burgess AP, Catalan J, Lant A. The role of anxiety and depression in
quality of life and symptom reporting in people with diabetes mellitus. Qual Life
Res 1998; 7: 197–204. :1008817812520
11. Snoek FJ, Malanda UL, de Wit M. Self-monitoring of blood glucose: psychological
barriers and benefits. Eur Diabetes Nurs 2008; 5: 112–115.
12. Burge MR. Lack of compliance with home blood glucose monitoring predicts
hospitalization in diabetes. Diabetes Care 2001; 24: 1502–1503.
org/10.2337/diacare.24.8.1502
Losing weight at any age can improve cardiovascular health
Weight loss at any age in adulthood is worthwhile because it
could yield long-term heart and vascular benefits. The results
are from a study ongoing from 1946, examining the impact of
lifelong patterns of weight change on cardiovascular risk factors in
a group of British men and women followed since birth.
They showed that the longer the exposure to excess body fat
(adiposity) in adulthood, the greater the cardiovascular-related
problems in later life, including increased thickness of the carotid
artery walls, raised systolic blood pressure, and increased risk of
diabetes. The findings were published online on 21 May 2014 in
the Lancet Diabetes & Endocrinology.
For the first time, the findings also indicate that adults who drop
a body mass index (BMI) category, from obese to overweight, or
from overweight to normal at any time during adult life, even if they
regain weight, can reduce these cardiovascular manifestations.
The study used data from 1 273 men and women from the UK
Medical Research Council National Survey of Health and Develop-
ment (NSHD). Participants were classified as normal weight, over-
weight or obese in childhood and at 36, 43, 53 and 60–64 years
of age. Cardiovascular phenotyping between the ages of 60 and
64 years with carotid intima–media thickness (cIMT; a surrogate
marker for cardiovascular events) was used to assess the effect of
lifetime exposure to adiposity on cardiovascular risk factors.
Prof John Deanfield, lead author, from University College
London (UCL) said, ‘Our study is unique because it followed
individuals for such a long time, more than 60 years, and allowed
us to assess the effect of modest, real-life changes in adiposity.
Our findings suggest that losing weight at any age can result
in long-term cardiovascular health benefits, and support public
health strategies and lifestyle modifications that help individuals
who are overweight or obese to lose weight at all ages.’
Elizabeth Cespedes and Frank Hu from the Harvard School of
Public Health, Boston, USA, commented on the study. ‘Although it
is encouraging that even transitory weight loss during adulthood
has cardiovascular benefits, only 2% of participants in the present
study had a sustained reduction in BMI category in adulthood,
underscoring the importanceofweightmaintenanceandprevention
of weight gain as priorities for public health programming and
policy. Improvements in diet and increases in physical activity are
crucial levers of long-term weight maintenance and prevention of
weight gain in middle-age and early adulthood.
Overweight individuals might have even greater health benefit
from lifestyle changes such as increased physical activity than
do normal-weight individuals. The results of this study affirm a
continued emphasis on public health policies that enable lifestyle
changes to achieve and, especially, to maintain a healthy BMI.’
They add, ‘Ideally, future research will address long-term
patterns of intentional versus unintentional weight loss, the
means to achieve weight loss and the weight loss maintenance
necessary to reduce cardiovascular endpoints.’
Source
can-improve-cardiovascular-health.