Daily activity level buffers stress-glycemia associations in older sedentary NIDDM patients

Is personality profile a relevant determinant of fatigue in multiple sclerosis?

The origin and pathophysiological background of multiple sclerosis (MS)-associated fatigue is poorly understood. There is no unifying concept of its nature and its determinants to date. This paper reviews possible influences of factors determining personality profile on fatigue in MS. Likewise, the role of psychological factors and their interaction with personality to promote fatigue is discussed. Current data suggest that fatigue, especially in early MS states, may be influenced by vulnerable personality traits and personality-associated features. Among them are depressive disease coping, avoidance behavior and inhibition, irritability, less extraversion, neuroticism, lower reward responsiveness, and somatization behavior. However, among the validated personality factors, no genuine influences that are independent of depression have been documented. From a psychological perspective, depressiveness, anxiety, and somatization may be relevant mediators of fatigue. Interesting to note that in early MS, a psychiatric diagnosis is significantly more likely than on a later stage of the disease and that fatigue and motivation might share neural circuits. It is hypothesized that psychological factors promote fatigue in MS by psychological distress and sustained neuroendocrine and neurovegetative stress response. Despite the limitations of data discussed in the paper, personality research might help to disentangle specific promoting factors of fatigue in MS. Further research efforts are warranted since they might open ways to early psychological intervention of MS-associated fatigue. This is all the more important since medication is insufficient until now.

Continuous glucose monitoring system in free-living healthy subjects: results from a pilot study

BACKGROUND AND AIM

The Continuous Glucose Monitoring System (CGMS) (Medtronic Minimed, Northridge, CA) provides an opportunity to better understand abnormalities in glucose metabolism in both healthy subjects and those with diabetes. The aims of our study were to assess the reliability of CGMS compared to self-monitoring of blood glucose (BG) and to analyze the graphs obtained in a sample of healthy free-living subjects in order to establish the suitability of CGMS in physiological studies.

METHODS

Eighteen healthy adults, 12 women and six men, were enrolled in this study. Each subject performed 24-h CGMS and inserted 24 glycemic values, measured through a glucose meter, during their common daily activities. Three subjects were excluded from the analysis since they did not meet accuracy criteria. None of the participants received any advice as regard diet and physical activity. Means and standard deviations were used to summarize quantitative data. Normal distribution of data was tested with the Shapiro-Wilk W test. Differences over time and association between glucose levels with other variables were evaluated with linear regression models for repeated measures.

RESULTS

We did not find statistically significant differences between CGMS measures and meter readings. In the subjects studied the mean glucose levels increase according to age, and we found a mean increase in glucose concentration of 0.50 mg/dL for every year of age. As regards gender, men presented a 4.63% higher mean glucose concentration than women. A 1.16% higher glucose concentration for every unit (kg/m(2)) of body mass index (BMI) was observed in both groups. All subjects presented glucose concentrations within the established range of normal glucose levels for 91% of the total duration of CGMS.

CONCLUSIONS

Our results suggest that long-term studies on larger groups of healthy subjects performing CGMS would be useful in order to better understand if BMI, daily stressors due to work or psychological stress, or other factors can influence daily BG variability and if these nonpathological alterations are related to development of glucose metabolism disorders.

Development of a community-based diabetes management program for Pacific Islanders

PURPOSE

This study examined the perception of diabetes among a sample of Pacific Islanders in Honolulu, Hawaii. All 23 participants were diagnosed with type 2 diabetes, ranged in age from 21 to 70 years, and had glycosylated hemoglobin levels of 5.8% to 13.9%.

METHODS

Four focus groups were held in English and audiotaped. Outreach workers served as translators and comoderators. The content of transcripts was analyzed with Ethnograph software by investigators. The priority issues were confirmed by the comoderators and participants.

RESULTS

Participants perceived diabetes as full of complications, emotions, symptoms, and behavior changes. Responses to hyperglycemia were fear, frustration, and uncertainty. Barriers to staying on the prescribed diet were habit, cultural ritual, ideal body image, and limited budget.

CONCLUSIONS

Participants suggested that helpful activities would include walking/support group, cooking class, community healthy food store, translated material, and family participation. A community-based diabetes program has been developing as a result of the focus group findings.