[Psychosocial predictors of metabolic instability in brittle diabetes--a multivariate time series analysis]

Brittle diabetes: Psychopathology and personality

The term "brittle" is used to describe an uncommon subgroup of patients with type I diabetes whose lives are disrupted by severe glycaemic instability with repeated and prolonged hospitalization. Psychosocial problems are the major perceived underlying causes of brittle diabetes. Aim of this study is a systematic psychopathological and personological assessment of patients with brittle diabetes in comparison with subjects without brittle diabetes, using specific parameters of general psychopathology and personality disorders following the multi-axial format of the current DSM-IV-TR (Diagnostic and Statistical manual of Mental Disorders - IV Edition - Text Revised) diagnostic criteria for mental disorders. Patients comprised 42 subjects with brittle diabetes and a case-control group of 42 subjects with stable diabetes, matched for age, gender, years of education, and diabetes duration. General psychopathology and the DSM-IV-TR personality disorders were assessed using the Symptom Checklist-90-Revised (SCL-90-R) and the Structured Clinical Interview for axis II personality Disorders (SCID-II). The comparison for SCL-90-R parameters revealed no differences in all primary symptom dimensions and in the three global distress indices between the two groups. However, patients with brittle diabetes showed higher percentages in borderline, histrionic, and narcissistic personality disorder. In this study, patients with brittle diabetes show no differences in terms of global severity of psychopathological distress and specific symptoms of axis I DSM-IV-TR psychiatric diagnoses in comparison with subjects without brittle diabetes. Differently, individuals with brittle diabetes are more frequently affected by specific DSM-IV-TR cluster B personality disorders.

New Methods in Exploring Old Topics: Case Studying Brittle Diabetes in the Family Context

BACKGROUND

In questing for a more refined quantitative research approach, we revisited vector autoregressive (VAR) modeling for the analysis of time series data in the context of the so far poorly explored concept of family dynamics surrounding instable diabetes type 1 (or brittle diabetes).

METHOD

We adopted a new approach to VAR analysis from econometrics referred to as the optimized multivariate lag selection process and applied it to a set of raw data previously analyzed through standard approaches.

RESULTS

We illustrated recurring psychosomatic circles of cause and effect relationships between emotional and somatic parameters surrounding glycemic control of the child's diabetes and the affective states of all family members.

CONCLUSION

The optimized multivariate lag selection process allowed for more specific, dynamic, and statistically reliable results (increasing R(2) tenfold in explaining glycemic variability), which were derived from a larger window of past explanatory variables (lags). Such highly quantitative versus historic more qualitative approaches to case study analysis of psychosomatics surrounding diabetes in adolescents were reflected critically.

Time-series analysis of continuously monitored blood glucose: the impacts of geographic and daily lifestyle factors

Type 2 diabetes is known to be associated with environmental, behavioral, and lifestyle factors. However, the actual impacts of these factors on blood glucose (BG) variation throughout the day have remained relatively unexplored. Continuous blood glucose monitors combined with human activity tracking technologies afford new opportunities for exploration in a naturalistic setting. Data from a study of 40 patients with diabetes is utilized in this paper, including continuously monitored BG, food/medicine intake, and patient activity/location tracked using global positioning systems over a 4-day period. Standard linear regression and more disaggregated time-series analysis using autoregressive integrated moving average (ARIMA) are used to explore patient BG variation throughout the day and over space. The ARIMA models revealed a wide variety of BG correlating factors related to specific activity types, locations (especially those far from home), and travel modes, although the impacts were highly personal. Traditional variables related to food intake and medications were less often significant. Overall, the time-series analysis revealed considerable patient-by-patient variation in the effects of geographic and daily lifestyle factors. We would suggest that maps of BG spatial variation or an interactive messaging system could provide new tools to engage patients and highlight potential risk factors.

[Does brittle diabetes exist as a clinical entity?]

The best comprehension about the instability of the glycemia levels in type 1 diabetes mellitus (T1DM) patients and the availability of new alternatives to successfully control it, like insulin pump therapy and the insulin analogues, underlined the questions about the brittle diabetes existence as a clinical entity as well as the necessity of define it. The aim of this article was to describe the concept of brittle diabetes in the light of the latest advances in the treatment of type 1 diabetes and propose objective criteria to evaluate the level of glucose liability.

Mood, eating attitudes, and anger in obese women with and without Binge Eating Disorder

OBJECTIVE

The aim of this study was to evaluate the anger levels and their management in obese patients.

METHODS

A total of 103 obese women [51 with Binge Eating Disorder (BED) and 52 without BED] were included in the study and compared to 93 healthy controls. They were assessed with the State-Trait Anger Expression Inventory (STAXI), Beck Depression Inventory (BDI), and Eating Disorder Inventory-2 (EDI-2).

RESULTS

The BDI score is higher in obese subjects than in controls and obese binge eaters have higher levels of depression than obese patients without BED. Differences among the three groups can be found in almost all subscales of the EDI-2, even after controlling for the variable depression (BDI). For STAXI, the only difference among the three groups, which remains significant after controlling for depression, is the tendency to express anger outside (AX-OUT), which is higher in obese binge eaters. The correlation study highlights the importance of impulsivity in the group of obese binge eaters, whereas in obese patients without BED, the tendency toward anger suppression (AX-IN) is seen.

DISCUSSION

Obese patients with BED might be considered a subgroup deserving greater psychiatric interest, both for the greater severity of the eating disorder and for the comorbidity with subthreshold depressive symptoms and with borderline personality traits. In obese patients without BED, eating behavior seems more correlated to the psychological functioning typical of psychosomatic disorders. Implications for treatment are discussed.