The Problem Areas in Diabetes (PAID) scale: psychometric evaluation survey in a Greek sample with type 2 diabetes

Several instruments have been developed for the assessment of emotional distress in patients with diabetes. The Problem Areas in Diabetes Scale (PAID) is a brief self-report scale that evaluates diabetes-related distress. There is a lack of validated instruments for the evaluation of psychological aspects in patients with diabetes in Greek language. The current study was conducted to translate and adapt the PAID scale in Greek language and to evaluate the psychometric properties in two different study populations of patients with diabetes. The aim of this study was to translate the Problem Areas in Diabetes (PAID) scale into Greek, adapt it culturally to Greece and determine its psychometric properties. The translation process included two forward translations, reconciliation, backward translation and pre-testing steps. The validation incorporated the exploration of internal consistency (Cronbach's alpha), test-retest reliability (interclass correlation coefficient), construct validity (exploratory factor analysis) and responsiveness (Spearman correlation coefficient). Participants included 101 consecutive patients from a rural primary healthcare centre and 101 patients from an urban hospital. All patients completed the PAID scale and the Short Form-36 (SF-36) version 2. Internal consistency considered good (Cronbach's alpha = 0.948). Interclass correlation coefficient was 0.942 (95% CI 0.915-0.961). Factor analysis yielded three factors: 'Diabetes-related emotional problems' (51.79% variance, Cronbach's alpha = 0.910), 'Food-related problems' (9.55% variance, Cronbach's alpha = 0.824) and 'Social support-related problems' (5.96% variance, Cronbach's alpha = 0.704). Screen plot test and conceptual congruency of items supported a three-factor solution. Total PAID showed a negative correlation with both SF-36 mental component summary (r = -0.733, P < 0.0001) and SF-36 physical component summary (r = -0.594, P < 0.0001). Our findings indicate that the Greek version of the PAID questionnaire is reliable and valid for patients with diabetes mellitus in Greece.

A high-protein low-fat diet is more effective in improving blood pressure and triglycerides in calorie-restricted obese individuals with newly diagnosed type 2 diabetes

BACKGROUND/OBJECTIVES

There is controversy over dietary protein's effects on cardiovascular disease risk factors in diabetic subjects. It is unclear whether observed effects are due to increased protein or reduced carbohydrate content of the consumed diets. The aim of this study was to compare the effects of two diets differing in protein to fat ratios on cardiovascular disease risk factors.

SUBJECTS/METHODS

A total of 17 obese (body mass index (BMI) ranging from 31 to 45 kg/m(2)) volunteers with type 2 diabetes (DM2), aged 46+/-3 years, consumed two diets, each for 4 weeks, with 3 weeks of washout period in a random, blind, crossover design. The diets were: (1) a high-protein low-fat diet (HP-LF, with 30% protein, 50% carbohydrates and 20% fat) and (2) a low-protein high-fat diet (LP-HF, with 15% protein, 50% carbohydrates and 35% fat). Their effects on fasting glycemic control, lipid levels and blood pressure, and on postprandial glucose and insulin responses after a standard test meal at the beginning and end of each dietary intervention were analyzed.

RESULTS

Both diets were equally effective in promoting weight loss and fat loss and in improving fasting glycemic control, total cholesterol and low-density lipoprotein (LDL) cholesterol, but the HP-LF diet decreased to a greater extent triglyceride (TG) levels (P=0.04) when compared with the LP-HF diet. HP-LF diet improved significantly both systolic and diastolic blood pressure when compared with the LP-HF diet (P<0.001 and P<0.001, respectively). No differences were observed in postprandial glucose and insulin responses.

CONCLUSIONS

A protein to fat ratio of 1.5 in diets significantly improves blood pressure and TG concentrations in obese individuals with DM2.

Impact of the metabolic syndrome and its components combinations on arterial stiffness in Type 2 diabetic men

AIM

Arterial stiffness (AS) is a risk marker of atherosclerosis and coronary artery disease, yet its association with metabolic syndrome (MS) in diabetic patients is not established. The aim of this study was to investigate possible association of MS or its components with AS in diabetic population and to identify the MS definition which better correlates with AS.

METHODS

Overall, 98 type-2 diabetic men, mean age 64+/-10 years, were classified into groups according to the presence of MS, using the National Cholesterol Educational Program-Adult Treatment Panel III (NCEP-ATPIII) and International Diabetes Federation (IDF) definition. AS was estimated using carotid-femoral pulse wave velocity (PWV). For between-group comparisons and correlations between MS and it's components with AS, t-test and Pearson's correlation coefficient were employed, respectively. For multivariable analysis a linear regression model was used.

RESULTS

PWV in those with (72.5%) and without NCEP-ATPIII MS was 13.4+/-2.9 vs 12+/-3.2 m/s (P=NS) and in those with (79.6%) and without IDF MS 13.6+/-2.8 vs 11+/-3.2 m/s (P=0.036). AS positively correlated with IDF MS (r=0.332, P=0.036), increased blood pressure (r=0.324, P=0.037), and the combination of increased waist circumference according to IDF with hypertension (r=0.380, P=0.013); no correlation with NCEP-ATPIII MS was detected. In multivariable analysis, age, hypertension, and IDF MS were independently associated with AS (beta=2.52, P=0.039).

CONCLUSIONS

IDF MS is independently associated with increased AS in diabetic men. Additionally, abdominal obesity, hypertension and older age were likely to be associated with increased AS. PWV measurement may be indicated in such patients.