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Eating disorder and diabetes mellitus
S234
Poster Session 2
P984
P986
Eating Disorder and Diabetes Mellitus LENA WILLIAM-OLSON.
Yoga Practice in People with Diabetes NORA MERCURI, Ercilia M. Olivera, A. Souto, Maria L. Guidi, Juan J. Gagliardino. CENEXA-Center of Experimental and Applied
Background:For persons with diabetes mellitus the disease itself might be seen as an “eating disorder”. At the same time it is reported that eating disorders are common among persons with diabetes, especially teenaged girls and young women. As beeing female is a risk factor for eating disorder this might be doubled for young girls and women with diabetes, previously often classified as “brittle diabetes”. Purpose of the study:Identify strategies to help persons with Diabetes Mellitus and Eating Disorders. Methods:In my work as psychologist for persons with diabetes I identified those with eating disorders and notified how problems once started and ways to give help for changing eating behavior. ResultstApproximately 40% of my clients suffered from eating disorders. Those with anorexia had underweight while bulimians often had normal weight. Most of them were young women with high levels of glycated haemoglobin and diabetic retinopathy. All of them reduced their intake of insulin to a minimum and avoided eating. Phobia concerning physical weight and focus on losing it was introducedeither by friends and schoolmates or by indifferent reception in diabetescare. All of them maintained a strict regimen of incessant physical exercise, often ordered by medical professionals. Eating often was more difficult for them than handling their diabetes. Conclusions: - Rules concerning food and exercise should be formulated in an atmosphere or mutual understanding. - Avoid orders concerning eating and exercise. - Observe that eating disorder might be hidden behind high levels of glycated haemoglobin. - Co-operate with professional psychologists.
Endocrinology (UNLP-CONICEZ PAHO/WHO Collaborating Center), School of Medicine, National Universiry of Lo Plats, La Plats, Buenos Aires, Argentina
P985 Writing in the Sand and Other Methods Requiring More Creativity Than Resources COLLEEN E. OSLER, John W. Kalk. Endocrinology, Witwatersrand University Medical School, Johannesburg,
Gauteng
Purpose: Over the past decades an abundance of educational, behavioral and organizational strategies and tools designed to promote self-management, improve adherence and preserve quality of life has appeared. Yet the application of these strategies and tools continues to have disappointing results. This presentation looks at diabetes educators (DE) as a primary tool and questions DE awareness of the impact of their presence in patient encounters, and further, it challenges their understanding of the term “self-management” and the implications of the concept “empowerment” Method: The expectations of DE were evaluated before an advanced course in chronic disease and diabetes management. After the course they reported on what they had gain from the course. This problem based course focused on self development, rather than knowledge, with an emphasis on reflection Results: Before the course the DE seemed to seek their own empowerment, usually in order to “instruct” patients. After the course DE reported much greater self awareness, a far less directive approach, were more open to include the patients, and were less stressed. Conclusion: We believe that together with the traditional skills and strategies taught to DE, we also need to include additional DE outcomes intended to enhance patient self-management, that increases DE self-awareness resulting in better selection of tools and strategies for “instilling” self-management and promoting greater independence. Thus DE self-awareness of their own needs and responses is likely to result in better reflection.
Aim:To evaluate the clinical and metabolic changes consecutive to daily yoga practices for 3 months in a group of people with diabetes (DM). Material and Methods: Sixteen women (3 Type 1 DM, 12 Type 2 DM, 1 insulin-requiring DM; mean age 61 fll years, DM history 21 *14 years) attending the Physical Activity Program at CENEXA were studied. The group yoga practices, monitored by a yoga instructor, consisted in asanas (postures), breathing, relaxation and meditation techniques. The sessions were carried out twice a week (total 27 sessions), complemented by sessions practiced daily by each individual the remaining days of the week. The data were recorded in questionnaires, including: I) Personal details: demographic information, dietary and physical activity habits at the beginning and at the end of the study period. 2) Medical registry: clinical and metabolic characteristics, type of treatment and control, complications at the beginning and the end of the study. 3) Follow-up: arterial pressure (AP), cardiac frequency (CF) and glycemia at the beginning and at the end of 13 alternate sessions. Results: Both attendance and compliance of the proposed schedule were high (> 80%) excepting 2 people who deserted, but completed 50% of the study. There were no overall significant differences (beginning vs. end of the study) in BMI, HbAi, lipid profile, dietary plan, habitual physical activity practice, AP, and treatment schedule. Conversely, there was a significant decrease in CF (9 sessions; p < 0.03) and glycemia (12 sessions; p-zO.03) during the sessions. Conclusion: The positive immediate effect of yoga practices upon metabolism (glycemia) and CF suggests that such practices would be beneficial for the treatment of people with DM.
P987 Predictors of Success in Insulin Pump Therapy M. SCHERWINSKI, A.M. Freund, M. Reinhold, E. Austenat. Privates Diabetes Institut, Berlin, Germany
Introduction: Our aim was to examine the success in insulin pump therapy concerning to medical and psycho-social aspects. Our initial hypothesis was that not all patients profit equally from pump therapy. Method: The importance of medical and psycho-social factors for the success of pump therapy was investigated in a sample of N = 60 diabetes patients (Type 1 and Type 2; age-range = 17-70 years, M = 44; 47% females). The following medical variables were assessed: (1) year since diagnosis of diabetes, (2) further chronic illnesses and the following psycho-social variables were assessed by using standardized questionnaires (3) number of social activities prior and after starting with pump therapy, and (4) tenacious goal-pursuit and flexible goal-adjustment in the face of obstacles or failure. Second, potential factors influencing the success of pump therapy were investigated. Results: Taking decrease in HbAlc over one year as a criterion, 35% of the patients showed no success (taking a decrease less than 3%), 33% showed moderate success (taking a decrease between 3% and 12%), and 31% showed good success (taking a decrease at least 12%). Results stress the importance of considering both, medical and psycho-social factors in pump therapy. Whereas neither chronological age, sex, or year since diagnosis were correlated with HbAlc values, patients reporting further chronic illnesses showed less success in pump therapy (change in HbAlc) over a one year period. With regard to psycho-social variables, patients who were selective concerning their past and present social activities (e.g., going to plays or the movies, actively engaging in sports, socialising with friends) showed better success in pump therapy than those who were less selective. Moreover, success in pump therapy was associated with flexible
Poster Session 2
P984
P986
Eating Disorder and Diabetes Mellitus LENA WILLIAM-OLSON.
Yoga Practice in People with Diabetes NORA MERCURI, Ercilia M. Olivera, A. Souto, Maria L. Guidi, Juan J. Gagliardino. CENEXA-Center of Experimental and Applied
Background:For persons with diabetes mellitus the disease itself might be seen as an “eating disorder”. At the same time it is reported that eating disorders are common among persons with diabetes, especially teenaged girls and young women. As beeing female is a risk factor for eating disorder this might be doubled for young girls and women with diabetes, previously often classified as “brittle diabetes”. Purpose of the study:Identify strategies to help persons with Diabetes Mellitus and Eating Disorders. Methods:In my work as psychologist for persons with diabetes I identified those with eating disorders and notified how problems once started and ways to give help for changing eating behavior. ResultstApproximately 40% of my clients suffered from eating disorders. Those with anorexia had underweight while bulimians often had normal weight. Most of them were young women with high levels of glycated haemoglobin and diabetic retinopathy. All of them reduced their intake of insulin to a minimum and avoided eating. Phobia concerning physical weight and focus on losing it was introducedeither by friends and schoolmates or by indifferent reception in diabetescare. All of them maintained a strict regimen of incessant physical exercise, often ordered by medical professionals. Eating often was more difficult for them than handling their diabetes. Conclusions: - Rules concerning food and exercise should be formulated in an atmosphere or mutual understanding. - Avoid orders concerning eating and exercise. - Observe that eating disorder might be hidden behind high levels of glycated haemoglobin. - Co-operate with professional psychologists.
Endocrinology (UNLP-CONICEZ PAHO/WHO Collaborating Center), School of Medicine, National Universiry of Lo Plats, La Plats, Buenos Aires, Argentina
P985 Writing in the Sand and Other Methods Requiring More Creativity Than Resources COLLEEN E. OSLER, John W. Kalk. Endocrinology, Witwatersrand University Medical School, Johannesburg,
Gauteng
Purpose: Over the past decades an abundance of educational, behavioral and organizational strategies and tools designed to promote self-management, improve adherence and preserve quality of life has appeared. Yet the application of these strategies and tools continues to have disappointing results. This presentation looks at diabetes educators (DE) as a primary tool and questions DE awareness of the impact of their presence in patient encounters, and further, it challenges their understanding of the term “self-management” and the implications of the concept “empowerment” Method: The expectations of DE were evaluated before an advanced course in chronic disease and diabetes management. After the course they reported on what they had gain from the course. This problem based course focused on self development, rather than knowledge, with an emphasis on reflection Results: Before the course the DE seemed to seek their own empowerment, usually in order to “instruct” patients. After the course DE reported much greater self awareness, a far less directive approach, were more open to include the patients, and were less stressed. Conclusion: We believe that together with the traditional skills and strategies taught to DE, we also need to include additional DE outcomes intended to enhance patient self-management, that increases DE self-awareness resulting in better selection of tools and strategies for “instilling” self-management and promoting greater independence. Thus DE self-awareness of their own needs and responses is likely to result in better reflection.
Aim:To evaluate the clinical and metabolic changes consecutive to daily yoga practices for 3 months in a group of people with diabetes (DM). Material and Methods: Sixteen women (3 Type 1 DM, 12 Type 2 DM, 1 insulin-requiring DM; mean age 61 fll years, DM history 21 *14 years) attending the Physical Activity Program at CENEXA were studied. The group yoga practices, monitored by a yoga instructor, consisted in asanas (postures), breathing, relaxation and meditation techniques. The sessions were carried out twice a week (total 27 sessions), complemented by sessions practiced daily by each individual the remaining days of the week. The data were recorded in questionnaires, including: I) Personal details: demographic information, dietary and physical activity habits at the beginning and at the end of the study period. 2) Medical registry: clinical and metabolic characteristics, type of treatment and control, complications at the beginning and the end of the study. 3) Follow-up: arterial pressure (AP), cardiac frequency (CF) and glycemia at the beginning and at the end of 13 alternate sessions. Results: Both attendance and compliance of the proposed schedule were high (> 80%) excepting 2 people who deserted, but completed 50% of the study. There were no overall significant differences (beginning vs. end of the study) in BMI, HbAi, lipid profile, dietary plan, habitual physical activity practice, AP, and treatment schedule. Conversely, there was a significant decrease in CF (9 sessions; p < 0.03) and glycemia (12 sessions; p-zO.03) during the sessions. Conclusion: The positive immediate effect of yoga practices upon metabolism (glycemia) and CF suggests that such practices would be beneficial for the treatment of people with DM.
P987 Predictors of Success in Insulin Pump Therapy M. SCHERWINSKI, A.M. Freund, M. Reinhold, E. Austenat. Privates Diabetes Institut, Berlin, Germany
Introduction: Our aim was to examine the success in insulin pump therapy concerning to medical and psycho-social aspects. Our initial hypothesis was that not all patients profit equally from pump therapy. Method: The importance of medical and psycho-social factors for the success of pump therapy was investigated in a sample of N = 60 diabetes patients (Type 1 and Type 2; age-range = 17-70 years, M = 44; 47% females). The following medical variables were assessed: (1) year since diagnosis of diabetes, (2) further chronic illnesses and the following psycho-social variables were assessed by using standardized questionnaires (3) number of social activities prior and after starting with pump therapy, and (4) tenacious goal-pursuit and flexible goal-adjustment in the face of obstacles or failure. Second, potential factors influencing the success of pump therapy were investigated. Results: Taking decrease in HbAlc over one year as a criterion, 35% of the patients showed no success (taking a decrease less than 3%), 33% showed moderate success (taking a decrease between 3% and 12%), and 31% showed good success (taking a decrease at least 12%). Results stress the importance of considering both, medical and psycho-social factors in pump therapy. Whereas neither chronological age, sex, or year since diagnosis were correlated with HbAlc values, patients reporting further chronic illnesses showed less success in pump therapy (change in HbAlc) over a one year period. With regard to psycho-social variables, patients who were selective concerning their past and present social activities (e.g., going to plays or the movies, actively engaging in sports, socialising with friends) showed better success in pump therapy than those who were less selective. Moreover, success in pump therapy was associated with flexible