SummaryAims: To explore the relationship between diabetes distress, glucose control and awareness of hypoglycaemia in adults with type 1 diabetes. Methods:We performed a cross-sectional study using data collected from 280 consecutive type 1 diabetes patients who used a routine clinic consultation tool that recorded HbA1c, hypoglycaemia awareness (measured using the Gold score) and diabetes distress (measured using the Diabetes Distress Scale 2 [DDS2]). We assessed correlations between DDS2 and HbA1c and DDS2 and Gold score and performed an ordinal regression analysis to identify factors contributing to distress.Results: Diabetes distress was significantly correlated with HbA1c (r = .319, P < .001) and Gold score (r = .258, P < .001) independently and with synergistic effect. Female gender was also associated with diabetes distress, while age, BMI, duration of diabetes, severity of complications and use of CSII pumps were not. Occurrence of severe hypoglycaemia (SH) episodes increased with Gold score in a linear manner throughout the scale. Conclusions:This study has identified new evidence of a significant, independent relationship between diabetes distress measured by the DDS2 and reduced awareness of hypoglycaemia in people with type 1 diabetes. It also demonstrates that diabetes distress is significantly associated with HbA1c and female gender independently. The DDS2 identifies distress associated with both hypo-and hyperglycaemia and can be a useful creening tool. Additionally, the occurrence of SH increases with increasing Gold score. K E Y W O R D Sdiabetes distress, hypoglycaemia, psychological aspects, type 1 diabetes
Diabetes of a predominant maturity-onset type has been identified as being up to ten times more prevalent in South Australian Aborigines than in Caucasians. On the evidence provided, nutritional status and obesity are thought to be dominant in the aetiology of the hyperglycaemia, although relative hyperinsulinaemia in full blood Aborigines suggests a significant racial genetic effect. It is suggested on these and other grounds that the diabetic genotype may represent a factor of previous survival advantage to the Aboriginal, now rendered deleterious by urbanization. The degree of hyperglycaemia, and its association with hyperlipidaemia, obesity, retinal arteriovenous changes and abnormal electrocardiographic findings, accentuates the significance of the diabetes, and underlines the serious need for ongoing nutritional education in these communities.
Blood pressure measurements were recorded in 522 adults and 141 10-19 year-old full and part blood Aborigines in five communities. The means for systolic and diastolic blood pressures at 40 years were close to those reported for Europeans, although below this age, values tended to be lower, and above 40 years tended to be higher than those reported in the Tecumseh study. Hypertension, as defined by the Princeton criteria, was present in 29%, more often in the men (1-6 to 1-0), and eight subjects satisfied the criteria for hypertensive heart disease (HHD). 522 electrocardiograms were recorded on adult subjects at five Aboriginal communities and classified according to categories of the Minnesota code. Of the 210 abnormalities observed, minor T wave inversions and minor S-T segment depression were the most commonly encountered, and were more frequent in female subjects. Q wave changes typical of myocardial infarction was found in 5% of the tracings and occurred mainly in older men. If hypertension and certain ECG codes are assumed to be "risk factors" for the development of clinical ischaemic heart disease (IHD), the urbanized Aboriginal had a higher prevalence compared with Caucasian subjects of the Busselton study. "Probable" and "suspect" ECG changes of IHD, although mainly in the older subjects, were found to be associated with hyperglycaemia, as recognised in Western society. It is postulated that urbanized Aborigines are prone to cardiovascular degenerative disease to a similar or possibly larger extent than Caucasians.
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