Patients' self-care behaviours have a major role in diabetes management. Diabetes education provides the required knowledge, but despite this, self-care is often suboptimal. The degree to which patients follow advice as regards the various self-care behaviours is determined by their health beliefs (Illness Representations or Personal Models) of diabetes. Psychometric studies have tried to categorize and measure the beliefs about illness that influence patients to adhere to treatment recommendations in diabetes. Various models have been proposed to explain the relationship between beliefs and behaviour. Leventhal's Self-Regulatory Model, which takes account of the emotional as well as the objective rational response to illness, currently seems to offer the best system for identifying the determinants of patient self-care behaviour. A review of interventions indicates those based on psychological theory offer professionals the best chance of maximizing their patients' contribution to diabetes self-management and achieving improved outcomes, both glycaemic and psychosocial. Studies designed specifically to modify illness representations are now being undertaken. This brief review aims to summarize developments in this area of psychological theory over the last 20 years and the implications for promoting better self-care behaviour in diabetes.Diabet. Med. 26, 5-13 (2009)
OBJECTIVEThis multicenter, double-blind, treat-to-target, phase 3 trial evaluated the efficacy and safety of fast-acting insulin aspart (faster aspart) versus insulin aspart (IAsp) in adults with type 2 diabetes receiving basal insulin and oral antidiabetic agents.
RESEARCH DESIGN AND METHODSThe primary end point was HbA 1c change from baseline after 26 weeks' treatment. After an 8-week run-in to optimize basal insulin, subjects were randomized (1:1) to mealtime faster aspart (n = 345) or IAsp (n = 344), titrated using a simple daily patientdriven algorithm, plus insulin glargine U100 and metformin.
RESULTS
HbA
CONCLUSIONSFaster aspart and IAsp were confirmed noninferior in a basal-bolus regimen regarding change from baseline in HbA 1c . Faster aspart improved 1-h PPG with no differences in 224-h PPG versus IAsp. Overall hypoglycemia rates were similar except for an increase in 022-h postmeal hypoglycemia with faster aspart.Basal insulins are one of the recommended steps in type 2 diabetes treatment intensification when oral antidiabetic drugs (OADs) no longer provide sufficient glycemic control (1). As b-cell function decreases further, maintaining target HbA 1c levels becomes challenging, even when target fasting plasma glucose (FPG) levels have been achieved (2), and further therapeutic intensification may be required (3). The aim of
Attendance at diabetes clinic is associated with improved medical outcome, however, significant numbers of people with type 1 diabetes choose not to attend. In order to understand the reasons underlying this decision, qualitative interviews were carried out with 12 long-term non-attenders. Three distinct groups emerged differing in terms of their cognitive and emotional responses to diabetes and their coping strategies: (1) the 'High fear' group; (2) the 'Patient as expert' group; and (3) the 'Low motivation' group. These differences should be recognized and suitable approaches developed to ensure that all people with diabetes are able to accept appropriate specialist support.
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