Biopsychobehavioral model of risk of severe hypoglycemia. Self-management behaviors.

Clarke, William L.; Cox, Daniel J.; Gonder-Frederick, L; Julian, Diana M; Kovatchev, Boris; Young-Hyman, Deborah Lee

doi:10.2337/diacare.22.4.580

Cited by 22 publications

(17 citation statements)

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“…This is consistent with a recent study demonstrating that patients with a history of SH during the previous year showed less effective behavior regarding preventing low blood glucose levels, recognizing decreasing blood glucose levels and self-treatment of hypoglycemia (16). In addition, patients experiencing SH may need support to deal with a heightened fear of hypoglycemia.…”

Section: Hypoglycemia Awarenesssupporting

confidence: 80%

Clinical characteristics of type 1 diabetic patients with and without severe hypoglycemia.

et al. 2000

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Clinical Characteristics of Type 1 Diabetic Patients With and Without Severe Hypoglycemia O R I G I N A L A R T I C L EOBJECTIVE -To investigate the frequency of severe hypoglycemia (SH) and hypoglycemic coma and to identify clinical and behavioral risk indicators in a nonselected population of type 1 diabetic patients. RESEARCH DESIGN AND METHODS-This study involved a retrospective clinical survey of 195 consecutive patients using a questionnaire addressing the frequency of SH (i.e., help from others required) and hypoglycemic coma during the previous year, general characteristics, behavior, hypoglycemia awareness, and the Hypoglycemia Fear Survey. Data regarding diabetes, treatment, long-term complications, comorbidity, and comedication were obtained from the patients' medical records.RESULTS -A total of 82% of subjects were receiving intensive insulin treatment, and mean ± SD HbA 1c was 7.8 ± 1.2%. Mean duration of diabetes was 20 ± 12 years. The occurrence of SH (including hypoglycemic coma) was 150 episodes/100 patient-years and affected 40.5% of the population. Hypoglycemic coma occurred in 19% of subjects (40 episodes/100 patient-years). CONCLUSIONS -SH and hypoglycemic coma are common in a nonselected population with type 1 diabetes. The presence of long-term complications, a threshold for symptoms of Ͻ3 mmol/l, alcohol use, and (nonselective) ␤-blockers were associated with SH during the previous year. If prospectively confirmed, these results may have consequences for clinical practice.

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Section: Hypoglycemia Awarenesssupporting

confidence: 80%

Clinical characteristics of type 1 diabetic patients with and without severe hypoglycemia.

et al. 2000

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“…Two treatment modalities are the ingestion of carbohydrate and an adjustment in medication(s). A logistic regression analysis of 6,425 self-monitored blood glucose events in 93 adults with type 1 diabetes showed that more insulin, less food, or more exercise predicted 61% of all blood glucose values Ͻ70 mg/dl (Ͻ3.9 mmol/l), but did not predict severe hypoglycemia (580). Although rigid definitions of hypoglycemia are useful for epidemiological studies, more flexible definitions are needed in the management of diabetes.…”

Section: Technical Reviewmentioning

confidence: 99%

Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications

et al. 2002

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“…Altobelli et al (1) studied 70 patients aged from 10 to 18 years and found age to be a factor in monitoring, with adolescents less likely to be daily monitors of their diabetes. Clarke et al (24) studied 93 type 1 diabetics and found no predictors of regular monitoring. Gregg et al (36) also found no features common to monitoring in a study of 625 African American adults.…”

Section: What Characterizes Patients More Likely To Manage Disease Efmentioning

confidence: 99%

Management of Chronic Disease by Patients

Clark

2003

Annu. Rev. Public Health

219

160

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Key Words self-management, disease management, self-regulation, disease management assessment s Abstract Chronic conditions dominate health care in most parts of the world, including the United States. Management of a disease by the patient is central to control of its effects. A wide range of influences in the person's social and physical environments enhance or impede management efforts. Interventions to improve management by patients can produce positive outcomes including better monitoring of a condition, fewer symptoms, enhanced physical and psychosocial functioning, and reduced health care use. Successful programs have been theory based. Self-regulation is a promising framework for the development of interventions. Nonetheless, serious gaps in understanding and improving disease management by patients remain because of an emphasis on clinical settings for program delivery, neglect of the factors beyond patient behavior that enable or deter effective management, limitations of study designs in much work to date, reliance on short-term rather than long-term assessments, and failure to evaluate the independent contribution of various program components. MANAGEMENT OF CHRONIC DISEASE BY PATIENTSControl of chronic disease continues to dominate the agenda of health care systems; this is because primary prevention and cure are not available for many diseases, and because the population worldwide is living longer with accompanying chronic conditions. Just as it is difficult to put what we know about primary prevention fully into practice (e.g., change behavioral patterns related to diet, physical activity levels, smoking, etc.), so too is it difficult to put into practice what is known about secondary prevention, that is, preventing and managing effects of disease. This chapter explores the factors that enable people with chronic disease to keep their conditions under control. Optimum disease management by the patient for purposes of this discussion is defined as the means to achieve the highest degree of functioning and lowest level of symptoms given the severity of a condition.Worldwide the leading causes of death are heart disease, cancer, and stroke, even in countries where infectious diseases rage. A range of other diseases, although intrinsically less likely to lead to premature death, are exceedingly costly in terms 0163 290 CLARK Figure 1Most common causes of death, United States. Rates are age adjusted to 2000 total U.S. population. These data are adapted from (53).of human suffering and economic productivity. Arthritis, diabetes, and asthma are good examples; HIV/AIDS is another. Although an infectious disease, the potential for slowing progression has caused HIV/AIDS to become a chronic condition as well.The overall burden of chronic disease in the United States is substantial. Figure 1 illustrates the numbers of cases of the major chronic conditions seen in the United States (54). Further, a host of other diseases, each striking smaller numbers of individuals (Parkinson's disease and cystic fibrosis a...

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Biopsychobehavioral model of risk of severe hypoglycemia. Self-management behaviors.

Cited by 22 publications

References 0 publications

Clinical characteristics of type 1 diabetic patients with and without severe hypoglycemia.

Clinical characteristics of type 1 diabetic patients with and without severe hypoglycemia.

Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications

Management of Chronic Disease by Patients

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