Intrinsic Motivation and Glycemic Control in Adolescents with Type 1 Diabetes

Abstract

Diabetic patients have been shown to excrete increased quantities of albumin, which is undetectable by conventional albumin antibodies (immunounreactive) using high-performance liquid chromatography (HPLC) (1). Furthermore, the lead time for the development of microalbuminuria (albumin excretion rate [AER] Ͼ20 g/min) measured by HPLC has been shown to occur 3.9 and 2.4 years earlier than that determined by radioimmunoassay (RIA) for type 1 and type 2 diabetic patients, respectively (2). This study not only identified that progression from normo-to microalbuminuria is associated with an increase in urinary immunounreactive albumin, but also raises the possibility that measurement of total albumin (immunoreactive plus immunounreactive) may allow earlier detection of progression to kidney disease.The aim of this study was to determine whether a group of type 2 diabetic patients with a low glomerular filtration rate (GFR) of Ͻ60 ml ⅐ min Ϫ1 ⅐ 1.73 m Ϫ2 , as measured by a single-injection isotopic technique using 99m Tc-DTPA (3), and normoalbuminuria, as measured by RIA, excrete increased quantities of immunounreactive albumin. Total albumin was measured by HPLC analysis (1,2), and immunoreactive albumin was measured by RIA on two to three consecutive urine samples collected from 38 type 2 diabetic patients attending the Austin & Repatriation Medical Centre, Victoria, Australia. Patients who had recurrent urinary tract infections or hematuria, known nondiabetic renal disease, or severe intercurrent illness, such as a malignancy or symptomatic cardiac failure, were excluded from the study.The major finding of this study is that 24% (9 of 38) of patients had an AER Ͼ20 g/min and 37% (14 of 38) of patients had an AER Ͼ15 g/min, as measured by HPLC, in comparison with RIA analysis, which detected 0% (0 of 38) of patients with an AER Ͼ20 g/min and 13% (5 of 38) of patients with an AER Ͼ15 g/min. There was no significant difference between HPLC and RIA analysis of albumin in urine from nondiabetic subjects (1). These results identify that type 2 diabetic patients with a GFR Ͻ60 ml ⅐ min Ϫ1 ⅐ 1.73 m Ϫ2 , and therefore presumably some form of kidney dysfunction, have an increased prevalence of urinary immunounreactive albumin. The possible pathogenesis of increased urinary immunounreactive albumin in these patients is limited given the absence of renal ultrastructural data. In fact, there is a paucity of information available regarding the renal morphology of normoalbuminuric patients with type 2 diabetes, regardless of their GFR. Nevertheless, the discrepancy between the HPLC and immunochemical assays demonstrates that conventional albumin assays may provide a relatively late diagnosis of incipient kidney disease at a threshold of 20 g/min.The combination of impaired renal function and normoalbuminuria in patients with diabetes was first highlighted by Lane et al. (4). For healthy nondiabetic individuals, the rate of decline in GFR with age has been reported to range from 0.6 to 1.0 ml ⅐ min Ϫ1 ⅐ 1.73 m Ϫ2⅐ year Ϫ1 (5). We ...

Relationship between motivational style and glycemic control in Jordanian patients with type 2 diabetes mellitus

“…A previous study, demonstrated that individuals who persisted in a specific educational course were more intrinsically and less extrinsically motivated, and that intrinsic motivation augmented self‐efficacy towards physical activity . Adolescents who are intrinsically motivated to manage their health are more likely to report adhering to their treatment . In addition, patients with intrinsic motivation have significantly better adherence to long‐term medication …”

“…39 Adolescents who are intrinsically motivated to manage their health are more likely to report adhering to their treatment. 17 In addition, patients with intrinsic motivation have significantly better adherence to long-term medication. 18 A randomized control trial showed that an intervention that promotes an intrinsic motivation towards physical activity was associated with significant weight loss.…”

“…Intrinsic motivation was found to be positively and significantly associated with adherence to therapeutic regimen, quality of life, and glycemic control . Adolescents with type 1 diabetes mellitus who are intrinsically motivated to manage their health are more likely to adhere to their treatment than those with extrinsic motivation . Adult patients who are intrinsically motivated are more likely to have better adherence to long‐term medications than those with extrinsic motivation .…”

“…16 Adolescents with type 1 diabetes mellitus who are intrinsically motivated to manage their health are more likely to adhere to their treatment than those with extrinsic motivation. 17 Adult patients who are intrinsically motivated are more likely to have better adherence to longterm medications than those with extrinsic motivation. 18 Women who received an SDT-based intervention reported significant weight loss and higher levels of exercise compared with their counterparts.…”

The influence of social contextual conditions and basic psychological need fulfillment on self-management and emotional distress among urban African American adults with type-2 diabetes mellitus : a mixed methods study.

“…In a study by Greening et al (2004), intrinsic motivation was found to be positively associated with adherence to treatment regimens among adolescent study participants living with Type-l diabetes.…”