OBJECTIVE: To observe the effects of moxibustion at different temperatures on cognitive function and blood glucose levels in patients with cognitive impairment associated with type 2 diabetes mellitus (T2DM). METHODS: A total of 66 T2DM patients with cognitive impairment were randomly assigned to a high-temperature group (22 cases, 1 case dropped out, 1 case was eliminated), a medium-temperature group (22 cases, 2 cases were eliminated), and a low-temperature group (22 cases, 2 cases were eliminated). All groups received moxibustion at Baihui (GV20), Dazhui (GV14), and Shenting (GV24) based on their existing glycemic control treatment. Moxibustion temperatures were maintained at 44-46 ℃ (high-temperature group), 41-43 ℃ (medium-temperature group), and 38-40 ℃ (low-temperature group), respectively, for 20 min per session, every other day, 3 times a week for 3 months. The Montreal cognitive assessment (MoCA) score, mini-mental state examination (MMSE) score, short-term memory (STM) accuracy and average reaction time, Rey-Osterrieth complex figure (ROCF) score, fasting plasma glucose (FPG), and glycated hemoglobin (HbA1c) were assessed before and after treatment. Clinical efficacy was evaluated after treatment. RESULTS: After treatment, MMSE scores in all three groups were higher than those before treatment (P<0.05). In the high-temperature group, the total MoCA score and the scores of visuospatial and executive function, memory and delayed recall, attention, naming, language, and abstraction were higher than those before treatment (P<0.05); the scores of ROCF copy, immediate recall, and delayed recall were higher than those before treatment (P<0.05); the HbA1c level was lower than that before treatment (P<0.05). In the medium-temperature group, the total MoCA score and the scores of memory and delayed recall, attention, and language were higher than those before treatment (P<0.05). STM accuracy was higher than before treatment (P<0.05), and STM average reaction time was shorter than before treatment (P<0.05) in both the high-temperature and medium-temperature groups. After treatment, the total MoCA score and the scores of visuospatial and executive function, memory and delayed recall, attention, and language in the high-temperature group were higher than those in the medium- and low-temperature groups (P<0.05); MMSE score, STM accuracy, and ROCF immediate recall and delayed recall scores were higher than those in the medium- and low-temperature groups (P<0.05); STM average reaction time was shorter than that in the medium- and low-temperature groups (P<0.05); HbA1c level was lower than that in the low-temperature group (P<0.05). The total MoCA score, attention score, and MMSE score in the medium-temperature group were higher than those in the low-temperature group (P<0.05), and STM average reaction time was shorter than that in the low-temperature group (P<0.05). There were no statistically significant differences in FPG within or between the three groups before and after treatment (P>0.05). The total effective rates were 75.0% (15/20) in the high-temperature group, 50.0% (10/20) in the medium-temperature group, and 15.0% (3/20) in the low-temperature group; the total effective rate in the high-temperature group was significantly higher than that in the low-temperature group (P<0.05). CONCLUSION Moxibustion at different temperatures has a dose-effect relationship in treating cognitive impairment in T2DM patients. A temperature range of 44-46 ℃ is more effective in improving cognitive function and stabilizing average blood glucose levels over 2-3 months.
Humans ; Diabetes Mellitus, Type 2/therapy* ; Male ; Female ; Moxibustion ; Middle Aged ; Aged ; Cognitive Dysfunction/psychology* ; Cognition ; Temperature ; Blood Glucose/metabolism* ; Adult ; Acupuncture Points

OBJECTIVES: This study identifies associated factors of ischemic heart disease (IHD) among post-menopausal Korean women at the biomedical (age, family history of hypertension, dyslipidemia, type 2 diabetes mellitus, or cerebro-cardiovascular disease, body mass index, and metabolic syndrome), biosocial (socioeconomic status and educational level), and psychosocial levels (stress, depression, smoking, binge alcohol consumption, and physical activity). METHODS: This study used a cross-sectional design with secondary data analysis of the 2013–2016 Korean National Health and Nutrition Examination Survey. Data from 3,636 women were analyzed by logistic regression analysis using a complex sample procedure. RESULTS: Of the biomedical factors, older age [odds ratio (OR): 2.99, 95% confidence interval (CI): 1.87–4.80, p < 0.001], family history (OR: 2.29, 95% CI: 1.44–3.65, p = 0.001), and metabolic syndrome (OR: 1.93, 95% CI: 1.27–2.95, p = 0.002) were associated with IHD in post-menopausal women. Of the psychosocial factors, depression (OR: 2.56, 95% CI: 1.66–3.96, p < 0.001) and smoking (OR: 1.92, CI: 1.04–3.55, p = 0.038) were associated with IHD in post-menopausal women. CONCLUSION: These findings suggest that healthcare providers need to consider the contributing adverse effects of older age, family history, metabolic syndrome, depression and smoking when evaluating risk factors for IHD in post-menopausal women.
Alcohol Drinking ; Body Mass Index ; Coronary Artery Disease ; Depression ; Diabetes Mellitus, Type 2 ; Dyslipidemias ; Female ; Health Personnel ; Humans ; Hypertension ; Logistic Models ; Myocardial Ischemia ; Nutrition Surveys ; Postmenopause ; Psychology ; Risk Factors ; Smoke ; Smoking ; Statistics as Topic

BACKGROUND: Recent evidences indicate that early rapid renal function decline is closely associated with the development and progression of diabetic kidney disease. We have investigated the association between carotid atherosclerosis and rapid renal function decline in patients with type 2 diabetes mellitus and preserved renal function.METHODS: In a prospective, multicenter cohort, a total of 967 patients with type 2 diabetes mellitus and preserved renal function were followed for 6 years with serial estimated glomerular filtration rate (eGFR) measurements. Common carotid intima-media thickness (CIMT) and presence of carotid plaque were assessed at baseline. Rapid renal function decline was defined as an eGFR decline >3.3% per year.RESULTS: Over a median follow-up of 6 years, 158 participants (16.3%) developed rapid renal function decline. While there was no difference in CIMT, the presence of carotid plaque in rapid decliners was significantly higher than in non-decliners (23.2% vs. 12.2%, P<0.001). In multivariable logistic regression analysis, presence of carotid plaque was an independent predictor of rapid renal function decline (odds ratio, 2.33; 95% confidence interval, 1.48 to 3.68; P<0.0001) after adjustment for established risk factors. The model including the carotid plaque had better performance for discrimination of rapid renal function decline than the model without carotid plaque (area under the receiver operating characteristic curve 0.772 vs. 0.744, P=0.016).CONCLUSION: Close monitoring of renal function and early intensive management may be beneficial in patients with type 2 diabetes mellitus and carotid plaques.
Carotid Artery Diseases ; Carotid Intima-Media Thickness ; Carotid Stenosis ; Cohort Studies ; Diabetes Mellitus, Type 2 ; Diabetic Nephropathies ; Discrimination (Psychology) ; Follow-Up Studies ; Glomerular Filtration Rate ; Humans ; Logistic Models ; Prospective Studies ; Risk Factors ; ROC Curve

Type 2 diabetes (T2D) has been associated with a high prevalence of depression.We aimed to determine the causal relation by performing a Mendelian randomization (MR) study using 34 T2D risk genetic variants validated in East Asians as the instrumental variable (IV). An MR analysis was performed involving 11 506 participants from a large longitudinal study. The T2D genetic risk score (GRS) was built using the 34 typical T2D common variants. We used T2D_GRS as the IV estimator and performed inverse-variance weighted (IVW) and Egger MR analysis. The T2D_GRS was found to be associated with depression with an OR of 1.21 (95% CI: 1.07-1.37) after adjustments for age, sex, body mass index, current smoking and drinking, physical activity, education, and marital status. Using T2D_GRS as the IV, we similarly found a causal relationship between genetically determined T2D and depression (OR: 1.84, 95% CI: 1.25-2.70). Though we found no association between the combined effect of the genetic IVs for T2D and depression with EggerMR(OR: 0.95, 95%CI: 0.42-2.14), we found an association for T2D and depression with IVW (OR: 1.75, 95% CI: 1.31-2.46) after excluding pleiotropic SNPs. Overall, the MR analyses provide evidence inferring a potential causal relationship between T2D and depression.
Aged ; Causality ; China ; epidemiology ; Depression ; epidemiology ; etiology ; Diabetes Mellitus, Type 2 ; complications ; genetics ; psychology ; Female ; Genetic Variation ; Genotype ; Humans ; Linear Models ; Longitudinal Studies ; Male ; Mendelian Randomization Analysis ; Middle Aged ; Polymorphism, Single Nucleotide ; Psychiatric Status Rating Scales ; Risk Factors ; Sensitivity and Specificity

PURPOSE: To examine the psychometric properties of a Turkish version of the Diabetes Fear of Injecting and Self-testing Questionnaire (D-FISQ). METHODS: Forward-backward translation of the D-FISQ from English into Turkish was conducted. Original English and translated forms were examined by a panel group. Validity was investigated using content, confirmatory factor analysis, and divergent validity. Reliability was assessed using Cronbach α values, item-total correlations, and intraclass correlations. The sample comprised 350 patients with diabetes. Data were analyzed using SPSS 15.0 for Windows and LISREL 8. RESULTS: The content validity index for the panel members was .90, which indicated perfect content validity; items in D-FISQ were clear, concise, readable, and distinct. Confirmatory factor analysis confirmed the original construct of the D-FISQ. All items had factor loadings higher than the recommended level of .40. The D-FISQ scores were discriminated by the level of anxiety. Reliability results were also satisfactory. Cronbach α values were within ideal limits. Item-total correlation coefficient ranged from .72 to .86. In terms of test-retest reliability, intraclass correlation coefficient was found to be over .90. CONCLUSIONS: D-FISQ is a valid and reliable questionnaire in assessing needle-prick fear among Turkish patients with diabetes. We recommend performing the Turkish D-FISQ in determining and screening patients with diabetes who have fear related to self-insulin injection and finger-prick test. Thus, health care professionals should be aware of the potential consequences of injection fear such as insulin misuse and poor self-monitoring of blood glucose, which may have unfavorable effects on optimal diabetes management.
Anxiety/etiology ; Blood Glucose Self-Monitoring/psychology ; Diabetes Mellitus, Type 1/drug therapy/*psychology ; Diabetes Mellitus, Type 2/drug therapy/*psychology ; *Fear ; Female ; Humans ; Hypoglycemic Agents/administration & dosage ; Injections/psychology ; Insulin/administration & dosage ; Male ; Middle Aged ; Psychometrics ; Reproducibility of Results ; Self Care/psychology ; Surveys and Questionnaires/standards ; Translations ; Turkey

PURPOSE: Health literacy has been attracting increasing attention because low health literacy is considered an important predictor of adverse health outcomes in many chronic conditions, including diabetes. However, it is unclear how health literacy is associated with health outcomes. The purpose of this study was to formulate a hypothetical structural equation model linking health literacy to self-efficacy, self-care activities, and health-related quality of life (HRQOL) in patients with type 2 diabetes. METHODS: cross-sectional survey design was employed, and 459 patients with type 2 diabetes were recruited from outpatient clinics in two university hospitals. The patients completed a pack of questionnaires. The hypothetical model was tested using structural equation modeling analysis. RESULTS: The values of multiple fit indices indicated that the proposed model provided a good fit to the data. Health literacy exerted not only a direct effect on self-care activities, but also an indirect effect on self-care activities via self-efficacy. However, health literacy exerted only an indirect effect on HRQOL. This structural model was invariant across hemoglobin-A1c-controlled and hemoglobin-A1c-uncontrolled groups. Based on R2 values, the final model accounted for 20.0% of the variance in selfefficacy, 61.0% of the variance in self-care activities, and 16.0% of the variance in HRQOL. CONCLUSIONS: This study suggests that self-care activities are crucial to the link between health literacy and HRQOL. Both health literacy and self-efficacy need to be considered in clinical practice for enhancing self-care activities in patients with type 2 diabetes. This approach may ultimately improve HRQOL in these patients.
Adult ; Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2/*nursing/*psychology ; Female ; *Health Knowledge, Attitudes, Practice ; *Health Literacy ; Humans ; Male ; Middle Aged ; Models, Theoretical ; Quality of Life/*psychology ; Republic of Korea ; Self Care/*psychology ; *Self Efficacy ; Surveys and Questionnaires ; Young Adult

OBJECTIVETo compare the efficacy between moving cupping at Hechelu combined with rubbing method and western medication for depression of diabetes mellitus (DM).

METHODSTwo hundred and sixteen patients were randomly divided into an observation group and a control group, 108 cases in each group. Patients in the observation group were treated with moving cupping at Hechelu combined with rubbing method, once every: other day; six treatments were considered as one course, and totally two courses were given with an interval of: 4 days between courses. Patients in the control group were treated with oral administration of fluoxetine hydrochloride capsules, once a day for consecutive 4 weeks. The Hamilton depression scale (HAMD), self-rating depression scale (SDS) and TCM symptom score were measured before treatment, after the treatment and in follow-up visit one and a half months after treatment. The fasting blood glucose was tested before and after treatment. The glycosylated hemoglobin (HbA1c) was tested in the follow-up visit.

RESULTSThe total effective rate was 90.9% (90/99) in the observation group, which was superior to 73.7% (70/95) in the control group (P < 0.05). After the treatment, HAMD, SDS and TCM symptom scores were all reduced apparently in the observation group and the control group (all P < 0.05). After the treatment and the follow-up visit, the TCM symptom score in the observation group was lower than that in the control group (P < 0.05). The levels of HbA1c and GLU were stable in the observation group, and were decreased compared with those before treatment; but the difference between the, two groups was not significant (P > 0.05).

CONCLUSIONThe Hechelu theory-based TCM treatment has better: efficacy for depression of diabetes mellitus than fluoxetine hydrochloride capsule, which has less adverse effects.

Acupuncture Points ; Adult ; Aged ; Blood Glucose ; metabolism ; Combined Modality Therapy ; Depressive Disorder ; etiology ; metabolism ; psychology ; therapy ; Diabetes Mellitus, Type 2 ; complications ; metabolism ; psychology ; Female ; Humans ; Male ; Massage ; Medicine, Chinese Traditional ; methods ; Middle Aged ; Treatment Outcome

INTRODUCTIONThe Diabetes Health Profile-18 (DHP-18) measures diabetes-related psychological well-being in patients with type 2 diabetes mellitus (T2DM). It includes 3 subscales: psychological distress (PD), barriers to activity and disinhibited eating. The psychometric properties of the DHP have not been evaluated in Asia. The aim of this study was to determine the psychometric properties of the DHP in multiethnic Singapore.

MATERIALS AND METHODSPatients between the ages of 18 to 65 diagnosed with diabetes (either type 1 or type 2) for at least 1 year were recruited from a diabetes outpatient clinic in a tertiary hospital. They completed a set of self-administered questionnaires including sociodemographic information and the DHP. Validity of the DHP was evaluated using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). Reliability was assessed with internal consistency and sensitivity was determined by effect size, associated with detecting a statistically significant and clinically important difference between various patient subgroups.

RESULTSA total of 204 patients with mean age 45.4 (11.9) years, comprising 64% males and 50% Chinese, 27% Indian and 12% Malay were studied. In CFA, model fit was poor. Forced 3-factor EFA supported the original 3-factor structure of the DHP. Convergent and discriminant validity was demonstrated (100% scaling success). DHP was sensitive across majority of social demographic, clinical and social-functioning determinants (i.e., effect size >0.3). Cronbach's alpha exceeded 0.70 for all subscales. Ceiling effects were negligible but large floor effects were seen for the PD subscale (23%).

CONCLUSIONThe DHP is valid, reliable and sensitive for measuring well-being in Asian patients with T2DM.

Adolescent ; Adult ; Aged ; Diabetes Mellitus, Type 1 ; psychology ; Diabetes Mellitus, Type 2 ; psychology ; Emotional Adjustment ; Ethnic Groups ; psychology ; statistics & numerical data ; Factor Analysis, Statistical ; Feeding Behavior ; psychology ; Female ; Humans ; Male ; Middle Aged ; Psychological Tests ; Psychometrics ; Reproducibility of Results ; Sensitivity and Specificity ; Singapore ; Stress, Psychological ; diagnosis ; etiology ; psychology ; Surveys and Questionnaires ; Young Adult

PURPOSE: This study was conducted to develop and test the effects of a motivational interviewing self-management program for use with elderly patients with diabetes mellitus. METHODS: A non-equivalent control group pretest-posttest design was used. The participants were 42 elderly diabetic patients (experimental group: 21, control group: 21). The motivational interviewing self-management program for elders with diabetes mellitus developed in this study consisted of a 12-week program in total (8 weeks for group motivational interviewing and education and 4 weeks for individual motivational interviewing on the phone). Data were collected between February 13 and May 3, 2013 and were analyzed using t-test, paired t-test, and repeated measure ANOVA with SPSS/WIN 18.0. RESULTS: For the experimental group, significant improvement was found for self-efficacy, self-care behavior, glycemic control and quality of life (daily life satisfaction, influence of disease) as compared to the control group. CONCLUSION: The study findings indicate that the motivational interviewing self-management program is effective and can be recommended as a nursing intervention for elderly patients with diabetes mellitus.
Aged ; Blood Glucose/analysis ; Diabetes Mellitus, Type 2/*psychology ; Female ; Humans ; Male ; *Motivational Interviewing ; Patient Education as Topic ; *Program Development ; *Program Evaluation ; Quality of Life ; Self Care ; Self Efficacy ; Surveys and Questionnaires

PURPOSE: The purpose of the study was to identify factors influencing physical activity among community-dwelling older adults with type 2 diabetes. The study design was based on the Theory of Triadic Influence. METHODS: A total of 242 older adults with type 2 diabetes participated in this study. Six variables related to physical activity in older adults, including self-efficacy, social normative belief, attitudes, intention, experience, and level of physical activity, were measured using reliable instruments. Data were analyzed using descriptive statistics, Pearson's correlation analyses, and a path analysis. RESULTS: The mean physical activity score was 104.2, range from zero to 381.21. The path analysis showed that self-efficacy had the greatest total effect on physical activity. Also, experience had direct and total effects on physical activity as well as mediated the paths of social normative beliefs to attitudes and intention to physical activity. These factors accounted for 10% of the total variance, and the fit indices of the model satisfied the criteria of fitness. CONCLUSION: The findings of the study reveal the important role of self-efficacy and past experience in physical activity in older adults with type 2 diabetes.
Aged ; Aged, 80 and over ; Attitude ; Diabetes Mellitus, Type 2/*physiopathology/psychology ; Female ; Humans ; Male ; Motor Activity/*physiology ; Personal Satisfaction ; Residence Characteristics ; Self Efficacy ; Surveys and Questionnaires