PURPOSE: The purpose of this study was to define the concept for psychological insulin resistance in the Korean population with diabetes. METHODS: The Hybrid model was used to perform the concept analysis of psychological insulin resistance. Results from both the theoretical review with 26 studies and a field study including 19 participants with diabetes were included in final process. RESULTS: The preceding factors of psychological insulin resistance were uncontrolled blood glucose and change in daily life. The concept of psychological insulin resistance was found to have three categories with 8 attributes such as emotional factors (negative feeling), cognitive factors (low awareness and knowledge, low confidence for self-injection) and supportive factors (economic burden, dependency life, embarrassing, feeling about supporters, feeling of trust in, vs mistrust of health care providers). The 8 attributes included 30 indicators. CONCLUSION: The psychological insulin resistance of population with diabetes in Korea was defined as a complex phenomenon associated with insulin therapy that can be affected by emotional factors, cognitive factors, and supportive relational factors. Based on the results, a tool for measuring psychological insulin resistance of Koreans with diabetes and effective programs for enhancing insulin adherence should be developed in future studies.
Blood Glucose ; Delivery of Health Care ; Dependency (Psychology) ; Diabetes Mellitus ; Insulin Resistance* ; Insulin* ; Korea ; Psychology

BACKGROUND: Diabetes mellitus is a chronic disease requiring continuous treatment and vigorous self-management. Reinforcement of effective self management and diabetes education are important factors in successful treatment. The aim of this study was to evaluate the effectiveness of the current diabetes education program on blood glucose control, self-management, and self-efficacy of patients with type 2 diabetes mellitus. METHODS: A total of 592 patients with newly diagnosed or uncontrolled type 2 diabetes mellitus were recruited to the diabetes education program from January to December 2007. We surveyed 338 patients from April to July 2008. A total of 117 patients had biochemical examinations and completed a questionnaire about knowledge, self-management and self-efficacy of diabetes treatment (no education group (n = 23), education group (n = 94)). RESULTS: The total scores from the questionnaires and the results of laboratory data showed no differences between the two groups. However, there were significant reductions in hemoglobin A1c level in the education group, as compared with the no education group (P = 0.039). Although the score for knowledge about diabetes mellitus was significantly higher in the education group (P = 0.005), greater knowledge was not reflected in the self-management or self-efficacy of the patients. CONCLUSION: The current diabetes education program had no effect on the self-management or self-efficacy of patients with diabetes, although did show some degree of association with blood glucose control and diabetes knowledge level. We conclude that a more effective diabetes education program needs to be developed and applied to daily practice for the improvement ofself-efficacy in patients with diabetes mellitus.
Blood Glucose ; Chronic Disease ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Hemoglobins ; Humans ; Reinforcement (Psychology) ; Self Care ; Self Efficacy ; Surveys and Questionnaires

PURPOSE: The purpose of this study was to develop and evaluate a Korean questionnaire to measure resilience in children with chronic illness. METHODS: Item construction was drawn from an extensive review of the literature, existing questionnaires and interviews with parents. Content validity was tested by experts. To further refine the questionnaire and test its reliability and validity, data were collected from the 202 children with asthma, diabetes mellitus or nephrotic syndrome. Corrected items were used to total correlation coefficient and test-retest reliability. Questionnaire testing was conducted using factor analysis, Cronbach's alpha, and correlation coefficients. Validity of the questionnaire was tested using internal consistency, construct validity, and criterion-related validity. RESULTS: Components of the questionnaire were in three domains; interpersonal characteristics, characteristics of coping, and intrapersonal characteristics. Factor analysis is showed five factors; positive self-understanding, self-reliance, resourcefulness, perception of positive family relationships, and intimacy. The questionnaire showed a high internal consistency. A significant positive correlation with the Numerical Rating Score and negative correlation with the Child Depression Inventory support the validity of the questionnaire. CONCLUSION: This instrument demonstrated high reliability and validity. Therefore, this instrument can contribute to the evaluation of resilience of chronically ill children and to any subsequent intervention as well as to develop a theory for resilience.
Adolescent ; Adult ; Asthma/*psychology ; Child ; Chronic Disease ; Depression/psychology ; Diabetes Mellitus/*psychology ; Humans ; Interviews as Topic ; Middle Aged ; Nephrotic Syndrome/*psychology ; Parents/psychology ; Program Evaluation ; *Questionnaires ; *Resilience, Psychological

BACKGROUND: Constipation occurs frequently in diabetes mellitus (DM). However, there are few reports that investigated the characteristics of constipation associated with DM. The purpose of this study was to evaluate the clinical features of constipation associated with DM. METHODS: Among constipated patients who visited Asan Medical Center from January 2000 to December 2004, 45 patients with DM (DM group) and 104 patients without DM (non-DM group) were included in this study. We reviewed the clinical presentation, results of anorectal manometry, colon transit time study, and defecogram. We also analyzed the response to biofeedback therapy. RESULTS: The severity of constipation symptoms before treatment was not different between DM and non-DM group. Patients with colon transit time over 56 hours were more frequent in DM group than in non-DM group (21/45, 46.7% vs. 31/104, 29.8% ; p=0.047). Among DM group, colon transit time and the duration of DM showed positive correlation (r=0.431, p=0.003). The resting anal sphincter pressure was significantly lower in DM group than in non-DM group (43.5+/-21.5 mmHg vs. 51.7+/-22.6 mmHg ; p=0.048). The results of defecography were similar between DM and non-DM group. Successful responses to biofeedback therapy were not different between DM and non-DM group (19/34, 55.9% vs. 43/79, 54.4% ; p=0.887). CONCLUSIONS: Slow transit constipation was more frequent in DM group than in non-DM group. The successful responses to biofeedback therapy appear to be similar between DM and non-DM group.
Anal Canal ; Biofeedback, Psychology ; Chungcheongnam-do ; Colon ; Constipation* ; Defecography ; Diabetes Mellitus* ; Humans ; Manometry ; Time and Motion Studies

The avulsion fracture of the calcaneal tuberosity is rare injury. Usually, it occurs from indirect trauma in old patients with osteoporosis or in patients with diabetic neuropathy. Especially, the bone and joint damage occurred in active patient with severe sensory loss or arthropathy related to nerve damage regardless of the cause is referred to neuropathic arthropathy. Generally, a patient with nondisplacement or minimally displacement is treated by conservative therapy and a patient with severe displacement is treated by open reduction and internal fixation. We experienced a 33 years-old woman with diabetes mellitus who had the displaced avulsion fracture of the calcaneal tuberosity without significant trauma and did not treat. We report upon this case at the 2 years follow-up.
Diabetes Mellitus ; Diabetic Neuropathies ; Displacement (Psychology) ; Female ; Follow-Up Studies ; Humans ; Joints ; Natural History ; Osteoporosis

PURPOSE: This study was to identify factors explaining health empowerment of older adults with high-risk of cardio-cerebrovascular diseases. METHODS: Using a structured questionnaire, data were collected from 148 older adults residing in two areas who have one or more of the following diseases; hypertension, diabetes mellitus, hyperlipidemia, and atherosclerosis. Data were analyzed using descriptive statistics, independent t-test, analysis of variance (ANOVA), Pearson correlation analysis, and hierarchical multiple regression. RESULTS: Health empowerment had a positive correlation with health literacy and social support. Perceived health status and social activity participation showed significant contribution in explaining health empowerment. CONCLUSION: This study showed that enhancing perceived health status and social activity participation are vital in an effort to improve health empowerment of the population. Main findings of this study can contribute to developing health empowerment interventions to improve health behavior practices of the older adults.
Adult* ; Aged ; Atherosclerosis ; Cardiovascular Diseases ; Diabetes Mellitus ; Health Behavior ; Health Literacy ; Humans ; Hyperlipidemias ; Hypertension ; Power (Psychology)*

BACKGROUND AND OBJECTIVES: Previous studies have evaluated atrial electromechanical delays (AEMDs) with a number of different definitions to discriminate patients with paroxysmal atrial fibrillation (PAF) from controls without PAF. However, their discriminative values for PAF have not previously been directly compared. SUBJECTS AND METHODS: A total of 65 PAF patients and 130 control subjects matched for age, sex, history of hypertension, and diabetes mellitus were selected. The AEMDi and AEMDp were defined as the time intervals from the initiation of the P wave on the surface electrocardiogram to the initiation and peak of the late diastolic transmitral inflow on pulsed wave Doppler images, respectively. The AEMDim and AEMDpm were defined as the time intervals from the initiation of the P wave on the surface electrocardiogram to the initiation and peak of the late diastolic lateral mitral annular motion on tissue Doppler images, respectively. RESULTS: There were no significant differences in the clinical characteristics between the two groups. All 4 AEMDs were consistently longer in the PAF group, and proven effective to differentiate the PAF patients from the controls. The AEMDi measurement had a larger area under the curve (AUC) than the other AEMDs, left atrial volume index, and P wave amplitude. However, the AEMDp, AEMDim, and AEMDpm measurements had AUCs similar to those of the left atrial volume index and P wave amplitude. CONCLUSION: The findings suggest that the AEMDi is better than the other AEMDs for the discrimination of PAF patients from the controls.
Area Under Curve ; Atrial Fibrillation* ; Diabetes Mellitus ; Discrimination (Psychology)* ; Echocardiography ; Electrocardiography ; Humans ; Hypertension

PURPOSE: The purpose of this study was to monitor the use of health-related quality of life (HRQOL) instruments in Korean studies of patients with diabetes. METHODS: Of 86 Korean studies initially identified, 17 studies met the inclusion criteria. For each study, a description of the instrument and its psychometric properties were monitored by the Instrument Review Criteria of the Scientific Advisory Committee. These criteria include conceptual definition, attributes, taxonomy, reliability, validity, responsiveness, administrative mode, and language adaptations. RESULTS: Five generic and one diabetes specific type questionnaires were identified from the 17 studies. Of those studies, conceptual definitions with the attributes of multi-dimension and subjectiveness were provided for 11 studies (71%). In the analysis of conceptual taxonomy, only 6 studies were classified as HRQOL, while other studies were done as QOL or health status. In monitoring of psychometric properties, reliability, validity, and responsiveness were reported for 88.2%, 64.7%, and 29.4%, respectively. One generic instrument was developed with a Korean population, while the other instruments were developed for Western countries. However, language adaptations were performed for only a few of the instruments. CONCLUSION: The psychometric properties including responsiveness of most instruments warrants further research, and the development of diabetes-specific HRQOL measurements should be sought to facilitate intervention outcomes across Korean studies of patients with diabetes.
Diabetes Mellitus/*psychology ; Health Status ; Humans ; Psychometrics ; *Quality of Life ; Questionnaires ; Republic of Korea

OBJECTIVETo study the changes in cognitive function of children with type 1 diabetes and explore the possible factors influencing cognitive function.

METHODSThirty-two children with type 1 diabetes (disease course equal to or more than one year) and aged from 6 to 16 years, were enrolled in this study. Cognitive function was evaluated by the Chinese Wechsler Intelligence Scale. Factors influencing cognitive function were investigated using multiple regression analysis. Thirty-two age- and gender-matched healthy children served as the control group.

RESULTSVerbal intelligence quotient in the diabetic group was significantly lower than in the control group (97±15 vs 118±13; P<0.01). Full intelligence quotient in the diabetic group was also lower than in the control group (99±15 vs 113±12; P<0.01). In the verbal scale test, a sub-test of the Wechsler Intelligence Scale, scores in knowledge, category, comprehension, arithmetics and vocabulary scale in the diabetic group were significantly lower than in the control group (P<0.01). Multiple regression analysis showed that glycosylated hemoglobin level was significantly negatively with full, verbal and operation intelligence quotients in diabetic children (r=-5.64, -7.29, -3.00 respectively; P<0.05).

CONCLUSIONSType 1 diabetes may affect adversely children's verbal intelligence quotient, resulting in a decreased full intelligence quotient. Glycosylated hemoglobin may be an independent risk factor for cognitive function in diabetic children.

Adolescent ; Child ; Cognition ; Diabetes Mellitus, Type 1 ; psychology ; Female ; Humans ; Intelligence ; Male ; Regression Analysis

Child ; Diabetes Mellitus ; etiology ; Diet ; Humans ; Hypertension ; etiology ; Lipids ; blood ; Obesity ; complications ; prevention & control ; psychology