[Show abstract][Hide abstract] ABSTRACT: Eating disorders are considered medical illnesses with diagnostic criteria based on psychological, behavioural, and physiologic characteristics. Eating disorders considerably impact the health status of affected individuals, potentially in a life-threatening manner. Over the past two decades, much progress has been made in the classification and understanding of eating disorders. In general terms, information about the classification, incidence, etiology, and effects of eating disorders encompasses three groups of psychopathologies with associated eating pattern abnormalities: anorexia nervosa; bulimia nervosa; and eating disorders not otherwise specified (EDNOS), including binge eating disorder. Disordered eating is not uncommon and can be detrimental to both short- and long-term health for patients with type 1 (and type 2) diabetes. Clinical and subclinical disordered eating behaviours such as binge eating disorder and EDNOS are more common in adolescent girls with type 1 diabetes than age-matched control subjects. Both comorbid disordered eating (subclinical as well as clinical) and elevated BMI can have a negative influence on glycemic control and health outcomes in type 1 diabetes. Understanding the complexities of eating disorders, such as influencing factors, comorbid illness, medical and psychological complications, and boundary issues, is critical in the effective treatment of eating disorders. The nature of eating disorders requires a collaborative approach by an interdisciplinary team of psychological, nutritional, and medical specialists.
No preview · Article · Jan 2011 · Giornale Italiano di Diabetologia e Metabolismo
[Show abstract][Hide abstract] ABSTRACT: A trial was performed to establish whether our group care model for lifestyle intervention in type 2 diabetes can be exported to other clinics.
This study was a 4-year, two-armed, multicenter controlled trial in 13 hospital-based diabetes clinics in Italy (current controlled trials no. ISRCTN19509463). A total of 815 non-insulin-treated patients aged <80 years with > or =1 year known diabetes duration were randomized to either group or individual care.
After 4 years, patients in group care had lower A1C, total cholesterol, LDL cholesterol, triglycerides, systolic and diastolic blood pressure, BMI, and serum creatinine and higher HDL cholesterol (P < 0.001, for all) than control subjects receiving individual care, despite similar pharmacological prescriptions. Health behaviors, quality of life, and knowledge of diabetes had become better in group care patients than in control subjects (P < 0.001, for all).
The favorable clinical, cognitive, and psychological outcomes of group care can be reproduced in different clinical settings.
[Show abstract][Hide abstract] ABSTRACT: Although there are progresses in the pharmacological treatment of patients with diabetes, nutrition and improvement in lifestyle remain the cornerstone of the treatment of diabetes mellitus type 2 (DMT2). Switching from individual visits to group visit (Group Care) there is evidence that we can effectively manage DMT2 reorganizing the outpatient clinic. The goal of this study is to evaluate if a structured intervention of therapeutic education (linked to the Group Care standards) may improve clinical parameters, behavior and knowledge on diabetes and quality of life compared to traditional one to one visits. Out of 102 patients with DMT2 diagnosed at least 3 years before, 51 were included in Group Care (A) and 51 followed a standard outpatient care (B). The two groups were similar for age (63.38 ± 9.68 years in group A vs 63.70 ± 6.99 years in group B) and years of diabetes (13.23 ± 6.62 years in group A vs 13.37 ± 3.91 years in group B). Every 3 months they had a follow up visit with fasting blood glucose, HbA 1c, BMI and blood pressure taken. At time 0, 12 and 24 months we have collected: total and HDL cholesterol, triglycerides, ECG and cardiovascular events and performed a screening for complications. At the end of the study a questionnaire on diabetes knowledge and two others in quality of life and behaviour were administered. All the 102 patients showed a clinical good results particularly HbA 1c result in group A (7.82 ± 1.40% at 6 months, and 7.65 ± 1.31% at 18 months) is statistically significant compared to group B. BMI shows an improvement in both groups at 24 months. The results of the questionnaires showed better knowledge on diabetes in group A, while the behavior does not differ significantly in both groups, with the exception of the item regarding problem-solving. This finding could explain why patients in group A have an overall better metabolic control compared to group B patients. An economic analysis of resources (related to the health care professionnels involved) has shown a significant benefit (more nurses and dietitians involved compared to traditional one to one patient-doctor time relationship).
No preview · Article · Dec 2009 · Giornale Italiano di Diabetologia e Metabolismo
[Show abstract][Hide abstract] ABSTRACT: The locus of control theory distinguishes people (internals) who attribute events in life to their own control, and those (externals) who attribute events to external circumstances. It is used to assess self-management behaviour in chronic illnesses. Group care is a model of systemic group education that improves lifestyle behaviour and quality of life in patients with Type 1 and Type 2 diabetes. This study investigated the locus of control in Type 1 and Type 2 diabetes and the possible differences between patients managed by group care and control subjects followed by traditional one-to-one care.
Cross-sectional administration of two questionnaires (one specific for diabetes and one generic for chronic diseases) to 83 patients followed for at least 5 years by group care (27 Type 1 and 56 Type 2) and 79 control subjects (28 Type 1 and 51 Type 2) of similar sex, age and diabetes duration. Both tools explore internal control of disease, the role of chance in changing it and reliance upon others (family, friends and health professionals).
Patients with Type 1 diabetes had lower internal control, greater fatalistic attitudes and less trust in others. Patients with either type of diabetes receiving group care had higher internal control and lower fatalism; the higher trust in others in those with Type 1 diabetes was not statistically significant. The differences associated with group care were independent of sex, age and diabetes duration.
Patients with Type 1 diabetes may have lower internal control, fatalism and reliance upon others than those with Type 2 diabetes. Receiving group care is associated with higher internal control, reduced fatalism and, in Type 1 diabetes, increased trust in others.
Full-text · Article · Feb 2008 · Diabetic Medicine
[Show abstract][Hide abstract] ABSTRACT: We showed previously that continuing education can be embedded into routine diabetes care by seeing patients in small groups rather than individually. Group Care was cost-effective in improving quality of life, knowledge of diabetes, health behaviours and clinical outcomes in people with type 2 diabetes. Aim of this study was to verify if Group Care can be applied also to type 1 diabetes. Randomized, controlled clinical trial comparing 31 patients managed by Group Care with 31 managed by traditional one-to-one care. A syllabus was built and later remodulated with the patients in a series of focus-group meetings. The primary end-point was changes in quality of life. Secondary end-points were: knowledge of diabetes, health behaviours, HbA1c and circulating lipids. After 5 years, quality of life improved among patients on Group Care, along with health behaviours (p < 0.001, both). Among controls, quality of life worsened (p < 0.001) whereas behaviours remained unchanged. HbA1c decreased in both groups of patients, though significantly so only in controls. Group Care is applicable also in type 1 diabetes, where it improves quality of life and health behaviours. Future programme adjustments should strive to impact more on metabolic control.
[Show abstract][Hide abstract] ABSTRACT: To investigate the locus of control in patients with type 2 diabetes followed by systemic group education (Group Care) and traditional one-to-one care.
In a post-hoc analysis, two questionnaires were administered to 56 patients who had been followed for 5-7 years by Group Care and 51 controls followed by individual care, similar by age, sex, diabetes duration, glycaemia, insulinaemia, weight and other clinical variables. Patients on Group Care had lower HbA1c (7.40 +/- 1.21%) than controls (7.99 +/- 1.48%), P = 0.027. The Peyrot and Rubin questionnaire, specific for diabetes, and the Wallston and Wallston questionnaire, more generic for chronic diseases, were administered. Both questionnaires explore 3 areas: internal control of disease, and the role of chance or powerful other people, including health operators, in changing the disease.
Both questionnaires showed lower scores for chance in patients followed by Group Care (P < 0.001), while scores for powerful others did not differ from those of patients followed by traditional care. The Peyrot and Rubin tool showed increased Internal Control (P < 0.001) in the patients followed by Group Care. Multivariate analysis showed that the HOMA index of insulin resistance was inversely related to Internal Control (B = -0.144, P = 0.005) independently of BMI and HbA1c.
Fatalistic attitudes were lower and internal control higher in patients with type 2 diabetes followed by Group Care. These changes may be related to insulin resistance, above and beyond the effects of body weight and metabolic control.
No preview · Article · Feb 2006 · Diabetes & Metabolism
[Show abstract][Hide abstract] ABSTRACT: We showed that continuing education can be embedded into routine diabetes care by seeing patients in small groups rather than individually. Group care was cost-effective in improving quality of life, knowledge of diabetes, health behaviours and clinical outcomes in people with type 2 diabetes. The aim of this study was to verify if group care can also be applied to type 1 diabetes.
Randomized, controlled clinical trial comparing 31 patients managed by group care with 31 managed by traditional one-to-one care. A syllabus was built and later remodulated with the patients in a series of focus-group meetings. The primary end-point was changes in quality of life. Secondary end-points were: knowledge of diabetes, health behaviours, HbA1c and circulating lipids. Differential costs to the Italian National Health System and to the patients were also calculated. After 3 years, quality of life improved among patients on group care, along with knowledge and health behaviours (p<0.001, all). Knowledge added its effects to those of group care by independently influencing behaviours (p=0.004) while quality of life changed independently of either (p<0.001). Among controls, quality of life worsened (p<0.001) whereas knowledge and behaviours remained unchanged. HDL cholesterol increased among patients on group care (p=0.027) and total cholesterol decreased in the controls (p<0.05). HbA1c decreased, though not significantly, in both. Direct costs for group and one-to-one care were Euros 933.19 and Euros 697.10 per patient, respectively, giving a cost-effectiveness ratio of Euros 19.42 spent per point gained in the quality of life scale.
Group care is applicable and also cost-effective in type 1 diabetes. It improves quality of life, knowledge and behaviours. Future programme adjustments should strive to impact more on metabolic control.
[Show abstract][Hide abstract] ABSTRACT: Patient education is seldom applied to daily diabetes practice because of lack of resources, trained operators and evidence-based models. We have shown that a group care model, in which traditional individual visits are substituted by group education sessions, is both feasible and cost-effective in improving clinical, cognitive and psycho-social outcomes and operators' satisfaction, and permits more rational use of resources. ROMEO (Ripensare l'Organizzazione per Migliorare l'Educazione e gli Outcome = Rethink Organization to iMprove Education and Outcomes) was started to: 1) evaluate if Group Care can be successfully implemented to other clinics, 2) verify if our encouraging results can be reproduced elsewhere, and 3) assess the clinical impact of group care in a larger patient population. ROMEO will be a multicentre, randomized, controlled clinical trial of group versus individual care in the routine management of T2DM. Preparation of an operating manual and videos, training of operators (physicians, nurses and dieticians) by interactive sessions, and evaluation of local facilities and resources have all been completed. Nine-hundred individuals aged < 80 with ≥ 1 known diabetes duration, treated by diet alone or with oral agents, were recruited from the patient populations of 15 centres and will be followed for 4 years. Having obtained their informed consent, patients are randomised within each centre to either group or individual care. Visits will be held every 3 months. Any patient will otherwise be seen on an individual basis, should any medical problem arise or for annual screening of complications or upon the patient's request. Fasting blood glucose, glycated haemoglobin, body weight, blood pressure, hypoglycaemic and anti-hypertensive treatments will be assessed 3-monthly. Serum creatinine, total and HDL cholesterol, triglyceride, uric acid, ECG and cardiovascular events will be assessed yearly. Diabetes knowledge, health behaviors and quality of life will be assessed bi-yearly. This paper reports on the results of a questionnaire administered to assess the implementation process in all centres involved, including all formal acts of recognition of the Group Care activities by local health authorities. All centres involved in ROMEO have completed an analysis of their internal organization and started rethinking their organization aimed at continuously improving their diabetes team performance.
No preview · Article · Mar 2004 · Giornale Italiano di Diabetologia e Metabolismo
[Show abstract][Hide abstract] ABSTRACT: Aim: To estimate cost-benefit of Enteral Nutrition in chronic disease and specially, in cerebrovascular disease. Research design and Methods: This study involved 15 patients in 7 months before enteral nutrition and 7 months after. To estimate anthropometric and biochemical parameters and costs for Public Health. Results: With regard to anthropometric and biochemical parameters we have had improvement with statistical significance of Weight, Hb, Ht, Total Protein, Albumin, Iron and Total Lynphocytes. At the same time has been observed a marked reduction of days of hospitalization; this action has determined a notable lowering of health-care expenses for nutritional therapy and other support therapy. Conclusions: Our datas confirms that Enteral Nutrition is a therapy very effective and with good cost benefits for chronics diseases.
[Show abstract][Hide abstract] ABSTRACT: To evaluate retrospectively the results of a screening for gestational diabetes (GD) carried out during the period 1981-91 on pregnant women with one or more risk factors for diabetes.
An oral glucose tolerance test (OGTT) was performed between the 14th and 18th weeks of pregnancy in 423 women. Those who were positive for gestational diabetes were successively treated with diet alone or together with insulin to obtain strict metabolic control.
Positivity for GD varied between 2.2% and 2.4% in all women studied and between 20.8% and 28.8% in pregnant women with two or more risk factors. Pathological deliveries (caesarian and dystocial) and macrosomias proved more frequent, though not significantly so, in pregnant women positive for GD compared to those who proved negative. The maternal 5 years follow up of women with previous GD showed 10% positivity for IGT and 14% positivity for diabetes.
Intensive treatment of a pregnant woman with GD, allows the achievement of results similar, in terms of maternal and fetal health, to those observable in non-diabetic pregnant women. GD moreover seems highly forseeable for the appearance of diabetes mellitus and it is therefore advisable, after pregnancy, to perform a long-term follow-up for preventive purposes.
No preview · Article · Jul 1994 · Minerva endocrinologica