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Biomedical subjects

D J Cox

Publications and source records attributed to D J Cox.

142 records · Page 8Linked to original sources
PubMedDate not supplied

Intensive versus standard blood glucose awareness training (BGAT) with insulin-dependent diabetes: mechanisms and ancillary effects.

Insulin-dependent diabetes mellitus (IDDM) patients make critical daily self-care decisions on the basis of what they estimate their blood glucose (BG) levels to be. This study: a) replicated efficacy of Standard Blood Glucose Awareness Training (BGAT), b) evaluated the relative efficacy of an Intensive Blood Glucose Awareness Training (BGAT) to enhance patient accuracy of BG estimation, and c) evaluated the mechanisms and ancillary effects of BGAT. Thirty-nine subjects were randomly assigned to one of three groups. Compared with Control, both Standard and Intensive BGAT improved accuracy (p less than 0.001). Intensive BGAT post-treatment accuracy relative to Standard BGAT did not reach statistical significance (p = 0.177). Greater improvement in accuracy was associated with poorer pretreatment accuracy. Only Intensive BGAT improved metabolic control (glycosylated hemoglobin), and this improvement was associated with poorer pretreatment control. The effects of BGAT were highly specific, affecting only accuracy and metabolic control, and not affecting fear of hypoglycemia, diabetes knowledge, of frequency of blood glucose monitoring.

Adult↗
PubMedDate not supplied

Issues for the coming age of continuous glucose monitoring.

PURPOSE: This article reports the results of a symposium in which diabetes educators considered and discussed issues that are likely to arise when continuous glucose monitoring (CGM) becomes available and readily accessible. METHODS: Fifteen certified diabetes educators and 5 others with complementary expertise participated in a discussion based on their responses to 11 questions designed to elicit perspectives on issues related to CGM. Issues for discussion and debate include those related to patient acceptance and lifestyle, implications for professional practice and reimbursement, concerns about professional liability, use of CGM data by insurers and payers, and CGM data transfer. RESULTS: Educators offered varied and sometimes conflicting responses to CGM-related issues. CONCLUSIONS: Awareness of CGM-related issues will likely become an important part of diabetes professional development and perspectives in practice. Identifying and framing the issues before the new technologies become available allow diabetes educators to participate proactively in structuring the emerging policies, procedures, and standards of care.

Attitude of Health Personnel↗
PubMedDate not supplied

The relationship between nonroutine use of insulin, food, and exercise and the occurrence of hypoglycemia in adults with IDDM and varying degrees of hypoglycemic awareness and metabolic control.

The purpose of this study was to determine objectively the relationships between changes in the usual amount of insulin injected, food eaten, and exercise performed, and the subsequent occurrence of low blood glucose (< 3.9 mM) in adults with IDDM and varying degrees of hypoglycemic awareness and metabolic control. Subjects used a handheld computer to record whether their most recent insulin, food, and exercise had been omitted or were greater than, less than, or about the same as usual following every measured blood glucose level of < 3.9 mM and > 5.6 mM. Responses for each self-management behavior were compared for the two blood glucose ranges. Food was omitted more frequently prior to a low glucose reading and exercise was omitted more frequently prior to a high glucose reading. More insulin, less food, and more exercise each were associated with low glucose levels. These findings underscore the importance of traditional diabetes education.

Adult↗
PubMedDate not supplied

Psychosocial sequelae of visual loss in diabetes.

This study evaluated whether degree of related visual impairment is associated with degree of psychological symptoms in general, and specifically more somatization, depression, anxiety, phobic anxiety, fear of hypoglycemia, and stress. A total of 49 volunteer subjects with diabetes-induced visual impairment were subdivided into totally blind and partially sighted groups, and were compared with 62 nonvisually impaired adults with diabetes. All were given the Brief Symptom Index, the Hypoglycemic Fear Survey, and the Perceived Stress Scale, along with a general questionnaire assessing demographic characteristics. Mean scores of the partially sighted group did not differ from the nonvisually impaired group, but the blind subjects reported more general psychological symptoms, somatization, anxiety, and phobic anxiety. Significantly more blind than sighted subjects exhibited clinical elevations on anxiety, phobic anxiety, and fear of hypoglycemia. Regression analysis confirmed the significant visual loss on psychological functioning and revealed large individual differences in how patients respond to visual loss. (ABSTRACT TRUNCATED)

Adaptation, Psychological↗
PubMedDate not supplied

Fear of hypoglycemia: quantification, validation, and utilization.

Hypoglycemia can lead to various aversive symptomatic, affective, cognitive, physiological, and social consequences, which in turn can lead to the development of possible phobic avoidance behaviors associated with hypoglycemia. On the other hand, some patients may inappropriately deny or disregard warning signs of hypoglycemia. This study presents preliminary reliability and validity data on a psychometric instrument designed to quantify this fear: the hypoglycemic fear survey. The instrument was found to have internal consistency and test-retest stability, to covary with elevated glycosylated hemoglobin, and to be sensitive to a behavioral treatment program designed to increase awareness of hypoglycemia.

Adolescent↗
PubMedDate not supplied

Self-measurement of blood glucose. Accuracy of self-reported data and adherence to recommended regimen.

Reflectance meters containing memory chips were used in a study that addressed several questions concerning routine use of self-monitoring of blood glucose (SMBG), including accuracy of patient blood glucose (BG) diaries, reliability of self-reported frequency of SMBG, and adherence to recommended SMBG regimen. Thirty adults with insulin-dependent diabetes used memory meters and recorded test results in diaries for 2 wk while performing their normal SMBG regimen. Analysis of glucose diaries showed that only 23% of the subjects had no diary errors and 47% had clinically accurate diaries (less than 10% error rate). The most common types of errors were omissions of values contained in meter memory and additions of values not contained in meter memory, with significantly more omissions than additions. Alterations of test values (e.g., changing a 300-mg/dl reading to 200 mg/dl) were extremely rare. There was no difference in the rate of errors that resulted in a more positive clinical profile (omitting unacceptable values and adding acceptable values) or a more negative clinical profile (omitting acceptable values and adding unacceptable values). Examination of the actual frequency of SMBG showed that most subjects (56.6%) measured their BG an average of two to three times each day. Self-report of SMBG frequency correlated with both actual frequency and HbA1. Although actual frequency of SMBG was not related to physicians' recommendations, the majority (64%) of subjects were self-testing as often or more often than they had been instructed.

Adult↗
PubMedDate not supplied

Accuracy of perceiving blood glucose in IDDM.

Type I (insulin-dependent) diabetic individuals and health professionals often assume that the symptoms of extremely low or high blood glucose (BG) levels can be recognized and, consequently, appropriate treatment decisions can be based on symptom perception. Because no research has documented the validity of these assumptions, this study tested the ability to perceive BG concentration. Nineteen type I adults, experienced in self-monitoring of BG (SMBG), estimated their BG 40-54 times just before measurement of actual BG. This procedure was repeated under two conditions: (1) in the hospital (hospital condition) while connected to an insulin/glucose infusion system that artificially manipulated BG, leaving subjects only symptomatic, or internal, cues and (2) in the natural environment (home condition), where both internal and external cues, e.g., food and insulin consumption, were available. Estimates significantly correlated with actual BG for 7 of 16 subjects in the hospital condition and for 18 of 19 subjects in the home condition. Believed ability to estimate BG did not predict documented ability in either condition. An evaluation of the treatment significance of estimation errors showed that the majority of errors were relatively benign. The most common error affecting clinical outcome was estimated euglycemia when actual BG was hypoglycemic or hyperglycemic.

Adult↗
PubMedDate not supplied

Evaluating driving performance of outpatients with Alzheimer disease.

BACKGROUND: Alzheimer disease (AD) is a progressive disease, with multiple physiologic, psychologic, and social implications. A critical issue in its management is when to recommend restrictions on autonomous functioning, such as driving an automobile. This study evaluates driving performance of patients with AD and its relation to patient scores on the Mini-Mental State Exam (MMSE). METHODS: This study compared 29 outpatients with probable AD with 21 age-matched control participants on an interactive driving simulator to determine how the two groups differed and how such differences related to mental status. RESULTS: Patients with AD (1) were less likely to comprehend and operate the simulator cognitively, (2) drove off the road more often, (3) spent more time driving considerably slower than the posted speed limit, (4) spent less time driving faster than the speed limit, (5) applied less brake pressure in stop zones, (6) spent more time negotiating left turns, and (7) drove more poorly overall. There were no observed differences between AD patients and the control group in terms of crossing the midline and driving speed variability. Among the AD patients, those who could not drive the simulator because of confusion and disorientation (n = 10) had lower MMSE scores and drove fewer miles annually. Those AD patients who had stopped driving also scored lower on their MMSE but did not perform more poorly on the driving simulator. Factor analysis revealed five driving factors associated with AD, explaining 93 percent of the variance. These five factors correctly classified 27 (85 percent) of 32 AD patients compared with the control group. Of the 15 percent who were improperly classified, there were three false positives (control participants misclassified as AD patients) and two false negatives (AD patients misclassified as control participants). The computed total driving score correlated significantly with MMSE scores (r = -.403, P = 0.011). CONCLUSION: Driving simulators can provide an objective means of assessing driving safety.

Aged↗