Diabetes & Metabolism Journal

Original Article

Type 1 Diabetes
Abnormal Responses in Cognitive Impulsivity Circuits Are Associated with Glycosylated Hemoglobin Trajectories in Type 1 Diabetes Mellitus and Impaired Metabolic Control: Helena Jorge, Isabel C. Duarte, Sandra Paiva, Ana Paula Relvas, Miguel Castelo-Branco; Diabetes Metab J. 2022;46(6):866-878. Published online March 22, 2022; DOI: https://doi.org/10.4093/dmj.2021.0307

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Background
Risky health decisions and impulse control profiles may impact on metabolic control in type 1 diabetes mellitus (T1DM). We hypothesize that the neural correlates of cognitive impulsivity and decision-making in T1DM relate to metabolic control trajectories.
Methods
We combined functional magnetic resonance imaging (fMRI), measures of metabolic trajectories (glycosylated hemoglobin [HbA1c] over multiple time points) and behavioral assessment using a cognitive impulsivity paradigm, the Balloon Analogue Risk Task (BART), in 50 participants (25 T1DM and 25 controls).
Results
Behavioral results showed that T1DM participants followed a rigid conservative risk strategy along the iterative game. Imaging group comparisons showed that patients showed larger activation of reward related, limbic regions (nucleus accumbens, amygdala) and insula (interoceptive saliency network) in initial game stages. Upon game completion differences emerged in relation to error monitoring (anterior cingulate cortex [ACC]) and inhibitory control (inferior frontal gyrus). Importantly, activity in the saliency network (ACC and insula), which monitors interoceptive states, was related with metabolic trajectories, which was also found for limbic/reward networks. Parietal and posterior cingulate regions activated both in controls and patients with adaptive decision-making, and positively associated with metabolic trajectories.
Conclusion
We found triple converging evidence when comparing metabolic trajectories, patients versus controls or risk averse (non-learners) versus patients who learned by trial and error. Dopaminergic reward and saliency (interoceptive and error monitoring) circuits show a tight link with impaired metabolic trajectories and cognitive impulsivity in T1DM. Activity in parietal and posterior cingulate are associated with adaptive trajectories. This link between reward-saliency-inhibition circuits suggests novel strategies for patient management.

Citations

Citations to this article as recorded by

The usefulness of an intervention with a serious video game as a complementary approach to cognitive behavioural therapy in eating disorders: A pilot randomized clinical trial for impulsivity management
Cristina Vintró‐Alcaraz, Núria Mallorquí‐Bagué, María Lozano‐Madrid, Giulia Testa, Roser Granero, Isabel Sánchez, Janet Treasure, Susana Jiménez‐Murcia, Fernando Fernández‐Aranda
European Eating Disorders Review.2023; 31(6): 781. CrossRef
Adaptations of the balloon analog risk task for neuroimaging settings: a systematic review
Charline Compagne, Juliana Teti Mayer, Damien Gabriel, Alexandre Comte, Eloi Magnin, Djamila Bennabi, Thomas Tannou
Frontiers in Neuroscience.2023;[Epub] CrossRef
Trust-based health decision-making recruits the neural interoceptive saliency network which relates to temporal trajectories of Hemoglobin A1C in Diabetes Type 1
Helena Jorge, Isabel C. Duarte, Miguel Melo, Ana Paula Relvas, Miguel Castelo-Branco
Brain Imaging and Behavior.2023; 18(1): 171. CrossRef

Review

Improving Patients' Adherence to Physical Activity in Diabetes Mellitus: A Review: Shan-hu Qiu, Zi-lin Sun, Xue Cai, Lili Liu, Bingquan Yang; Diabetes Metab J. 2012;36(1):1-5. Published online February 17, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.1.1

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Regular physical activity (PA) is a key element in the prevention and management of type 2 diabetes mellitus (T2DM). Participation in regular PA improves blood glucose control and can prevent or delay T2DM and its complications, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life. However, most people with T2DM are not active and show poor adherence. This paper reviews the possible barriers to PA and strategies to improve the adherence to PA. Based on the currently available literature, it is concluded that self-efficacy and social support from family, friends, and health care providers play the important role in adoption and maintenance of regular PA. Here we also highlight some new modern and innovative interventions that facilitate exercise participation and improve the adherence.

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Original Articles

Factors that Affect Medication Adherence in Elderly Patients with Diabetes Mellitus: Kyung-Ae Park, Jung-Guk Kim, Bo-Wan Kim, Sin Kam, Keon-Yeop Kim, Sung-Woo Ha, Sung-Taek Hyun; Korean Diabetes J. 2010;34(1):55-65. Published online February 28, 2010; DOI: https://doi.org/10.4093/kdj.2010.34.1.55

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Abstract PDF PubReader

Background

This study was conducted to evaluate the factors affecting medication adherence in geriatric diabetic patients treated at private clinics and tertiary hospitals. We compared the factors affecting medication adherence between these two patient groups.

Methods

We included 108 diabetic patients older than 65 years treated at one tertiary hospital and 157 patients older than 65 years treated at two private clinics. We conducted an interview survey based on the Health Belief Model, and used a questionnaire that included the self-efficacy variable. For the medication adherence, Morisky's self-report was used.

Results

The medication adherence based on Morisky's self-report was significantly higher in tertiary hospital patients (61.1%) compared to private clinic patients (43.2%) (P < 0.01). The results showed that drug storage and self-efficacy were factors affecting adherence to medication in tertiary hospital patients (P < 0.05). The adherence was high in cases of proper drug storage (odds ratio [OR], 5.401) and in cases with high self-efficacy (OR, 13.114). In private clinic patients, financial level (P < 0.05), recognition of the seriousness of diabetes complications (P < 0.05) and self-efficacy (P < 0.01) were associated with medication adherence. The medication adherence was significantly lower in patients whose financial state were moderate than those with lower (OR, 0.410), and medication adherence was significantly higher in patients who had higher perceived severity (OR, 2.936) and in patients with higher self-efficacy (OR, 4.040).

Conclusion

Different strategies should be used to increase medication adherence in geriatric diabetic patients, depending on institutions whether they are treated.

Citations

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Factors Influencing Adherence to Preventive Behavior on Chronic Complications of Diabetes Mellitus.: Soon Gu Kim; Korean Diabetes J. 2008;32(1):77-82. Published online February 1, 2008; DOI: https://doi.org/10.4093/kdj.2008.32.1.77

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Abstract PDF

BACKGROUND
The prevalence of diabetes is steadily increasing in Korea. The increase of people with diabetes will ultimately result in taking a turn for the worse, not only affecting the health of the people, but there will be an increase of social finances. This study was aimed at investigating the factors influencing adherence to preventive behavior on chronic complications of Diabetes Mellitus. METHODS: Data was collected by questionnaires from 332 diabetic patients who were visited out-patient clinics, with 323 finally selected for the study. The data was analyzed by the SPSS program. RESULTS: The level of knowledge on chronic complications of Diabetes Mellitus was 18.02 points space(maximum 24 points). The level of hardiness was 119.80 points(maximum 240 points). The level of adherence to preventive behavior on chronic complications of Diabetes Mellitus was 49.11 points(maximum 75 points). The score of knowledge and hardiness showed a significant correlation with adherence to preventive behavior on chronic complications of Diabetes Mellitus. The significant predictors influencing adherence to preventive behavior were treatment, knowledge of Diabetes Mellitus, and hardiness. CONCLUSION: This study suggests that treatment, knowledge, and hardiness are significant influencing factors on adherence to preventive behavior on chronic complications of Diabetes Mellitus. The results of this study will contribute to developing a program for people with diabetes.

Citations

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Factors Related to Perceived Health Status in Patients with Type 2 Diabetes
Ang Li Won, Seung Hyun Yoo, Myoung Soon You
Korean Journal of Health Education and Promotion.2014; 31(3): 1. CrossRef
Relationships of Motivational Factors and Diabetes Self-management Behavior in Community Dwelling Older Adults
Kyoungsan Seo, Misoon Song
Journal of muscle and joint health.2012; 19(3): 308. CrossRef

Perceived barriers to Dietary Practice Adherence Among Persons with Diabetes.: O Keum Song, Hong Woo Nam, Do Ho Moon, Kyung Ho Lim, Hyun Kyung Moon, Eul Sang Kim; Korean Diabetes J. 1998;22(3):381-391. Published online January 1, 2001

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Abstract PDF: BACKGROUND
Diet therapy is viewed as a cornerstone of diabetes care and emphasized to all the type of diabetes. The diet has been identified by many patients as one of the most difficult part of managing their diabetes. They may have several factors to influence adherence to a dict. The purpose of this study was to identify dietary practice adherence and perceived barriers(intrinsic and extrinsic factors) among the persons with diabetes at Diabetes Clinic in Nationwide.. METHODS: The survey questionnaire was mailed to 852 persons with diabetes member via diabetes educators of 156 hospitals, clinics and 24 health centers. Questionnaire divided into 3 part;(1)background information (2)meal regularity and food intake as a dietary practice adherence (3)40 items with motive/ attitude as a intrinsic factor and knowledge, resources/authority as a extrinsic factor was rated by the thoughts and feelings associated with barriers to dietary practice adherence. 432 questionnaires were returned. The response rate was 51%. RESULTS: Meal regularty was more satisfactory than food intake. Deficit of meal regularity was reasonable spacing between meal and snack' due to "grazing", "weak will", "hunger feeling". Deficit of food Intake was protein food in 3 meal a day' 43% less recommendation due to I wouldnt disturb anyone so I used to eat something available", fear of hyperglycemia, bother to prepare food. Conclusions: The respondents to this questionnaire were members of Diabetes Clinics. They perceived that motive/attitude(intrinsic factors) was as the major barriers while authority/resources(extrinsic factors) was as a minor barriers to the dietary practice adherence. Tliese results suggest that dietary strategies may need to be developed cognitive-behavioral aspect and problem-solving skills for alteration in 'Real-life' diabetic situation to dietary practice adherence.

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