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Purpose and Background The relationship between risk perceptions and diabetes self-care remains ambiguous. This study aimed to assess baseline, 1-year follow-up, and change score relationships among perceived risk, diabetes self-care, and glycemic control for adult individuals participating in a behavioral intervention that improved glycemic control relative to the active control. Method One-year randomized trial compared a behavioral telephonic intervention with a print only intervention. Participants ( N  = 526) are members of a union/employer sponsored health benefit plan, with HbA 1c  ≥ 7.5 %, prescribed at least one oral diabetes medication. Participants rated perceived risk of diabetes and its complications and diabetes self-care at baseline and 1 year. Data were collected in a large urban area in the USA. Results There were no relationships between risk perceptions and glycemic control during the study. Baseline perceived risk predicted follow-up self-care. Additionally, participants assigned to the intervention group showed significant changes in dietary and exercise adherence at high levels of risk knowledge and low levels of optimistic bias. Conclusion Perceived risk relates to dietary, exercise, and medication adherence in diabetes. The perceived risk construct might foster a more coherent conceptualization of the relationship between one’s diabetes, possible complications, and diabetes self-care behaviors.

Stringent glucose demands render the brain susceptible to disturbances in the supply of this main source of energy, and chronic stress may constitute such a disruption. However, whether stress-associated cognitive impairments may arise from disturbed glucose regulation remains unclear. Here we show that chronic social defeat (CSD) stress in adult male mice induces hyperglycemia and directly affects spatial memory performance. Stressed mice developed hyperglycemia and impaired glucose metabolism peripherally as well as in the brain (demonstrated by PET and induced metabolic bioluminescence imaging), which was accompanied by hippocampus-related spatial memory impairments. Importantly, the cognitive and metabolic phenotype pertained to a subset of stressed mice and could be linked to early hyperglycemia 2 days post-CSD. Based on this criterion, ∼40% of the stressed mice had a high-glucose (glucose >150 mg/dL), stress-susceptible phenotype. The relevance of this biomarker emerges from the effects of the glucose-lowering sodium glucose cotransporter 2 inhibitor empagliflozin, because upon dietary treatment, mice identified as having high glucose demonstrated restored spatial memory and normalized glucose metabolism. Conversely, reducing glucose levels by empagliflozin in mice that did not display stress-induced hyperglycemia (resilient mice) impaired their default-intact spatial memory performance. We conclude that hyperglycemia developing early after chronic stress threatens long-term glucose homeostasis and causes spatial memory dysfunction. Our findings may explain the comorbidity between stress-related and metabolic disorders, such as depression and diabetes, and suggest that cognitive impairments in both types of disorders could originate from excessive cerebral glucose accumulation.

To identify the unique sources of diabetes distress (DD) for adults with type 1 diabetes (T1D). Sources of DD were developed from qualitative interviews with 25 T1D adults and 10 diabetes health care providers. Survey items were then developed and analyzed using both exploratory (EFA) and confirmatory CFA) analyses on two patient samples. Construct validity was assessed by correlations with depressive symptoms (PHQ8), complications, HbA1C, BMI, and hypoglycemia worry scale (HWS). Scale cut-points were created using multiple regression. An EFA with 305 U.S. participants yielded 7 coherent, reliable sources of distress that were replicated by a CFA with 109 Canadian participants: Powerlessness, Negative Social Perceptions, Physician Distress, Friend/Family Distress, Hypoglycemia Distress, Management Distress, Eating Distress. Prevalence of DD was high with 41.6% reporting at least moderate DD. Higher DD was reported for women, those with complications, poor glycemic control, younger age, without a partner, and non-White patients. We identified a profile of seven major sources of DD among T1D using a newly developed assessment instrument. The prevalence of DD is high and is related to glycemic control and several patient demographic and disease-related patient characteristics, arguing for a need to address DD in clinical care.

Background Stress hyperglycaemia is common among older adults hospitalised with community-acquired pneumonia (CAP) and is associated with delirium; however, the underlying inflammatory pathways remain unclear. We investigated whether the neutrophil-to-lymphocyte ratio (NLR) and procalcitonin (PCT) mediate the relation between the stress-hyperglycaemia ratio (SHR) and delirium. Methods This single-centre retrospective cohort included 412 patients aged ≥ 65 years admitted for CAP. Delirium was assessed daily with the Confusion Assessment Method. Logistic regression models yielded odds ratios (ORs) for delirium, whereas linear regression models for NLR and PCT provided standardised beta coefficients (β_std). All continuous variables (SHR, NLR and PCT) were z-scored prior to mediation analysis. Results Delirium developed in 99 patients (24.0%). After adjustment for age, sex and comorbidities, SHR (OR = 9.13, 95% CI 4.44–18.96), NLR (OR = 1.12 per unit, 95% CI 1.06–1.19) and PCT (OR = 1.14 per ng/mL, 95% CI 1.06–1.21) were independent predictors of delirium. The total standardised effect of SHR on delirium was β_std = 0.321, of which 80.6% was direct (β_std = 0.259, 95% CI 0.149–0.427). The NLR-mediated pathway accounted for 19.4% of the association (β_std = 0.062, 95% CI 0.024–0.107). Pathways involving PCT—alone or in sequence with NLR—were not significant. Conclusions In older CAP patients, stress hyperglycaemia substantially elevates delirium risk, predominantly through a direct mechanism only partly (≈ 20%) mediated by systemic inflammation reflected by NLR. Prompt detection and management of acute hyperglycaemia may therefore offer a practical approach to delirium prevention. Prospective multicentre studies are needed to confirm causality and to test glucose- and inflammation-modulating interventions.

OBJECTIVE: To clarify previous findings that diabetes distress is related to glycemic control and self-management whereas measures of depression are not, using both binary and continuous measures of depression. RESEARCH DESIGN AND METHODS: Four hundred and sixty-three type 2 patients completed measures of diabetes distress (Diabetes Distress Scale [DDS]) and clinical depression (Patient Health Questionnaire 8 [PHQ8]). PHQ8 was employed as either a binary (≥10) or continuous variable. Dependent variables were A1C, diet, physical activity (PA), and medication adherence (MA). RESULTS: The inclusion of a binary or continuous PHQ8 score yielded no differences in any equation. DDS was significantly associated with A1C and PA, whereas PHQ8 was not; both DDS and PHQ8 were significantly and independently associated with diet and MA. CONCLUSIONS: The lack of association between depression and glycemic control is not due to the use of a binary measure of depression. Findings further clarify the significant association between distress and A1C.

The consensus algorithm for the medical management of type 2 diabetes was published in August 2006 with the expectation that it would be updated, based on the availability of new interventions and new evidence to establish their clinical role. The authors continue to endorse the principles used to develop the algorithm and its major features. We are sensitive to the risks of changing the algorithm cavalierly or too frequently, without compelling new information. An update to the consensus algorithm published in January 2008 specifically addressed safety issues surrounding the thiazolidinediones. In this revision, we focus on the new classes of medications that now have more clinical data and experience.

Managing blood glucose levels is challenging for elite athletes with type 1 diabetes (T1D) as competition can cause unpredictable fluctuations. While fear of hypoglycemia during physical activity is well documented, research on hyperglycemia-related anxiety (HRA) is limited. HRA refers to the heightened fear that hyperglycemia-related symptoms will impair functioning. This study investigates current strategies employed to mitigate HRA during competition and the development of alternative approaches. Elite athletes with TID, aged >14 who self-reported HRA during competition were recruited. Elite athletes were defined as individuals exercising >10 hours per week whose athletic performance has achieved the highest competition level. 60 to 90-minute virtual semi-structured interviews were analyzed using an Interpretative Phenomenological Analysis. Ten elite athletes with T1D (average age 25 ± 3 years; T1D duration 12 ± 8 years; number of competitions per year 27 ± 19; training time per week 12 ± 6 hours) reported the strategies they currently use to mitigate HRA. These strategies include managing insulin and nutrition intake, embracing social support networks, using technology, practicing relaxation techniques, establishing routines, performing pre-competition aerobic exercise, and maintaining adequate sleep hygiene. Several additional approaches that could be implemented were identified including establishing targeted support networks, developing peer-reviewed resources on HRA, ensuring support teams have sufficient tools, and improving existing technology. Elite athletes with T1D use physiological and psychological strategies to mitigate HRA during competition. This finding highlights the need for increased support and education for these athletes, and advancements in technology. A multidisciplinary approach involving healthcare professionals, athletic staff, and peer mentors could help integrate personalized anxiety management and diabetes care strategies into training regimens, enhancing both mental resilience and performance outcomes for athletes with T1D.

Background The stress hyperglycemia ratio (SHR) is an emerging glycemic marker in critical care, but its relationship with delirium in elderly surgical and trauma ICU patients remains unclear. This study explored the association between SHR and delirium to inform early identification strategies. Methods We performed a retrospective cohort study using the MIMIC-IV database, including 1,111 ICU patients aged ≥ 65 years with surgical or trauma admissions. SHR was calculated as the ratio of admission glucose to estimated average glucose (based on HbA1c) and categorized into quartiles. The primary outcome was ICU delirium, identified using the CAM-ICU tool; in-hospital mortality served as a secondary outcome. Multivariable logistic regression, restricted cubic spline (RCS) analysis, and propensity score matching (PSM) were used to assess associations and robustness. performance was evaluated via ROC curves. Results Delirium occurred in 31.1% of patients. Higher SHR was independently associated with greater odds of delirium (Q4 vs. Q1 adjusted OR = 2.79; 95% CI: 1.79–4.35), and this association remained after PSM. RCS analysis indicated a nonlinear relationship between SHR and delirium (P for nonlinearity = 0.0019), and a linear association with in-hospital mortality. SHR demonstrated limited discriminatory ability (AUCs: 0.625 for delirium, 0.654 for mortality). Conclusion SHR was independently associated with delirium in elderly surgical ICU patients. These findings support its potential role in delirium risk stratification, though prospective validation is needed.

Background and Objectives: This study investigated whether the interaction between heavy alcohol use and depression amplifies the risk of hyperglycemia in psychiatric patients. Materials and Methods: We conducted a cross-sectional study on 172 patients (aged 18–65) hospitalized at the “Elisabeta Doamna” Clinical Psychiatric Hospital, Romania. The data included fasting blood glucose, gamma-glutamyl transferase (GGT), Beck Depression Inventory (BDI), and Alcohol Use Disorders Identification Test (AUDIT) scores. Results: Moderate positive correlations were observed between depression scores and blood glucose (r = 0.44) and between alcohol consumption and blood glucose (r = 0.43). The interaction term (BDI × AUDIT) was statistically significant in multiple regression (β = 0.012, p = 0.001), and the model explained 39.1% of glucose variability. Logistic regression analysis revealed that neither high alcohol consumption (OR = 1.38, p = 0.441) nor severe depression alone (OR = 1.30, p = 0.582) were significantly associated with hyperglycemia. However, their interaction demonstrated a strong and statistically significant effect (OR = 19.3, 95% CI: 3.22–115.81, p = 0.001). The prevalence of hyperglycemia reached 95.8% in patients with both risk factors. Conclusions: The combined presence of high alcohol consumption and severe depression significantly increases the risk of hyperglycemia. These findings highlight the importance of integrated screening and interventions in psychiatric settings.

Carbohydrate metabolism disorders resulting in hyperglycemia are among the most common metabolic complications of pregnancy. According to 2017 data from the International Diabetes Federation (IDF), 16.2% of pregnancies are complicated with hyperglycemia, of which gestational diabetes mellitus (GDM) accounts for 86.4% of cases. Carbohydrate metabolism disorders developing during pregnancy require the patient to change her lifestyle or, in some cases, to undergo pharmaceutical treatment, which may affect various aspects of the patient’s life, including her perceived quality of life (QoL). The purpose of the present study was to evaluate levels of QoL, social support, acceptance of illness, and self-efficacy among pregnant patients with hyperglycemia. The study was performed between July 2016 and September 2017 in a group of hyperglycemic pregnant women. The following instruments were used: the World Health Organization Quality of Life—BREF (WHOQOL-BREF), the Berlin Social Support Scales (BSSS), the Acceptance of Illness Scale (AIS), the Generalized Self-Efficacy Scale (GSES) and a standardized interview questionnaire. Participants rated their overall QoL (3.64 points) higher than their overall perceived health (3.43). In terms of social support, the highest scores were obtained in terms of actually received support (3.53) and perceived available instrumental support (3.52), while the lowest in terms of support seeking (2.99) and the need for support (2.95). The mean acceptance of illness score among the hyperglycemic pregnant women that were studied was 31.37, and the mean generalized self-efficacy score was 31.58. Participants’ reported QoL in the various WHOQOL-BREF domains was associated with specific social support scales, acceptance of illness, and generalized self-efficacy.