5. Facilitating Positive Health Behaviors 23 Flashcards
What are some interventions that can potentially improve sleep outcomes?
Sleep extension and pharmacological treatments for sleep have been found to improve sleep outcomes AND POSSIBLY INSULIN RESISTANCE.
THERE IS EVIDENCE
What percentage of people with type 2 diabetes are estimated to have obstructive sleep apnea?
24–86%
What is the sleep health recommendation for screening in people with diabetes?
The sleep health recommendation is to consider screening for sleep health in people with diabetes, including symptoms of sleep disorders, disruptions to sleep due to diabetes symptoms or management needs, and worries about sleep.
Who should be referred to for sleep medicine and/or behavioral health professional?
People with diabetes who show symptoms of sleep disorders, disruptions to sleep due to diabetes symptoms or management needs, or worries about sleep should be referred to sleep medicine and/or a qualified behavioral health professional.
What has early-onset type 1 diabetes been associated with in terms of intellectual abilities?
- Early-onset type 1 diabetes linked to intellectual deficits.
- Repeated severe hypoglycemia may worsen cognitive abilities.
What are the consequences of severe hypoglycemia?
Severe hypoglycemia is associated with decline and immediate symptoms of mental confusion.
What has been associated with cognitive decline in individuals with diabetes?
Having diabetes over decades—type 1 and type 2
Who should cognitive capacity be monitored for in individuals with diabetes?
Cognitive capacity should be monitored throughout the life span for all individuals with diabetes, particularly in those who have documented cognitive disabilities, those who experience severe hypoglycemia, very young children, and older adults.
What should be considered if cognitive capacity changes or appears to be suboptimal for patient decision-making and/or behavioral self-management?
If cognitive capacity changes or appears to be suboptimal for patient decision-making and/or behavioral self-management, referral for a formal assessment should be considered.
What is the recommendation regarding cognitive capacity in individuals with diabetes?
The recommendation is to monitor cognitive capacity throughout the life span for all individuals with diabetes, particularly in those who have documented cognitive disabilities, those who experience severe hypoglycemia, very young children, and older adults.
When should people be screened for prediabetes or diabetes after psychiatric medication initiation?
4 months later
Why should people be screened for prediabetes or diabetes regularly?
People should be screened regularly because of the increased risk associated with diabetes and prediabetes.
What is the recommendation for providing support to people with diabetes and serious mental illness?
The recommendation is to provide an increased level of support through enhanced monitoring of and assistance with diabetes self-management behaviors.
When should individuals prescribed with atypical antipsychotic medications be screened for prediabetes and diabetes?
Screening recommendations:
- Initial screening: Patients should be screened four months after starting medication.
- Early screening: If clinically indicated, patients should be screened sooner than the four-month mark.
- Annual screening: Patients should undergo screening at least once a year.
What should be monitored in individuals with diabetes who are prescribed second-generation antipsychotic medication?
3
- Weight changes
- Glycemia
- Cholesterol levels.
Incretin therapies work in which two circuitries to modulate food intake and energy balance?
Incretin therapies work in the appetite and reward circuitries to modulate food intake and energy balance.
What are the three symptoms that incretin therapies aim to reduce?
Incretin therapies aim to reduce uncontrollable hunger, overeating, and bulimic symptoms.
What is the potential relevance of incretin therapies for the treatment of disrupted or disordered eating?
The use of incretin therapies may have potential implications and relevance for the treatment of disrupted or disordered eating.
What is the link between insulin omission and weight loss in people with type 1 diabetes?
Insulin omission is a disordered eating behavior that is commonly reported among people with type 1 diabetes, and it is done in order to induce glycosuria and lose weight.
When should screening for disordered or disrupted eating behavior be considered?
Screening for disordered or disrupted eating behavior should be considered when hyperglycemia and weight loss are unexplained based on self-reported behaviors related to medication dosing, meal plan, and physical activity.
What is recommended when someone with diabetes presents with symptoms of disordered eating behavior, an eating disorder, or disrupted patterns of eating?
When someone with diabetes presents with symptoms of disordered eating behavior, an eating disorder, or disrupted patterns of eating, it is recommended to reevaluate their treatment plan in consultation with a qualified professional who has familiarity with the diabetes disease physiology, treatments for diabetes and disordered eating behaviors, and weight-related and psychological risk factors for disordered eating behaviors.
What are the key qualifications required for the professional who should be consulted when reevaluating the treatment plan for someone with diabetes and symptoms of disordered eating behavior or disrupted patterns of eating?
The key qualifications include familiarity with the diabetes disease physiology, treatments for diabetes and disordered eating behaviors, and weight-related and psychological risk factors for disordered eating behaviors.
According to the recommendations, how often should depressive symptoms be screened in people with diabetes?
At least annually
Who should be referred to for treatment of depression in conjunction with collaborative care with the diabetes treatment team?
Qualified mental health professionals or other trained health care professionals with experience using evidence-based treatment approaches for depression
When should assessment for depression be considered for individuals with diabetes?
Beginning at diagnosis of complications or when there are significant changes in medical status
When should health care professionals consider screening people with diabetes for anxiety symptoms or diabetes-related worries?
Health care professionals should consider screening people with diabetes for anxiety symptoms or diabetes-related worries.
Who should be referred to a trained professional for intervention to help re-establish awareness of symptoms of hypoglycemia and reduce fear of hypoglycemia?
People with hypoglycemia unawareness, which can co-occur with fear of hypoglycemia, should be referred to a trained ANIXIETY professional.
What should health care professionals do if anxiety symptoms indicate interference with diabetes self-management behaviors or quality of life?
Health care professionals should discuss diabetes-related worries and may refer to a qualified mental health professional for further assessment and treatment.
When should people with diabetes, caregivers, and family members be routinely monitored for diabetes distress?
People with diabetes, caregivers, and family members should be routinely monitored for diabetes distress, particularly when treatment targets are not met and/or at the onset of diabetes complications.
Who should be referred for further assessment and treatment if indicated in cases of diabetes distress?
A qualified mental health professional or other trained health care professional should be referred for further assessment and treatment if indicated in cases of diabetes distress.
When should a person with diabetes be referred to a qualified behavioral or mental health professional?
A person with diabetes should be referred to a qualified behavioral or mental health professional if they have a positive screen on a validated screening tool for depressive symptoms, diabetes distress, anxiety, fear of hypoglycemia, or cognitive impairment.
What are some situations that warrant referral of a person with diabetes to a qualified behavioral or mental health professional?
Some situations that warrant referral of a person with diabetes to a qualified behavioral or mental health professional include a positive screen on a validated screening tool for depressive symptoms, diabetes distress, anxiety, fear of hypoglycemia, or cognitive impairment, the presence of symptoms or suspicions of disordered eating behavior, intentional omission of insulin or oral medication for weight loss, suspicion of serious mental illness, youth and families with behavioral self-care difficulties, declining or impaired ability to perform diabetes self-care behaviors, and before or after bariatric or metabolic surgery if ongoing adjustment support is needed.
When are key opportunities for psychosocial screening in diabetes care?
Key opportunities for psychosocial screening occur at diabetes diagnosis, during regularly scheduled management visits, during hospitalizations, with new onset of complications, during significant transitions in care, at the time of medical treatment changes, or when problems with achieving A1C goals, quality of life, or self-management are identified.
When should psychosocial screening be conducted for individuals with diabetes?
Psychosocial screening should be conducted at diabetes diagnosis, during regularly scheduled management visits, during hospitalizations, with new onset of complications, during significant transitions in care, at the time of medical treatment changes, or when problems with achieving A1C goals, quality of life, or self-management are identified.
Did psychosocial interventions have a significant impact on A1C in a systematic review and meta-analysis?
Yes, psychosocial interventions had a modest but significant improvement on A1C according to a systematic review and meta-analysis.
What should be considered when screening older adults with diabetes?
Cognitive impairment, frailty, and depressive symptoms should be considered when screening older adults with diabetes.
What is advised in terms of monitoring cognitive capacity for older adults with diabetes?
Monitoring of cognitive capacity, i.e., the ability to actively engage in decision-making regarding treatment plan behaviors, is advised for older adults with diabetes.
Is there evidence that vigorous-intensity exercise accelerates the rate of progression of DKD?
No, there is no evidence that vigorous-intensity exercise accelerates the rate of progression of DKD.
Do people with DKD need specific exercise restrictions in general?
No, there appears to be no need for specific exercise restrictions for people with DKD in general.
Why should individuals with diabetic autonomic neuropathy undergo cardiac investigation before engaging in intense physical activity?
Because cardiovascular autonomic neuropathy is an independent risk factor for cardiovascular death and silent myocardial ischemia.
What is cardiovascular autonomic neuropathy?
Cardiovascular autonomic neuropathy is a condition that increases the risk of cardiovascular death and silent myocardial ischemia in individuals with diabetes.
How can autonomic neuropathy increase the risk of exercise-induced injury or adverse events?
Autonomic neuropathy can increase the risk of exercise-induced injury or adverse events through decreased cardiac responsiveness to exercise, postural hypotension, impaired thermoregulation, impaired night vision due to impaired papillary reaction, and greater susceptibility to hypoglycemia.
What are some potential effects of autonomic neuropathy on exercise?
Some potential effects of autonomic neuropathy on exercise include decreased cardiac responsiveness, postural hypotension, impaired thermoregulation, impaired night vision, and greater susceptibility to hypoglycemia.
According to studies, what is the effect of moderate-intensity walking on the risk of foot ulcers or reulceration in those with peripheral neuropathy who use proper footwear?
Moderate-intensity walking does not lead to an increased risk of foot ulcers or reulceration in those with peripheral neuropathy who use proper footwear.
Why may vigorous-intensity aerobic or resistance exercise be contraindicated for individuals with proliferative diabetic retinopathy or severe nonproliferative diabetic retinopathy?
Vigorous-intensity aerobic or resistance exercise may be contraindicated due to the risk of triggering vitreous hemorrhage or retinal detachment.
Are routine preventive measures for hypoglycemia advised for individuals not treated with insulin or insulin secretagogues BEFORE EXERCISES?
No, routine preventive measures for hypoglycemia are usually not advised in these cases.
What factors determine whether individuals on these therapies need to ingest added carbohydrate before exercising?
The factors include pre-exercise glucose levels (<90 mg/dL or 5.0 mmol/L), ability to lower insulin doses during the workout, time of day exercise is done, and intensity and duration of the activity.
What options are available for individuals on these therapies to lower insulin doses during workouts?
The options include using an insulin pump or reducing pre-exercise insulin dosage.
Why may individuals on these therapies need to ingest added carbohydrate before exercising if their pre-exercise glucose levels are below 90 mg/dL?
They may need to ingest added carbohydrate to prevent hypoglycemia during exercise.
How long should aerobic activity bouts ideally last for adults with type 2 diabetes?
Aerobic activity bouts should ideally last at least 10 minutes.
What is the recommended goal for daily aerobic activity for adults with type 2 diabetes?
The recommended goal for daily aerobic activity for adults with type 2 diabetes is approximately 30 minutes or more most days of the week.
How much does structured exercise lower A1C in people with type 2 diabetes?
Structured exercise interventions of at least 8 weeks’ duration have been shown to lower A1C by an average of 0.66%.
Is a significant change in BMI necessary for structured exercise interventions to lower A1C in people with type 2 diabetes?
No, structured exercise interventions have been shown to lower A1C even without a significant change in BMI.
What are some examples of nonsedentary activities that can be promoted to sedentary individuals with type 1 and type 2 diabetes?
Examples include walking, yoga, housework, gardening, swimming, and dancing.
What types of training are recommended for older adults with diabetes?
Flexibility training and balance training are recommended 2–3 times/week for older adults with diabetes. Yoga and tai chi may be included based on individual preferences to increase flexibility, muscular strength, and balance.
