Walter Thomas

Comorbidity of Diabetes and Eating Disorders: Does diabetes control reflect disturbed eating behavior?

OBJECTIVE This multicenter study was designed to explore the prevalence of clinical and subclinical eating disorders (EDs), the extent of intentional omission of insulin and oral antidiabetic agents, and its relationship to glycemic control in an inpatient and outpatient population of men and women with type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS Data have been collected from 12 diabetes medical centers in two German cities. In a questionnaire and interview-based study, a sample of male and female patients (n = 341 type 1, n = 322 type 2) was assessed for the following eating disorders: anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorder not otherwise specified. For lack of interview data of several patients meeting the screening criteria, prevalence ranges were calculated. RESULTS The overall prevalence range of current EDs was 5.9–8.0% (lifetime prevalence 10.3–14.0%). When patients were stratified according to type 1 and type 2 diabetes, there was no difference in prevalence of EDs. However, the distribution of the EDs was different in both types of diabetes, with a predominance of binge eating disorder in the type 2 diabetes sample. Type 1 (5.9%) and type 2 (2.2%) diabetic patients reported deliberate omission of hyperglycemic drugs (insulin or oral agents) in order to lose weight. Compared with control subjects, neither the presence of EDs nor insulin omission influenced diabetic control. CONCLUSIONS There seems to be no difference in prevalence rates of EDs in both types of diabetes; however, distribution of EDs is different. The findings suggest that neither EDs nor insulin omission are necessarily associated with poor control of glycemia. Binge eating disorder seems to precede type 2 diabetes in most patients and could be one of the causes of obesity that often precedes type 2 diabetes.

DIABETES MELLITUS AND EATING DISORDERS: A MULTICENTER STUDY ON THE COMORBIDITY OF THE TWO DISEASES

Because diet is a key issue in the treatment of diabetes mellitus, it is assumed that these patients are prone to eating disorders. In a multicenter study, we have therefore assessed the prevalence of eating disorders in 662 patients with insulin dependent diabetes mellitus (IDDM) (n = 340) and non-insulin-dependent diabetes mellitus (NIDDM) (n = 322). A two-stage study combining self-rating questionnaires and a standardized interview was carried out. We found a prevalence of eating disorders of 5.9% (lifetime prevalence of 10%), irrespective of gender and type of diabetes; 4.1% of the whole sample reported intentional insulin undertreatment or omission. When patients were stratified according to IDDM and NIDDM, there was no difference in the prevalence of all eating disorders (point prevalence 5.5% vs. 6.5%, lifetime prevalence 10.0% vs. 9.9%). Prevalence of bulimia nervosa (BN) was more frequent in IDDM patients (point prevalence 1.5% vs. 0.3%, lifetime prevalence 3.2% vs. 1.9%) and binge eating (BED) was more frequent in NIDDM patients (point prevalence 1.8% vs. 3.7%, lifetime prevalence 2.6% vs. 5.9%). We conclude that eating disorders seem to be equally frequent in IDDM and NIDDM patients. However, there might be different features of eating disorders in both types of diabetes.

A Multimedia Tool for the Informed Consent of Patients prior to Gastric Banding

Objective: Severe obesity is a clear indication for appropriate, effective weight loss therapy. One option is operative intervention, e.g., gastric banding. Risks of the operation and therapeutic alternatives need to be comprehensibly presented to the patient. The literature has shown that better informed consent is obtained using information presented in a multimedia/video‐based format. The current study developed and evaluated a multimedia program aimed at obtaining informed consent from obese patients before gastric banding.

Job satisfaction amongst psychosocial workers

Abstract The job satisfaction profile of persons working within the counselling and helping professions (educators, remedial pedagogens, and pedagogens in a disabled workshop setting) was compared to the population norm scores. There was evidence of a general ‘burned-out’ profile: psychosocial workers exhibited greater general job pressure and dissatisfaction, complained more about their relationship to coworkers, and felt unable to pursue their recreational and recovery needs. Furthermore, this characteristic profile is not affected by work context (child-care institutes, remedial centres or disabled workshops), age or gender (females were somewhat less career-motivated compared to males). Neuroticism was positively correlated with job pressure and dissatisfaction. Extraverts were inclined to be more dissatisfied with their work and yielded higher career motivation scores compared to introverts. There was some indication that the combinative effects of trait Psychoticism and Neuroticism may relate to a composite ‘fusing’ general job dissatisfaction, and job pressure.

Personality profiles of adolescent hypertensives

In a large-scale epidemiological investigation involving over 8000 adolescents, a sample of 96 newly diagnosed (non-hospitalised) hypertonics were compared to a healthy group of schoolmates matched in terms of age, sex, and educational attainment. Both groups were administered the Freiburg Personality Questionnaire; a strategy of correlational, factorial, and discriminant analyses was implemented in order to identify trait differences between non-medicated hypertensives and controls. Univariate primary scale comparisons between groups revealed that male hypertensives exhibited significantly diminished scores on the primaries, aggressivity, and dominance, coupled with less openness to expression (dimensions which were positively loaded on a higher order factor associated with positive affectivity or extraversion-introversion). Female hypertensives revealed identical between-group differences, but female hypertensives were additionally characterised by reduced scores on the trait depressiveness. Furthermore, female hypertensives were more introverted and less emotionally labile than their normative counterparts.

Evaluation eines psychosozialen Versorgungsmodells im Rahmen der stationären internistischen Akutversorgung onkologischer Patienten

In den letzten 2 Jahrzehnten fuhrten die Fortschritte in der onkologischen Therapie zu einer Vergroserung der Heilungschancen bzw. einer Verlangerung der Uberlebenszeit fur viele Malignomkranke. Im Zusammenhang mit den intensiven Bemuhungen um diese Fortschritte wuchs aber auch das Bewustsein fur die Grenzen kurativer Moglichkeiten in der Onkologie. Beide Entwicklungen fuhrten zu einer Neubewertung der therapeutischen Zielsetzungen und der Weiterentwicklung der Organisationsformen onkologischer Krankenversorgung. Bei Therapieplanung und -bewertung wird heute neben der Uberlebenszeit zunehmend auch die Lebensqualitat des Patienten berucksichtigt. Damit mus die Onkologie ihren wissenschaftlich-medizinischen Ansatz erweitern: Die subjektiven Bewertungen und Gefuhle des Krebspatienten werden zum Gegenstand systematischer wissenschaftlicher Betrachtung.