Psychological and Medical Well-being and their Relation in Adults with Insulin-Dependent Diabetes Mellitus

Björn Karlson

Forskningsoutput: AvhandlingDoktorsavhandling (sammanläggning)

Sammanfattning

This thesis includes five studies involving different samples of adult patients with insulin-dependent diabetes mellitus (IDDM).

Studies one and two concern effects on metabolic control and quality of life of changing from conventional insulin treatment with three syringe injections per day to an intensified insulin treatment with three syringe injections daily using an insulin pen. In study one, 16 patients, randomly assigned to two groups participated in a six month long study. They were treated, in reverse orders for the two groups, for three months using the conventional treatment and three months using the intensive regimen. In study two, 78 patients were followed for 12 months after a similar change to insulin pen treatment. In both studies, insulin pen treatment was associated with improvement, not in metabolic control, but in assessed quality of life, a change appearing in both studies during the first three months of insulin pen treatment, and a change shown in study two to remain stable after 12 months.

Study three concerned relationships in 152 IDDM patients between perceived burden of illness (BI) and depressive symptoms (assessed using SCL-90), and relations of these measures in turn to objective data on metabolic control, and such late diabetic complications as retinopathy and nephropathy, and both demographic and treatment-related data. Degree of depressiveness was largely unrelated to disease severity, but was related to perceived burden of living with the disease, the specific worries and concerns associated with a depressed mood varying with metabolic control.

In study four, qualitative analysis of interview results for 34 patients showed certain modes of adaptation to IDDM to be related to the following: various personality traits, assessed by the Karolinska Scales of Personality (KSP), emotional well-being (assessed using SCL-90), and knowledge of diabetes. Two adaptational modes, termed "accepting" and "struggling" with the disease, respectively, were distinguished. "Strugglers" showed greater depression and anxiety, more limited knowledge of diabetes, a personality profile on KSP characterised by greater somatic anxiety, muscular tension, impulsivity and monotony avoidance and a lesser degree of socialisation than the "accepters", although both groups scored within the normal range on the KSP-variables involved. No group differences in objective medical measures of either metabolic control or late diabetic complications were found.

In study five, cognitive functioning changes in relation to both metabolic control and development of late diabetic complications were examined longitudinally in 22 patients treated under routine conditions. Subjects were extensively examined medically and were tested neuropsychologically (visuo-spatial function, verbal and spatial memory) when entering the study (at an age of 31.4+6.1 years and with a diabetes duration of 4.9+1.8 years) and after 10 years diabetes duration. The cognitive functioning of the group showed no permanent deterioration but appeared to fluctuate intra-individually. Changes in cognitive functioning and medical measures were largely unrelated.
Originalspråkengelska
KvalifikationDoktor
Tilldelande institution
  • Institutionen för psykologi
Handledare
  • [unknown], [unknown], handledare, Extern person
Tilldelningsdatum1997 mars 21
Förlag
ISBN (tryckt)91-22-01746-1
StatusPublished - 1997

Bibliografisk information

Defence details
Date: 1997-03-21
Time: 10:15
Place: Carolinasalen, Kungshuset, Lundagård
External reviewer(s)
Name: Wibell, Lars
Title: Docent
Affiliation: Akademiska sjukhuset, Uppsala
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Ämnesklassifikation (UKÄ)

  • Psykologi

Fria nyckelord

  • Tillämpad och experimentell psykologi

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