A program was developed to improve independence, self- esteem, and glycemic control in patients with diabetes and blindness. Twenty-nine individuals with both insulin- dependent and noninsulin dependent diabetes mellitus entered 12-week programs that included education focusing on diabetes self-management skills for the visually impaired, monitored exercise sessions, and group support. Glycated. hemoglobin valuesfellfrom 13.0% ± 0.6% (SEM) to 11.4% ± 0.5% (P=.001). Exercise tolerance in a 12-minute walk test improved from 0. 48 ± 0. 04 to 0. 64 ± 0.05 miles (P=.001). Marked improvements occurred in psychosocial indices, demonstrated through changes in the Rand Mental Health Index from 155 ± 6 to 174 ± 5 (P=. 0001), the Rosenberg Self- Esteem Scale from 22 ± 1 to 19 ± 1 (P =. 001), the Zung Depression Scale from 0.50 ± 0. 02 to 0. 44 ± 0. 02 (P =.001), and the Diabetes Self- Reliance Test from 60 ± 3 to 74 ± 2 (P=.0001).
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References
1.
Herman WH, Teutsch SM, Sepe SJ, et al. An approach to the prevention of blindness in diabetes. Diabetes Care1983;6:608-13.
2.
Krolewski AS , Warram JH, Rand LI, et al. Risk of proliferative diabetic retinopathy in juvenile-onset type I diabetes: a 40-yr follow-up study. Diabetes Care1986;9:443-52.
3.
Kolterman S.Practical techniques for instructing the visually impaired diabetic. J Vis Impairment & Blind1978;72:368-71.
4.
Schulz J.What the health professional must know about the blind diabetic. J Vis Impairment & Blind1978;72:376-79.
5.
Stetten D. Jr.Coping with blindness. N Engl J Med1981;305:458-60.
6.
Holmes DMThe person and diabetes in psychosocial context. Diabetes Care1986;9:194-206.
7.
Jacobson AM, Rand LI, Hauser STPsychological stress and glycemic control: a comparison of patients with and without proliferative diabetic retinopathy. Psychosom Med1985;47:372-81.
8.
Oehler JWDiabetes and vision loss: improving the services of the American Diabetes Association. Diabetes Care1986;9:95-96.
Bernbaum M. , Albert SG, Brusca SR, Drimmer A., Duckro PNPromoting diabetes self-management and independence in the visually impaired—a model clinical program. Diabetes Educ1988;14:51-54.
11.
Abraham ECPerry RE, Stallings M.Application of affinity chromatography for separation and quantification of glycosylated hemoglobins. J Lab Clin Med1983 ; 102:187-97.
12.
Bentzen CL, Acuff KJ, Marechal B., et al. Direct determination of lipoprotein cholesterol distribution with micro-scale affinity chromatography columns. Clin Chem1982;28:1451-56.
13.
Durnin Jvga , Womersley J.Body fat assessed from total body density and its estimation from skin fold thickness: measurements on 481 men and women aged from 16 to 72 years. Br J Nutr1974;32:77-97.
14.
Astrand PO, Rodahl K.Textbook on work physiology. 2nd ed. New York: McGraw-Hill, 1977:343-61.
15.
Cooper KHA means of assessing maximal oxygen intake. Correlation between field and treadmill testing. JAMA1968;203:135-38.
16.
James FW, Kaplan S., Glueck CJ, et al. Responses of normal children and young adults to controlled bicycle exercise. Circulation1980;61:902-12.
17.
Prior JC, Alojado NC, Hunt JA, Begg ISUse of tactile techniques for self-monitoring of blood glucose in visually impaired patients with diabetes mellitus. Diabetes Care1984;7:313-17.
18.
Products for people with vision problems. American Foundation for the Blind, New York.
19.
Special tools, instruments and materials for the blind. Scientific Products for the Blind, Southeastern, Pennsylvania .
20.
Tattersall RB , McCulloch DK, Aveline M.Group therapy in the treatment of diabetes . Diabetes Care1985;8:180-88.
21.
Zung Wwk.A self-rating depression scale. Arch Gen Psychiatry1965;12:63-70.
22.
Brook RH, Ware JE Jr, Davies-Avery A., et al. Overview of adult health status measures fielded in Rand's Health Insurance Study. Med Care1979;17 (suppl 7):1-55.
23.
Robinson JP, Shaver PRMeasures of social psychological attitudes. Ann Arbor, Michigan: Institute for Social Research, 1972:98-101.
24.
Bernbaum M. , Albert SG, Duckro PNPsychosocial profiles in patients with visual impairment due to diabetic retinopathy. Diabetes Care1988; 11:551-57.
25.
Brown FGPrinciples of educational and psychological testing. 2nd ed. New York: Holt, Rinehart & Winston, 1976:51-80.
26.
Nunnally JCPsychometric theory. 2nd ed. New York: McGraw-Hill, 1978:225-46.
27.
Ingelfinger JA , Mosteller F., Thibodeau LA, Ware JHBiostatistics in clinical medicine. New York: Macmillan, 1983:126-37.
28.
Yki-Jarvinen H., DeFronzo RA, Koivisto VANormalization of insulin sensitivity in type I diabetic subjects by physical training during insulin pump therapy. Diabetes Care1984;7:520-27.
29.
Trovati M., Carta Q., Cavalot F., et al. Influence of physical training on blood glucose control, glucose tolerance, insulin secretion, and insulin action in non-insulin-dependent diabetic patients. Diabetes Care1984;7:416-20.
30.
Bogardus C. , Ravussin E., Robbins DC, et al. Effects of physical training and diet therapy on carbohydrate metabolism in patients with glucose intolerance and non-insulin-dependent diabetes mellitus. Diabetes1984;33:311-18.
31.
Zinman B., Zuniga-Guajardo S., Kelly D.Comparison of the acute and long-term effects of exercise on glucose control in type I diabetes. Diabetes Care1984;7:515-19.
32.
Kaplan RM, Wilson DK, Hartwell SL, et al. Prospective evaluation of HDL cholesterol changes after diet and physical conditioning programs for patients with type II diabetes mellitus . Diabetes Care1985;8:343-348.
33.
Landt KW, Campaigne BN, James FW, Sperling MAEffects of exercise training on insulin sensitivity in adolescents with type I diabetes. Diabetes Care1985;8:461-65.
34.
Ronnemaa T. , Mattila K., Lehtonen A., Kallio V.A controlled randomized study on the effect of long-term physical exercise on the metabolic control on type 2 diabetic patients. Acta Med Scand1986;220:210-24.
35.
Stunkard AJ , Penick SBBehavior modification in the treatment of obesity: the problem of maintaining weight loss. Arch Gen Psychiatry1986;36:801-6.
36.
Stunkard AJ , Craighead LW, O'Brien R.Controlled trial of behaviour therapy, pharmacotherapy, and their combination in the treatment of obesity. Lancet1980;2:1045-47.
