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      Adherencia al tratamiento en adolescentes diabéticos tipo 1 chilenos: una aproximación psicológica Translated title: Psychological factors associated to patient's treatment compliance in Chilean diabetic teenagers

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          Background: Treatment compliance among patients with type 1 diabetes mellitus, is low in 50% of diabetic teenagers, becoming a social and medical problem. Aim: To determine psycho-social factors associated to treatment compliance among Chilean diabetic type 1 teenagers. Patients and methods: A non experimental study of 61 diabetic teenagers (age 14.9±1.9 years, 37 male). The number of blood glucose determinations, socioeconomic level and practice of sports was measured. Psychological tests were applied to analyze self-efficiency, motivation of achievement, self-esteem and knowledge of the illness and its treatment. As a measure of patient compliance, glycosilated hemoglobin (HB1Ac) was measured. Results: Six patients had a good control of diabetes (HB1Ac <7%), 24 had HB1Ac values between 7 and 8.9, and 31 (51%) had values of 9% or more, considered as a poor diabetes control. The intensified insulin treatment scheme, the knowledge of the illness and its treatment and the sense of self-efficiency, were the factors associated with a better compliance with treatment. Teenagers of higher socio-economical levels had a better compliance with treatment. Conclusions: Fifty percent of Chilean diabetic teenagers in this sample had a poor control of the disease and the variable knowledge about the disease is the better predictor of patient compliance (Rev Méd Chile 2005; 133: 307-13)

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          The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus

          Long-term microvascular and neurologic complications cause major morbidity and mortality in patients with insulin-dependent diabetes mellitus (IDDM). We examined whether intensive treatment with the goal of maintaining blood glucose concentrations close to the normal range could decrease the frequency and severity of these complications. A total of 1441 patients with IDDM--726 with no retinopathy at base line (the primary-prevention cohort) and 715 with mild retinopathy (the secondary-intervention cohort) were randomly assigned to intensive therapy administered either with an external insulin pump or by three or more daily insulin injections and guided by frequent blood glucose monitoring or to conventional therapy with one or two daily insulin injections. The patients were followed for a mean of 6.5 years, and the appearance and progression of retinopathy and other complications were assessed regularly. In the primary-prevention cohort, intensive therapy reduced the adjusted mean risk for the development of retinopathy by 76 percent (95 percent confidence interval, 62 to 85 percent), as compared with conventional therapy. In the secondary-intervention cohort, intensive therapy slowed the progression of retinopathy by 54 percent (95 percent confidence interval, 39 to 66 percent) and reduced the development of proliferative or severe nonproliferative retinopathy by 47 percent (95 percent confidence interval, 14 to 67 percent). In the two cohorts combined, intensive therapy reduced the occurrence of microalbuminuria (urinary albumin excretion of > or = 40 mg per 24 hours) by 39 percent (95 percent confidence interval, 21 to 52 percent), that of albuminuria (urinary albumin excretion of > or = 300 mg per 24 hours) by 54 percent (95 percent confidence interval 19 to 74 percent), and that of clinical neuropathy by 60 percent (95 percent confidence interval, 38 to 74 percent). The chief adverse event associated with intensive therapy was a two-to-threefold increase in severe hypoglycemia. Intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy in patients with IDDM.
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            THE SELF-EFFICACY SCALE: CONSTRUCTION AND VALIDATION

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              Ethical principles of psychologists and code of conduct.

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                Author and article information

                Journal
                rmc
                Revista médica de Chile
                Rev. méd. Chile
                Sociedad Médica de Santiago (Santiago, , Chile )
                0034-9887
                March 2005
                : 133
                : 3
                : 307-313
                Affiliations
                [01] Temuco orgnameUniversidad Mayor orgdiv1Facultad de Psicología Chile
                [02] orgnamePontificia Universidad Católica de Chile orgdiv1Facultad de Medicina orgdiv2Programa de Formación de Endocrinología Chile
                Article
                S0034-98872005000300006 S0034-9887(05)13300306
                10.4067/S0034-98872005000300006
                127c61fc-011a-47f6-8e05-552539b55832

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 06 January 2005
                : 26 May 2004
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 30, Pages: 7
                Product

                SciELO Chile

                Categories
                ARTICULOS DE INVESTIGACION

                Patient compliance,Adolescent psychology,Diabetes mellitus, type 1

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