Kirjoittaja Aihe: The primary genetic associations of T1D involve  (Luettu 2670 kertaa)

The primary genetic associations of T1D involve the human leukocyte antigen (HLA) class II region encoded by genes within the major histocompatibility complex (MHC) chromosome 6p21 (Barrett et al., 2009). There are several HLA alleles associated with genetic susceptibility for T1D (HLA-DR3, DQB1�?201 and HLA-DR4, DQB1�?302 in particular) (Pociot et al., 2010) and other HLA alleles associated with protection from type 1 diabetes (e.g., HLA-DR2, DQB1�?602) (Pugliese et al., 2016). The pathogenesis of T1D in those with a genetic predisposition by nature of HLA-risk alleles involves progression from altered immune function to development of autoantibodies to tissue inflammation to clinical disease droplet pen needles. At each stage of progression, both genetic and environmental factors may be at play (Jerram & Leslie, 2017).

Intervention trials have shown that the behavioral strategies and principles of social cognitive theory (Bandura, 1991), including self-monitoring (along with review of and feedback on progress), self-regulation, self-efficacy, goal-setting, reinforcement, problem-solving, and relapse prevention, are effective for weight management and reducing risk for diabetes (Hill-Briggs et al., 2011; Venditti, 2016). Given the role of meal timing in glucose metabolism and glycemic control, meal regulation also is a key component of weight management interventions and has particular relevance in the prevention and treatment of diabetes (Qian & Scheer, 2016; Reutrakul et al., 2014). The DiAlert trial, which applied social cognitive theory and promoted goal-setting related to healthful eating and physical activity, showed improvements in weight loss and systolic blood pressure among relatives of individuals with diabetes (Heideman et al., 2015). Moreover, a review of diabetes prevention programs suggests that intensive behavior change strategies, including self-monitoring, review of and feedback on progress, self-efficacy, goal-setting, reinforcement, problem-solving, and relapse prevention, delivered in both face-to-face individual and group settings typically included additional contacts with interventionists to promote adherence and maintenance of learned health behaviors (Baker, Simpson, Lloyd, Bauman, & Singh, 2011). The Look AHEAD trial, which targeted individuals with diabetes and obesity, used an intensive lifestyle intervention that included self-monitoring, self-regulation, goal-setting, and problem-solving (Look AHEAD Research Group, 2006) and was found to improve weight, glycated hemoglobin (HbA1c) levels, lipid levels, use of diabetes medications, blood pressure, fitness, depressive symptoms, and health-related quality of life (Look AHEAD Research Group, 2010, 2014a). Participants who received the intensive lifestyle intervention demonstrated greater engagement in weight management behaviors than those in the control condition caresens lancets, and individuals who more often used the weight management behaviors had a greater likelihood of maintaining weight loss than those who used the weight management behaviors less often (with higher likelihood of weight regain; Look AHEAD Research Group insulin syringe sizes, 2014b). A recent meta-analysis of randomized controlled trials found that interactive self-management interventions may be useful for individuals with poorly controlled diabetes, particularly when including review of and feedback on progress, problem-solving, and goal-setting (Cheng et al., 2017).

Two studies revealed no association between friend or peer support and psychological outcomes. In a study involving the same emerging adult sample described in the previous paragraph, general friend support at age 12 was unrelated to depressive symptoms, alcohol use, or smoking at age 19 (Helgeson et al., 2014b). Because friends are likely to change between age 12 and age 19, it may not be surprising that friend support at age 12 did not predict outcomes at age 19. Another study, involving a sample of 74 adolescents who varied widely in age (12�?8 year), found general peer support was unrelated to depression, controlling for sex, SES, and illness duration (Skinner & Hampson, 2000).


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