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110 Type 1 Diabetes – Complications, Pathogenesis, and Alternative Treatments

elevations in HbA1c values, repeated problems with diabetic ketoacidosis and amenorrhea (Olmsted et al, 2008). Recently, Markowitz et al. (Markowitz et al, 2010) proposed a 16-items diabetes-specific self-reported measure of disordered eating for brief screening tool for

Individual or group intervention aimed to increase self-esteem, appearance and body acceptance, and family-based interventions with the objective of developing flexible approaches to food and meal planning may help to avoid the development of DEBs in type

Diabetes self-management is crucial to prevent early morbidity. Although more experimental research is needed, especially in minority populations and the non-adolescent age range, the addition of coping skills training and problem solving interventions to the clinical care of patients with diabetes appears warranted. Such interventions can be incorporated into routine diabetes education programs or the content included in regular diabetes care visits. Interventions using coping skills training and problem solving for children, adolescents, and adults with diabetes and their families should be individualized to their lifestyle, respect individual differences and routines, incorporate social support, and be reinforced and followed over time. Behavioral theory should be used in the design of

Today is well-known that disordered eating behaviors and subthreshold disordered eating disorders are more prevalent in girls with type 1 diabetes than their peers without diabetes. DEB persists over time and its rates and symptoms severity increase with age. In type 1 diabetic women, the predominant ED are BN and EDNOS. Furthermore, these patients also develop specific DEB such as diet restriction, and insulin misuse in order to lose weight, with the consequent impairment of their metabolic control which is followed by acute diabetic complications such as diabetic ketoacidosis, dehydration or electrolyte anomalies, and chronic microvascular complications, mainly diabetic retinopathy, that even increase

Full established DEB and ED are difficult to manage. The management of these conditions requires a multidisciplinary team formed by an endocrinologist/diabetologist, nurse educator, nutritionist, psychologist and, frequently, a psychiatrist who should be consulted to evaluate and treat with psycho pharmaceutical products the possible psychiatric comorbidities of these patients. Unfortunately, the mentioned team is often

The best psychological methods to treat these anomalies are not determined yet. According to personal experience, patients tend to be treated individually or in group and, frequently,

disordered eating in diabetes. Table 3.

Adolescents or young women with type 1 diabetes Patients with high concern on body weight or shape Patients with not adequate coping with diabetes

Type 1 diabetic patients with amenorhea

Poor metabolic control including frequent episodes of ketoacidosis

Table 3. Clues to early diagnose ED or DEB in type 1 diabetics

1 diabetic patients.

**11. Conclusions** 

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**7** 

*Portugal* 

**Predictors of Adherence, Metabolic Control** 

Diabetes Mellitus Type I (DM1) is a diagnosed disease that appears before age 35 (Hanas, 2007) and is well known, in the pediatric population, as one of the most common diseases (Serafino, 1990). The diagnosis occurs mostly in childhood and adolescence, often between

The definition of adolescence is a bit controversial but OMS (1965) establishes adolescence between 10 and 19 years old. The beginning of adolescence starts with the appearance of the first biological changes of puberty. According to Erikson's theory of psychosocial development (Erikson, 1968), the central task of adolescence is the development of autonomy, identity and self integration (Barros, 2003). In fact, identity formation, in adolescence, requires a reorganization of capacities, desires, needs and interests in the adolescent, as well as a quest for more independence towards parents. Nevertheless, the difficulties, even in the well succeeded resolution of the psychosocial tasks, may result in "identity confusion" (Erikson, 1968). In adolescents with diabetes, the disease can be an additional stressor functioning as another factor that requires acceptation and self integration. Diabetes exposes adolescents to potentially unpleasant experiences (having to explain others about the disease, medical exams, etc.) that can limit or prevent normal development and life experiences in adolescence (Close et al., 1986). On the other hand, physiological and hormonal changes that take place in adolescence may increase insulin resistance contributing to a weak control of diabetes (Duarte, 2002). In short, adolescence is a developmental phase, marked by changes and identity formation ,that requires a permanent and dynamic adaptation of the adolescent, ranging from feelings of acceptation to anger/anxiety and even depression (Leite, 2005) that can affect adherence to therapy and adaptation to illness. It is important to keep in mind that *being adolescent* is more important

Adherence to therapy in chronic disease is considered one of the main problems that may end in treatment failure (Leite, 2005). Kristeller and Rodin, in 1984, suggested that adherence

**1. Introduction** 

ages 5 and 11 (Eiser, 1990).

than *being diabetic* (Burroughs et al., 1997).

**1.1 Adherence and metabolic control** 

 **and Quality of Life in Adolescents** 

 **with Type 1 Diabetes** 

M. Graça Pereira1, A. Cristina Almeida2, Liliana Rocha1 and Engrácia Leandro2 *1University of Minho, School of Psychology 2University of Minho, Social Sciences Institute* 

