**8. Management of inadequate coping attitudes in type 1 diabetic patients**

Several major trial carried out in the past decades, have demonstrated that intensive diabetes management for type 1, as well as type 2 diabetes, can delay or prevent the onset and progression of many complications of the disease, especially microvascular complications (DCCT, 1993; UKPDS, 1998). Such studies also have demonstrated that achieving excellent glycaemia control requires complex self-management behaviors to be learned and maintained.

Traditionally, diabetes education has focused on increasing knowledge about diabetes and its care and increasing skills to perform self-care behaviors, such as blood glucose monitoring. However, it is clear that although knowledge and skills are important prerequisites to diabetes self-management, additional training in the application of this knowledge and skills in day-to-day living are necessary for longer-term maintenance and improved outcomes. Cognitive-behavioral interventions such as coping skills training focus primarily on improving behavioral skills are necessary to achieve better glycaemia and psychosocial outcomes in patients with diabetes and in their relative members (Grey & Berry, 2004).

### **8.1 Social problem solving**

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

with DEB had an increased risk for retinopathy (Rydall et al, 1997). A more recent longitudinal study observed that diabetic patients aged 11 to 25 years with DEB or insulin misuse had a significant risk for the development of two or more serious complications, such as repeated episodes of diabetic ketoacidosis, increased rate of hospital admission and

Therefore, ED in type 1 diabetics have clearly shown to be associated with impaired metabolic control (Jones et al, 2000; Vila et al, 1993; Friedman S et al, 1995; Affenito et al 1997; Affenito et al 1998; Rydall et al, 1997), more frequent episodes of ketoacidosis (Polonsky et al, 1994), and an earlier than expected onset of diabetes-related microvascular complications, particularly, retinopathy (Affenito et al, 1997; Colas et al, 1991; Rydall et al, 1997; Steel et al, 1987; Ward et al, 1995). In this sense, disordered eating status was more predictive of diabetic retinopathy than was the duration of diabetes, which is a wellestablished risk factor for microvascular complications (Diabetes Control and Complications Trial Research Group, 1993). Furthermore, ED in type 1 diabetic patients is associated with

Regarding to mortality, an 11-year follow-up study reports that insulin restriction conveyed more than a three-fold increased risk of mortality in type 1 diabetic patients after controlling for age, body mass index and HbA1c values. Age of death was younger among insulin restrictors, with a mean age of death of 45 years, as compared to 58 years among those

Insulin restriction becomes a more significant problem in older adolescents and in early adulthood. Once the pattern of frequent and habitual insulin restriction becomes entrenched, its consequent poor diabetes self-care can be complex and difficult to treat.

mortality (Peveler et al, 2005).

high mortality (Walker et al, 2002).

Figure 1.

reporting appropriate insulin use (Goebel-Fabbri et al, 2007).

Fig. 1. Consequences of insulin misuse in type1 diabetic patients.

Social problem solving assists individuals when they are faced with peer or family pressures or any decision in which they are confronted with a dilemma. Social problem solving is a process by which an individual learns to think through the steps of having a problem and reaching a decision about how to handle the problem. The process assists individuals to look at all possible outcomes of situations and the possible consequences of their decisions (Duangdao & Roesch, 2008).
