This remission dataset

documents - and provided the means of - my losing 100 pounds of fat and rendering myself, according to my doctor, "no longer diabetic" within a year of diagnosis of type 2 diabetes. Despite my doctor's use of the word at the time, I don't claim to have "cured" myself. By this expert consensus definition, I achieved remission, having reached and sustained normal levels of blood glucose (blood sugar).

Type 2 diabetics who can achieve remission, or normoglycemia (euglycemia), are as close to a cure as is possible for a disorder characterized as chronic (no cure) and progressive (only gets worse). Remission can vastly improve quality of life and can forestall T2D's usual progression through comorbidities toward premature death.

Day-to-day data are self-reported. Medical outcomes are documented by Kaiser-Permanente.
Showing posts with label health. Show all posts
Showing posts with label health. Show all posts

the poker face of depression

As part of the promotional apparatus for Batman v. Superman: Dawn of Justice.,Yahoo Movies interviewed Ben Affleck and Henry Cavill. Interviewer Tom Butler asked Cavill and Affleck to respond to the critics' "mixed response" to the film. Cavill gives a stock Hollywood reply: Critics don't matter, what matters is box office. (Cavill actually tries to state his criticism of critics more diplomatically, though his attempt totally misrepresents the nature and value of professional criticism. Of course, he uses "audience" as a euphemism for box office.) Affleck, prompted by Butler, simply says "I agree" (with Cavill).

Enter YouTube producer Sabconth, who inserts a montage/barrage of critically damning quotes, fades out Cavill's audio, digitally pans and zooms in to Affleck, and replaces the substance of Cavill's response with the first verse of Simon and Garfunkel's "The Sounds of Silence." Sabconth's text montage conceals Affleck's grin and laugh in reaction to the phrase "mixed response," and cuts before the small smile he gives after his brief answer. (Presumably incidentally, the manipulated clip suggests Cavill is a blathering fool; wrong-headed and/or deceptive as his response may be, it's not foolish. The man is doing his job.) That clip, under the title "Batman V Superman - Sad Affleck," goes viral.

Along with some 14 million others, I Laughed Out Loud. And as soon as the clip ended, I Googled "Ben Affleck depression." Sure enough, Affleck's celebrity and recent divorce bubbled up: both "depression" over the divorce, and Depression as a cause of it. (This just in: Depressed people can be hard to live with.) I can't offer a diagnosis I'm not qualified to make of a person I've never met. I can look at a clip of an actor's unscripted reaction and hear my gut say: I recognize that face, and it resonates with what I know about myself as a chronic anxious depressive.

The Internet thought otherwise. "Sad Affleck" became a fixed phrase. Variety's Lamarco McClendon elaborated, taking Affleck to task for his downward gaze and describing him as "distraught" and "sullen," as well as "saddened." McClendon's piece begins with a taunt that Batman (Affleck) can't "hold his composure in the face of adversity," (Many of us might say that composure is exactly what Affleck held; clearly we do not work in Hollywood.) Michael Cavna's reading in The Washington Post is more sympathetic: "Affleck...looks vulnerable concerning his new superhero turn as the Dark Knight, and the mind behind those hurt eyes seems to wander..."

So which is it? Sadness, downcastness, distraction, sullenness, discomposure, vulnerability, hurt, a wandering mind? Yes. Welcome to depression, friends, that ever handy Wet Blanket that throws itself over our material and emotional turmoil, and life's disappointments and fears, and keeps our heads from exploding at the shocks others seem to be able to ride out with "composure."

As diabetics, we are prone to depression. Depressives are prone to diabetes. As with insulin resistance and the accretion of body fat, I find the chicken-and-egg question less valuable than recognizing a vicious cycle that requires intervention to break. As with most mind-body dynamics, there are few cleanly reciprocal dyads. Research notes the correspondence of risk factors for diabetes with those for chronic pain and depression, including poverty, low social status, susceptibility to discrimination, past injuries, physical inactivity, lower self-confidence or self-esteem, and a lack of social support.

Ben Affleck would seem to be exempt from many of these risk factors: Both his present life and his past include many elements of privilege; they also include an alcoholic (since rehabilitated) father who apparently stumbled through a series of working-class jobs, and whom he "lost"—since reconciled—at age 11. I'm sure many people would find my own responses to chronic depression inappropriate, pathetic, ludicrous. (We may find out with a forthcoming personal tour of my depression, to be published with further information on depression and diabetes research.) While sometimes the temptation to laugh at or feel superior to celebrities—or me—may be too much to resist, I hope these observations might spark a bit more empathy and a bit less judgment toward depressed people in your life—including, as needed, yourself.

Graphic sourced from Living with Invisible Illness.

Beyond Nagging: How Do Mobile Phone Diabetes Programs Drive Behavior Change?

Methods This was a mixed methods observational cohort study. Study participants were members of the University of Chicago Health Plan (UCHP) who largely reside in a working-class, urban African American community. Surveys were conducted at baseline, 3 months (mid-intervention), and 6 months (postintervention) to test the hypothesis that the intervention would be associated with improvements in self-efficacy, social support, health beliefs, and self-care. In addition, in-depth individual interviews were conducted with 14 participants and then analyzed using the constant comparative method to identify new behavioral constructs affected by the intervention.

Results The intervention was associated with improvements in 5 of 6 domains of self-care (medication taking, glucose monitoring, foot care, exercise, and healthy eating) and improvements in 1 or more measures of self-efficacy, social support, and health beliefs (perceived control). Qualitatively, participants reported that knowledge, attitudes, and ownership were also affected by the program. Together these findings were used to construct a new behavioral model.

Conclusions This study’s findings challenge the prevailing assumption that mobile phones largely affect behavior change through reminders and support the idea that behaviorally driven mobile health interventions can address multiple behavioral pathways associated with sustained behavior change.

The Diabetes Educator November/December 2014 vol. 40 no. 6 806-819 doi: 10.1177/0145721714551992 via @edifyHEALTH