Compared to other Canadians, Aboriginal people suffer disproportionately from Type 2 diabetes and its complications. In an attempt to fill gaps in services for Aboriginal people to support better management of diabetes and to prevent further complications, the West Side Community Clinic launched a monthly outreach diabetes education program using an informal hands-on approach to learning about meal planning and other forms of diabetes management. The purpose of this qualitative study was to determine the impact that the program has had on the participants' health and well-being through the stories they shared in a group or individual interview. Out of the core group of 30 women, most of them Aboriginal, eleven participated in the group interview and five women participated in individual interviews.<p>Findings reveal that the program's impact on participants' health and well-being is embedded within the context of their lives. Diabetes is managed within multiple life realities in an individual, a familial and a community context. The women report learning management skills and sharing support among participants and staff of Diabetes Morning; and altered health status such as regulated blood glucose levels and weight loss. Opportunities for change include more programming like Diabetes Morning, more often, more information, access to low-cost diabetes-friendly foods, communication with health care practitioners, and integrating knowledge on a day-to-day basis. Domains for outcome indicators and contextual indicators are suggested for the program.

Compared to other Canadians, Aboriginal people suffer disproportionately from Type 2 diabetes and its complications. In an attempt to fill gaps in services for Aboriginal people to support better management of diabetes and to prevent further complications, the West Side Community Clinic launched a monthly outreach diabetes education program using an informal hands-on approach to learning about meal planning and other forms of diabetes management. The purpose of this qualitative study was to determine the impact that the program has had on the participants' health and well-being through the stories they shared in a group or individual interview. Out of the core group of 30 women, most of them Aboriginal, eleven participated in the group interview and five women participated in individual interviews.<p>Findings reveal that the program's impact on participants' health and well-being is embedded within the context of their lives. Diabetes is managed within multiple life realities in an individual, a familial and a community context. The women report learning management skills and sharing support among participants and staff of Diabetes Morning; and altered health status such as regulated blood glucose levels and weight loss. Opportunities for change include more programming like Diabetes Morning, more often, more information, access to low-cost diabetes-friendly foods, communication with health care practitioners, and integrating knowledge on a day-to-day basis. Domains for outcome indicators and contextual indicators are suggested for the program.

Thesis (Ph. D.)--Rutgers University, 2009. / "Graduate Program in Nursing." Includes bibliographical references (p. 81-87).

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Thesis (M. Med. Sc.)-University of KwaZulu-Natal, 2006.

As women who experience Gestational Diabetes Mellitus (GDM) are at considerably greater risk of developing type 2 diabetes in life, prevention of GDM is particularly important. The objectives of this research were to identify lifestyle predictors associated with GDM in a developing country and to validate a physical activity questionnaire for assessing total energy expenditure in a Pakistani population. / A prospective cohort study of 750 South Asian women recruited early in gestation was conducted in Karachi, Pakistan. Eligibility criteria included South Asian origin and ≤ 18 weeks gestation. Data on physical activity, diet, socio-demographic covariates, weight, height and body composition were obtained at recruitment and women were followed to assess GDM status at ≥ 26 weeks of gestation. / Logistic regression analysis of data from 611 women to assess the impact of age, body fat percentage, height, family history of diabetes, parity, level of education, rate of weight gain during pregnancy, and daily energy expenditure on the development of GDM was undertaken. The risk of GDM increased with increasing maternal age (yr), OR 1.13 (CI 1.06-1.21), body fat (%), OR 1.07 (CI 1.03-1.13), and decreased with daily energy expenditure (100 kcal), OR 0.89 (CI 0.79-0.99). Replacing body fat (%) with pre-gravid BMI provided similar results. Using a nested case (n=49) control (n=98) study design, conditional logistic regression analysis was conducted to assess the association between total energy, macronutrient and fiber intake and GDM. The risk of GDM decreased with increasing amounts of protein as a percentage of total energy intake, OR 0.75 (CI 0.60-0.95). / The Monitoring trends and determinants of cardiovascular disease Optional Study of Physical Activity (MOSPA) questionnaire was assessed against a Caltrac accelerometer (n=50). Subjects wore a caltrac accelerometer for 5 consecutive days. A correlation of 0.51 (P<0.01) was found between MOSPA questionnaire and Caltrac accelerometer values. / Advanced maternal age and body fat (%) predicted increased risk for GDM while physical activity was protective. Hence, prevention strategies should target increasing physical activity, sufficient to alter body composition, in this South Asian population.

<p>This study determined the affordability of medicines for diabetic patients attending the diabetic clinic of the University of Nigeria Teaching Hospital (UNTH), Enugu. The Study was a cross-sectional time-delimited, descriptive study of affordability of Medicines for diabetic patients aged &gt / 18 years and who pay for medicines out of pocket. A structured questionnaire was used to collect sociodemographic information about patients and the prescription was assessed in terms of conformity with essential medicines list (EML), cost and ability to be completely filled by the patient. Data was analysed using EPI Info software.the results show that medicines prescribed for diabetes are unaffordable to the majority of patients who attend the UNTH diabetic clinic.</p>

Diabetes causes early structural changes to the glomerular basement membrane (GBM), which alters its function and leads to loss of protein in urine. Formation of advanced glycation endproducts (AGEs) is one mechanism proposed to be responsible for the structural changes to the GBM. AGEs are thought to affect blood flow i.e. glomerular filtration rate (GFR) and vascular permeability which over time manifests as overt proteinuria. The gradual loss of minute amounts of protein (albumin) is referred to as microalbuminuria (MA). Microalbuminuria is a dynamic process, with patients regressing to normoalbuminuria more often than progressing to overt proteinuria. Microalbuminuria is not specific to patients with diabetic nephropathy (DN) and new markers specific to DN are being sought. A prospective study was undertaken at the Inkosi Albert Luthuli Central Hospital (IALCH) to evaluate the relationship of serum glycated albumin, urinary and serum components of capillary basement membrane and DN in South African Black and Indian patients with type 1 diabetes. The study was undertaken with sampling of blood and urine at baseline, 6-months, 1 year and 2-year follow-up. Serum glycated albumin, urinary type IV collagen and plasma fibronectin were measured at each visit. Since correlations could be performed only at each time point individually, generalised estimating equation (GEE) regression models were constructed in SPSS (15.0) with time specified as a factor in order to take account of relationships among variables over time. The results of this study showed that serum percentage glycated albumin (PGA), plasma fibronectin (FN) and urinary type IV collagen were not better predictors of incipient impaired renal function than MA. Although previous authors have variously reported serum GA, plasma FN and urinary type IV collagen to be predictive of impaired renal function, these studies were conducted mainly in patients with overt DN. The present study suggest that markers of overt renal dysfunction are not necessarily useful predictors of incipient DN. Differences in predictive relationships point to a different disease processes in the two ethnic groups. Of particular note was the lack of a predictive relationship of either fasting plasma glucose (FPG) or glycated haemoglobin (HbA1c) with any of isotope GFR, estimated GFR and proteinuria in Black patients. The most significant finding of this study showed that combination of serum creatinine and MA provided broadest range of predictors of isotope GFR, estimated GFR and proteinuria. / Thesis (M.Sc.)-University of KwaZulu-Natal, Westville, 2010.

Im Rahmen der Versorgungsforschung sollte die Ergebnisqualität der Betreuung schwangerer Typ-1- und Typ-2-Diabetikerinnen (PMDM) anhand des neonatalen Er-gebnisses und der Stoffwechselparameter geprüft und festgestellt werden, ob die Diag-nostik- und Therapieempfehlungen der Leitlinien realisiert wurden und welchen Einfluss die veränderten Betreuungsstrukturen im Gesundheitssystem nach 1990 darauf hatten. Dazu wurden die relevanten Daten zu Schwangerschaftsverlauf (einschließlich des ophthalmologischen Befundes) und Zustand der Neugeborenen (NG) von 104 Müt-tern erhoben und ausgewertet, die zu Beginn des strukturellen Wandels 1990-92 (n=56) und danach 2007-10 (n=48) im Zentrum betreut wurden. Der somatische Zustand der NG wurde nach der Gewichtsperzentile und der Perzentile des Gewichts-Längen-Index beurteilt. Die Einschätzung der Stoffwechselqualität erfolgte auf Basis der computerge-stützt (CAMIT) erfassten Blutglukosewerte des Selbstkontrollmonitoring und der HbA1c-Werte. Die Ergebnisse wurden an den Vorgaben der Leitlinien und der Hypertrophierate der Neugeborenen gemessen und untereinander verglichen. Die Stoffwechselparameter hypertropher (n=29) und eutropher (n=68) NG wurden verglichen und der Einfluss einer Mikroangiopathie bei Müttern mit (n= 20) und ohne (n= 56) Retinopathia diabetica untersucht. Bei zunehmend dezentralisierter Betreuung sank der Anteil im Zentrum entbundener Mütter von 88% auf 42% (2007-10) bei gleichzeitig signifikant späterem Betreuungsbe-ginn im Zentrum. Die signifikant älteren (30,8 vs. 25,9 Jahre) Mütter mit höherem Ge-wicht zu Schwangerschaftsbeginn (79,1 vs. 64,3kg) wurden von signifikant schwereren Kindern entbunden (MW 3642g vs. 3172g). Die Hypertrophierate >97.Perzentile des gestationsaltersbezogenen Geburtsgewichtes (29,2% vs. 12,3%) und >95.Perz. des Gewichts-Längen-Index (41,7% vs. 17,8%) stieg signifikant bei ebenfalls signifikant hö-heren HbA1c-Werten und Mittleren Blutglukosewerten im Schwangerschaftsverlauf in den Jahren 2007-10 im Vergleich zu 1990-92. Signifikante Unterschiede dieser Stoff-wechselparameter finden sich auch zwischen hypertrophen (n=29) und eutrophen NG (n=68) bei fehlenden signifikanten Unterschieden von Alter und Gewicht der Mütter. Mütter mit (n=20) und ohne (n=56) Retinopathie unterscheiden sich jedoch nur durch signifikant höhere HbA1c-Werte zu Schwangerschaftsbeginn. Bei 2007-10 signifikant weniger ophthalmologisch untersuchter Mütter. Die Strukturveränderungen wirkten sich auf die Arbeit des Zentrums aus. Der Anstieg der Hypertrophierate bei zunehmender Diskrepanz der Stoffwechselführung zwischen Leitlinienempfehlung und Praxis weist auf die notwendige Optimierung der interdisziplinären Zusammenarbeit in enger Kooperation zwischen Zentrum und nieder-gelassenen Diabetologen hin.

<p>This study determined the affordability of medicines for diabetic patients attending the diabetic clinic of the University of Nigeria Teaching Hospital (UNTH), Enugu. The Study was a cross-sectional time-delimited, descriptive study of affordability of Medicines for diabetic patients aged &gt / 18 years and who pay for medicines out of pocket. A structured questionnaire was used to collect sociodemographic information about patients and the prescription was assessed in terms of conformity with essential medicines list (EML), cost and ability to be completely filled by the patient. Data was analysed using EPI Info software.the results show that medicines prescribed for diabetes are unaffordable to the majority of patients who attend the UNTH diabetic clinic.</p>