Interest in the ketogenic diet and its potential to treat obesity and type 2 diabetes has been steadily growing in recent years. With a very limited amount of calories coming from carbohydrates (typically < 50 gm/day), and the majority of calories coming from fat, this diet leads to a states of physiological ketosis, in which ketone bodies replace glucose as the primary source of energy. Early clinical trials found this to lead to a spontaneous reduction in calories consumed, and it has been suggested that a state of ketosis has appetite suppressing properties. There are a few studies evaluating self-reported decrease in hunger while consuming a ketogenic diet, as well as the changes in hormone levels associated with appetite, but this evidence is limited. The primary determinant of weight change is the difference between calories consumed and calories burned, however there is some suggestion that the macronutrient composition of the ketogenic diet may have a specific metabolic advantage for weight loss separate from the total number of calories in deficit. Multiple diet comparison studies have found the ketogenic diet to be effective for weight loss in the short term, particularly when compared to low fat diets. It is questionable whether the ketogenic diet is sustainable in the long term, particularly without frequent nutritional counseling and monitoring. Still, there is preliminary evidence that the ketogenic diet can lead not only to a large amount of weight loss, but may also be effective in treating and reversing type 2 diabetes. Clinical trials have shown decreases in HbA1c, fasting glucose, and reduction of antiglycemic medication requirements, though it is unclear if these effects are primarily due to weight loss itself, or the specific composition of the ketogenic diet. These benefits need to be weighed against the risks, and a common criticism is its high fat content which can adversely affect serum lipid levels and thus risk of cardiovascular disease. Consuming a ketogenic diet with a high intake of saturated fat has been found to increase LDL cholesterol, however this effect can be mitigated by favoring polyunsaturated or monounsaturated fats instead. While the above findings provide a preliminary understanding of the effects of the ketogenic diet, more research is needed to further elucidate the effectiveness and safety of the diet for treating obesity and type 2 diabetes.

The prevalence of overweight and obesity in adolescents has increased dramatically over the past few decades. This increase is associated with a higher risk of developing Type 2 Diabetes Mellitus (T2DM). The "R.U.A. Healthy Kid?" program was created to target modifiable risk factors related to development of T2DM. This study specifically focuses on the influence of snacking habits. Researchers have documented an increase in snacking occasions and preference for low-nutrient snacks among adolescents. Many adolescent diabetes prevention programs target dietary behaviors, but none have used the Stages of Change as a theoretical framework to promote behavior change. The purpose of this study was to determine the impact of a three month community-based intervention on snack consumption and snacking habits of adolescents with risk factors for T2DM. Additionally, it explored the use of the Stages of Change model to understand how the intervention impacted adolescents' movement through the stages, and if reported stage was related to reported snack consumption and snacking habits. At completion of the study, the majority of participants reported forward progress in stages of change, indicating they were actively making changes in regards to high-nutrient (healthy) snacking. There was also a decrease in low-nutrient (unhealthy) snack consumption, and a significant improvement in overall snacking score. Participants reported several factors influenced their snack choice including hunger, taste, and availability. These findings are important to the development of appropriate programs to encourage healthy dietary behaviors at a young age.

In the past 30 years the prevalence of obesity has almost trebled resulting in an increased incidence of type 2 diabetes mellitus (T2DM) and other co-morbidities. Visceral adipose tissue is believed to play a vital role in these conditions, but underlying mechanisms remain unclear. A close association exists between obesity, diabetes and oxidative stress, resulting in increased reactive oxygen species formation. The experiments in this thesis address this by searching for possible biochemical changes which may be specific for the onset of obesity related T2DM, as well as looking for genetic alterations at molecular and gene expression levels. This thesis also explored various techniques such as polymerase chain reaction (PCR), colorimetric assays and real-time RT-PCR. The aim was to investigate the role of adipose tissue in obesity and T2DM, focusing on markers of oxidative stress and gene expression in human visceral adipose tissue from subjects categorised as lean, obese and obese with T2DM. This cross-sectional study measured two markers of oxidative stress, two markers of DNA damage, gene expression analysis and identification of genes associated with T2DM and obesity. Specific gene sequencing was carried out on the glutathione reductase gene to determine possible gene variants. Results showed a paradoxical decrease in adipose markers of oxidative stress in subjects with obesity and T2DM. There appeared to be a protective mechanism in these subjects, displaying reduced levels of oxidative stress compared to other groups. This could be due to a significant proportion of these subjects being on ACE inhibitor and statin therapy, which may be confounding results and minimising the effects of the oxidative burden. Additionally, the same subjects showed an increased expression of the glutathione reductase gene. It is difficult to conclude if the decreased levels of oxidative stress in these subjects were a result of the increased glutathione reductase expression in the visceral adipose tissue or if there remains an unseen factor influencing the dramatic expression change seen in this group of subjects. No glutathione reductase gene variants were identified in these samples. This analysis highlighted that within this sample set, the impact of oxidative stress is in fact reversible as the antioxidant capacity in these subjects is evident, and in combination with correct drug therapy it may be possible to combat oxidative burden and reduce the subsequent damage inflicted upon the cells.

Thesis submitted in fulfilment of the requirements for the degree Masters of Technology: Radiography in the Faculty of Health and Wellness Sciences at the Cape Peninsula University of Technology / BACKGROUND: Diabetic patients are at increased risk of cardiovascular events and stroke, and its prevention is therefore the desired goal. In the arsenal of available techniques, ultrasound plays a vital role in primary healthcare. It is reliable, cost-effective and a noninvasive diagnostic tool that may prove beneficial for screening individuals at risk of cardiovascular disease (CVD) and stroke in SA. OBJECTIVE: To determine the interrelationships between carotid ultrasound findings with glycaemia status and contributing risk factors of atherosclerosis in the selected population. METHODS: Initially blinded by the glycaemia status, blood results, contributing risks and patient demographics, both carotid arteries were evaluated with duplex ultrasound (DUS), during July 2010 – July 2011. Using graphs, figures, frequency tables, means and standard deviations for the selected study population, univariate, multivariate and stepwise regression analysis was done to determine the association between ultrasound findings and risk factors for atherosclerosis. The hypothesis tested in this study was to determine if there is an increased incidence of carotid artery intima-media thickening (CIMT), plaque formation and stenosis in patients diagnosed with T2DM and hyperglycaemia in a very specific sub-population of mixedancestory, residing in Bellville South Africa (BSA). RESULTS: Of 534 subjects, 375 were of mixed ancestry and ≥35yrs of age, which met the inclusion criteria for the carotid ultrasound substudy. The glycaemic status for each individual was established, and 44% (165/375) were diagnosed hyperglycaemic, of which 66.7% (110/165) were diabetic (T2DM) and 33.3% (55/165) were pre-diabetic (Pre-DM). Majority (56%:265/375) had a normal glycaemic status. The ultrasound measurement of the carotid wall thicknesses (Mean Rt. and Lt. CIMT) revealed a statistically significant rise from normal glycaemia status to DM status for both the males (p = 0.0115*; p = 0.0259*) and females (p < 0.0001**; p < 0.0001**) respectively. In terms of plaques and internal carotid artery (ICA) stenosis (124/375), when grouped into normal and hyperglycaemic sub-groups, indicated plaque presence and some form of narrowing. A <50% stenotic ratio noted in 61% (76/124) of the hyperglycaemic group, that was 1.6 times higher than those with normal glycaemia (48/124). Predisposing factors demonstrated significantly higher levels in the females than in the males. The univariate multiple regression analysis after adjusted R² of 0.3247 for all independent variables (predisposing /contributing risk factor markers) of age (yrs.), SBP (mmHg), hs-CRP (mg/L), S-Cotinine (ng/mL) and LDL (mmol/L) showed statistically significant positive associations with dependent variable of the mean carotid wall thickness (p < 0.0001**, p< 0.0001**, p = 0.0033*, p = 0.0409* and p = 0.0044)* respectively. Statistically significant positive differences and standard error (SE), for every unit of change (1yr.) of age (yrs.), as a contributing factor for herosclerosis, there was a change in the mean carotid wall thickness as predicted according to this model. The total contribution of independent risk factors to CIMT ultrasound measurements were calculated as 34.5% (Adjusted R² = 0.3247). In the multivariate stepwise regression analysis, the independent variables of age (p< 0.0001) ** and systolic blood pressure (p < 0.0001) ** showed the strongest positive association with carotid wall thickeness changes. The hs-CRP (mg/L) inflammatory markers (p = 0.0014)* and LDL (mmol/L) (p = 0.0208)* were the 2nd and 3rd highest positive associated contributory risk factors for carotid artery wall thickening. The hip circumference (p = 0.0008)* and waist circumference (p = 0.0 555) + risk factors related to obesity was significant and approached significance, respectively, with the predicted increase of carotid artery wall thickening. CONCLUSION: Subjects diagnosed with T2DM and hyperglycaemia had increased levels of CIMT, plaques and carotid artery stenosis, compared to those subjects without T2DM. Age and systolic blood pressure, inflammatory (raised hs-CRP) and LDL cholesterol changes, and central (truncal) waist circumference adiposity, were positively associated with increased carotid intima media thickness. Smoking (S-Cotinine) and gender also reflected a direct relationship with CIMT changes. The hip circumference adiposity and diastolic blood pressure measurements were not directly associated with an increase in CIMT, which are in keeping with hypertension and obesity formulas. These findings confirm the association of thickened CIMT, plaques and stenosis with ‘unhealthy’ T2DM subjects at higher risk of CVD and stroke. The total contribution of independent risk factors to CIMT measurements were calculated as 34.5% (Adjusted R² =0.3247). The gathered information, discussion of results, and concluding statements thereby supports the recommendation of carotid artery ultrasound evaluation, for screening and diagnosis in primary health care, for ‘flagging’ high risk individuals at risk of stroke, so that lifestyle changes and appropriate management is early adopted.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Revisión por pares / INTRODUCCIÓN: Los pacientes con diabetes mellitus tipo 2 son más propensos a una baja calidad de vida, discapacidad e incluso muerte. También, tienen una mayor predisposición a la depresión en comparación con los pacientes no diabéticos; así como una evolución favorable producto de la evaluación e intervención de su salud mental. OBJETIVOS: El objetivo de este estudio fue explorar la presencia de síntomas depresivos en una población ambulatoria con diagnóstico de diabetes mellitus tipo 2 y filiación militar. También examinar los factores asociados a la presencia de síntomas depresivos. MÉTODOS: Realizamos un estudio transversal en 108 personas con diabetes mellitus tipo 2, durante enero de 2012 en una muestra ambulatoria de un hospital de las fuerzas armadas. Los síntomas depresivos se evaluaron con el test autoaplicado de Zung. Usamos la prueba de Chi-cuadrado para examinar las asociaciones entre síntomas depresivos y los factores asociados de interés. Usamos modelos lineales generalizados crudos y ajustados para estimar las Razones de Prevalencia (RP) de la asociación entre las características clínicas y sociodemográficas con la presencia de síntomas depresivos. RESULTADOS: La prevalencia de sintomatología depresiva fue de 56,5% (intervalo de confianza 95%: 46,6-66,0%). El análisis bivariado mostró como significativa la asociación entre la presencia de síntomas depresivos con las variables: sexo, edad y complicaciones clínicas de la diabetes. En los análisis ajustados, la retinopatía diabética [RP: 1,3; intervalo de confianza 95%: 1,1-1,7], y la neuropatía diabética [RP: 1,4; intervalo de confianza 95%: 1,1-1,7] se asociaron a una mayor presencia de síntomas depresivos luego de considerar el sexo de los participantes. CONCLUSIONES: Observamos una elevada presencia de síntomas depresivos en la población de estudio, especialmente en los pacientes geriátricos o del sexo femenino. También en aquellos con complicaciones tardías de la diabetes mellitus tipo 2, y que probablemente representen la repercusión de la enfermedad en la calidad de vida del paciente. Un abordaje multidisciplinario, con enfoque físico y mental, debe ser considerado ya que podría beneficiar a la evolución de los pacientes con esta concomitancia en Perú.

Background: A marked increase of type 2 diabetes and associated morbidity and mortality rate over the last 10 years has been recorded in Malaysia. Ineffective diabetes management and a lack of self-care practice among type 2 diabetic patients have been identified as the major reasons for this problem. Research in other countries has highlighted a range of factors influencing effective self-care of type 2 diabetes including patients' perspectives of diabetes, sociocultural issues, religious beliefs and support from healthcare. Nevertheless, there is paucity of research conducted in Malaysia. Therefore, the exploration of self-care practice and self-care support provision in patients with type 2 diabetes in Malaysia is needed to understand the problem. Aims: To understand the self-care practice of patients with type 2 diabetes in Malaysia and the factors that influence the patients' self-care practice. To understand the type 2 diabetes’ self-care support provision in Malaysia from the perspective of patients, healthcare professionals, and healthcare system. Methods: A qualitative, single embedded case study design was utilised. Eighteen patients with type 2 diabetes and 19 healthcare professionals (physicians, diabetes educators, nurse, pharmacist and dietician), involved in self-care support provision primary- and secondary-care settings in Kuala Lumpur and Putrajaya, Malaysia, participated in in-depth semi-structured interviews between November 2012 and June 2013. In addition, data were collected through participant-observation of clinic consultations, and analysis of relevant documents used in the provision of diabetes management in the respective clinics. The framework technique supported analysis of data. Data were stored and managed using Nvivo 9 software. Findings: The findings indicate that patients with type 2 diabetes had a good understanding of diabetes and self-care, but a lack of self-care support meant that effective self-care was difficult to sustain. Healthcare professionals’ (HCPs’) provision of self-care support was restricted due to several factors, including lack of opportunity to provide self-care support, unsuitable clinic environment and a fragmented management within primary and secondary care. Additionally, barriers in patient–HCP communication, a combination of the personal, interpersonal and inter-professional HCP factors, and a traditional medical model adopted by Malaysian healthcare system, seem to have influenced the practice and quality of the service delivered. Conclusion: It is clear that the increased incidence of uncontrolled type 2 diabetes is not merely due to poor self-care practice by patients, but also due to constraints in service delivery and underdevelopment of self-care support provision. The evidence generated can assist in the development of strategies to improve the quality of care and facilitate changes in the self-care support provision in Malaysia.

Type 2 diabetes mellitus (T2DM) is a widespread metabolic disorder that continues to grow in prevalence both in the United States and worldwide. T2DM is an immense public health crisis and has been declared an epidemic by the United States Centers for Disease Control and Prevention. T2DM is a heterogeneous disease that is characterized by chronic hyperglycemia that is caused by dysfunction of the insulin transduction pathway. Particularly in T2DM, individuals with the disease experience a progressive loss of insulin production by pancreatic β cells in the setting of peripheral insulin resistance. Due to the dysfunction of insulin’s actions, glucose in circulation is unable to enter insulin’s target cells and remains in the bloodstream. Formerly known as adult-onset diabetes, T2DM has recently become more commonplace in youthful populations, particularly in adolescents during puberty. Several risk factors have been identified for T2DM, which defines a population of study to determine the underlying pathogenesis of T2DM and possible therapeutic interventions. While extensive research on T2DM has been performed, the heterogeneous nature of the disease makes it difficult to understand the relationship between genetic susceptibility and environmental triggers. The trend of reaching younger populations is extremely worrying as the loss of glycemic control in T2DM is associated with various medical complications. The most commonly seen complications in T2DM include neuropathy, nephropathy, retinopathy, and cardiovascular disease. These complications come with a significant burden that greatly increases mortality and reduces one’s quality of life. One of the underlying causes of the growing prevalence of youth-onset T2DM is the growing pediatric obese population. The increasing prevalence of pediatric obesity, in turn, is likely tied to adolescents getting less sleep, having diets high in carbohydrates, and having insufficient physical activity. Compared to T2DM that precipitates later in life, youth-onset T2DM appears to have a more aggressive nature, where glycemic control is quickly lost, and complications arise sooner in the disease course than adults. Unfortunately, compared to the various drug classes available to adults, options for youths with T2DM are limited. Currently, the only pharmacologic therapies available to youths are metformin and insulin and given that youths quickly lose metabolic control, new therapies are desperately needed to combat this epidemic. Lifestyle interventions are also widely used in pediatric populations, but success with lifestyle monotherapy is limited. Adherence to treatment plans is a barrier to positive outcomes in youthful populations, which may be improved by having patients and their families attend diabetes education programs. The aggressive nature of youth-onset T2DM and the limited amount of available therapies make it difficult to maintain control diabetes in this youthful population, which is concerning given the huge costs associated with diabetes for both individuals and health care systems. To combat this epidemic of youth-onset T2DM, aggressive monitoring is needed to identify high-risk populations and to prevent and delay T2DM in these populations. Reducing the prevalence of youth-onset T2DM will require efforts to increase the physical activity of youths and to reduce the consumption of foods that greatly increase blood sugar. Additionally, efforts should be made to ensure that youths are getting adequate amounts of sleep. Bariatric surgery has been demonstrated positive results in remission of T2DM in youths, but such an invasive procedure may be an extreme solution in a vulnerable population.

The use of telehealth in healthcare has grown in recent years; however, little is known about the effectiveness of this delivery method in the management of Type 2 diabetes mellitus (T2DM). Guided by the chronic care model and telehealth in chronic disease model, the purpose of this systematic literature review was to explore evidence related to lowering hemoglobin A1c levels and managing T2DM using telehealth in the outpatient setting. The practice-focused questions explored telehealth interventions used in T2DM management and their effectiveness. The Joanna Briggs Institute (JBI) method for conducting systematic literature reviews was the process, and data were compiled using the PRISMA evidence-based minimum set for reporting. Eighteen studies met the inclusion criteria for this project. Data were extracted, analyzed, and synthesized using JBI tools for data extraction and critical appraisal. Article appraisals revealed numerous telehealth interventions for management of T2DM including telephone, Internet-based, clinical video, remote monitoring, and smart phones/applications. Overall, telehealth interventions showed statistically significant improvement in the hemoglobin A1c levels of participants compared to traditional outpatient care. Success of the interventions is associated with components of evidenced-based diabetes management such as education, self-management, support, and feedback loop. The implications of this project for positive social change include the integration of telehealth interventions in the outpatient setting to manage T2DM with enhanced access to care, reduction in health disparities, and improved health outcomes for society.

BACKGROUND: Long-term exposure to fine particulate matter (PM2.5) has been identified as a potential risk factor for developing type 2 diabetes mellitus (T2DM). Given the rising prevalence of T2DM and unhealthy concentrations of PM2.5 in China, our attention is brought to examining the association in this region of the world. Furthermore, rural China, although largely ignored, also finds itself suffering from increased risks of T2DM and high levels of PM2.5. OBJECTIVE: The goal of this study is to characterize the relationship between long-term exposure to PM2.5 and the risk of T2DM in rural China. We do so by confirming that greater long-term exposure to PM2.5 is associated with a higher risk of T2DM incidence, assessing the potential multiplicative and additive interactions with important covariates, and identifying constituents of PM2.5 that may be responsible for the effect PM2.5 on the increased incidence of T2DM. CONCLUSIONS: Greater long-term exposure to PM2.5 is associated with increased risk of developing T2DM in rural Deqing County, Zhejiang, China. Smoking status modifies the relationship between PM2.5 and T2DM incidence on a multiplicative scale. There is no synergism between smoking and PM2.5 in association with T2DM incidence. There is no conclusive evidence on which constituents of PM2.5 play greater roles in the adverse effects of PM2.5 on T2DM incidence.

No description available.