Background: Diabetes is a growing chronic disease that affects more than 29 million adults in the United States and 422 million adults globally. Women with a history of gestational diabetes (GDM) are identified to be at higher risk for developing subsequent type 2 diabetes mellitus (T2DM). The prevalence of GDM varies based on the data collection method, response rate, and diagnostic criteria. The aim of this study is to examine the association between history of GDM diagnosis and current T2DM status and how the relationship differs based on the participant’s age, race, and BMI. Methods: Data from the 2011-2012 and 2013-2014 National Health and Nutrition Examination Surveys (NHANES) were analyzed to conduct a cross-sectional study of 4,006 U.S. non-pregnant women ages 20 years and older with a history of prior pregnancy. The race/ethnicity of the participants include non-Hispanic Whites, non-Hispanic Blacks, Mexican Americans, non-Hispanic Asians, and "Other" variables. Univariate and multivariate logistic regression analyses were used to determine the association between history of GDM and current T2DM status stratified by age, race, and BMI. Results: Three hundred and fifteen subjects from a sample size of 4006 were found to have a history of GDM. Of the 315 participants with GDM, 111 (35.2%) were found to develop T2DM. After controlling for age, race, and body mass index (BMI), women with a history of GDM were found to be at greater odds of T2DM (OR=4.71; 95% CI: 3.52-6.28) compared to women without a history of GDM. A multivariate analysis was performed adjusting for other covariates such as age, race, BMI, and cholesterol. When stratified by participant age, women between the ages of 20-44 years with a history of GDM were linked with an increased risk of T2DM (OR= 3.02; 95% CI: 1.88-4.85). Overweight and obese women with a history of GDM have a 2.5-fold risk of developing T2DM (OR=2.51; 95% CI: 1.49-4.23). Discussion: This study provides further understanding and awareness on the role of GDM during the subsequent risk for T2DM. Our study shows women between the ages of 20 and 44 years and with elevated BMIs (25 ≥ kg/m2) are at increased risk of developing subsequent T2DM. Findings suggest the need for health promotion and prevention efforts towards the populations at risk. Early intervention post-pregnancy and education may help prevent women with a history of GDM from developing T2DM.

Class of 2005 Abstract / Objectives: The purpose was to describe the glycemic control of hospitalized patients treated with sliding scale insulin (SSI) and correlate glycemic episodes to other factors. Methods: The records of 315 patients admitted to a private, 166-bed hospital between August 25 and November 30, 2004 were identified from orders for antidiabetic medications then screened for inclusion and exclusion criteria. 135 of these patients met the criteria for inclusion in this study and their charts were reviewed for demographic data, medical history, medication regimens, blood glucose measurements and SSI use during hospitalization. Hypoglycemia was defined as less than or equal to 50 mg/dL and hyperglycemia greater than 250 mg/dL. Results: Orders for SSI were written for 93% of diabetic patients admitted. 2,904 blood glucose fingerstick measurements were recorded: 15.9% were greater than 250 mg/dL and 0.689% were under 50 mg/dL. The only statistically significant result was the correlation between increased numbers of hyperglycemic episodes and the consumption of the hospital’s “diabetic diet,” p<0.001. The small group of patients admitted for cellulitis (N=6) also experienced more hyperglycemic episodes. There was a trend approaching significance, p=0.055, for an increased number of hyperglycemic episodes in patients with admission blood glucose value over 200 mg/dL. Results based upon the hospital’s standard SSI regimen were not significantly different from other variations of SSI. Implications: SSI was almost always prescribed for hospitalized patients with type 2 diabetes and this regimen resulted in poor glucose control in approximately 17% of fingerstick measurements.

Class of 2005 Abstract / Objectives: The purpose of the study was to evaluate if rosiglitazone was being used in full compliance with the SAVA consensus criteria for appropriate use of thiazolinediones. Methods: A retrospective chart review was performed on 50 SAVA patients selected at random from a list of patients that were on rosiglitazone treatment as of March 15, 2005. Results: The percent of patients who met all of the criteria set forth by the SAVA when initiating therapy was 44%. Rosiglitazone treatment should not have been started in 28 out of the 50 patients. Once initiated on rosiglitazone, patients’ follow-up ALT was only obtained in 16% of patients. Once rosiglitazone has been prescribed for 3 months, HbA1c should decrease. Twenty percent of the patients showed an increase in HbA1c from baseline and were continued on the medication despite the criteria. Implications: Once therapy was initiated, the majority of patients studied failed to meet the SAVA guidelines for the appropriate use of rosiglitazone. In addition, a majority failed to follow the aspects of the guideline regarding initiation of rosiglitazone therapy.

Class of 2008 Abstract / Objectives: To determine the cost-effectiveness of adding a thiazolidinedione (TZD) versus insulin glargine (glargine) as a triple regimen for treatment of Type 2 diabetes mellitus for patients not controlled with metformin and a sulfonylurea. Methods: A decision analytic model was developed to compare the clinical outcomes and costs of triple therapy with either a TZD or glargine. Published literature was used to determine treatment efficacy and the frequency of clinically important adverse effects. Cost data were obtained from the 2007 Physician Fee Reference and North Carolina Industrial Commission website. The decision tree was built using TreeAge software. Clinical outcome measures included HgA1c (A1C) control, hypoglycemia frequency, and the development of edema associated with the use of these medications. A Monte Carlo probabilistic sensitivity analysis was conducted to determine the mean and 95% CIs for both treatment efficacy and costs. Results: There was no statistically significant difference in the efficacy of adding either a TZD or glargine in achieving a goal A1C ≤ 7%. However, glargine triple therapy was estimated to be significantly less costly than TZD triple therapy ($3,161/yr; 95% CI $3,116 to $3,356 versus $3,769/yr; 95% CI $3,667 to $3,902, respectively). Conclusions: Most patients requiring triple therapy for the management of T2DM should receive glargine rather than a TZD due to the significantly lower cost producing similar clinical efficacy.

Introduction: The global burden of diabetes can be minimised by interventions focusing on the control of glucose levels. Effective self-management and quality of care have improved diabetes outcomes such as glycaemic levels. However, few studies directly evaluate the relative importance of individual aspects of self-management and quality of care on glycaemic control. Therefore, I evaluated the individual contribution and relative importance of specific aspects of self-management and quality of care on the glycaemic control of Mexican patients with type 2 diabetes. Methods: A longitudinal cohort study was conducted. Consecutive patients were recruited from the waiting rooms in five primary care practices in the city of Aguascalientes, Mexico (from December 2009 to April 2010). These practices are part of the largest social security institution in Mexico (the Mexican Institute for Social Security). Predictors of glycaemic control were measured from medical records and interviews with patients at baseline. Self-management was measured using four questionnaires: the Diabetes Knowledge Questionnaire (DKQ-24), the Medical Prescription Knowledge Questionnaire (MPKQ), the Summary of Diabetes Self-Care Activities (SDSCA), and the Diabetes Self Efficacy Scale. Quality of care was measured using three questionnaires and by extracting data from medical records to evaluate an index of continuity of care (MMCI) and treatment intensification. The questionnaires used were the continuity of care scale from the General Practice Assessment Questionnaire (GPAQ), the Patient–Doctor Communication Scale (PDCS), and the Patient Satisfaction with Diabetes Care scale (PSDC). Glycaemic control (HbA1c levels) was measured at two time points: baseline and six month follow-up. The main analysis was a multivariate regression model with HbA1c at six-month follow-up as the dependent variable and with self-management and quality of care as predictors and demographic and clinical factors as covariates. A secondary analysis considered the interaction between self-management and quality of care in the prediction of HbA1c at six-month follow-up using a multivariate regression model including HbA1c at baseline in the model. Results: The multivariate linear regression model, that included all variables, was significant and explained 36 % of the variance (P <0.01). Patients had lower HbA1c at follow-up if they had lower levels of HbA1c at baseline, received care at one particular practice in the city, had diabetes of shorter duration, and were prescribed monotherapy. When HbA1c at baseline was removed from the model it explained 14% of the variance (P <0.01). Practice and medical prescription remained significant. In addition, lower levels of HbA1c at follow-up were related to the patient undergoing appropriate treatment intensification by their general practitioner. In the secondary analysis, the interaction showed that if treatment was not intensified, good self-managers had lower HbA1c (P <0.01) but if treatment was intensified, the level of self-management had no effect. Conclusions: Treatment intensification was the main predictor of lower HbA1c levels at follow-up. Although none of the self-management predictors was significantly related to HbA1c, an exploratory analysis of self-management/quality of care interactions showed that patients who did not receive treatment intensification but performed more self-management behaviours had lower HbA1c levels at follow-up.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Objective: To describe and compare attitudes, lifestyle behaviors, and cardiometabolic risk factors between individuals with and without a relative with type 2 diabetes mellitus (T2DM) living in the same household. Methods: A secondary analysis of baseline data from an implementation study in Peru was conducted. The outcomes were attitudes towards changing lifestyle behaviors (e.g. intentions towards losing weight, increasing physical activity, reducing salt consumption, etc), profiles of health lifestyle behaviors (e.g. daily smoking, heavy drinking, and physical activity), and cardiometabolic risk factors (e.g., overweight [body mass index ≥25 kg/m2] and hypertension); whereas the exposure was the presence of at least one relative with known diagnosis of T2DM living in the same household. Multilevel logistic mixed effect regression models were used to estimate odds ratios (OR) and 95% confidence intervals (95% CI). Results: A total of 2298 records, 1134 (49.4%) males, mean age 43.3 (SD: 17.2) years, were analyzed. There was no evidence of a difference in lifestyle-changing attitudes, smoking, alcohol drinking, physical activity levels, and hypertension between individuals with and without relatives with T2DM. Overweight was 63% more common among individuals having a relative with a T2DM in multivariable model (OR = 1.63; 95% CI: 1.03–2.61). Conclusions: Individuals with relatives with T2DM have higher probabilities of being overweight compared to those who did not have relatives with T2DM in the same household. The absence of differences on lifestyle-related attitudes and behaviors highlight the need of involving relatives of patients with T2DM on intervention strategies to further enhance diabetes prevention and management efforts. / National Heart, Lung, and Blood Institute / Revisión por pares / Revisión por pares

京都大学 / 0048 / 新制・課程博士 / 博士(農学) / 甲第21833号 / 農博第2346号 / 新制||農||1068(附属図書館) / 学位論文||H31||N5205(農学部図書室) / 京都大学大学院農学研究科応用生物科学専攻 / (主査)教授 菅原 達也, 教授 澤山 茂樹, 教授 佐藤 健司 / 学位規則第4条第1項該当 / Doctor of Agricultural Science / Kyoto University / DGAM

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Objective: The objective of this study was to characterize the composition of the gut microbiota in type 2 Diabetes Mellitus (T2DM) patients with adequate and inadequate metabolic control, and its relationship with fiber consumption. Results: A total of 26 patients with type 2 diabetes mellitus (T2DM) were enrolled, of which 7 (26.9%) cases had adequate metabolic control (HbA1c < 7%) and 19 (73.1%) inadequate metabolic control (HbA1c ≥ 7%). It was observed that among patients with controlled T2DM, 2 (28.6%) cases presented good intake of fiber and 5 (71.4%) cases a regular intake. In contrast, in patients with uncontrolled T2DM, 13 (68.4%) patients reported a regular intake and 6 (31.6%) a poor intake. In relation to the identification of the gut microbiota, both groups presented a similar characterization. There were differences in the population of bacteria identified in both groups, however, the results were not statistically significant. The most frequently identified bacteria in controlled and uncontrolled T2DM patients were Prevotella (71.4% vs 52.6%), followed by Firmicutes (71.4% vs 42.1%), Proteobacteria (71.4% vs 36.8%) and Bacteroidetes (57.1% vs 37.8%). On the other hand, Fusobacterium, Actinobacteria were not identified in either of the two groups of study. / Revisión por pares

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Typ 2-diabetes är en folkhälsosjukdom som ökar drastiskt på både en nationell och global nivå. Behandlingen av typ-2 diabetes utgår till stor del utifrån att patienten genomför en god egenvård. För att stötta patienter i sin egenvård har användandet av E-hälsa ökat i hälso- och sjukvården. Genom rätt anpassad information och samråd med sjuksköterskan gällande egenvård vid typ-2 diabetes kan E-hälsa vara en möjlighet till att stärka patienten i sin egenvård. Litteraturöversiktens syfte är att belysa patienters upplevelser av E-hälsa som stöd i egenvård vid typ 2-diabetes. Metoden som valdes var en litteraturöversikt baserat på 16 vetenskapliga artiklar. I resultatet framkom två teman; E-hälsans inverkan på egenvård och utformning av teknik. E-hälsans inverkan på egenvård framställdes ur tre underteman; Patienter upplevde en ökad kontroll, E-hälsa påverkade patienters engagemang och kunskap skapar förutsättningar. Utformning av teknik framställdes ur två underteman; Personcentrerad E-hälsa och avsaknad av mänskliga möten. För att E-hälsa ska utvecklas och uppnå vision E-hälsa 2025, är det av vikt att ta del av patienters upplevelser för att sjuksköterskan ska kunna tillmötesgå patienters vårdbehov.