Type 2 diabetes is a devastating disease that has been rising in prevalence in the United States over the last 70 years, a rise which has paralleled the obesity epidemic and use of artificial sweeteners. This is especially concerning due to the many detrimental comorbid complications stemming from this potentially longstanding disease, including retinopathy, nephropathy, and neuropathy. Xylitol is an alternative sweetener that has been gaining popularity due to its intense sweetening power, as well as reported antidiabetic effects. Studies on rats induced with type 2 diabetes have found that xylitol helps in reducing blood glucose and insulin secretion, as well as increase protein and fat metabolism, post prandial satiety, and oxygen free radical destruction. These promising results have provided ample evidence to test the effects of xylitol on humans. The proposed study will examine the results of daily xylitol intake (0%, 2.5%, 5%, and 10%) on blood sugar levels over 1 year in newly diagnosed type 2 diabetics. Plasma samples will be taken 3 times during the study period to examine HbA1c, fasting blood glucose, Glucagon-Like Peptide 1, Cholecystokinin, and Superoxide Dismutase. At the end of 1 year of treatment, patient samples will be averaged into 6 month and 12 month results for each parameter and compared using ANOVA and student T-tests. We will test whether the results of this study mirror those seen in previous research on rats, that the antidiabetic effects of xylitol increase relative to concentration. This study hopes to provide further evidence on the need for xylitol supplementation in the diet of type 2 diabetics, either independently or to augment medical treatment, in helping to prevent progression of disease and reduce comorbid complications.

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Background: Obstructive Sleep Apnea (OSA) is a chronic breathing disorder that is estimated to affect 20% of the US adult population. Intermittent hypoxia and sleep fragmentation caused by OSA likely affects cardiometabolic function. Individuals with OSA might be at risk of developing hypertension and type 2 diabetes (T2DM), with a dose-response relationship related to OSA severity. The objective of this study was to estimate the association between severity of OSA at diagnosis with 1) incidence of hypertension incidence of hypertension and 2) incidence of T2DM. Methods: We conducted a retrospective cohort study of Kaiser Permanente members diagnosed with OSA during 2000-2005. Adults without baseline hypertension or T2DM were eligible. Patients were excluded if hypertension or T2DM was diagnosed within one year prior to OSA diagnosis, and right censored at the end of follow-up or at the time Kaiser Permanente membership ended. Kaplan-Meier curves and Cox Proportional Hazard models were used to estimate the association between OSA severity and incident hypertension and incident diabetes. Results: Overall 719 patients were diagnosed with OSA during the study periods; 614 were included as those at risk of developing either hypertension (N=265) or T2DM (N=489). Overall, 261 had severe OSA at diagnosis. Those with severe OSA were more likely to be middle aged, overweight, and have prevalent hypertension or T2DM. Among those without prevalent hypertension at OSA diagnosis, 47.4% (126/266) were subsequently diagnosed with hypertension. Among those without prevalent T2DM at OSA diagnosis, 16.3% (80/491) were subsequently diagnosed with T2DM. After adjusting for BMI and prevalent T2DM, the hazard rate of incident hypertension among patients with severe OSA was 1.35 (95%CI: 0.88-2.06) compared to the rate among patients with mild OSA. The hazard rate of incident T2DM among patients with severe OSA was 1.49 (95%CI: 0.83-2.67) compared to the rate among patients with mild OSA after adjusting for BMI and prevalent hypertension. Discussion: We found high incidence rates of hypertension and T2DM among adults diagnosed with OSA. Severe OSA at diagnosis was associated with increased risk of either incident hypertension or T2DM, but not significantly (for p≤0.05).

African-American women (AAW) have had the largest increase in diagnosed diabetes in the US. Few studies have focused solely on dietary changes (one of the foundations for diabetes self-care), particularly in the context of family and the role of AAW. The purpose of this descriptive ethnographic study was to explicate cultural influences on food practices of AAW with type 2 diabetes (T2DM) in order to inform the health care community as well as future development of culturally-tailored interventions. Specific aims were to describe typical daily food practices and identify cultural influences on food practices of AAW with T2DM. Symbolic Interactionism, a sensitizing framework for viewing AAW with T2DM as a subculture, guided this study. Purposeful sampling was used to recruit 20 AAW who: were between 35 and 70 years of age, had been diagnosed with T2DM, shopped and prepared meals for their families, and attended church functions where food was served . Data collection consisted of one-one-one interviews and participant observation of church fellowship dinners, grocery shopping, and food preparation. A social anthropological approach to content analysis was used to describe behavioral regularities in food practices. Trustworthiness was maintained by an audit trail. Findings indicate that for informants in this study, who had diabetes ranging from 2 to 30+ years, there is a constant struggle between cultural food practices and eating healthier because of diabetes, particularly within the home setting where a majority of daily food practices take place. Difficulties in making dietary modifications result from conflicts between the need to change dietary practices to control diabetes and personal food preferences, as well as the preferences of people within the participants' social network. In addition, difficulties derive from AAW's emotional dedication to the symbolism of food and traditional cultural food practices. AAW are the gatekeepers for family food practices and are the keys to healthy dietary practices. This study begins to fill the research gap regarding cultural dietary food practices of this population. With increased knowledge, researchers and health care providers will be better able to improve AAW food practices, and ultimately improve diabetes control in this high-risk population. / text

<p>Övervikt hos patienter med typ 2 diabetes är en riskfaktor för att utveckla komplikationer. Komplikationer kan drabba ögon, njurar, nerver och blodkärl. Sjuksköterskan har en viktig roll i arbetet med att hjälpa överviktiga typ 2 diabetiker att minska sin vikt. Viktminskning hos överviktiga typ 2 diabetiker kan leda till ökat välbefinnande och minska risken för komplikationer. Syftet med litteraturstudien var att beskriva omvårdnadsåtgärder för att patienter med övervikt och typ 2 diabetes ska sänka sin vikt. Metoden som användes var en systematisk litteraturstudie, där tio vetenskapliga artiklar har sammanställts i resultatet. Tre huvudkategorier med tillhörande underkategorier identifierades. Dessa huvudkategorier har sin grund i Socialstyrelsens definition av omvårdnadsåtgärder (SOSFS 1993:17). Resultatet visar att sjuksköterskan har en viktig roll i att stödja, informera och även samordna vården för att underlätta en viktminskning hos patienter med övervikt och typ 2 diabetes. Stöd innebär bland annat att hjälpa patienten att finna motivation för att genomföra en viktminskning. Stöd innebär även att underlätta för patienten att lösa problem som dyker upp under viktminskningen. Bedömning, planering och målsättning bör göras individuellt och i samråd med patienten och andra involverade vårdgivare. För att lyckas med en viktminskning bör patienten utbildas i vikten av goda kostvanor och regelbunden motion.</p>

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ABSTRACT Background: A prerequisite for diabetes complications to be prevented or at least delayed is that the person with type 2-diabetes has a well-controlled blood sugar. Self-monitoring blood glucose is part of self-management, therefore it is important to find out how this is experienced by people with type 2-diabetes so that the diabetes-nurse can provide the support the person needs. Purpose: The aim of this study was to describe experiences of self-monitoring blood glucose for persons with type 2-diabetes. Method: The study was performed with descriptive qualitative method. To gain access to the material, semi-structured interviews were conducted in two focus groups. A group of women (67-87 years) and a group of men (40-80 years). Qualitative content analysis was used to analyze the transcribed material. Results: After processing and analysis, the categories emotions and knowledge and support emerged. The parent theme was identified as "knowing but not doing". To the category of emotions was found the subcategories of shame and bad conscience, fear of high and low values, discomfort and disgust, confirmation and control, and affinity with others. To the category of knowledge and support, three subcategories were identified, self-monitoring blood glucose and technology, as well as support, help and education. Conclusion: In summary, it can be said that people with type 2 diabetes experiences and experiences of measuring their blood sugar show that it is associated with both positive and negative emotions and a need for continuous support from the diabetes nurse. The results of the study are supported by previous research in the field. Keywords: self-monitoring blood glucose, self-measuring blood glucose, type 2-diabetes, self-management / SAMMANFATTNING Bakgrund: En förutsättning för att diabeteskomplikationer ska kunna förhindras eller i alla fall fördröjas, är att personen med typ 2-diabetes har ett välkontrollerat blodsocker. Blodsockermätning är en del av egenvården, därför är det betydelsefullt att ta reda på hur detta moment upplevs av personer med typ 2-diabetes så att diabetessjuksköterskan kan ge det stöd personen behöver. Syfte: Syftet med studien var att beskriva upplevelser och erfarenheter av att mäta blodsocker för personer med typ 2-diabetes. Metod: Studien utfördes med beskrivande kvalitativ metod. För att få tillgång till materialet genomfördes halvstrukturerade intervjuer i två fokusgrupper. En grupp med kvinnor (67-87 år) och en grupp med män (40-80 år). Kvalitativ innehållsanalys användes vid analys av det transkriberade materialet. Resultat: Efter bearbetning och analys framträdde kategorierna känslor samt kunskap och stöd. Det överordnade temat identifierades som ”att veta men inte göra”. Till kategorin känslor hittades subkategorierna skam och dåligt samvete, rädsla för höga och låga värden, obehag, olust och äckel, bekräftelse och kontroll samt samhörighet med andra. Till kategorin kunskap och stöd identifierades de tre subkategorierna samsyn, blodsockermätning och teknik samt stöd, hjälp och utbildning. Slutsats: I studien framkom att både upplevelser och erfarenheter av att mäta blodsockret påverkar om personer med typ 2-diabetes genomför mätningar i den utsträckning som rekommenderas. Därför är det betydelsefullt att diabetessjuksköterskan arbetar personcentrerat för att kunna ge det stöd till egenvård som personen vill ha.   Nyckelord: Blodsockermätning, typ 2-diabetes, egenvård

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The protein Poly was first discovered in Drosophila melanogaster, during a screening for third chromosome lethal mutations. Drosophila poly mutant larvae exhibit a slower rate of development. However, they reach the third instar larval stage and remain at that stage for 21 days before they die without reaching pupation. This phenotype is attributed to developmental impairment of the imaginal discs, therefore suggesting defects in cell growth and/or proliferation. During that stage, the mutant larvae develop melanotic masses. Poly is conserved and its homolog, Elp6, is one of the small subunits of the Elongator Complex, a complex involved in many cellular functions including transcription and translation. Drosophila larvae mutated at the Elp3 gene, the gene encoding the catalytic subunit of the Elongator complex, develop melanotic masses, a phenotype very similar to that of poly. The Heck laboratory published that Poly is a positive mediator of the Insulin Receptor/TOR (InR/TOR) pathway, which leads to protein, glycogen and fatty acid synthesis, regulates cell growth and apoptosis. It was shown that Poly interacts with InR, at least in some cases, therefore promoting cell growth and metabolism (Bolukbasi et al., 2012). The Drosophila genome shares 60% similarity to the human, with 77% of the genes attributed to a human disease having a Drosophila counterpart (Chien et al., 2002). In 2011, an intriguing study by Musselman et al. reported that feeding wild type Drosophila larvae with excessive amounts of sucrose led to the development of an insulin resistance phenotype similar to that of Type 2 Diabetes (T2D), thus rendering Drosophila an easily accessible T2D model. The phenotype included impaired metabolism, slower rate of development, and excessive accumulation of triglycerides (TAG) in the larval fat body. In my thesis research, I examined the involvement of Poly in insulin resistance - T2D using Drosophila as a model. The understanding of the connection between the protein and the disease came upon the discovery of a new form of Poly, Poly14. Poly14 is enriched in the Drosophila fat body, the equivalent of the human fat tissue and liver and its protein levels are significantly decreased when larvae are fed a high sucrose diet, compared to other types of diets – potentially linking the protein to the onset of T2D. Poly mRNA levels were also lower. To examine whether the overexpression of poly might be able to rescue the insulin resistance phenotype, two new Drosophila transgenes were generated with the ability to express the gene in a tissue of interest. In these two new transgenes, Poly is tagged with tRFP (Red Fluorescence Protein) at the N’- (UAS_N’RFPpoly) or the C’-terminus (UAS_polyC’RFP). Overexpression of Poly rescued the insulin resistance phenotype, therefore implicating Poly as a possible important regulator in the development of the insulin resistance phenotype. All of the above findings suggest a vital role of Poly in metabolism and the development of the insulin resistance/diabetic phenotype in Drosophila, providing us the opportunity for new tools in this very medically-relevant field of research.