Purpose: To examine the effectiveness of a community-based intensive multifactorial clinical intervention for patients with Type 2 diabetes, to evaluate the feasibility of achieving clinical targets for glycemic control in a community setting, and to identify factors that are predictive of glycemic control in this cohort (age, gender, disease duration, continuity of care, pharmacologic treatment, diabetes self-care and smoking status). Methods: Participants with Type 2 diabetes referred to the Diabetes Clinic following dissemination of the 2003 Clinical Practice Guidelines of Canadian Diabetes Association and who attended a minimum of two physician visits within a twelve month period were deemed eligible for participation. 70 patients were included in this retrospective study. Baseline and twelve month values for the following biomedical outcomes were collected via chart audit: BMI, hemoglobin A1c, blood pressure (systolic, diastolic) and lipid profile (HDL, LDL, triglycerides, total cholesterol, TC:HDL ratio). Data for identification of predictive factors for glycemic control were also retrieved by chart audit. Results: The results of the paired t-test yielded a significant improvement in hemoglobin A1c (p<0.05), systolic blood pressure (p<0.01), HDL-cholesterol (p<0.05), LDL-cholesterol (p<0.01), total cholesterol (p<0.05) and total cholesterol:HDL ratio (p<0.05) over twelve months. No significant difference in BMI, diastolic blood pressure or triglycerides was reported over twelve months. Over half the sample (52.9%) achieved clinical targets for glycemic control (hemoglobin A1c <7.0%) at twelve months. Logistic regression analysis identified disease duration (O.R. = 0.90, 95% CI Exp(B) = 0.079 - 0.773, p = 0.01) and continuity of care (O.R. = 0.25, 95% CI Exp(B) = 0.831 - 0.969, p = 0.02) as significant predictors of glycemic control at twelve months. Conclusions: These findings demonstrate the effectiveness of this community-based intensive multifactorial clinical intervention for patients with Type 2 diabetes and show that the implementation of CPGs related to glycemic control is feasible in a community-based setting. Additionally, patients in this cohort with increased disease duration and increased continuity of care were less likely to achieve clinical targets for glycemic control following a twelve month intensive multifactorial clinical intervention for Type 2 diabetes. In summary, health professionals should strive to implement similar intensive multifactorial interventions in community practice in order to decrease the likelihood of diabetes-related complications and improve the patients quality of life.

Dietary proteins from Atlantic salmon and cod have previously been shown to have antidiabetic effects. Since dietary proteins are digested into small peptides before being absorbed through the intestinal mucosa, it is reasonable to deduce that the antidiabetic effect is due to enzymatically-digested peptides rather than the proteins themselves. The aim of this study was to develop a protocol to recover peptides with antidiabetic effects from salmon and cod protein digests and then scale up and optimize the salmon protein hydrolysate production process for industrial-scale production. The peptide mixtures were screened using cell culture assays for insulin-modulating activities and were further fractionated and purified for the final identification. Total yields of salmon and cod protein hydrolysates (<1 kDa) as measured by Kjeldahl nitrogen were 16.9% and 40.1%, respectively. The production process used for the salmon protein hydrolysate (<1 kDa) showed good reproducibility and potential for the industrial-scale production.

Women with gestational diabetes (GD) are at higher risk of developing type 2 diabetes (DM) after delivery compared to those without GD. Numerous studies in the general population have identified that adoption of healthy lifestyles can prevent DM; however limited research has focused on women with GD. The purpose of this randomized pilot study was to determine the effectiveness of an educational intervention of SUGAR (Start Understanding Gestational Diabetes and Risk of Type 2 Diabetes), on women’s perceived risk of developing DM, knowledge of DM, self-efficacy to adopt healthy lifestyle behaviors and adoption of healthy lifestyle behaviors after childbirth among women with GD. A total of 23 women (mean age of 29.7, SD=3.9), 18 in SUGAR group and 5 in control group (CG) completed self-reported standardized questionnaires (Risk Perception Survey for Developing Diabetes adapted for women with GD; Self-Rated Abilities for Health Practices; Health Promotion Lifestyle Profile II; General Sleep Disturbance Scale; and Demographic Questionnaire) at baseline (third trimester) and post-test (postpartum 6-8 weeks). Intervention was given post the baseline data collection with a booster session at 2-4 weeks postpartum. The women in CG received attention control treatment. Study participants were obese (BMI M=33.1, SD=7.7) and a majority had a family history of DM. Findings showed that self-efficacy was the single significant predictor and accounted for 22% of the variance of healthy lifestyle behaviors. Participants had a clinical significant sleep disturbance during both pregnancy and postpartum. At baseline, poor sleepers reported a lower self-efficacy. The intervention significantly increased DM knowledge for women in the SUGAR group; however, not for perceived risk, self-efficacy nor healthy lifestyle behaviors. There was no difference between groups for postpartum glucose screening rates with only 39% receiving recommended testing. Future research needs to focus on prevention programs and center on self-efficacy, postpartum glucose screening, improve sleep, and adoption of healthy lifestyle behaviors. To ensure a better preventive care for GD women, education provided for both patients and health care provider is needed.

The aim of this study was to describe the prevalence of gingivitis, periodontitis and dental caries in individuals with type 2 – diabetes. The study was conducted in a form of a general literature review with the restricted to the following conditions: human studies, English, and articles published between 2007 - 2012. Articles lacking a control group were excluded. The data were collected through searches of the medical database PubMed. A compilation of 11 scientific articles was examined. In individuals with diabetes mellitus type 2, the presence of gingivitis was identified in 3 articles, periodontitis in 10, and dental caries in 3 articles. The 3 articles that showed presence of gingivitis demonstrated that individuals with type 2 – diabetes had a higher prevalence of gingivitis compared to non-diabetic individuals. A higher prevalence of periodontitis in individuals with type 2 – diabetes mellitus was found in 10/10 publications. Theses studies demonstrated in individuals with type 2 – a significantly higher incidence of deep pocket depths, attachment loss, recession defects and with higher plaque and gingival index scores. The three articles that showed the presence of dental caries also demonstrated a higher prevalence of dental caries in individuals with type 2 – diabetes mellitus.  The articles included in the literature study showed statistically significant higher prevalence of gingivitis, periodontitis, and dental caries in individuals with type 2 – diabetes mellitus than in individuals without a diagnosis of diabetes. Keywords: Type 2 – Diabetes, Gingivitis, Periodontitis and Dental Caries

Methylglyoxal (MG) is a reactive á-oxoaldehyde and a glucose metabolite. Previous studies in our laboratory have shown that MG induces the production of reactive oxygen species (ROS), such as superoxide (O2.-), nitric oxide (NO) and peroxynitrite (ONOO-), in vascular smooth muscle cells (VSMCs, A-10 cells). However, the effect of endogenous MG and mechanisms of MG-induced oxidative stress have not been thoroughly explored. The present study investigated fructose (a precursor of MG)- induced ONOO- formation in A-10 cells and whether this process was mediated via endogenous MG formation; roles of MG in regulating mitochondrial ROS (mtROS) production and mitochondrial functions in A-10 cells; and effect of MG on neutrophils in patients with type 2 diabetes mellitus (T2DM). Fructose induced intracellular production of MG in a concentration- and time- dependent manner. A significant increase in the production of NO, O2.−, and ONOO− was observed in the cells exposed to fructose or MG. Fructose- or MG-induced ONOO− generation was significantly inhibited by MG scavengers and by O2.− or NO inhibitors. The data showed that fructose treatment increased the formation of ONOO− via increased NO and O2.− production in A-10 cells, and this effect was directly mediated by an elevated intracellular concentration of MG. By inhibiting complex III and manganese superoxide dismutase activities, MG induced mitochondrial overproduction of O2.-, and mitochondrial ONOO- further. MG also reduced mitochondrial ATP synthesis, indicating the dysfunction of mitochondria. In addition, MG increased plasma NO levels in patients with T2DM, which reflected the oxidative status in those patients. MG-induced oxidative stress in patients with T2DM significantly enhanced levels of cytokines released from neutrophils. Moreover, the neutrophils from T2DM patients showed a greater proclivity for apoptosis, which was further increased by in vitro MG treatment. Our data demonstrate that MG-induced oxidative damage, particularly ONOO- production, contributes to the pathogenesis of T2DM and its vascular complications.

Obesity is an increasing health problem which is causally associated with insulin resistance and type 2 diabetes. Oxidative stress, i.e. overproduction of reactive oxygen species, is associated with insulin resistance and obesity and may be a major risk factor in the onset and progression of diabetes. Bernlohr Lab at University of Minnesota have study oxidative stress in adipocytes by silencing the enzyme glutathione S-transferase A-4 (GSTA4), an enzyme detoxifying 4-hydroxynonenal formed during oxidative stress. Their results indicate that lysine acetylation, an important post-translational modification, may be involved during oxidative stress. In this study lysine acetylation has been investigated in condition of oxidative stress in 3T3-L1 adipocytes and subcutaneous adipose tissue from mice using SDS-PAGE gel electrophoresis and western blot. Lysine acetylation was analyzed in different compartments of the cell such as in cytoplasm, mitochondria as well as in whole cell extracts. Silencing of GSTA4 and stimulation by TNF-α in 3T3-L1 adipocytes resulted in an increase of lysine acetylation in cytoplasm. Furthermore, stimulation by IL-6 did not have any effect on lysine acetylation. Surprisingly, subcutaneous adipose tissue from mice fed on a high-fat diet showed a decrease of lysine acetylation in cytoplasm compare to mice fed on a chow diet. In conclusion, lysine acetylation seems to change during oxidative stress and may be an important factor during insulin resistance, type 2 diabetes and obesity. Therefore, studying lysine acetylation and enzymes modulating acetylation may potentially increase our understanding of insulin resistance, type 2 diabetes and obesity and could lead to new therapies.

Föreliggande systematiska litteraturstudie syftade till att klarlägga vilka omvårdnadsbehov som föreligger hos patienter med typ 2-diabetes. Sammanlagt 15 vetenskapliga artiklar valdes ut via sökmotorn Electronic Library Information Navigator (ELIN), databasen Cumulative Index of Nursing and Allied Health (CINAHL) samt sökmotorn och databasen för medicinska artiklar som drivs av United States National Library of Medicine (MEDLINE), för vidare granskning. Sökorden type 2 diabetes AND quality of life AND nurs* användes. Alla titlar lästes, om titeln verkade relevant för forskningsområdet lästes även abstraktet. Kvalitetsgranskning av artiklarna genomfördes efter granskningsmallar med 28 bedömningskriterier. Omvårdnadsbehoven hos patienter med typ 2-diabetes som framkom vid artikel granskningen evidensgraderades på basen av kvalitetsgranskningen med hjälp av graderingsskala. Resultatet visade att hjälp till förbättrad egenvård, önskan om utökad utbildning, information och kunskap, socialt stöd och kontinuerlig vårdkontakt var de omvårdnadsbehov som studien fann evidens för. Omvårdnadsbehov hos patienter med typ 2-diabetes som framkom var kända sedan tidigare men föreliggande studie säkrade evidensen för dessa. Resultatet diskuterades utifrån Virginia Hendersons omvårdnadsteori där omvårdnaden måste ha en utgångspunkt i individens egna upplevelser av sina behov och hur dessa behov på bästa sätt kan tillfredsställas. Med hjälp av studiens resultat sammanlänkat med Virginia Hendersons teori om individens omvårdnadsbehov kan sjuksköterskan få en bättre bild av vilka behov som föreligger hos patienter med typ 2-diabetes för att bevara deras livskvalité.

Denna litteraturstudies syfte var att identifiera och evidensgradera de omvårdnadsåtgärder med vilka sjuksköterskan kan motivera patienter med diabetes typ-2 till egenvård. De 27 utvalda artiklarna, som svarade mot uppsatsens syfte, söktes från databaserna Cinahl, Elin@dalarna, Medline och PubMed. För att kunna bedöma utsedda kvantitativa och kvalitativa artiklars vetenskapliga kvalitet granskades artiklarna utifrån modifierade granskningsmallar efter förlagor av Forsberg och Wengström (2008). Kvalitetsbedömningen gav vid handen att av 27 artiklar, var 3 av hög vetenskaplig kvalitet och 24 artiklar var av medelgod kvalitet men ingen artikel bedömdes vara av låg kvalitet. På basen av artikelkvaliteten evidensgranskades de funna omvårdnadsåtgärderna i enlighet med Bahtsevanis (2008) rekommendationer. I litteraturstudien identifierades fyra huvudområden i omvårdnadsåtgärder inom diabetesvården: Livsstilsförändringar, Utbildning, Egenvård samt Personalens betydelse. Omvårdnadsåtgärderna Livsstilsförändringar, Utbildning och Egenvård vilade på måttligt vetenskapligt underlag och omvårdnadsåtgärden Personalens betydelse vilade på stark vetenskaplig grund. Resultaten diskuterades utgående från omvårdnadsteoretiker Orems humanistiska modell, som inbegriper egenvårdsbrist, som är en beskrivning av och förklaring till varför en person behöver omvårdnad, vilken sker när egenvårdskapaciteten är mindre än personens egenvårdskrav. Modellen bygger på antaganden om och generella kännetecken på till exempel omvårdnadssituationer och inkluderar begreppen omvårdnadskapacitet, hjälpmetoder och olika omvårdnadssystem.

Syfte: Syftet var att beskriva upplevelser av gruppbaserad patientutbildning bland patienter med nydebuterad typ 2-diabetes.Metod: Studien genomfördes med hjälp av semistrukturerade intervjuer. Data bearbetades med hjälp av kvalitativ innehållsanalys.Resultat: Tre huvudteman kunde urskiljas; (1) ett sammanhang med andra skapar möjlighet till utveckling av egenvård, (2) hinder som komplicerar framsteg i egenvård och (3) svårigheter med gruppbaserad patientutbildning. Många vittnade om att förändringsprocessen startade redan vid diagnostillfället, men att den gruppbaserade patientutbildningen gav ytterligare möjlighet till kunskapsinhämtning och tillämpning av kunskap. Gruppdeltagarna delgav varandra värdefull kunskap och stärkte och gav stöd åt varandra, vilket ledde till personliga vinster. Det fanns hinder som försvårade framsteg i egenvård exempelvis bristande insikt och personliga egenskaper. Deltagarna uttryckte negativa synpunkter såsom att inte uppskatta deltagande i grupp och om svårigheter i delar av undervisningen. Slutsats: Deltagarna upplevde den gruppbaserade patientutbildningen positiv och berikande och som en betydelsefull del av förändringsprocessen. Kunskapsutbytet och gemenskapen i gruppen ansågs vara de viktigaste beståndsdelarna. Samtliga deltagare hade gjort positiva förändringar i levnadsvanor och framsteg i egenvård tack vare den gruppbaserade patientutbildningen. Det fanns dock hinder som försvårade förändringsprocessen.

Abstract According to recent clinical treatment, doctors give patients medicines based on clinical experience and biochemical data. However, biochemical data simply provides an initial physiology reaction. Although the data is enough for doctors to diagnose diseases, it does not help much for doctors to indicate the most useful medicine. Therefore, doctors will use the first line, cheap or low dose medicine to cure patients by previous clinical experience. It will not only extend the time of treatment but also lower the medical quality. Not to mention the side effects and increases the cost. Consequently, using SNP¡]Single Nucleotide Polymorphism¡^will help doctors to find out different patients¡¦ genotype and forecast the result of medicine. It will control disease efficiently and decrease the medical costs. Methods: This study will be discussed with an accurate test of how to check the genotypes of diabetes mellitus and predict the result of treatment from pharmacogenetic. The method was using PCR (Polymerase Chain Reaction) and RFLP (Restriction Fragment Length Polymorphism) to analyze patients¡¦ different genotype. Besides, this study uses the One-Way ANOVA to interpret the relationship between ABCC8-E16 and type 2 diabetes. In conclusion, the antidiabetic drugs- Sulfonylurea derivatives are suitable for ABCC8-E16 genotype patients. This result can be a reference for doctors to remedy diabetics. It will not only save the cost but also shorten the time of treatment, and it will impact deeply for personalized medicine in the future. type 2 diabetes, Sulfonylurea, SNP, PCR, RFLP, pharmacogenetic, personalized medicine