maria.cristina.rc2690@gmail.com / Article / Introduction: There is limited and controversial information regarding the potential impact of depression on glycemic control. This study aims to evaluate the association between depression and poor glycemic control. In addition, the prevalence of depression and rates of poor glycemic control were determined. Methods: Cross-sectional study performed in the endocrinology unit of two hospitals of ESSALUD in Peru. The outcome of interest was poor glycemic control, evaluated by glycated hemoglobin (HbA1c: < 7% versus ≥ 7%), whereas the exposure of interest was depression defined as 15 or more points in the Patient Health Questionnaire-9 tool. The association of interest was evaluated using Poisson regression models with robust standard errors reporting prevalence ratios (PR) and 95% confidence intervals (95% CI) adjusting for potential confounders. Results: A total of 277 participants, 184 (66.4%) males, mean age 59.0 (SD: 4.8), and 7.1 (SD: 6.8) years of disease were analyzed. Only 31 participants (11.2%; 95% CI: 7.5%–14.9%) had moderately severe or severe depression, whereas 70 (25.3%; 95% CI 20.3%–30.8%) had good glycemic control. Depression increased the probability of having poor glycemic control (PR = 1.32; 95% CI 1.15–1.51) after adjusting for several potential confounders. Conclusions: There is an association between depression and poor glycemic control among type 2 diabetes patients. Our results suggest that early detection of depression might be important to facilitate appropriate glycemic control and avoid further metabolic complications. / We would like to thank Dr Viviana Ulloa who helped us to access data and T2D patients, and Dr Percy Mayta- Tristan for revising initial versions of the manuscript. AB-O is supported by Wellcome Trust Research Training Fellowship in Public Health and Tropical Medicine (Grant number 103994/Z/14/Z). / Revisión por pares

Genome wide association studies (GWAS) have transformed the study of the heritability of complex diseases such as type 2 diabetes (T2D), with the current tally of established risk loci close to ninety. Each of these loci has the potential to offer novel insights into the biology of this disease, and opportunities for clinical exploitation. However, the complexity of T2D has often frustrated efforts to achieve these functional and translational advances. This thesis aims to delve into the functional characterisation of two known susceptibility loci, KLF14 and ADCY5, and describe findings relevant to disease pathology. KLF14 and ADCY5 are two loci associated with T2D predisposition working through disparate mechanisms. Variants at the maternally imprinted KLF14 locus are associated with measures of insulin resistance and expression data has implicated KLF14 as a master regulator of genes in adipose tissue. In contrast, variation at the ADCY5 locus is associated with impaired beta cell function, high fasting glucose, and low birth weight suggesting ADCY5 is having an effect on insulin secretion. In this thesis, ENU mouse models of these two genes are investigated functionally to elucidate more about the pathology of common human variation at these loci. A mouse model was derived with an ENU point mutation at Adcy5 Y1064C. Phenotyping of this model revealed improved oral glucose tolerance, and secretion studies from isolated islet cells demonstrated impaired glucagon secretion from mice homozygous for the Y1064C mutation in the presence of adrenaline. These results suggest that Adcy5 is involved in glucagon regulation in the alpha cell. The Adcy5 Y1064C confers a protective effect against hyperglycaemia in mouse indicating that the T2D risk allele at the ADCY5 locus in humans may have the opposite direction of effect. A mouse model containing the ENU point mutation Klf14 R238L predicted to be disruptive to KLF14 protein function showed no significant difference in body weight, measures of insulin resistance, or blood cholesterol. However, expression of several genes associated in trans with variation near KLF14 in humans was changed in adipose tissue and skeletal muscle when the R238L mutation was inherited maternally compared to mice which had inherited the mutation paternally or carried two wild type alleles. This result suggests a mechanism by which Klf14 is regulating genes across metabolic tissues.

Diabetesrelaterade sår är en senkomplikation av typ 2 diabetes som karaktäriseras av infektion, sårbildning och/eller förstörelse av djupare vävnader. De vanligaste orsakerna till uppkomsten av sår är perifer neuropati, fotdeformitet och trauma med varierande grad av perifer kärlsjukdom. Hos personer med typ 2 diabetes är förekomsten av diabetesrelaterade sår varierat mellan 2 % till 6,8 % och personer med försämrad metabol kontroll har en ökad risk att drabbas av sår. En av de viktigaste åtgärderna för att undvika diabetesrelaterade sår är preventiva åtgärder genom egenvård eller assisterad egenvård. Syfte: Att genom litteraturöversikt kartlägga hur personer med typ 2 diabetes bedömer sin livskvalité vid diabetesrelaterade sår. Metod: Litteraturöversikt som utgjordes av tio artiklar med kvantitativ och mixad metod. Artiklarna hade sökts fram i databaserna Pubmed och Chinal och värderades med hjälp av både SBU:s granskningsmallar och modifierade kvalitetsgranskningsmallar. Resultat: De tio artiklarna visade att personer med diabetes hade försämrad hälsorelaterad livskvalité (HRQoL), jämfört med populationen i allmänhet och att det försämrades ytterligare vid diabetesrelaterade sår. Personer med diabetesrelaterade sår upplevde en större inskränkning i rörlighet och socialt liv, vilket påverkade HRQoL negativt. Minst påverkades HRQoL på mental hälsa generellt men det fanns en ökad variabilitet av ångest/depression hos personer med diabetesrelaterade sår relaterat till oro över sårläkningen, rädsla för att vara beroende av andra och rädsla för amputation. Slutsats: Personer med diabetesrelaterat sår har en försämrad livskvalité gällande mental hälsa och fysisk hälsa. Det är viktigt att vi inom hälso- och sjukvården bistår dessa patienter tidigt med rätt instanser och individuellt stöd.  Både gällande behandlingen av såret men också hjälp så att de kan hantera vardagen mentalt och fysiskt.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / O diabetes mellitus tipo 2 à uma doenÃa de importÃncia crescente na saÃde pÃblica, jà que sua incidÃncia e prevalÃncia tÃm avanÃado de forma assustadora, sendo causada por uma combinaÃÃo de fatores genÃticos e estilo de vida. Em face disso, a saÃde pÃblica indica a prevenÃÃo primÃria para identificar os fatores de risco para DM2 e traÃar estratÃgias com vistas a evitar a exposiÃÃo ao risco, retardando ou impedindo o aparecimento da doenÃa. Objetivou-se avaliar o risco para o desenvolvimento do DM2 entre adultos de Itapipoca-CE. Trata-se de pesquisa quantitativa, com delineamento transversal e observacional, realizada no perÃodo de janeiro a marÃo de 2010, com 419 usuÃrios da EstratÃgia SaÃde da FamÃlia do municÃpio de Itapipoca-CE, com idades entre 20 e 59 anos. Para a coleta de dados aplicou-se um formulÃrio no qual se registraram dados sociodemogrÃficos e clÃnicos e o Finnish Diabetes Risk Score. Os dados foram armazenados no Excel, sendo processados no Statistical Package for Science Social versÃo 18.0. O estudo foi aprovado pelo Comità de Ãtica em Pesquisa da Universidade Federal do Cearà sob protocolo 346/09. Dos 419 usuÃrios participantes, 88,1% eram do sexo feminino; a mÃdia de idade foi de 37 anos; 60,4% eram casados ou mantinham uniÃo estÃvel; 39,4% cursaram atà o ensino fundamental incompleto e 58,2% pertenciam Ãs classes econÃmicas D/E. Em relaÃÃo aos fatores de risco para DM2, 25,3% tinham idade &#8805; 45 anos; 59,7% estavam com excesso de peso; 84% foram classificados em risco cardiovascular; 83,3% eram sedentÃrios; 53,7% relataram nÃo comer frutas e/ou verduras diariamente; 12,9% tomavam anti-hipertensivos; 5,3% mencionaram histÃria prÃvia de glicose alta e 47% histÃria familiar de DM2. Segundo observou-se, 5,2% da amostra foram classificados com hipertensÃo e apenas 0,7% com provÃvel diabetes. Quanto ao grau de risco para DM2, 24,6% estavam em baixo risco; 63% em risco moderado e 11,7% em alto risco. Entre os participantes com alto risco, 12,0% eram homens; 30,2% tinham idades &#8805; 45 anos; 37,4 estavam com excesso de peso; 21,1% estavam em risco cardiovascular aumentado; 12,9% eram sedentÃrios; 14,7% nÃo comiam frutas/verduras diariamente; 31,5% tomavam anti-hipertensivos; 81,8% relataram histÃria de glicose alta e 23,9% histÃria familiar de DM2. Esse estudo abre portas para uma posterior pesquisa de intervenÃÃo no municÃpio, na qual os indivÃduos com alto risco para DM2 seriam acompanhados pelos profissionais de saÃde da ESF e dos NÃcleos de Apoio à SaÃde da FamÃlia, com orientaÃÃes quanto Ãs mudanÃas no estilo de vida, e com intervenÃÃes nos fatores de risco potenciais encontrados, objetivando reduzir ou retardar o aparecimento da doenÃa. / The type 2 diabetes mellitus is a disease of increasing importance in public health, since its incidence and prevalence have dauntingly advanced, and has been caused by a combination of genetic factors and lifestyle. In this view, public health indicates primary prevention to identify risk factors for T2DM and strategize in order to avoid exposure to risk by delaying or preventing the onset of the disease. The objective was to evaluate the risk for the development of T2DM among adults in Itapipoca town-CearÃ. It is a quantitative research with cross-sectional observational study conducted from January to March 2010, with 419 users of EstratÃgia SaÃde da FamÃlia (ESF) in Itapipoca town-CearÃ, the participants aged between 20 and 59 years. To collect data we applied a form in which demographic and clinical data and Finnish Diabetes Risk Score were registered. The data were stored in Excel, and processed in the Statistical Package for Social Science 18.0. The study was approved by the Ethics Committee of the Federal University of CearÃ, under protocol 346/09. Out of the 419 participating users, 88.1% were female and the average age was 37 years, 60.4% were married or had common law-marriage, 39.4% attended to part of primary school and 58.2% belonged to lower social classes. Regarding risk factors for T2DM, 25.3% were aged &#8805; 45 years, 59.7% were overweight, 84% were classified as cardiovascular risk, 83.3% were sedentary, 53.7% reported not eating fruit and / or vegetables daily, 12.9% were taking anti-hypertensive, 5.3% reported a previous history of high glucose and 47% had family history of T2DM. As observed, 5.2% of the sample were classified as having hypertension, and only 0.7% with probable diabetes. As for the risk levels for T2DM, 24.6% were at low risk, 63% in moderate risk and 11.7% at high risk. Amongst participants with high risk, 12.0% were men, 30.2% were aged &#8805; 45 years, 37.4% were overweight, 21.1% were at increased cardiovascular risk, 12.9% were sedentary; 14.7% did not eat fruit / vegetables daily, 31.5% took antihypertensive drugs, 81.8% reported a history of high glucose and 23.9% had family history of T2DM. This study opens doors for further intervention research in the town, in which individuals at high risk for T2DM would be accompanied by health professionals from the ESF and the NÃcleos de Apoio à SaÃde da FamÃlia. With the aim to reduce or delay the onset of the disease, the individuals would be given guidance as to changes in lifestyle and interventions on potential risk factors found.

Bakgrund: Vid typ 2 diabetes förekommer en minskad insulinproduktion samtidigt som cellerna i kroppen inte är lika känsliga för insulinet. Livsstilsförändring är den främsta behandlingen vid typ 2 diabetes i form av fysisk aktivitet, kostförändringar och rökstopp. Litteraturstudien grundar sig i Orems omvårdnadsteori. Syfte: Syftet var att beskriva erfarenheter av livsstilsförändringar hos individer med typ 2 diabetes. Metod: Metoden grundar sig i en systematisk litteraturstudie och sökningarna gjordes i Cinahl, PubMed och Psycinfo varav 11 artiklar inkluderades i resultatet. I analysen urskiljdes skillnader och likheter som bildade koder och slutligen kategorier. Resultat: Resultatet grundar sig i fyra kategorier: Kunskapens betydelse, Hantera egenvård, Svårigheter med egenvård och Relationers betydelse. Resultatet visade hur kunskap spelade en stor roll för livsstilsförändring. Det framgick olika sätt i hur individer utför egenvård och hur svårigheter uppstod i samband med kost, motion och medicinering. Relationer och stöd från bland annat familj och vänner spelade en viktig roll för individens livsstilsförändring. Slutsats: Det råder en stor kunskap- och egenvårdsbrist där sjuksköterskan har ett betydelsefullt ansvar gällande individanpassad information och stöd inom egenvård. En förbättring i form av individanpassad information och stöd är något som har stor efterfrågan och behov i dagens samhälle.

Både typ 2-diabetes och D-vitamin brist ökar hos världens befolkning och ett samband mellan förekomsten av dem båda har setts i olika studier. Typ 2-diabetes ger en minskad känslighet för insulin samt en ökad resistens där cellerna svarar dåligt på insulinet. Med tiden tröttas de insulinproducerande β-cellerna ut och sekretionen avtar. Vitamin D bildas ur 7-dehydrokolesterol i hudens celler vid UV-ljusbestrålning eller tas upp från födan. Vitamin D har många funktioner, bland annat att genom att det uppreglerar insulinreceptorer, ökar kalciumupptag och hämmar inflammationer. Syftet med denna studie var att undersöka hur tillskott av vitamin D påverkar sekretion av insulin samt känsligheten och resistensen för insulin, hos personer med typ 2-diabetes eller med ökad risk att drabbas av sjukdomen. Studien gjordes som en litteraturstudie där studier söktes på PubMed via Linnéuniversitetets bibliotek. Studierna skilde sig åt då det gällde både längd på behandling och dos av vitamin D, vilket gjorde det svårt att tydligt se om D-vitamintillägg påverkar de olika faktorerna. Dock verkar det finnas ett samband mellan halten 25(OH)D och insulinkänslighet samt insulinresistens. När halten 25(OH)D i blodet ligger på en nivå runt 60 ng/ml påverkas känsligheten och resistensen positivt. Sekretion av insulin påverkas mindre av enbart D-vitamintillskott, då detta är en kalciumberoende process. Fler studier behövs där deltagarna är fler och studietiden längre för att klargöra effekten av vitamin D på insulinkänslighet, insulinsekretion och insulinresistens.

Human immunodeficiency virus (HIV) is one of the largest public health problems internationally today and southern Africa is the part of the world that is most affected. Successful research has led to new improved antiretroviral drugs. Even if these drugs are improved and more successful, they bring along side effects. Research studies have shown that treatment of HIV entails metabolic changes and increases the risk for developing diabetes. This side effect can have a large impact on the patient’s quality of life and the affected patients often have to make lifestyle changes. To be able to develop the care around this group of patients, it is important to understand the complexity of nursing them. The aim with our study is to look into how nurses in Namibia experience caring for patients with HIV who also has type 2 diabetes as a side effect from antiretroviral drugs. Our study is a qualitative study based on interviews with six nurses working at Katutura hospital in Windhoek, Namibia. We did the interviews at Katutura hospital and the interviews were recorded. We transcribed the interviews and used Lundman &amp; Hallgren Granheims (2012) method for analyzing the collected data. The result showed that health education raises awareness and through that, the prevention of HIV increases and the risk of failure for already infected persons is reduced. Overall shall openness be a leading influencer in every aspect around the patient, the nurses, the community and the family’s treatment. The discussion brings up the importance of educating people both in the community and inside the healthcare spectra. It also brings up the importance of openness, both from the patients and nurses.

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.