Thesis (M Med (Family Medicine))--University of Limpopo (Medunsa Campus), 2010. / Introduction: Diabetes Mellitus still remains an important non- communicable disease globally. The burden of the disease continues to rise even in the sub-Saharan Africa. Aim: The study aimed to assess and describe the dietary practices and the prevalence of obesity among type 2 diabetic patients seen at Scott Hospital. Methods: A descriptive cross- sectional study was conducted among type 2 diabetic patients at Scott Hospital, Morija, Lesotho. A simple random sample of 50 participants was selected and each completed an interviewer administered questionnaire. The administration of the questionnaire was done by the researcher and a research assistant. Socio- demographic characteristics of the participants were obtained, anthropometric measurements were height and weight of each participant with subsequent determination of the BMI. Dietary intake was assessed using questions from a modified food frequency questionnaire of 16 food groups that reflect the commonest food items available. Results: The results showed that 86% (43/50) of the participants were females and 14% (7/50) were males with a female: male ratio of 6:1. The majority (72%) were above age 50 years and with regards to educational status, 62% had primary school education as the highest level attained. Four percent (4%) had no formal education. Fifty percent (50%) of the participants were unemployed. The mean weight of the participants was 84.22 ± 13.51 kg and the mean height was 157.76 ± 6.10 cm. The mean BMI was 33.97 ± 4.99 kg/m². Seventy-eight percent (38/50) of the participants were obese, and 14% (7/50) of the participants who were females, were morbidly obese with BMIs ≥ 40kg/m². The prevalence of obesity when stratified by gender showed that 57% (4/7) of male participants and 81% (35/43) of female participants were obese. According to the dietary assessments, food groups with the highest reported consumption per unit per month were; maize meals, breakfast-cereals and bread respectively. Conclusion: The study showed a predominantly female and elderly population of type 2 diabetics at Scott Hospital, Morija, Lesotho. The prevalence of obesity was high (78%) among the participants and this further supports the view that obesity is a major risk factor for type 2 diabetes. Reported dietary intake showed a higher consumption of carbohydrates and a very low intake of dietary fibre as represented by legumes. Keywords: Type 2 diabetes mellitus, dietary habits and obesity.

acase@tulane.edu / Study aim: This study aimed to assess the individualized treatment goals (A1C, Blood Pressure, LDL-C) for patients with type 2 diabetes mellitus (T2DM), which lead to optimal health outcomes by different treatment strategies. Background and significance: The evidences in medical guidelines came from clinical trials with highly selected patients, whereas the treatment goals may differ in some subgroups. Additionally, considerable confusions on treatment target has resulted from recent changes in guidelines. So, there is a critical need to examine heterogeneity in optimal goals that lead to the most efficacious treatment options. Methods: A retrospective longitudinal study was conducted for veterans with T2DM by using US Veterans Affairs (VA) Administrative Database (Jan 2005 and Dec 2015). Longitudinal medical records were prepared for each 6-month cycle and multivariate longitudinal regression was used to estimate the risk of microvascular and macrovascular complication events and mortality. Second-degree polynomial and splines were applied in the model to identify the optimal goals in their associations with lowest risk of clinical outcomes by controlling the demographic characteristics, medical history, and medications. Results: 124,651 patients with T2DM were selected, with 62.68 years old (SD=10.96) and 6.72 (SD=6.68) follow-up years at average. In general population, A1C=6.06, LDL-C=106.10 and BP=137.90/98.00 were associated with lowest mortality risk. As of achieving lowest risk of microvascular and macrovascular complication, the optimal goals were A1C=6.81, LDL-C=109.10; and A1C=6.76, LDL-C=111.65, SBP=130.60 respectively. The optimal goals differed between age and racial subgroups. Lower SBP for younger patients and lower LDL-C for blacks were identified with better health outcomes. Conclusions: Individualized treatment goals were identified and multi-faceted treatment strategies targeting hypertension, hyperglycemia and hyperlipidemia may improve health outcome in veterans with T2DM. In addition to general ADA recommended goals, health system may examine their own large, more diverse patients with T2DM for better quality of care. / 1 / Qian Shi

<p>Typ 2 diabetes har genom ökad levnadsstandard vuxit till ett världsomfattande problem. I Sverige har cirka 300 000 personer typ 2 diabetes. Omvårdnaden av denna patientgrupp kommer till stor del bestå av stöd och information. Syftet med litteraturstudien var att beskriva betydelse av stöd och information till patienter med typ 2 diabetes. Ett bra stöd från hälso- och sjukvårdspersonal och närstående är positivt för patienten. För att på bästa sätt tillägna sig information är det viktigt att den anpassas efter den enskilda individen. Utbildning i grupp visar sig vara ett bra alternativ då deltagarna upplever det som positivt att träffa andra i samma situation. Resultatet visar att kunskap och stöd ger bättre självkänsla, välbefinnande, trygghet, minskning av HbA1C och ökar följsamheten för patienten. Då effekterna av information och utbildning tenderar att vara kortsiktiga så bör framtida forskning finna de faktorer som leder till de bästa långsiktiga effekterna.</p>

There is substantial evidence of the elevated risk of cancer among individuals with type 2 diabetes. Very little is known, however, about the role that antidiabetic therapies play in this relationship. The objective of this program of research was to examine whether there is a therapeutic risk associated with antidiabetic therapies that increase circulating insulin levels, such as sulfonylureas and exogenous insulin, or a therapeutic benefit associated with antidiabetic therapies that reduce insulin resistance, such as metformin and the glitazones. This objective was achieved through four related population-based cohort studies using the administrative databases from Saskatchewan Health. The first study looked at the effect of the older antidiabetic therapies metformin and sulfonylureas on cancer mortality. The focus of the second study was to explore more closely the effect of metformin and sulfonylurea by using a time-varying Cox regression to define drug exposures. The third study looked more closely at the effect of exogenous insulin therapy and cancer mortality, and the last study focused on the more recently available antidiabetic therapy the glitazones and cancer mortality. We found that individuals with type 2 diabetes exposed to sulfonylurea monotherapy had a significantly increased risk of cancer-related mortality, compared to patients exposed to metformin. We also observed a dose-response gradient with exogenous insulin therapy and cancer mortality, whereby individuals exposed to higher levels of insulin had a higher risk of cancer mortality. In the last study, we found that the newer class of antidiabetic therapies, the glitazones, were associated with a decreased risk of cancer mortality. These finding add further support that antidiabetic therapies may play a moderating role in the relationship between type 2 diabetes and cancer outcomes. However, it is unclear whether the increased risk of cancer mortality we observed was related to a toxic effect of sulfonylureas and exogenous insulin or a protective effect of metformin and glitazones, or due to some unmeasured effect related to both choice of drug therapy and cancer risk. Future research should incorporate a non-diabetes control cohort for comparison and examine the more proximal outcome measure cancer incidence. / Epidemiology

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.

Typ 2 diabetes har genom ökad levnadsstandard vuxit till ett världsomfattande problem. I Sverige har cirka 300 000 personer typ 2 diabetes. Omvårdnaden av denna patientgrupp kommer till stor del bestå av stöd och information. Syftet med litteraturstudien var att beskriva betydelse av stöd och information till patienter med typ 2 diabetes. Ett bra stöd från hälso- och sjukvårdspersonal och närstående är positivt för patienten. För att på bästa sätt tillägna sig information är det viktigt att den anpassas efter den enskilda individen. Utbildning i grupp visar sig vara ett bra alternativ då deltagarna upplever det som positivt att träffa andra i samma situation. Resultatet visar att kunskap och stöd ger bättre självkänsla, välbefinnande, trygghet, minskning av HbA1C och ökar följsamheten för patienten. Då effekterna av information och utbildning tenderar att vara kortsiktiga så bör framtida forskning finna de faktorer som leder till de bästa långsiktiga effekterna.

Compared to other Canadians, Aboriginal people suffer disproportionately from Type 2 diabetes and its complications. In an attempt to fill gaps in services for Aboriginal people to support better management of diabetes and to prevent further complications, the West Side Community Clinic launched a monthly outreach diabetes education program using an informal hands-on approach to learning about meal planning and other forms of diabetes management. The purpose of this qualitative study was to determine the impact that the program has had on the participants' health and well-being through the stories they shared in a group or individual interview. Out of the core group of 30 women, most of them Aboriginal, eleven participated in the group interview and five women participated in individual interviews.<p>Findings reveal that the program's impact on participants' health and well-being is embedded within the context of their lives. Diabetes is managed within multiple life realities in an individual, a familial and a community context. The women report learning management skills and sharing support among participants and staff of Diabetes Morning; and altered health status such as regulated blood glucose levels and weight loss. Opportunities for change include more programming like Diabetes Morning, more often, more information, access to low-cost diabetes-friendly foods, communication with health care practitioners, and integrating knowledge on a day-to-day basis. Domains for outcome indicators and contextual indicators are suggested for the program.

Studies show that insulin induced activation and assembly of insulin receptor substrate-1 (IRS1) and phosphatidylinositol-3-kinase (PI3K), within remodelled actin structures is critical for GLUT4 translocation to the cell surface in muscle cells. This study identifies the F-actin binding protein, nexilin, as a novel IRS1 binding partner. Insulin stimulates nexilin to dissociate from IRS1 and interact with actin. Nexilin knockdown has no effect on insulin-stimulated IRS1 tyrosine phosphorylation, but does enhance insulin-stimulated IRS1-PI3K interaction, increasing PIP3 formation, PKB activation and glucose uptake. This study also shows that nexilin overexpression may have an inhibitory effect on PKB phosphorylation and glucose uptake in adipocytes. These findings suggest nexilin is a negative regulator of IRS1 action on PI3K and insulin-stimulated dissociation of IRS1-nexilin allows the formation of IRS1-PI3K complexes in cytoskeletal-membrane compartments. Nexilin also specifically associates with the PH domain of IRS1, and not IRS2, suggesting a mechanism for signaling specificity of these isoforms.

Studies show that insulin induced activation and assembly of insulin receptor substrate-1 (IRS1) and phosphatidylinositol-3-kinase (PI3K), within remodelled actin structures is critical for GLUT4 translocation to the cell surface in muscle cells. This study identifies the F-actin binding protein, nexilin, as a novel IRS1 binding partner. Insulin stimulates nexilin to dissociate from IRS1 and interact with actin. Nexilin knockdown has no effect on insulin-stimulated IRS1 tyrosine phosphorylation, but does enhance insulin-stimulated IRS1-PI3K interaction, increasing PIP3 formation, PKB activation and glucose uptake. This study also shows that nexilin overexpression may have an inhibitory effect on PKB phosphorylation and glucose uptake in adipocytes. These findings suggest nexilin is a negative regulator of IRS1 action on PI3K and insulin-stimulated dissociation of IRS1-nexilin allows the formation of IRS1-PI3K complexes in cytoskeletal-membrane compartments. Nexilin also specifically associates with the PH domain of IRS1, and not IRS2, suggesting a mechanism for signaling specificity of these isoforms.

Bakgrund: Typ 2-diabetes mellitus är en global sjukdom som snabbt ökar i antal. Den viktigaste delen av behandlingen handlar om att äta ”rätt” kost och allt fler personer blir i behov av kostrekommendationer och kostförändringar. Syfte: Beskriva personer med typ 2-diabetes upplevelser av att göra kostförändringar. Metod: Systematisk litteraturstudie där 13 artiklar, tolv kvalitativa och en kvantitativ/kvalitativ, analyserades med hjälp av innehållsanalys. Resultat: Många med typ-2 diabetes kände sig utanför och upplevde känslor av frustration, ilska, stress och oro. Kosthållningen upplevdes som svår på grund av att kostrekommendationerna var otydliga och ständigt förändrades, dock ansågs motion vara till hjälp. Vardagen upplevdes ofta som en kamp mellan vad som var bäst ur sjukdomssynpunkt, sina begär och frestelser. Denna kamp kunde jämföras med ett missbruk. Det framgick att det fanns skillnader på hur kvinnor och män hanterade sin diagnos och hur de förhöll sig till kostrekommendationerna. Flera uppgav även att maten fått förändrad betydelse, från något positivt till något negativt. Acceptans, sjukdomsinsikt, stöttning och uppmuntran tillsammans med kontroll, planering, mättnad och tillfredställelse upplevdes som viktigt. Slutsats: De med typ 2-diabetes upplevde många känslor där begäret spelade en viktig roll. I slutändan ledde känslorna ofta till hinder i kosthanteringen och en dålig självbild.