archives@tulane.edu / Gestational diabetes mellitus (GDM) increases the lifetime risk of developing type 2 diabetes mellitus (T2DM) in the mother; however, biological mechanisms remain relatively unknown, and known risk factors have shown to be incomplete. Both epidemiological and experimental research suggest that environmental exposure to particulate matter (PM2.5) may initiate and further progress chronic diseases such as T2DM. This study investigates the association between PM2.5 exposure and the risk of T2DM among women with a history of GDM. Associations between prevalent and incident T2DM with PM2.5 utilized two PM2.5 metrics: 1) annual average PM2.5 concentration and 2) annual average modeled PM2.5 exposure, calculated from daily PM2.5 concentration levels provided by the USRA/NASA Marshal Space Flight Center. Data from the Southern Community Cohort Study, who at recruitment reported a previous diagnosis of GDM, for whom T2DM, risk factor, and follow-up information were available, was provided. In total, 2403 participants were included in the analysis of prevalent T2DM, and 1036 participants were included in the analysis of incident T2DM. Associations between proximity to roadways and race with PM2.5 metrics were also conducted. Participants that live close to roadways were exposed to higher annual average PM2.5 concentrations and annual average modeled PM2.5 exposures. When stratified by race, non-Black participants were exposed to higher averages. After adjustment, a significant association was observed between annual average PM2.5 concentration and incident T2DM (hazards ratio (HR)= 1.022, 95% confidence interval (CI): 1.003, 1.040). No association was observed between annual average PM2.5 concentrations and prevalent T2DM. Annual average modeled PM2.5 exposure was not associated with either prevalent or incident T2DM. Results were partly consistent with previous literature. Additional studies with a greater range of air pollution exposures, including higher levels, additional pollutants, and more tailored exposure models, are warranted to investigate hypothesized associations. / 0 / Ashley Bell

No abstract available. / Thesis (DPhil)--University of Pretoria, 2010. / Biokinetics, Sport and Leisure Sciences / unrestricted

Question: Can passive static stretching lower blood glucose in an at-risk population? Design: Randomised, within-participant experimental study. Participants: 22 adults (17 males) either at increased risk of Type 2 diabetes or with Type 2 diabetes. Intervention: The participants reported to the laboratory 2. hr after eating a meal, and drank 355. ml of fruit juice (∼43. g carbohydrate). Thirty minutes later, they underwent either a 40. min passive static stretching regimen or a mock passive stretching regimen. Stretching consisted of six lower body and four upper body static passive stretches. For the mock stretches, the same positions were adopted, but no tension was applied to the musculature. Outcome measures: Blood glucose levels for both the stretching and mock stretching were analysed from a finger prick sample using a hand-held glucometer. Values were obtained at baseline (0. min), during the regimen (20. min), and after the regimen (40. min) on both study days. Results: Compared to mock stretch, stretching resulted in a significantly greater drop in blood glucose at 20. min (mean difference 28. mg/dL, 95% CI 13 to 43; or 1.57. mmol/L, 95% CI 0.72 to 2.39). This effect was also statistically significant at 40. min (mean difference 24. mg/dL, 95% CI 9 to 39; or 1.35. mmol/L, 95% CI 0.50 to 2.17). Conclusion: These results suggest that passive static stretching of the skeletal muscles may be an alternative to exercise to help lower blood glucose levels.

Bakgrund: Typ 2-diabetes är ett stort och ökande folkhälsoproblem över hela världen. Livsstilsfaktorer spelar stor roll när det gäller att drabbas av sjukdomen. På liknande sätt spelar en god behandling samt livsstilsförändringar in i att reversera sjukdomen. Hälsosamma matvanor samt fysisk aktivitet leder till att främja en god hälsa under hela livet och därmed förhindra ohälsa och sjukdom. Det hälsofrämjande arbetet spelar stor roll i att stödja individen till att stärka sin hälsa. Sjuksköterskan kan i sitt hälsofrämjande arbete hjälpa personen med typ 2-diabetes genom att delge information om kost och vikten av fysisk aktivitet . Syfte: Att beskriva sjuksköterskans hälsofrämjande arbetet med personer som lever med typ 2-diabetes . Metod: För att hitta relevanta artiklar användes ett flertal kombinationer av sökord. Sökning i databaserna Medline, PubMed och CINAHL bidrog till ett stort utbud av artiklar. Till slut inkluderades 10 artiklar av både kvantitativ och kvalitativ karaktär. Resultat: Presenterade av sjuksköterskans perspektiv i tre olika kategorier Vikten av utbildning och ge god information för personer med typ 2-diabetes och sjuksköterskor, Egenvård och Sjuksköterskans informerade roll vid livsstilsförändring för personer med typ 2 diabetes. Resultatet visade att utbildning är viktig för både sjuksköterskor och personer med typ 2 diabetes. Utbildningen hjälper sjuksköterskan att på bästa sätt stödja och ge rätt råd. Personer med typ 2-diabetes behöver informationen och kunskapen om kost och fysisk aktivitet , för att kunna uppleva empowerment och därmed själva kunna göra de nödvändiga egna livsstilsförändringarna.

Background: Self-monitoring of blood glucose (SMBG) can inform on the timing of hyperglycaemia; however there is currently no standardised approach to utilise these data to improve glycaemic control in type 2 diabetes patients. Aims: To assess the efficacy of structured blood glucose testing in guiding an insulin titration algorithm in poorly controlled, insulin-treated type 2 diabetes patients. The secondary aim was to compare change in HbA1c between the study subjects and matched controls receiving standard treatment. Methods: This six-month prospective intervention recruited 39 poorly controlled (HbA1C ≥ 8.5% or 69.4 mmol/mol), type 2 diabetes subjects using twice-daily biphasic insulin from two public hospitals in Tshwane, South Africa. Patients were asked to perform structured SMBG over 4 weeks and return monthly for consultations where physicians titrated insulin doses using a standardised algorithm guided by the data collected. Post-hoc analysis was performed to assess glycaemic control of study participants compared to those receiving standard treatment. Results: It was found that mean HbA1c decreased over the study period by 1.89% (95% CI: -2.46 to -1.33, p-value<0.001). Mean SMBG and mean fasting plasma glucose (FPG) decreased by 1.6 mmol/L (95% CI: -2.5 to -0.6 mmol/L, p-value: 0.002) and 1.5 mmol/L (95% CI: -2.2 to -0.2 mmol/L, p-value: 0.024), respectively. Hypoglycaemic event rate (≤3.9 mmol/L) was 33.08 events per patient-year. Total daily insulin use increased by a mean 40.12 units.day-1 (SE: 7.7, p-value<0.001); weight increased by an average 3.98 kg (95% CI: 2.56 to 5.41, p-value <0.001) over the study period. Study participants were found to have a greater mean (SE) reduction of 0.777% (0.404) in HbA1c compared to patients receiving standard care, which fell short of statistical significance (95% CI: -1.569 to 0.015%, p-value: 0.054) due to lack of power (56.5%) in the post-hoc comparison. Conclusion: A structured SMBG programme that advises monthly algorithmic insulin titration can improve glucose control in type 2 diabetes patients using insulin, with moderate hypoglycaemic events and weight gain. / Dissertation (MSc)--University of Pretoria, 2016. / National Research Foundation (NRF) / Roche Products (South Africa) / School of Health Systems and Public Health, University of Pretoria / School of Medicine, University of Pretoria / School of Health Systems and Public Health (SHSPH) / MSc / Unrestricted

Periodontitis (PD) and type 2 diabetes mellitus (T2D) are chronic inflammatory diseases in which the host immune system encounters changes in its T and B cell distribution and function. Both disorders are increasingly prevalent in the U.S. and while T2D is a risk factor for periodontal disease, PD can exacerbate diabetes. Previous studies have unsuccessfully attempted to determine the underlying molecular mechanism for the relationships between T2D and periodontitis. To test directly the effect of T2D on periodontitis, I quantified cytokine production by gingival immune cells from three types of subjects: healthy, periodontal disease and T2D with periodontal disease, using single cells purified via flow cytometry and assessed for function with an enzyme-linked immunospot (ELISPOT) assay. The cells were sorted into subtypes according to CD45+, CD4+, CD8+, CD11b+, CD19+ and/or CD56+ expression, were stimulated by PMA, ionomycin or LPS, and were aliquoted into a well of a 96-well ELISPOT plate for 36 hours. Outcomes showed that CD4+ is the predominant cell population in lymphocytes and that gingiva tissues from periodontitis/T2D group produced higher concentrations of cytokines characteristic of the Th1 T cell subset, namely IL-2, IL-10, TNF-α and IFN-γ (p<0.05, <0.001, <0.001, <0.01, respectively) compared to tissues from either healthy or periodontitis group. This work illustrates that T2D increases inflammation in periodontitis through an increase in Th1 T helper cell function.

Obesity is a significant health care problem, affecting more than one third of the United States population and is an important risk factor for Type 2 Diabetes Mellitus (T2D). Adipose tissue expansion results in the recruitment and accumulation of macrophages, which secrete proinflammatory cytokines that impair insulin signaling. Adenosine regulates inflammation by signaling through G-protein coupled receptors (GPCRs), such as the A2b adenosine receptor (A2bAR). Recently a role for adenosine receptors has been described in the differentiation of osteoblasts and adipocytes. This thesis tests the hypothesis that the A2bAR regulates adipose tissue dynamics at the level of preadipocyte differentiation and macrophage inflammation. This thesis showed that activation of the A2bAR inhibited preadipocyte differentiation. A2bAR-induced adipocyte inhibition was dependent on the expression of Krüppel-like factor 4 (KLF4), which is important for stem cell maintenance and renewal. A2bAR knockdown enhanced adipogenesis in vitro and A2bAR knockout (KO) mice had more adipocytes as compared to wild type (WT) mice, suggesting enhanced adipogenesis in the absence of the A2bAR. The translational potential of this work is strengthened by the previous finding of elevated A2bAR expression in adipose tissue of obese individuals as well as our new finding of a close correlation between the expression of A2bAR and KLF4 in adipose tissue of obese individuals. A2bAR KO mice have impaired insulin resistance, in part due to reduced levels of insulin receptor substrate-2 (IRS-2). Proinflammatory cytokines have been shown to reduce IRS-2 levels. Given the role of the A2bAR in regulating inflammation, the contribution of A2bAR signaling in macrophages to insulin resistance was elucidated. Transgenic mice that express A2bAR only in macrophages were generated. Intriguingly, restoration of A2bAR signaling in macrophages ameliorated insulin resistance, glucose tolerance, and fat and liver tissue insulin signaling. As expected, tissue and plasma proinflammatory cytokine levels were reduced to that of WT mice. This suggested that the protective effect of A2bAR signaling on insulin resistance was due in large part to A2bAR control of macrophage cytokine expression. This thesis highlights the importance of A2bAR signaling in adipogenesis and in regulating inflammation in the setting of obesity and T2D.

Bakgrund – Typ 2 diabetes mellitus är en av Värdens folksjukdomar som kraftigt ökar nedåt i åldrarna, med förändring i näringsvanor och stillasittande livsstil. Människor med typ 2 diabetes har stora risker att utveckla mikro- och makrovaskulära komplikationer och detta ökar behandlingskostnader och förkortar personens livslängd. Behandlingen för sjukdomen kräver att personen gör ett antal livsstilsförändringar i bland annat kost och motion. Syfte - syfte av denna studie är att beskriva patienters upplevelser av egenvård vid typ-2 diabetes. Metod - Denna studie genomfördes som en litteraturöversikt baserad på vetenskapliga artiklar med kvalitativ design. Resultat - analysen resulterade i olika upplevelser av egenvård och dessa har kategoriserats i huvudkategorier med underkategorier: 1) Att anpassa sig till de nya levnadsvanorna: Ny kosthållning och Nya motionsvanor, 2) Behöv av stöd; Stöd från närstående och Stöd från sjuksköterska, 3) Att lära sig nya levnadsvanor. Patienterna upplevde en förändrad livsstil på grund av de omständigheter diabetes gav. Information, motivation och färdigheter var tre viktiga faktorer för att patienterna skulle göra livstilförändring för att egenvård ska lyckas. Diskussion - Patienten själv och relationen till sjuksköterskan är huvudpunkter som påverkar patientens livstilförändringsprocessen för att egenvården ska lyckas. Sjuksköterskan gör allt för att uppnå maximalt stöd för patienten.

Bakgrund: Diabetes typ 2 är en sjukdom som blivit allt mer vanlig och kommer att enligt forskning öka de kommande åren. Vid diabetes typ 2 har kroppen svårt att hålla och reglera sockerhalten i blodet tillräckligt låg. Behandling av diabetes typ 2 fokuserar på livsstilsförändringar därför är patientens men även sjuksköterskans delaktighet viktig. Syfte: Syftet var att belysa vuxna patienters upplevelser av livsstilsförändringar vid diabetes typ 2 Metod: En litteraturstudie baserad på 10 kvalitativa vetenskapliga artiklar som analyserades med manifest innehållsanalys. Resultat: Det framkom tre huvudkategorier och sex underkategorier av analysen. Patienterna upplevde svårigheter att genomföra, behålla och kombinera livsstilsförändringarna med vardagssysslor men upplevde också att omgivningen hade både en positiv och en negativ påverkan på deras möjligheter att genomföra livsstilsförändringarna. Sjuksköterskans närvaro och lyhördhet för den enskilda individens upplevelse underlättade livsstilsförändringarna.  Slutsats: Vid livsstilsförändringar var patienterna med om både positiva och negativa upplevelser. Trots de stora kraven som är svåra att upprätthålla upplevde många välbefinnande vid livsstilsförändringarna. Stöd och engagemang från omgivningen kunde även skapa osäkerhet, oro och rädsla. Med hjälp av sjuksköterskans stöd och lyhördhet kunde livsstilsförändringarna genomföras och kombineras med vardagslivet

Diabetes, a major public health challenge in St. Kitts, has been a focus of international public health community research. Although researchers have demonstrated that diabetes self-management education is a cost-effective strategy for the prevention of diabetes-related complications, they have yet to establish whether there is adequate education occurring in treatment settings with diabetic patients. The purpose of the study was to implement and evaluate the short-term effectiveness of a diabetes self-management education intervention on diabetes-related knowledge and accepted behavioral changes to decrease risk for complications. Based on a self-care approach, this education intervention was designed to improve diabetes-related knowledge and self-management behaviors. To test and evaluate the pre and post intervention effect, a convenience sample of 15 patients diagnosed with Type 2 diabetes attending a scheduled diabetic clinic completed the Diabetes Knowledge Test and a researcher-designed sociodemographic survey, which included self-report of blood glucose self-monitoring and foot care behaviors. The results of these analyses indicated that the participants’ knowledge level increased (p = < .001). However, Chisquare and Fisher’s exact tests determined no significant changes in the participants’ self management behaviors. The results may be attributed to the short time frame of the intervention. The implications for positive social change include opportunities to improve inter-professional collaboration in programs that will create positive effects on diabetic self care and reduce the incidence of negative health outcomes. Furthermore, the use of a self-care approach by health care professionals could be a key factor in strengthening diabetes knowledge, engagement, and self-management for Type 2 diabetic patients.