Indiana University-Purdue University Indianapolis (IUPUI) / Immigrants are at elevated risk for not having their diabetes treatment appropriately intensified, likely resulting in poorly-controlled diabetes and increased morbidity and mortality. Immigrant status is a powerful sociodemographic cue, yet its influence on providers’ diabetes treatment decisions is unknown. The study objective was to determine the effect of patient immigrant status on providers’ decisions to (1) take no action, (2) add an oral hypoglycemic agent (OHA), (3) add/switch to insulin, or (4) refer the patient to an endocrinologist. Participants were 140 medical students/professionals (‘providers’). Providers viewed profiles (videos + vignettes) for virtual patients differing in immigrant status (born in Mexico or U.S.; other characteristics held constant). Analyses were completed at the group (‘nomothetic’) and individual (‘idiographic’) levels. Nomothetic results indicated providers were less likely to refer foreign-born patients to endocrinology than U.S.-born patients (p=0.03). No differences were detected for the other three treatment likelihood ratings. Idiographic results indicated that about half of provider decisions were influenced by patient immigrant status (i.e., Cohen’s d≥0.50) across all four treatment decisions. Effect size data show an almost even split between higher treatment ratings for foreign-born vs. U.S.-born patients for three decisions (take no action, add an OHA, add/switch to insulin), explaining why group-level differences for these ratings did not emerge (i.e., they were cancelled out). This study found that providers are less likely to refer foreign-born patients to endocrinology, potentially leading to therapeutic inertia. In addition, half of individual-level provider decisions were meaningfully influenced by patient immigrant status. However, traditional group-level analyses mask these important individual-level differences. These systematic differences in treatment based on non-relevant factors could lead to unintended adverse outcomes for the foreign-born population.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20568号 / 医博第4253号 / 新制||医||1022(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 原田 浩, 教授 武藤 学, 教授 戸井 雅和 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Typ 2 diabetes är en långvarig sjukdom som kräver livslång egenvård där patienters erfarenheter av egenvård är högst individuella. Egenvårdsförmågan, men även förtroendet till sin förmåga påverkades livet igenom. En förändrad livssituation kunde påverka patientens förmåga att upprätthålla egenvårdsförmågan, även efter lång tids sjukdom. För att patienterna skulle våga att delge rädslor och svårigheter var det av stor vikt att relationen mellan sjuksköterska och patient bygger på ömsesidighet och respekt. Stöd från familj och vänner var av stor vikt, här hade sjuksköterskan en viktig roll att uppmuntra, vara lyhörd för patienters individuella behov till stöd i sin egenvård. Med ett personcentrerat förhållningssätt kan sjuksköterskan främja patienters förmåga till god egenvård.

No description available.

Background: A cross-sectional design was employed to ascertain the relationship between dairy consumption and insulin resistance (IR) in 272 middle-aged, nondiabetic women. Methods: Participants kept a seven-day weighed food record to report their diets, including consumption of dairy foods. IR was assessed using the homeostatic model assessment (HOMA), using the following formula: fasting plasma insulin (µU/ml) x fasting plasma glucose (mg/dL)/405. The Bod Pod was used to examine body fat percentage, and accelerometry over a seven-day period was used to assess physical activity. HOMA values were log-transformed and regression analysis and the General Linear Model procedure were used to determine how mean HOMA differed across low, moderate, and high dairy intake groups. Results: (Mean ± SD) age: 40.1 ± 3.0 years, physical activity (average activity counts for one week, divided by 1,000): 2700.1 ± 781.9, body fat percentage: 31.7 ± 6.9, weight (kg): 66.1 ± 10.0, fasting glucose (mg/dL): 86.7 ± 5.9, fasting insulin (µU/mL): 7.0 ± 4.2, energy intake (kcal/day): 2051.9 ± 319.1, kcal from carbohydrate (%): 55.7 ± 6.2, kcal from protein (%): 13.8 ± 2.5, kcal from fat (%): 30.5 ± 5.8, soluble fiber (g per 1,000 kcal): 1.7 ± 0.9, insoluble fiber (g per 1,000 kcal): 3.8 ± 1.9, dairy intake (servings/day): 1.1 ± 1.0, HOMA: 1.5 ± 1.0, log-transformed HOMA: 0.3 ± 0.6. Those in the highest quartile for dairy consumption had significantly higher log-transformed HOMA (0.41 ± 0.53) than those in the moderate (0.22 ± 0.55) or low (0.19 ± 0.58) consumption categories (F = 6.90, p = 0.0091). This relationship remained significant after controlling for all covariates (F = 4.71, p = 0.030). Controlling for physical activity strengthened the relationship between dairy consumption and IR by 7%. Adjusting for body weight, percent of kcal from fat, and insoluble and soluble fiber intake also strengthened the relationship. Controlling for energy intake and body fat percentage weakened the relationship by 32% and 13%, respectively, though it remained significant. Conclusion: High dairy consumption is significantly associated with IR in middle-aged, nondiabetic women.

Type 2 diabetes (T2D) is increasing in the United States, currently affecting 11.3% of the nation. The Developmental Origins of Health and Disease Hypothesis suggests that environmental stresses in utero and in early stages of life, such as preterm birth (age), can lead to development of adulthood diseases, including T2D. However, research on the association between preterm birth and T2D is sparse and predominantly based on European ancestry populations. We examined this association in postmenopausal women (N = 85,356) from the Women’s Health Initiative, a nationwide prospective cohort. Logistic regression models were used to examine the association between self-reported preterm birth and T2D status, adjusting for demographic and lifestyle covariates. Preterm birth was significantly and positively associated with odds of T2D at baseline (unadjusted: OR=1.51, 95% CI 1.24, 1.83; P

Diabetes is one of the most common chronic medical conditions with 34.2 million people affected in the US. It costs $327 billion in medical expenses, lost work, and wages. Diabetics are at higher risk of major medical complications. 90 to 95% of 30 million Americans with diabetes are classified as type 2 (Centers for Disease Control and Prevention, 2020). Management of diabetes is within the scope of OT practice as it is part of health management and maintenance. It is described as how a person develops, manages, and maintains routines and habits for health and wellness promotion. A 2018 online survey was conducted with US-based Occupational Therapy (OT) and Occupational Therapy Assistant (OTA) program directors. Nearly half of the OT and more than half of the OTA program directors reported only 1.5–>3hrs is devoted to diabetes care and management in their curriculum. A 2019 online survey was disseminated to OT practitioners to ascertain their self-reported competence and knowledge about type 2 diabetes mellitus and its lifestyle management. OT clinicians reported minimal to somewhat skilled in educating and training clients in self-help skills related to diabetes management. OT practitioners are suggested to take training and courses that are relevant to their practice and domain for long-term retention of content and tasks (Custers, 2010). The American Occupational Therapy Association encourages OT practitioners to include health-promoting tasks in their practice as the profession’s roots and values are aligned with the health promotion (Wood, et al., 2013).

The purpose of this thesis was to determine the perceived risk of falling and its relationship to balance and falls in older community-dwelling adults with type 2 diabetes mellitus (DM2). Study One was a systematic review of published literature on risk factors for falling in older adults with DM2. Study Two was a prospective cohort study for parameter estimation, the goal was to determine the test-retest reliability, internal consistency, construct validity and factor structure of a falls Risk Perception Questionnaire in older community-dwelling adults with DM2. Study Three was also a prospective cohort study; the goals of this study were to determine the association between perceived of falling and balance in older adults with DM2 and to determine whether older adults alter their perceived risk of falling after receiving feedback about their balance. The information gained from these studies will be used to guide subsequent research as well as falls risk assessment and prevention in older adults with DM2. / Thesis / Master of Science (MSc)

None / Introduction: As the prevalence of diabetes continues to rise in Canada, South Asians, as the largest visible minority group in Canada, are at higher risk for developing diabetes than the general population. Although diabetes self-management education (DSME) interventions for South Asians with type 2 diabetes (T2DM) have been researched, these interventions have not been assessed for their cultural congruency. Methods: This systematic review examined the effectiveness of DSME interventions for South Asians with T2DM. Electronic databases (MEDLINE, EMBASE, Cochrane CENTRAL and CINAHL) were searched since inception, along with relevant reviews and guidelines. Title and abstract and full text screening were conducted independently by two reviewers; data extraction was done by one reviewer and confirmed by another. Quality assessment of the included studies was completed using the Cochrane Risk of Bias tool; cultural congruency was assessed using Leininger’s Sunrise Model. All results were synthesized narratively. Results: A total of 1259 studies were found in the search, of which only four randomized controlled trials (RCT) met the inclusion criteria. All studies were consistent in showing a reduction in A1C following the intervention; however only one study reported statistically significant reductions in A1C. Interventions were conducted in person, with follow-up periods ranging from six months to two years, with the use of South Asian community link workers in most interventions. Bias was identified across all studies for sequence generation, allocation concealment and blinding. All studies had limited evidence of cultural congruency, particularly for gender roles and responsibilities. Conclusions: This review found limited effectiveness of culturally specific DSME interventions for South Asians with T2DM. Furthermore, the interventions were scant in their description of cultural congruency. Future research ought to begin with designing interventions for cultural congruency and improved methodologies for DSME research to improve internal and external validity. / Thesis / Master of Science (MSc) / South Asians are the largest visible ethnic minority group in Canada and are at high risk of developing type 2 diabetes (T2DM). This research project aims to understand how diabetes self-management education (DSME) and support (DSMS) is delivered to South Asians with T2DM and how these practices are culturally tailored. The scientific literature was searched using electronic databases to find 1259 research studies, of which four examined the effectiveness of DSME/DSMS provided to migrant South Asians with T2DM. Only one study showed significant improvements in blood glucose control. All of the four studies contained several DSME/DSMS components and they all failed to address differences in gender roles and responsibilities in relation to South Asian culture. Thus, there is a need for future studies to design DSME/DSMS interventions that are culturally tailored to improve blood glucose control and thus, improve the health and well-being of South Asians with T2DM.

Bakgrund: Typ 2 diabetes mellitus (T2DM) är en globalt växande sjukdom och är nationellt en av de vanligaste folksjukdomarna. Behandlingen baseras på egenvård, vilket omfattar kosthantering, regelbunden fysisk aktivitet, blodglukoskontroller och i många fall strävan efter viktnedgång. Detta ställer stora krav på individens eget ansvar och förmåga att ta beslut gällande sin vård i vardagen. Syfte: Syftet med litteraturstudien var att beskriva erfarenheter som inverkade på genomförandet av egenvården hos personer diagnostiserade med typ 2 diabetes mellitus. Metod: Litteraturöversikten baserades på åtta kvalitativa studier. Databassökningar genomfördes i Cinahl och PubMed. Analysprocessen genomfördes med insipiration av Popenoes beskrivning av innehållsanalys vid litteraturstudie.  Resultat: I analysarbetet framkom sju subkategorier och tre övergripande kategorier. De framtagna kategorierna var: Egen kapacitet och förståelse för egenvårdens betydelse, Stödjande relationer och samspelande omständigheter för egenvården samt Egenvårdens inverkan på självbilden.  Konklusion: Litteraturstudiens resultat visar på behovet av en helhetssyn när det gäller egenvården, som integrerar individuellt stöd, anpassad kunskap och positiv förstärkning, för att främja hälsa och välbefinnande hos personer med T2DM.