Bakgrund Den svenska hälso- och sjukvården genomgår en omställning mot en personcentrerad, hållbar och tillgänglig vård, där digital teknik är centralt. Sverige förväntas vara världsledande inom e-hälsa år 2025 och för distriktssköterskor innebär det ett nytt arbetssätt med krav på nya färdigheter, i omvårdnaden av patienter med typ 2 diabetes. Syfte Att beskriva distriktssköterskors erfarenhet av e-hälsa i omvårdnaden av patienter med typ 2 diabetes. Metod Metoden var en systematisk litteraturstudie baserad på 15 vetenskapliga artiklar. Data analyserades med stöd av Bettany- Saltikov och McSherrys niostegsmodell. Resultat Resultatet mynnade ut i tre teman: implementering av e-hälsa, e-hälsa som verktyg i omvårdnadsarbetet och e-hälsa som relationsskapande verktyg. Varje tema omfattande tre kategorier.  Slutsats Distriktssköterskors erfarenheter av e-hälsa skiljde sig åt och sågs som ett bra komplement till fysiska besök. Utbildning, kommunikativ förmåga, tekniska och organisatoriska förutsättningar samt ett stödjande ledarskap ansågs vara främjande faktorer för distriktssköterskors möjlighet till att anpassa sig till en alltmer omfattande digitalisering. För att Sverige ska kunna nå målet att vara världsledande inom e-hälsa år 2025 ses behov av mer forskning om e-hälsa samt implementeringsstrategier.

OBJECTIVE: The 10th leading cause of death in the United States is heart disease. Most of the deaths by heart disease has a correlation with an occlusion of the coronary arteries. While diabetes mellitus is currently the 7th leading cause of death, which is a chronic condition that affects more than 37 million people in America. The global epidemic of obesity largely explains the dramatic increase in the incidence and prevalence of type 2 diabetes (T2D) over the past 25 years. Statins are well known drugs to decrease LDL for individuals who suffer from hypercholesterinemia; however, there is also an increased risk of developing diabetes mellitus. An estimation of 10-20 per 10,000 patients per year demonstrated an excess risk of T2D with the long-term use of statin. Here we examine the effects of simvastatin and pitavastatin on pancreatic ß-cell function to determine whether altered insulin secretion may contribute to an increased risk of T2D. METHODS: The experiments were performed using clonal pancreatic ß-cells (INS-1). The cells were grown in 4 mM glucose in RPMI media. Cells were grown for three days before adding the different types of statins: simvastatin and pitavastatin for one day. Then the cells were used to perform the glucose-induced insulin secretion (GSIS) experiment. Insulin secretion and insulin content were assay using a fluorescence-based immunoassay. The study was calculated using Microsoft Excel. Standard variance and standard error were used to assess the difference sets of data. RESULTS: INS-1 cells responded to acute glucose stimulation after chronic culture in both low (4 mM) and high (11 mM) glucose. Secretion from cells cultured at 4 mM glucose was higher than cells cultured at 11 mM glucose at all glucose concentrations tested, characteristic of the effects of glucolipotoxicity (GLT). Insulin content in cells cultured at high glucose was decreased 8.6-fold compared to cells cultured at the more physiological low glucose condition. When normalized to basal secretion cells cultured at high glucose exhibited basal hypersecretion and increased GSIS compared to those in low glucose. Simvastatin (100 nM, 24 hrs) increased basal insulin secretion to a greater extent than Pitavastatin. The effects of pitavastatin on basal insulin secretion were less consistent than seen with simvastatin. Simvastatin was also shown to inhibit GSIS from cells cultured at 4 mM glucose, while pitavastatin increased GSIS. CONCLUSION: Both pitavastatin and simvastatin alter insulin secretion from pancreatic ß-cells. The effect of simvastatin to both increase basal and decrease GSIS, characteristic of GLT suggests pitavastatin may be the statin of choice to reduce the risk of statin-induced T2D.

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Bakgrund: Typ 2 diabetes mellitus drabbar fler och fler personer i världen. Detta växande problem medför en rad hälsorisker och komplikationer. Stigma kring sjukdomen är även vanligt förekommande i olika miljöer. Detta attribut riskerar att förstärka påverkan hos dessa personer negativt. För att undvika dessa hinder till hälsa har sjuksköterskan en central roll i behandlingen där hen med sitt personcentrerade arbetssätt utformar lämpliga omvårdnadsåtgärder när egenvårdsbrist uppstår. Syfte: Syftet var att belysa hur stigma upplevs hos personer med diabetes typ 2. Metod: En litteraturöversikt där två databaser hjälpt till att selektera ut lämpligt material som bestod av 16 vetenskapliga originalartiklar. Resultat: I resultatet speglades upplevelsen av stigma, vilken inverkan stigma innebar och olika konsekvenser den bidrog till. Stigma orsakade tre dimensioner av lidande hos personen, egenvård försummades och relationer kunde förändras. Medvetenheten av att riskera utsättas för diskriminering skapade oro och olika strategier för att undkomma och hantera stigma beskrevs. Diskussion: Att drabbas av en långvarig sjukdom kunde hanteras på olika sätt, men när stigma inkluderades kunde det kännas övermäktigt och skapa lidande. Genom personcentrerad vård kan sjuksköterskor identifiera individuella behov och resurser när egenvårdsbrist uppstår. Slutsats: Stigma upplevdes i alla kontext och påverkade personer med typ 2 diabetes negativt. Litteraturöversiktens resultat kan bidra med kunskap om en växande patientgrupps upplevelser kring sin utsatthet. Genom ökad kunskap och förståelse finns förutsättningar att stigma utrotas, och sjuksköterskan får ytterligare verktyg till att fullända optimal personcentrerad vård. / <p>2023-11-03</p>

Physical activity is important for the management and treatment of type 2 diabetes (T2D). Interval exercise training has been shown to improve glycemic control in people with T2D; however, studies have generally utilized high volume protocols and/or specialized equipment that limit translation to a “real world” setting. The present proof-of-concept study examined the efficacy of brief, intermittent stair climbing exercise to improve indices of glycemic control in adults with T2D, using continuous glucose monitoring (CGM) under controlled dietary conditions. Each session involved 3 x 60-s bouts of vigorously ascending and slowly descending a single flight of stairs. This was set within a 10-min period, which otherwise involved walking for a warm-up, cool-down and recovery in between bouts. Data are reported for n=5 participants (52 ± 18 y, BMI: 31 ± 5 kg/m2, HbA1c: 6.6 ± 0.7 %; mean ± SD) who performed 18 training sessions over 6 weeks. Mean 24-h glucose and time spent in hyperglycemia (> 10 mmol/L) were unchanged after an acute session of stair climbing (p=0.38 and p=0.42, respectively) or after 6 weeks of training (p=0.15 and p=0.47, respectively). Measures of glycemic variability were improved in the 24-h period following a single session of stair climbing, based on reductions in the mean amplitude of glycemic excursions (MAGE) (4.4 ± 1.5 vs. 3.5 ± 1.0 mmol/L, p =0.02) and the standard deviation (SD) around the mean (1.7 ± 0.5 vs. 1.4 ± 0.5 mmol/L, p=0.02). There was a meal-specific improvement in postprandial hyperglycemia after training, with the incremental area under the curve (iAUC) of the lunchtime meal reduced by 36 ± 42 % (p=0.01). These preliminary results demonstrate the feasibility of stair climbing as a physical activity option for people with T2D, although the acute and chronic effects of this training on indices of glycemic control remain equivocal. / Thesis / Master of Science in Kinesiology / Physical activity is important for the management of type 2 diabetes (T2D). Interval training, which involves alternating periods of relatively intense exercise and recovery, can improve blood sugar control in adults with T2D. This has largely been shown in laboratory settings using specialized equipment and protocols that may not be practical or time-efficient. This small, proof-of-concept study examined whether brief, intermittent stair climbing exercise could improve blood sugar control in people with T2D. Average blood sugar measured over 24 hours was unchanged after a single bout of stair climbing and after 18 sessions of training performed over 6 weeks. However, stair-climbing exercise reduced blood sugar fluctuations in response to specific meals. These preliminary findings suggest that interval stair climbing is a feasible exercise option for adults with T2D, but the precise effects on blood sugar control remain to be clarified.