Bakgrund: Typ 2-diabetes är en sjukdom som i ökar Sverige. En viktig uppgift som sjuksköterskan har är att motivera patienter med typ 2-diabetes till livsstilsförändringar vad gäller kost, motion, rökavvänjning och stresshantering och får dessutom skriva ut fysisk aktivitet på recept. Intresset för komplementär och alternativ medicin (KAM) ökar i västvärlden. Syfte: Syftet med föreliggande studie var att belysa möjliga effekter av yoga, tai chi och qigong på ett urval objektiva och subjektiva parametrar hos vuxna personer med eller med risk för typ 2-diabetes. Metod: Litteraturöversikt, baserad på 17 vetenskapliga studier. En innehållsanalys gjordes för att sammanställa materialet och studera likheter och skillnader. Resultat: Yoga, tai chi och qigong hade i vissa fall positiva effekter på parametrarna blodglykos, lipider, kroppsmått, blodtryck, fysiskt och psykiskt välbefinnande, vitalitet, stresshantering, och motivation för egenvård. Diskussion: Att ställa de olika studiernas resultat mot varandra var inte möjligt på grund av att de skiljde sig från varandra vad gäller urval, design och intervention. Då dessa mind-body-terapier ej är vetenskapligt bevisade får de inte rekommenderas av sjuksköterskor. Dock åligger det sjuksköterskor enligt Socialstyrelsens kompetensbeskrivning att inspirera till dialog om införande av ny kunskap. Slutsats: Innan rekommendationer kan ges bör effekten av de olika teknikerna undersökas närmare.

Cytochrome P450¡]CYP¡^2J2, the single member of human cytochromes P450 II J subfamily, plays an important role in the biosynthesis of biologically active cis-epoxyeicosatrienoic acids. An allelic variant named CYP 2J2*7, a relatively frequent G¡÷T substitution at position-50 relative to the transcription start site, which interrupts a critical Sp1 binding site, results in both decreased promoter activity in vitro and reduced circulating levels of CYP2J2 epoxygenase metabolites. Epoxyeicosatrienoic acid (EETs) are endogenously produced and incorporated into membrane phospholipids in the pancreas. Low concentrations of 5,6-EETs stimulate insulin secretion, whereas 8,9-, 11,12-, and 14,15-EETs stimulate glucagon secretion from the pancreas. Peroxisome proliferator-activated receptors (PPARs) are ligand-activated transcription factors belonging to the nuclear hormone receptor superfamily. EETs increased PPAR-£\ and PPAR-£^ transcription activity. PPAR-£\ and PPAR-£^ play a key role in the regulation of adipogenesis, lipid metabolism, insulin sensitivity and inflammation. Thus, genetic abnormalities in the function or expression of CYP2J2, the pathogenetic of enzymes may play a role in diabetes. The present study investigates whether CYP 2J2*7 gene polymorphism can be associated with type 2 diabetes in a Chinese population. We studied 2,073 Chinese type 2 diabetes patients and 704 control subjects without. CYP 2J2*7 gene polymorphism was determined by PCR-RFLP and real-time PCR. In both study groups, the genotype frequency distributions of this polymorphism were in Hardy-Weinberg equilibrium. The CYP2J2*7 genotype distribution or allele frequencies were not different between type 2 diabetes and control subjects. Diabetics with young age of onset¡]¡Ø35 years old¡^ had a higher frequency of T variant than that of the age of onset of greater than 35 years old and controls ( GG / GT + TT = 84.2% / 15.8% vs. 90.3% / 9.7% vs. 91.3% / 8.7%¡Fp = 0.018¡Ap = 0.027 ). CYP2J2*7 genotype had a statistically significant association with age of onset ( p for trend = 0.042 ). The HOMA-IR and HOMA-£] values were significantly higher in diabetic patients with young age of onset compared to those of late onset diabetics and controls. CYP2J2*7 polymorphism was associated with HOMA-IR and HOMA-£] in diabetics with young age of onset and controls, subjects and T variants had significant higher value of HOMA-IR and HOMA-£]¡]early onset diabetics¡GGG / GT + TT = 8.9 ¡Ó 6.1 / 6.4 ¡Ó 3.8, p=0.045¡Fcontrols¡GGG / GT + TT = 2.6 ¡Ó 1.1 / 2.1 ¡Ó 0.8, p = 0.007¡^.These findings suggest that CYP 2J2*7 polymorphism may play a role in the pathogenesis of young onset type 2 diabetes and family diabetic history.

No description available.

The prevalence of insulin resistance and type 2 diabetes mellitus (T2DM) in obese children and adolescents is growing at an alarming rate, especially in ethnic minorities. It is not clear whether young people of different ethnic backgrounds vary in their metabolic response to excessive adiposity. Differences in lipid partitioning in the abdominal fat compartments have been observed among different ethnic groups. The aim of this study was to evaluate whether there are ethnic differences in intramyocellular lipid (IMCL) levels that are related to differences in insulin sensitivity. Eighty-two obese children and adolescents underwent 1) 1H nuclear magnetic resonance (NMR) spectroscopy to non-invasively quantify IMCL levels in their soleus muscle, 2) an oral glucose tolerance test and (in a subset of subjects) a euglycemic-hyperinsulinemic clamp to assess insulin sensitivity, 3) a dual-energy X-ray absorptiometry (DEXA) scan to measure total percent body fat, and 4) magnetic resonance imaging to measure abdominal fat distribution. IMCL levels in Hispanic children and adolescents (1.50 ± 0.64%) were significantly greater than in their Caucasian (1.19 ± 0.40%) and African-American (1.09 ± 0.49%) peers. Visceral fat was significantly lower in African Americans (42.7 ± 18.8cm2) and were similar in Caucasians (70.9 ± 27.5cm2) and Hispanics (77.3 ± 41.9cm2). The three groups were not different with respect to insulin sensitivity. For the entire cohort, IMCL levels were inversely related to insulin sensitivity. There was a significant correlation between visceral fat and insulin resistance in Hispanics and Caucasians but not in African Americans. In conclusion, these data suggest that there are significant ethnic differences in lipid partitioning in both the muscle and abdominal compartment. These findings may explain ethnic differences in insulin sensitivity and further the understanding of the pathogenesis of insulin resistance and T2DM.

Thesis (M.A.)--Indiana University, 2009. / Title from screen (viewed on February 1, 2010). Department of English, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Ulla M. Connor, Frank M. Smith, Honnor Orlando. Includes vitae. Includes bibliographical references (leaves 138-139).

Type 2 diabetes is a growing disease in the population which includes that older people are a risk group. With the disease grows even cost’s. A lifestyle change is a major part of the treatment for type 2 diabetes. There are several factors that suggest positive effects on prevention among the elderly where, among other things, economic and health benefits are presented. A study has been conducted with a qualitative approach in which data collection method consisted a semi-structured interview. The aim of the study was to investigate how older experiencing daily life with a diagnosis of type 2 diabetes with Sense of coherence as a theoretical framework. A purposeful sampling where the selection criteria was to recruit 65 years or older people with type 2 diabetes, resulting in five interviewees were chosen. The method of analysis constituted a manifest content analysis. The result shows that the disease contributes to change and affect life after diagnosis, also the need to gather knowledge about the disease occurred. Experiences of existing and non-existent support was mentioned, and that treatment options were pleasantly arranged. Diabetes complications was something that was disturbing and factors in life so as to be single, to go away and to give up the things that gave satisfaction was something complicated. There were deficiencies in health care and the need for enhanced patient education. The conclusion was that life is affected when diagnosed type 2 diabetes and supportive and hindering factors were experienced by diabetic patients, continued preventive efforts should be focused in the area to allow health and increase public health. / Typ 2-diabetes är en växande sjukdom i befolkningen där bland annat äldre är en riskgrupp. Samtidigt som sjukdomen växer ökar även kostnaderna. En livsstilsförändring är en stor del av behandlingen vid typ 2-diabetes. Det förekommer flertal faktorer som tyder på positiva effekter vid förebyggande arbete bland äldre där bland annat ekonomiska och hälsomässiga vinster presenteras. En studie har genomförts med en kvalitativ ansats där datainsamlingsmetoden utgjordes av en semistrukturerad-intervjustudie. Syftet med studien var att undersöka hur äldre upplever det dagliga livet med diagnosen typ 2-diabetes med Känsla av sammanhang som referensram. Ett målinriktat urval där urvalskriterierna var att rekrytera personer som var 65 år eller äldre med typ 2-diabetes, resulterade i att fem intervjupersoner valdes. Analysmetoden utgjorde en manifest innehållsanalys. Resultatet visar att sjukdomen bidrar med förändringar och påverkar livet efter diagnosen, även behov av att samla kunskap kring sjukdomen förekom. Upplevelser av befintligt samt obefintligt stöd nämndes, och att behandlingsalternativen var positivt anordnade. Diabeteskomplikationer var något som var oroväckande, faktorer i livet så som att vara ensamstående, att resa bort samt att ge upp saker som gav tillfredsställelse var något som försvårade. Det förekom brister i hälso- och sjukvården samt behov av utökad patientundervisning. Slutsatsen blev att livet påverkas något av typ 2-diabetes och stödjande samt hindrande faktorer upplevs av diabetespatienter, fortsatt förebyggande arbete bör fokuseras inom området för att möjliggöra hälsa och förbättra folkhälsan.

PANcreatic-DERived Factor (PANDER), or FAM3B, is a 235-amino acid protein strongly expressed within and secreted from the endocrine pancreas. Research surrounding PANDER has revealed a large role for the protein in maintaining glucose homeostasis, as evidenced by several Ad-PANDER overexpressing murine models, our lab's pancreas-specific PANDER transgenic overexpressor, and most recently our mixed genetic C57/129J PANDER knockout (PANKO) mouse. However, PANDER's overall role in glycemic regulation and glucose homeostasis has yet to be studied in a purebred C57BL/6J PANDER knockout model. Here we present the first phenotypic characterization of our global PANDER knockout mouse on a C57BL/6J background (PANKO-C57) where we examined metabolics through glucose/insulin tolerance testing, fasting glycemia, and body weights, the concentrations of hormonal analytes along with lipids and corticosterones, and full elucidation of hepatic insulin signaling through the insulin signaling cascade. Overall, the PANKO-C57 mice exhibited increased body weights with enhanced glucose tolerance and lower fasting glycemia, similar peripheral insulin sensitivities, increased hepatic lipidemia, and enhanced hepatic insulin signaling at critical insulin signaling molecules. Taken together, the PANKO-C57 demonstrates that the disruption of PANDER results in selectively enhanced hepatic insulin signaling yet with increased lipidemia and overall body weight. These findings reveal a novel role for PANDER in differentially controlling lipogenesis and hepatic glucose production that may selectively impact overall glycemic control and potentially facilitate the onset and/or progression of type 2 diabetes.

The present study assessed the relationship between Body Mass Index (BMI) and healthcare cost, utilization and health-related quality of life (HRQoL) of type 2 diabetes patients using the Medical Expenditure Panel Survey (MEPS) database. Study subjects were at least 18 years of age, diagnosed with diabetes and taking ≥1 oral antidiabetic medication. Data were extracted over a 5-year period (01/01/2006-12/31/2010). The main study outcomes were healthcare costs and utilization and HRQoL. The study covariates were age, gender, race, smoking status, census region of residence, marital status, insurance status, Charlson comorbidity index score and additional bed days. Study objectives were addressed using generalized linear model, negative binomial and multivariate regression analyses. A final un-weighted sample size of 7,003 patients was obtained. Mean age (±SE) was 61.2 (±0.24) years, mean BMI (±SE) was 32.2 (±0.12), and 50.4% were males. The majority was white (77.4%), did not smoke (84.5%), and were married (60.4%). Based on BMI categories, 12.6% had normal weight (BMI: 18.0-24.9); 29.2% were overweight (BMI: 25.0-29.9); 45.6% were obese (BMI: 30.0-39.9), and 12.6% were morbidly obese (BMI≥ 40.0). Compared to normal-weight patients; overweight, obese or morbidly obese patients had significantly higher (p<0.05) diabetes-related direct medical costs. However, overweight patients had significantly lower (p=0.021) all-cause direct medical costs. Furthermore, compared to normal weight patients, obese patients had a significantly higher (p=0.009) number of ambulatory care visits, while overweight patients had a significantly lower (p=0.035) number of emergency department visits. In addition, being obese or morbidly obese was associated with a significantly higher (p<0.0001) number of prescribed medicines compared to normal-weight patients. Compared to normal-weight patients; being obese or morbidly obese was also significantly (p<0.0001) associated with lower physical component summary (PCS-12) scores (i.e., worse quality of life) while being overweight was significantly (p=0.038) associated with higher mental component summary (MCS-12) scores (i.e., better quality of life). In conclusion, the present study suggests that among type 2 diabetes patients, being obese may be associated with negative consequences (in terms of healthcare costs, utilization and outcomes). Hence, there is the need to address obesity among type 2 diabetes patients in order to improve their health outcomes and significantly reduce healthcare costs and resource utilization. / text

This thesis used attachment theory and the common sense model of illness as theoretical backgrounds to examine the mechanisms that contribute to the quality of the support seeking behaviour and social interactions between patients with type 2 diabetes and their partners. Specifically, this thesis examined actor and spouse effects of working models of attachment on health outcomes, and illness perceptions on health outcomes for both patients and partners. Furthermore, it determined if support seeking, supportive interactions, and negative interactions mediated between the attachment and health outcomes and illness perception and health outcomes. At study entry, 70 patients with type 2 diabetes and their partners completed measures on attachment, illness perceptions, support seeking, receipt of supportive interactions and of negative interactions, satisfaction with support received, and health outcomes. Health outcomes included psychological distress and physical health for patients and partners, and diabetes well-being for patients only. Six months later, participants again completed measures on supportive and negative interactions, satisfaction with support received, and health outcomes. The data were examined both cross-sectionally (including mediational analyses) and longitudinally. The cross-sectional analyses revealed a number of actor and spouse effects in the relationships between attachment and health outcomes, and illness perceptions and health outcomes. Patients who scored higher on attachment-anxiety experienced higher levels of psychological distress and lower levels of diabetes well-being. Also, the partners of these patients experienced higher levels of psychological well-being. Furthermore, covert support seeking behaviour and negative interactions were found to be significant mediators between patient attachment-anxiety and patient psychological distress and diabetes well-being. In addition, support satisfaction mediated the relationship between patient attachment-anxiety and patient psychological distress. Illness perceptions, specifically timeline cyclical perceptions, were also shown to be related to health outcomes, and receipt of negative interactions. Patients and partners who scored higher on timeline cyclical experienced higher levels of psychological distress. Also receipt of negative interactions mediated the relationship between timeline cyclical and psychological distress. Some significant changes over time found when the data were examined longitudinally. For example, patients who scored higher on attachment-anxiety at study entry experienced higher levels of psychological distress over time, and had a partner who also experienced higher levels of psychological distress over time. In addition, partners who scored higher on personal control and who had a spouse (patient) who scored higher on timeline cyclical at study entry experienced higher levels of psychological distress overt time. Taken together, both the cross-sectional and longitudinal findings emphasize the contribution of the partner and his or her interactions with the patient to patient well-being. In the same manner, the results also highlight the effect of the patient’s illness on the partner’s well-being. These findings have important practical implications, especially for practitioners who aim to design intervention to help patients and their partners better adapt to the patient’s illness.

Cognition and Self-Management in Type 2 diabetes in the older person was studied using neuropsychological evaluation and self-management assessments. Type 2 diabetes is increasing in prevalence, erodes quality of life, and places significant burden on healthcare services. The condition is largely self-managed, requiring daily performance of a variety of tasks. Impaired cognition has been associated with Type 2 diabetes, particularly in those who have had diabetes for longer or are older. It is unknown whether such changes in cognition seen in Type 2 diabetes affect the ability to self-manage the condition; the few studies that have been conducted in this area have shown little consensus in focus, methodology, or results. This thesis aimed to investigate any links between cognitive impairment and diabetes self management skills in an older population with Type 2 diabetes, by determining assessment schedules for both selfmanagement and cognition in this population and searching for associations between the two. Literature review, questionnaire and focus group studies pointed towards four main components of diabetes selfmanagement; diabetes knowledge, self-efficacy, motivation, and diabetesspecific problem solving abilities. A theoretical framework emerged from this analysis; Bandura’s Social Cognitive Theory provides a context for the interaction of environment, society and cognitions in health behaviours. A systematic review found several associations between self-management skills and abilities, and global and individual areas of cognition, including links between executive function and memory, and diabetes knowledge, insulin skills, adherence to medications, missed appointments, and decreased frequency of self-care activities. A further clinical study identified several associations including visual and working memory, and reaction times, with diabetes knowledge. Future studies with larger sample sizes might revisit these associations. Clinical implications include the need for routine cognitive assessment in an older population with Type 2 diabetes; interventions might include checking medication adherence, diabetes knowledge, and referral to support groups.