Diabetes is a chronic, complex illness with a risk for acute and long-term complications. The aim of this quality improvement project on prevention of type 2 diabetes was to increase self-management behaviors in patients at high risk of type 2 diabetes, decrease the financial burden of type 2 diabetes, and decrease the incidence of complications that can occur from type 2 diabetes. The primary outcome of this project was each participant reporting at least one lifestyle modification that would be helpful in preventing type 2 diabetes after attending two group education sessions. A pretest posttest design was used for this project. Three completed the initial questionnaires, and two attended the educational sessions and completed the posttest questionnaires. Of the total number of participants, one reported a decrease in hot/cold cereal, regular soda, sugar or honey in coffee/tea, other potatoes, tomato sauces, chocolate, doughnuts, and cookies, cake, pies, brownies. Two participants reported a decrease in fruit juice, fried potatoes, and pizza. One participant had an increase in physical activity while the other participant had no change in physical activity. The landmark Diabetes Prevention Program (DPP) Trial demonstrated that counseling on a healthy diet and moderate physical activity reduced the incidence of type 2 diabetes. The two participants in this project reported they made some helpful changes in diet after two education sessions. It is vital to the success of a prevention program to convey the significance of preventing a chronic disease such as type 2 diabetes

Abstract Background: Individuals with type 2 diabetes mellitus (T2D) face many challenges in self-management of their current disease state. Nutrition education has been identified as a key component in managing metabolic control in individuals diagnosed with T2D. The purpose of this study is to investigate the effect of a 4-week nutrition intervention on glycated hemoglobin (HbA1c) and nutrition knowledge by food security status in individuals with T2D who attend the Family Health Centers of Georgia (FHCGA) located in West Atlanta. Methods: Subjects enrolled in the study (n=6) completed a nutrition knowledge survey at the beginning of the intervention and had their HbA1c values extracted from the FHCGA medical record. Subjects then entered a 4-week group nutrition intervention program. The program consisted of four lessons that focused on the basic diet for diabetes, food label reading, grocery store shopping and eating out with diabetes. Subjects took a nutrition knowledge survey after the intervention and were asked to return to have a follow-up blood draw for HbA1c levels. Results: Two out of six subjects completed the entire protocol. The HbA1c for this subject was higher after the nutrition intervention. An additional two subjects completed all of the lessons and the post survey, but did not have a follow-up HbA1c drawn. The mean nutrition knowledge score pre-intervention (72.33 + 5.13) was lower than the mean post-intervention score (78.67 + 4.04) but was not significantly different. When subdivided by food security status, subjects with a higher food security status had a lower baseline HbA1c. Conclusion: Nutrition knowledge scores increased after nutrition education but not significantly. The effect of nutrition education on HbA1c by food security status could not be determined due to low participation. Future studies with a larger sample size and incentives for compliance are needed to investigate how group nutrition education influences metabolic control in food insecure and secure people with T2D.

Background: A marked increase of type 2 diabetes and associated morbidity and mortality rate over the last 10 years has been recorded in Malaysia. Ineffective diabetes management and a lack of self-care practice among type 2 diabetic patients have been identified as the major reasons for this problem. Research in other countries has highlighted a range of factors influencing effective self-care of type 2 diabetes including patients' perspectives of diabetes, sociocultural issues, religious beliefs and support from healthcare. Nevertheless, there is paucity of research conducted in Malaysia. Therefore, the exploration of self-care practice and self-care support provision in patients with type 2 diabetes in Malaysia is needed to understand the problem. Aims: To understand the self-care practice of patients with type 2 diabetes in Malaysia and the factors that influence the patients' self-care practice. To understand the type 2 diabetes’ self-care support provision in Malaysia from the perspective of patients, healthcare professionals, and healthcare system. Methods: A qualitative, single embedded case study design was utilised. Eighteen patients with type 2 diabetes and 19 healthcare professionals (physicians, diabetes educators, nurse, pharmacist and dietician), involved in self-care support provision primary- and secondary-care settings in Kuala Lumpur and Putrajaya, Malaysia, participated in in-depth semi-structured interviews between November 2012 and June 2013. In addition, data were collected through participant-observation of clinic consultations, and analysis of relevant documents used in the provision of diabetes management in the respective clinics. The framework technique supported analysis of data. Data were stored and managed using Nvivo 9 software. Findings: The findings indicate that patients with type 2 diabetes had a good understanding of diabetes and self-care, but a lack of self-care support meant that effective self-care was difficult to sustain. Healthcare professionals’ (HCPs’) provision of self-care support was restricted due to several factors, including lack of opportunity to provide self-care support, unsuitable clinic environment and a fragmented management within primary and secondary care. Additionally, barriers in patient–HCP communication, a combination of the personal, interpersonal and inter-professional HCP factors, and a traditional medical model adopted by Malaysian healthcare system, seem to have influenced the practice and quality of the service delivered. Conclusion: It is clear that the increased incidence of uncontrolled type 2 diabetes is not merely due to poor self-care practice by patients, but also due to constraints in service delivery and underdevelopment of self-care support provision. The evidence generated can assist in the development of strategies to improve the quality of care and facilitate changes in the self-care support provision in Malaysia.

Type 2 diabetes mellitus (T2DM) is a widespread metabolic disorder that continues to grow in prevalence both in the United States and worldwide. T2DM is an immense public health crisis and has been declared an epidemic by the United States Centers for Disease Control and Prevention. T2DM is a heterogeneous disease that is characterized by chronic hyperglycemia that is caused by dysfunction of the insulin transduction pathway. Particularly in T2DM, individuals with the disease experience a progressive loss of insulin production by pancreatic β cells in the setting of peripheral insulin resistance. Due to the dysfunction of insulin’s actions, glucose in circulation is unable to enter insulin’s target cells and remains in the bloodstream. Formerly known as adult-onset diabetes, T2DM has recently become more commonplace in youthful populations, particularly in adolescents during puberty. Several risk factors have been identified for T2DM, which defines a population of study to determine the underlying pathogenesis of T2DM and possible therapeutic interventions. While extensive research on T2DM has been performed, the heterogeneous nature of the disease makes it difficult to understand the relationship between genetic susceptibility and environmental triggers. The trend of reaching younger populations is extremely worrying as the loss of glycemic control in T2DM is associated with various medical complications. The most commonly seen complications in T2DM include neuropathy, nephropathy, retinopathy, and cardiovascular disease. These complications come with a significant burden that greatly increases mortality and reduces one’s quality of life. One of the underlying causes of the growing prevalence of youth-onset T2DM is the growing pediatric obese population. The increasing prevalence of pediatric obesity, in turn, is likely tied to adolescents getting less sleep, having diets high in carbohydrates, and having insufficient physical activity. Compared to T2DM that precipitates later in life, youth-onset T2DM appears to have a more aggressive nature, where glycemic control is quickly lost, and complications arise sooner in the disease course than adults. Unfortunately, compared to the various drug classes available to adults, options for youths with T2DM are limited. Currently, the only pharmacologic therapies available to youths are metformin and insulin and given that youths quickly lose metabolic control, new therapies are desperately needed to combat this epidemic. Lifestyle interventions are also widely used in pediatric populations, but success with lifestyle monotherapy is limited. Adherence to treatment plans is a barrier to positive outcomes in youthful populations, which may be improved by having patients and their families attend diabetes education programs. The aggressive nature of youth-onset T2DM and the limited amount of available therapies make it difficult to maintain control diabetes in this youthful population, which is concerning given the huge costs associated with diabetes for both individuals and health care systems. To combat this epidemic of youth-onset T2DM, aggressive monitoring is needed to identify high-risk populations and to prevent and delay T2DM in these populations. Reducing the prevalence of youth-onset T2DM will require efforts to increase the physical activity of youths and to reduce the consumption of foods that greatly increase blood sugar. Additionally, efforts should be made to ensure that youths are getting adequate amounts of sleep. Bariatric surgery has been demonstrated positive results in remission of T2DM in youths, but such an invasive procedure may be an extreme solution in a vulnerable population.

Bakgrund: Typ 2-diabetes är en kronisk sjukdom som leder till komplikationer i olika delar av kroppen. Egenvård genom kostförändringar minskar risken för komplikationer. Följsamheten av kostråd brister dock ibland. En viktig uppgift för sjuksköterskan är att främja egenvården hos patienter med typ 2-diabetes. Syfte: Syftet med denna studie var att identifiera faktorer som har samband med patienters följsamhet av kostråd vid typ 2-diabetes. Metod: Litteraturstudie utformade enligt Polit och Becks sökstrategi. Artiklarna identifierades från PubMed med kvalitativ och kvantitativ ansats. Kvalitets- och resultatanalys genomfördes. De granskade artiklarnas resultat granskades och delades in i relevanta teman. Resultat: 11 artiklar motsvarade uppsatsens syfte. I resultatanalysen identifierades fem teman: (1) familj och närstående, (2) sociala och kulturella aktiviteter, (3) kunskap och information, (4) attityder och beteende, och (5) sociodemografiska aspekter. Information och kunskap om typ 2-diabetes och kost hos patienter och deras familj, ekonomisk situation, stress, stöd från familj, hälsokunskap och motivation för att skapa förändring är några exempel på faktorer som identifierades ha samband till följsamhet av kostråd. Slutsats: Genom att känna till och ta hänsyn till faktorer relaterade till egenvård kan sjukvårdspersonalen erbjuda omvårdnad baserad på vetenskaplig information och vårdetiska principer. / Background: Type 2-diabetes is a chronic disease with a range of associated complications. Self-care, in the form of dietary regulation, has shown to help make the disease more manageable. However, compliance with dietary recommendations is often lacking. An important responsibility of the nurse is to support and encourage self-care in diabetic patients. Aim: This study aims to identify factors associated with patients' adherence to dietary advice in type 2-diabetes. Method: This literature study uses the method described by Polit and Beck. Articles of both quantitative and qualitative methodology were extracted from PubMed. Content was reviewed and compiled under relevant thematics. Results: Eleven articles met the study inclusion criteria. Five categories were identified: (1) family and nearest of kin, (2) social and cultural activities, (3) knowledge and information, (4) attitudes and behavior and (5) sociodemographics. Patient and family knowledge about type 2-diabetes and diet, financial situation, stress, family support, knowledge and being motivated to change are examples of the factors identified found to be related to compliance with dietary advice. Conclusions: Awareness of factors related to self-care motivation and compliance, can help health care professionals practice nursing, based on scientific evidence and health ethics.

Sammanfattning Bakgrund: Typ 2 diabetes är en av den vanligaste folksjukdomarna och är utbredd världen över hos personer i alla åldersgrupper. Ökningen av typ 2 diabetes kan kopplas till fysisk inaktivitet, övervikt samt osund kosthållning. Vid typ 2 diabetes förekommer det svårighet för kroppen att reglera samt hålla blodsockernivåerna låga. Med hjälp av livsstilsförändringar kan patienterna dock förbättra sitt tillstånd. Med hjälp av kunskap om patienters upplevelse av livsstilsförändringar skapas en djupare förståelse och möjliga behandlingsstrategier för tillståndet.  Syfte: Beskriva patienters erfarenheter av livsstilsförändringar vid typ 2 diabetes. Metod: Den beskrivande litteraturstudie genomfördes utifrån tio vetenskapliga studier. Varav sex stycken med kvalitativ ansats, tre med kvantitativ ansats samt en mixad studie. Resultat: Denna litteraturstudie baseras på resultatet av tio vetenskapliga artiklar, utifrån dessa skapades tre teman. Resultatet från studien påvisar att patienter upplevde livsstilsförändringar som utmanade och hade behov av olika faktorer som stöd, kunskap, information samt motivation. Dessa faktorer kan bidra till att underlätta för patienter vid livsstilsförändringar. Slutsats: Sjuksköterskans bemötande samt förmåga att vara lyhörda inför patientens behov är av stor vikt. För att kunna utveckla vården och bidra till en mer effektiv egenvård så krävs strategier gällande förmedlingen av kunskap. Kontinuerligt stöd från närstående samt hälso- och sjukvården är väsentligt för att patienten ska lyckas med sina livsstilsförändringar och förhoppningsvis se en förbättring i sin diabetessjukdom.

The use of telehealth in healthcare has grown in recent years; however, little is known about the effectiveness of this delivery method in the management of Type 2 diabetes mellitus (T2DM). Guided by the chronic care model and telehealth in chronic disease model, the purpose of this systematic literature review was to explore evidence related to lowering hemoglobin A1c levels and managing T2DM using telehealth in the outpatient setting. The practice-focused questions explored telehealth interventions used in T2DM management and their effectiveness. The Joanna Briggs Institute (JBI) method for conducting systematic literature reviews was the process, and data were compiled using the PRISMA evidence-based minimum set for reporting. Eighteen studies met the inclusion criteria for this project. Data were extracted, analyzed, and synthesized using JBI tools for data extraction and critical appraisal. Article appraisals revealed numerous telehealth interventions for management of T2DM including telephone, Internet-based, clinical video, remote monitoring, and smart phones/applications. Overall, telehealth interventions showed statistically significant improvement in the hemoglobin A1c levels of participants compared to traditional outpatient care. Success of the interventions is associated with components of evidenced-based diabetes management such as education, self-management, support, and feedback loop. The implications of this project for positive social change include the integration of telehealth interventions in the outpatient setting to manage T2DM with enhanced access to care, reduction in health disparities, and improved health outcomes for society.

Typ 2-diabetes är en allvarlig sjukdom som kan leda till en rad komplikationer och i förlängningen förtida död. Viktigaste åtgärd för att undvika komplikationer är god blodglukoskontroll som kan uppnås med god egenvård, vid behov kombinerat med farmakologisk behandling. Egenvården ställer dock höga krav på individen i form av beslutsamhet, kunskap och praktiska färdigheter. Sjuksköterskan har en central roll i att stödja och utbilda patienten i egenvård genom ett personcentrerat förhållningssätt. Hälsolitteracitet bedömer patientens förmåga att ta emot, förstå och använda sig av information som är riktad till att förbättra och bevara sin egna hälsa. Syftet var att beskriva hur hälsolitteracitet påverkar egenvården hos personer med typ 2-diabetes. Syftet besvarades genom att utföra en litteraturöversikt. Hälsolitteracitet kan eventuellt påverka egenvården vid typ 2-diabetes både direkt och indirekt, resultatet är dock tvetydigt då inga entydiga direkta samband funnits. Tydligast påverkan på egenvården har kunnat ses då hälsolitteracitet verkat indirekt via självförmåga. Konsensus saknas för hur hälsolitteracitet definieras och bedöms. Ytterligare forskning behövs kring begreppet hälsolitteracitet och dess eventuella effekt på egenvården vid typ 2-diabetes.

No description available.

Adolescent type 2 diabetes (T2D) diagnoses are on the rise. Consistent with the adult literature, preliminary evidence in adolescents suggests that T2D is associated with reduced brain volume and white matter microstructural integrity. As part of the Cognitive Performance in Adolescents with T2D (CPAT2D) study, this project aimed to test whether T2D diagnosis is associated with poorer cognitive performance in adolescents. Five adolescents with obesity and T2D (60% female; body mass index [BMI] percentile 98.2 ± 2.0; age 16.7 ± 1.1 years) were recruited and matched to two control adolescents with obesity but without T2D (50% female; BMI percentile 99.9 ± 0.2; age 15.9 ± 1.3 years) on at least three of the following characteristics: age, sex, pubertal stage and habitual sleep duration. All participants wore a wrist actigraphy device for seven consecutive nights to measure sleep at home and then completed two neuromotor cognitive tasks at a laboratory testing session assessing motor preparation (simple reaction time task) and executive functioning (affective shifting task [AST]). Control data were available through the Sleep Manipulation in Adolescents at Risk of Type 2 Diabetes (SMART2D) study. Premotor reaction time outcomes in either task and proportions of commission and omission error trials in the AST were subsequently analyzed. Based on this preliminary participant sample, there is no evidence to suggest that adolescents with compared to without T2D perform differently on the neuromotor cognitive tasks. The results should be confirmed once the intended sample size is reached. In the meantime, clinicians should monitor for changes in cognitive function in adolescents with T2D, perhaps by asking about academic achievement. The majority of our sample exhibited sub-optimal movement behaviours; to preserve overall health, adolescents with obesity and/or T2D should strive to meet sleep, physical activity and screen time recommendations for their age group.