BACKGROUND: Long-term exposure to fine particulate matter (PM2.5) has been identified as a potential risk factor for developing type 2 diabetes mellitus (T2DM). Given the rising prevalence of T2DM and unhealthy concentrations of PM2.5 in China, our attention is brought to examining the association in this region of the world. Furthermore, rural China, although largely ignored, also finds itself suffering from increased risks of T2DM and high levels of PM2.5. OBJECTIVE: The goal of this study is to characterize the relationship between long-term exposure to PM2.5 and the risk of T2DM in rural China. We do so by confirming that greater long-term exposure to PM2.5 is associated with a higher risk of T2DM incidence, assessing the potential multiplicative and additive interactions with important covariates, and identifying constituents of PM2.5 that may be responsible for the effect PM2.5 on the increased incidence of T2DM. CONCLUSIONS: Greater long-term exposure to PM2.5 is associated with increased risk of developing T2DM in rural Deqing County, Zhejiang, China. Smoking status modifies the relationship between PM2.5 and T2DM incidence on a multiplicative scale. There is no synergism between smoking and PM2.5 in association with T2DM incidence. There is no conclusive evidence on which constituents of PM2.5 play greater roles in the adverse effects of PM2.5 on T2DM incidence.

No description available.

Objectives: To describe the profile of Canadian adults with type 2 diabetes mellitus (T2DM), examine the prevalence of diabetes-related complications and investigate the factors associated with having common diabetes-related complications. Methods: Self-reported data from Statistics Canada’s 2011 Survey on Living with Chronic Diseases in Canada (SLCDC) – Diabetes component were available to describe the prevalence of T2DM, related complications and co-morbidities. Associations with diabetes-related complications were evaluated using logistic regression models. Survey weights and bootstrapping resampling method were applied to account for the complex survey design. Results: 2,341 T2DM respondents (weighted Canadian population estimate n=1,365,165) had a mean age of 62.9 years and diabetes duration of 10.6 years. The prevalence of diabetes-related complications and comorbidities were high: eye (34.0%), foot or leg (24.4%), cardiovascular (22.6%), renal (15.7%), neuropathy (10.8%), hypertension (68.4%) and high cholesterol (67.2%). Factors associated with diabetes-related complications were: Eye: > 65 years of age (odds ratio [OR] 3.7, 95% CI 2.4 – 5.5, p=<0.0001); household income < $29,999 (OR 1.9, 95% CI 1.1 – 3.2, p=0.01), diabetes duration > 10 years (OR 2.3, 95% CI 1.6 – 3.5, p<0.001), cardiovascular complications (OR 1.8, 95% CI 1.1 – 2.9, p=0.01). Renal: duration of diabetes 6 – 9 years (OR 3.0, 95% CI 1.4 – 6.3, p=0.02), duration of diabetes > 10 years (OR 2.1, 95% CI 1.1 – 3.9, p=0.04) Cardiovascular: male sex (OR 1.9, 95% CI 1.3 – 2.7, p=0.0006), eye complication (OR 1.9, 95% CI 1.2 – 3.0, p=0.007), foot or leg complication (OR 2.0, 95% CI 1.3 – 3.0, p=0.002). Foot or leg: cardiovascular complication (OR 2.0, 95% CI 1.4 – 3.1, p=0.0006). Neuropathy: household income $30,000 - $59,999 (OR 2.1, 95% CI 1.2 – 3.9, p=0.03); duration of diabetes >10 years (OR 1.9, 95% CI 1.1 – 3.8, p=0.01), foot or leg complication (OR 7.0, 95% CI 4.1 – 11.8, p<0.0001), eye complication (OR 2.0, 95% CI 1.1 – 3.7, p=0.006). Conclusions: The presence of diabetes-related complications among Canadians with T2DM is multifactorial. / Thesis / Master of Science (MSc)

Metformin is the most common type 2 diabetes therapy, and may also reduce colorectal cancer growth. Currently, two mechanisms driving reduced cancer growth are considered: 1) Regulation of glucose and insulin levels, which may support cancer growth, and 2) Direct entry into cancer cells to activate the AMP-activated kinase (AMPK) protein, and inhibit cell growth pathways. The gut microbiome is the community of commensal microorganisms in the gastrointestinal tract. It is also affected by metformin, and may elevate production of short-chain fatty acids (SCFAs). Therefore, this thesis aimed to clarify how metformin may inhibit colorectal cancer growth and if the microbiome is involved. The hyperglycemic-responsive, murine-derived MC38 colon cancer cell line was used to test these effects. This model was confirmed to experience growth stimulation caused by high-fat diet (HFD) feeding in mice. Daily i.p. injections of metformin (100mg/kg) had no measurable effect on glucose and insulin sensitivity, or MC38 tumor growth. Oral metformin (250mg/kg) improved glucose tolerance and inhibited MC38 tumor growth in HFD-fed mice. To see if the gut microbiome is required for this effect, the antibiotic ampicillin was used to limit the gut microbiome. The addition of ampicillin blunted metformin’s glucose sensitization and tumor inhibition effects. A fecal microbiome transfer model was then used to isolate the role of the microbiome. Conventional mice fed HFD and gavaged with feces from metformin-treated donors experienced no glucose or insulin tolerance improvements. However, tumor growth was decreased by 30%, and serum SCFAs concentrations were elevated. The SCFA butyrate inhibited in vitro MC38 colony growth, but did not activate AMPK. These data suggest that metformin alters the gut microbiome, and fecal transfer from metformin-treated animals can uncouple MC38 tumor growth inhibition from the glucose homeostasis effects of metformin. These novel findings support a new mechanism for metformin to prevent cancer growth and development. / Thesis / Doctor of Philosophy (PhD) / Metformin is the most commonly used type 2 diabetes therapy, and may also reduce colorectal cancer growth. Anti-cancer effects may be caused by: 1) decreased glucose and insulin levels, which support cancer growth; or 2) entry into cancer cells to directly decrease cell growth. The gut microbiome, microorganisms that live symbiotically in the gastrointestinal tract, is also affected by metformin. This thesis aimed to clarify how metformin can inhibit cancer, and if the microbiome is involved. Mice treated with metformin had improved glucose metabolism and decreased colorectal tumor growth; when an antibiotic was introduced, this effect was lost. A fecal microbiome transfer model was used to determine if the microbiome is driving this effect. Mice receiving feces from metformin treated mice also experienced tumor growth inhibition. This suggests that the gut microbiome is involved in the anti-cancer effects of metformin, and is a new potential mechanism of action.

Type 2 Diabetes Mellitus (T2DM), a metabolic disorder denoted by elevated blood glucose levels and insufficient insulin action, is growing in prevalence worldwide . Barriers to improving disease outcome resolve primarily around identifying and intervening during the preliminary stages of insulin resistance, a state clinically referred to as pre-diabetes. Emerging evidence suggests that mitochondrial dysfunction may underlie , and potentially precede, progressive insulin resistance, suggesting that biomarkers indicative of mitochondrial dysfunction could predict disease risk and status. In this study, we examined epigenetic modifications, in the form of DNA methylation, in the promoter region of peroxisome proliferator activated receptor gamma coactivator 1 alpha (PGC-1α), a known regulator of mitochondrial biogenesis. Following the initiation of a high fat diet, we observed significant genotypic (DNA methylation) and phenotypic (mitochondrial copy number) alterations in C57/BL6 rodent models. These changes preceded overt disease onset, as classified by clinically utilized indices, which included the homeostatic model assessment for insulin resistance (HOMA-IR), the homeostatic model assessment for β-cell dysfunction (HOMA- β), and the quantitative insulin-sensitivity check index (QUICKI). Our data indicate that methylation analysis may serve as an effective clinical parameter to use in conjunction with physiological criterion for the diagnosis of pre-diabetes and the assessment of T2DM disease risk, and adds to the growing body of work seeking to elucidate the role. / Doctor of Philosophy / High blood glucose, referred to as type 2 diabetes (T2DM), increases the risk for heart and kidney disease, blindness, stroke, and death. Efforts to prevent T2DM have centered primarily around behavioral interventions, which include increased physical activity and decreased caloric intake. Importantly, the interventions are most effective when implemented early on in disease progression. In this study, we sought to examine the effects of a high fat diet on the epigenetic profile of PGC-1α, a gene responsible for maintaining mitochondrial biogenesis. The mitochondria, the powerhouse of the cell, is responsible for maintaining the energy systems in the body. Therefore, we examined how increasing in caloric intake resulted in changes in the epigenetic profile of the PGC-1α promoter, and how these changes impacted mitochondrial number. Further, we sought to examine how hypermethylation of PGC-1α led to changes in gene and protein expression in the mitochondria. Results from our study indicate that DNA methylation changes preceded disease onset, as characterized by the homeostatic model assessment for insulin resistance (HOMA-IR), the homeostatic model assessment for β-cell dysfunction (HOMA- β), and the quantitative insulin-sensitivity check index (QUICKI). Our data indicate that methylation analysis may serve as diagnostic and risk assessment tool for pre-diabetes and T2DM in conjunction with physiological measures.

Yes / Individuals with type 2 diabetes play a pivotal role in their health. Enhancing the self-management of diabetes can improve blood glucose control, and quality of life, and reduce diabetes-related complications. We have identified factors influencing the self-management of type 2 diabetes to inform strategies that may be applied in the long-term management of blood glucose control. Methods: We conducted a systematic literature review of recent studies published between January 2010 to December 2020 to identify the available evidence on effective self-management strategies for type 2 diabetes. The databases used for the searchers were Scopus, PubMed, Science Direct, CINAHL, and Google Scholar. We assessed English language publications only. The screening of titles was duplicated by two researchers. We then conducted a thematic analysis of the key findings from eligible publications to identify reoccurring messages that may augment or abate self-management strategies. Results: We identified 49 relevant publications involving 90,857 participants. Four key themes were identified from these publications: Individual drive, social capital, Knowledge base, and Insufficient health care. High motivation and self-efficacy enabled greater self-management. The importance of family, friends, and the health care professional was salient, as were the negative effects of stigma and labelling. Enablers to good self-management were the level of support provided and its affordability. Finally, the accessibility and adequacy of the health care services emerged as fundamental to permit diabetes self-management. Conclusions: Self-management of type 2 diabetes is an essential strategy given its global presence and impact, and the current resource constraints in health care. Individuals with type 2 diabetes should be empowered and supported to self-manage. This includes awareness raising on their role in self-health, engaging broader support networks, and the pivotal role of health care professionals to inform and support. Further research is needed into the capacity assessment of healthcare systems in diabetes medicine, targeted low-cost resources for self-management, and the financial requirements that enable self-management advice to be enacted. / While this research did not receive any specific project funding, KRB is funded by a University of Otago Pacific Ph.D. Scholarship. ANR is funded as a Research Fellow by the National Heart Foundation.

Bakgrund: Typ 2 diabetes är en växande folksjukdom och är förenad med följdsjukdomar. Ökningen beror främst på ohälsosamma levnadsvanor. Behandlingen av typ 2 diabetes innebär att förändra livsstilen, vilket medför stora utmaningar för den enskilda personen. En bristande följsamhet till behandlings råd bidrar oftast till komplikationer och följdsjukdomar, vilket leder till ökade samhällskostnader och stora utmaningar för hälso- och sjukvården. Syfte: Syftet med denna litteraturöversikt är att beskriva patientens följsamhet till behandlingsråd hos personer med typ 2 diabetes. Metod: En litteraturöversikt baserad på 15 vetenskapliga artiklar där både kvalitativa och kvantitativa artiklar granskats. Artiklarna samlades in via databaserna Cinahl och Pubmed. Resultat: Viktiga beståndsdelar som framkom i resultatet och påverkade följsamheten av behandlings råd hos personer med typ 2-diabetes var information, kunskapsbrist, utbildning, självmedvetande, socialt stöd och personcentrering. Alla ovanstående faktorer var viktiga för att uppnå livsstilsförändring. Slutsats: Sjuksköterskan måste ha en förståelse för vilka behandlingsråd som påverkar följsamheten vid typ 2 diabetes. Sjuksköterskan måste få en bild av patientens tidigare erfarenheter, kunskap och personliga egenskaper för att sedan anpassa information och utbildning till patienten. Dessa faktorer ökar självmedvetenheten och motivation tillsammans med stöd av anhöriga vilket leder till god följsamhet till behandlingsråd vid typ 2 diabetes. / Background: Type 2 diabetes is a increasing and is associated with complications. The increase is mainly due to unhealthy living habits. The treatment of type 2 diabetes primarily involve changing of lifestyle, which poses great challenges for the individual. A lack of compliance to change lifestyle advice may contribute to complications which leads to increased cost and major challenges for healthcare. Aim: The purpose of this literature review is to describe factors that affect the adherence to treatment advice among persons with type 2 diabetes. Method: A Literature review based on 15 scientific publications with qualitative and quantitative design. Articles were collected from the databases Cinahl and Pubmed. Results: Factors that emerged that affected the adherence to treatment advice in people with type 2 diabetes were information, lack of knowledge, education, self-awareness, social support and person centred approach. All the above factors were important to achieve lifestyle changes. Conclusion: Nurses must have an understanding of the factors that affect the compliance to lifestyle advice of Type 2 diabetes. Nurses need to be aware of the patients previous experience, knowledge and personal characteristics. To make the information and education feasible to the patient these factors increase self-awareness and motivation together with support from relatives resulting in good adherence to lifestyle advice to patients with type 2 diabetes.

Att lägga om sin livsstil är inte lätt, men i många fall kan det vara nödvändigt för att bibehålla en god hälsa. Ett exempel på ett sådant tillfälle är vid en diabetesdiagnos, där förstahandsbehandlingen består i livsstilsförändring, som främst innefattar kost, motion och rökstopp. Resultat från tidigare forskning visar att det är viktigt att patienten är motiverad att genomföra en livsstilsförändring, och även diabetessköterskorna i den här studien är av den uppfattningen. Det är viktigt att patienten själv tar ansvaret för sin sjukdom, det är bara han eller hon som kan förändra sin livsstil. Syftet med studien var att undersöka hur diabetessköterskorna hjälpte sina patienter att hitta motivation till livsstilsförändring. En kvalitativ intervjumetod användes för att samla material, fem diabetessköterskor intervjuades. Den efterföljande analysen är inspirerad av hermeneutisk metod. Resultatet av studien visar att patienten själv måste hitta sin motivation, det finns inget sätt för diabetessköterskan att konkret hjälpa sin patient att hitta den. Diabetessköterskans uppgift är att finnas där när patienten själv hittat sin motivation, och leda patienten rätt. / To change your way of living is not easy, but in many cases it might be necessary to sustain a good health. An example of this is when you get a diagnosis of diabetes and the first treatment is a change of lifestyle, especially concerning diet, exercise and no smoking. Former studies have shown that the patient has to be motivated to change their lifestyle and this is the opinion of diabetes nurses in this study as well. It is important that the patient takes the responsibility for the disease because it’s only himself who can change the lifestyle. The aim of this study was to look into how the diabetes nurses helped the patients to find motivation to a change of lifestyle. Five nurses were interviewed. A qualitative field survey has been used to gather the material and the following analysis is inspired of the hermeneutic method. Results of the study show that the patients have to find the motivation on their own and that the diabetes nurse doesn’t have a concrete way of helping him or her. The nurse’s task is to be there when the patient has found the motivation and lead them on to the right track.

Bakgrund: I Sverige har 325 000 människor diagnosen typ 2-diabetes. Sjukdomen ställer stora krav på individen. För att sjuksköterskan ska ge en god omvårdnad behövs kunskaper om patientens individuella behov av stöd. Syfte: Syftet var att beskriva patienters upplevelser av sjuksköterskans stöd vid typ 2-diabetes. Metod: Studien genomfördes som en allmän litteraturstudie där nio vetenskapliga artiklar kvalitetsgranskades och analyserades. Resultat: Patienters upplevelser av sjuksköterskans stöd kategoriserades som emotionellt, informativt och värderande stöd. Viktiga faktorer i sjuksköterskans stöd var gemensamt engagemang, tillit, lindring av bördan, att bli sedd som en individ, kunskap genom information, dialog, kontroll och bekräftelse. Diskussion: Två faktorer diskuterades som påverkade upplevelsen av sjuksköterskans stöd. Hur sjuksköterskan gjorde patienterna delaktiga och tillgodosåg patientens individuella behov ansågs vara väsentligt. Slutsats: Det finns ett behov av att belysa hur patienter upplever sjuksköterskans stöd. Genom att sjuksköterskan har insikt i vad ett gott stöd innebär kan patienten få redskap till sjukdomshantering och ett förbättrat välmående. / Background: In Sweden, 325 000 people have the diagnoses of type 2-diabetes. The disease makes great demands on the individual. The nurse needs knowledge about the patient´s individual needs of support to give good nursing care. Aim: The aim was to describe the patients’ experiences of nurse-support in type 2-diabetes. Method: The study was conducted as a literature review and based upon nine scientific articles that were quality assessed and analyzed. Results: The patients’ experiences of nurse-support were categorized as emotional, informational and evaluative support. Important factors given about the nurse´s support was participation by both nurse and patient, trust, easing the burden, to be seen as an individual, knowledge through information, dialogue, control and acknowledgment. Discussion: Two factors were discussed that affected the patients’ experiences of nurse-support. How the nurse included the patients’ in the recovery and management of their disease and catered to the patient´s individual needs that were considered to be essential. Conclusion: There is a need to highlight how the patients’ experience the nurse's given support. Insight from the nurse into what good support means to the patient can improve disease management and well-being.

Typ-2-diabetes är en kronisk välfärdssjukdom som är associerad med livsstilsförändringar. Omvårdnaden av typ-2-diabetes har traditionellt förknippats med egenvård och patientinformation. Det finns en stor kunskap om typ-2-diabetes och vilka konsekvenser det medför. Det är viktigt att Hälso- och sjukvårdspersonal även har kunskap om människors personliga upplevelser av hälsa och välbefinnande vid typ-2-diabetes. Det finns annars en risk att hälso- och sjukvårdpersonalen fokuserar för mycket på sjukdomen och missar den unika sjukdomsupplevelsen. Syftet med denna studie är att beskriva människors upplevelser av att leva med typ-2 diabetes. Metoden som valdes hade en kvalitativ ansats där data samlades in genom intervjuer. Intervjuerna transkriberades och analyserades utifrån kvalitativ innehållsanalys. Resultatet utmynnande i ett överordnat tema balans mellan Trygghet – Otrygghet och aktiviteter som krav och möjligheter ger hanterbarhet. Temat beskrivs utifrån två huvudkategorier och beskrivande underkategorier. Studien visar att människor med typ-2-diabetes generellt erfar en god hälsa och ett gott välbefinnande utifrån deras egna förutsättningar. De levda erfarenheterna och de olika kraven för hanteringen av typ-2-diabetes varierar utifrån varje människa. Detta indikerar att hälso- och sjukvården bör vara uppmärksam på hur människor betraktar sin subjektiva upplevelse av hälsa och välbefinnande utifrån typ-2-diabetes. / Type-2-diabetes is a chronic welfare disease that is associated with life-style changes. Traditionally, the caring of type-2-diabetes has been associated with self-care and patient information. There is an extensive knowledge on type-2-diabetes and which consequences it results in. It is also important that health care professionals also have knowledge on people’s unique experiences of health and well-being living with type-2-diabetes. Otherwise there is a risk that the health care professionals focus too much on the disease and miss the subjective illness behind the unique person. The aim of this study is to describe people’s experiences of living with type-2-diabetes. A qualitative method was chosen. Data was collected through interviews. The interviews were transcribed and analyzed using qualitative content analysis. The authors found one theme; Balance between security – insecurity and the experience of activities as demands and possibilities give manageability. This study shows that people with type-2-diabetes generally experience good health and well-being in terms of their own resources. However, the lived experiences and the different demands of handling type-2-diabetes vary among people. This indicates that the health care professionals need to pay attention to the experiences of the unique person.