Thesis (MFamMed)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Background: The number of adults affected by diabetes mellitus in developing countries, such as South Africa, is projected to grow by 170%, from 84 to 228 million people between 1995 and 2025 .This high and increasing prevalence of diabetes worldwide, and the economic burden of diabetes on developing countries like South Africa emphasizes the importance of ensuring good glycemic control so as to slow down the rate of disease progression and prevent complications. The district health care facilities are the foundation of the health care system of South Africa. The current practice is that diabetics have a point of care random blood glucose (RBG) done on the morning of their clinic appointment and this is used as a form of assessment of glycemic control during the consultation. For further clinical decision making a HbA1c is done once a year as a benchmark of glycemic control. The practical clinical question that arises is whether the assumptions underlying local clinical decision making using the RBG are valid and to what extent RBG can be used to guide clinical management. Aim and Objectives: The aim of this study was to assess the strength of the correlation between RBG and HbA1c and to make recommendations for the interpretation of RBG results in adult patients with Type 2 Diabetes taken at Karl Bremer District Hospital out-patient department. The objectives were: To determine glycaemic control in the study population and compare differences between age, sex and racial groups , and determine the RBG cut-off with the best sensitivity and specificity for predicting poor glycaemic control (HbA1c>7.0% ) as well as the predictive value, likelihood ratio and pre/post-test odds and probability at this cut off. Methods: A retrospective analysis of existing hospital data and the HbA1c tests requested from the NHLS by Karl Bremer Hospital over the 2011 year period. The data was analysed by means of a receiver operating characteristic (ROC) curve analysis to determine the value of RBG with the best combination of sensitivity and specificity to predict poor control of diabetes. A p-value of < 0.05 was assumed to represent statistical significance and 95% confidence intervals were used to describe the estimation of unknown parameters. HbA1c level of < = 7% was taken as representing good control and > 7% poor control. Results: Data was obtained on 349 diabetic patients of whom 203 (58.2%) were female and 146 (41.8%) male. This study population had a mean age of 54.7 years, mean RBG of 13.0mmol/l and mean HBA1c of 9.4%. The total number of black patients was 79 (23%), coloured patients 147 (42%) and white patients 122 (35) % and their mean RBG were 15.4 mmol/l, 12.8 mmol/l and 11.9 mol/l respectively. There was a statistically significant correlation between increasing RBG and increasing HbA1c (p< 0.01). The best value obtained on the ROC curve was an RBG of 9.8 mmol/l, which had a sensitivity of 77% and a specificity of 75%, positive predictive value of 0.88, positive likelihood ratio 3.08 and post-test probability of 88.2% for predicting an HbA1c above 7%. Conclusion: It was concluded that a moderate correlation exists between RBG and HbA1c in this population of diabetic patients. .The best RBG for determining poor control, defined as a HbA1c>7.0%, was found to be 9.8mmol/l and this RBG had a sensitivity of 77% , specificity of 75% and positive predictive value of 88%. Significant differences were found in pre- and post -test probability for different racial groups. Point of care testing using this level of RBG for clinical decision making will inappropriately categorise 23% of patients in this population and therefore introducing point of care testing for HbA1c is recommended.

abstract: Curcumin is an active ingredient of Curcuma longa (Turmeric) and is studied extensively for its antioxidant, anti-inflammatory, anti-bacterial, anti-viral, and anti-cancer properties. The purpose of this study was to examine the effects of turmeric on blood glucose and plasma insulin levels. The study utilized a placebo-controlled, randomized cross-over design with participants serving as their own control. Eight glucose tolerant healthy participants completed the full study. Three-weeks washout period was kept in between six-weeks. Prior to the test meal day, participants were asked to eat a bagel with their evening dinner. During the day of the test meal, participants reported to the test site in a rested and fasted state. Participants completed mashed potato meal tests with 500 mg of turmeric powder or placebo mixed in water, followed by 3 weeks of 500 mg turmeric or placebo supplement ingestion at home. During this visit blood glucose finger picks were obtained at fasting, 30, 60, 90, and 120 min post-meal. Blood plasma insulin at fasting and at 30 min after the test meal were also obtained. During week 4, participants reported to the test site in a rested and fasted state where fasting blood glucose finger pricks and blood plasma insulin were measured. During week 5 to 7, participants were given a washout time-period. During week 8, entire process from week 1 to 4 was repeated by interchanging the groups. Compared to placebo, reduction in postprandial blood glucose and insulin response were non-significant after ingestion of turmeric powder. Taking turmeric for 3 weeks had no change in blood glucose and insulin levels. However, taking turmeric powder supplements for 3 weeks, showed a 4.4% reduction in blood glucose. Change in insulin at 30 min were compared with baseline insulin level showing no significant change between placebo and turmeric group. Fasting insulin after 3-weeks consumption of turmeric did not show any significant change, but showed a larger effect size (0.08). Future research is essential to examine the turmeric powder supplement benefits over a long period of time in healthy adults and whether it is beneficial in preventing the occurrence of type 2 diabetes. / Dissertation/Thesis / Masters Thesis Nutrition 2017

No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / Regulation of the pyruvate dehydrogenase complex (PDC) is important for glucose homeostasis and control of fuel selection by tissues. Knocking out pyruvate dehydrogenase kinase 4 (PDK4), one of four kinases responsible for regulation of PDC activity, lowers blood glucose levels by limiting the supply of three carbon compounds for gluconeogenesis. Down regulation of PDK4 expression is also important for control of blood glucose by insulin. The primary goal was to determine whether PDK4 should be considered a target for the treatment of diabetes. A major concern is that inhibition of fatty acid oxidation by PDK4 deficiency may promote fat accumulation in tissues and worsen insulin sensitivity. This was examined by feeding wild type and PDK4 knockout mice a diet rich in saturated fat. Fasting blood glucose levels were lower, glucose tolerance was better, insulin sensitivity was greater, and liver fat was reduced in PDK4 knockout mice. The reduction in liver fat is contradictory to the finding that fibrate drugs increase PDK4 expression but ameliorate hepatic steatosis in rodents. To investigate this phenomenon, wild type and PDK4 knockout mice were fed the high saturated fat diet with and without clofibric acid. The beneficial effect of clofibric acid on hepatic steatosis was greater in the PDK4 knockout mice, indicating up regulation of PDK4 is not necessary and likely opposes the effect of clofibric acid on hepatic steatosis. Clofibric acid dramatically lowered the amount of hepatic CD36, a plasma membrane translocase required for fatty acid import, suggesting a novel mechanism for prevention of hepatic steatosis by fibrates. PDK4 deficiency had no effect on CD36 expression but reduced the enzymatic capacity for fatty acid synthesis, suggesting clofibric acid and PDK4 deficiency ameliorate hepatic steatosis by independent mechanisms. Investigation of the mechanism by which insulin regulates PDK4 expression revealed a novel binding site for hepatic nuclear factor 4α (HNF4α) in the PDK4 promoter. The stimulatory effect of HNF4α was sensitive to inhibition by Akt which is activated by insulin. The findings suggest PDK4 is a viable target for the treatment of hepatic steatosis and type 2 diabetes.

Blood sugar levels were determined in toadfish and catfish by the Folin reducing procedure and a specific enzymatic glucose procedure. The difference between the two values was considered to be the rest reduction (RR). After alloxan injection, the RR level increased greatly reaching a peak at one hour and then decreasing. The glucose level rose more slowly. An attempt was made to study these changes in blood by paper chromatography using silver nitrate to detect reducing compounds. In normal blood, glucose, an unidentified compound, and several other reducing compounds present in small amounts were separated. The large amount or RR present after alloxan could not be detected by silver nitrate. The significance of the results was discussed and future investigations were suggested. / Thesis / Master of Science (MSc)

No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / Glucose homeostasis is maintained through the coordinated actions of insulin secretion from pancreatic beta cells and insulin action in peripheral tissues. Dysfunction of insulin action yields insulin resistance, and when coupled with altered insulin secretion, results in type 2 diabetes (T2D). Exocytosis of intracellular vesicles, such as insulin granules and glucose transporter (GLUT4) vesicles is carried out by similar SNARE (soluble NSF attachment receptor) protein isoforms and Munc18 proteins. An additional regulatory protein, Doc2b, was implicated in the regulation of these particular exocytosis events in clonal cell lines, but relevance of Doc2b in the maintenance of whole body glucose homeostasis in vivo remained unknown. The objective of my doctoral work was to delineate the mechanisms underlying regulation of insulin secretion and glucose uptake by Doc2b in effort to identify new therapeutic targets within these processes for the prevention and/or treatment of T2D. Towards this, mice deficient in Doc2b (Doc2b-/- knockout mice) were assessed for in vivo alterations in glucose homeostasis. Doc2b knockout mice were highly susceptible to preclinical T2D, exhibiting significant whole-body glucose intolerance related to insulin secretion insufficiency as well as peripheral insulin resistance. These phenotypic defects were accounted for by defects in assembly of SNARE complexes. Having determined that Doc2b was required in the control over whole body glycemia in vivo, whether Doc2b is also limiting for these mechanisms in vivo was examined. To study this, novel Doc2b transgenic (Tg) mice were engineered to express ~3 fold more Doc2b exclusively in pancreas, skeletal muscle and fat tissues. Compared to normal littermate mice, Doc2b Tg mice had improved glucose tolerance, related to concurrent enhancements in insulin mumsecretion from beta cells and insulin-stimulated glucose uptake in the skeletal muscle. At the molecular level, Doc2b overexpression promoted SNARE complex assembly, increasing exocytotic capacities in both cellular processes. These results unveiled the concept that intentional elevation of Doc2b could provide a means of mitigating two primary aberrations underlying T2D development.

Thesis (MPH.) -- University of Limpopo, 2014 / Objective: The purpose of this study was to determine the prevalence of impaired glucose tolerance, impaired fasting glucose, undiagnosed type 2 diabetes and its associated risk factors among adults patients attending the outpatient department of a level one hospital in a rural community of Barkley West, South Africa. Research methodology: This was a cross-sectional survey conducted by a simple random sampling of adults patients F 30 years old. Patients were screened using the American Diabetes Association and the World Health Organisation criteria. First, patients underwent the 75g oral glucose tolerance test and secondly, the 12-hours fasting plasma glucose tests after pre-test results of 5.5 mmol/L were obtained considered as positive for screening. To determine the prevalence of IGT, IFG, and undiagnosed type 2 diabetes; tests were conducted using both the capillary finger puncture and the laboratory methods. To ensure validity and reliability, each patient underwent two tests (fasting and random) by the capillary finger puncture method and two tests (fasting and random) by the laboratory method. Results: Eighty-five (85) questionnaires were distributed, supervised and returned by a research assistant, which brought the response rate to 100%. All patient known living with diabetes mellitus was not included in the study. The prevalence of IGT was 34.1% [34% for females and 9.4% for males] and that for IFG was 23.6% [25% for females and 6.0% for males]. The prevalence of undiagnosed type 2 diabetes discovered during the survey was 9.3% by 2-hours 75g glucose tolerance test [8.2% for females and 1.1% for males] and that by 12-hours fasting plasma glucose, the prevalence was 5.8% [4.7% for females and 1.1% for males].The associated risk factors were physical inactivity, overweight and obesity, unhealthy diet, alcohol consumption, hypertension, smoking habit, family history of diabetes, social deprivation and poverty. The prevalence of hyperglycaemia was also high among female patients due to a higher BMI with 25% overweight (females 18% overweight, males 7% overweight) and 75% obese (females 54% of obesity, males 21% of obesity); higher waist circumference with higher abdominal fat (females 71.7% had a W/C F 88 cm, males 28% had a W/C F 102 cm.); and a larger waist-to-hip ratio (females 61.1% had WHR > 0.85, males 7% had a WHR > 1.0). The sensitivity, specificity, positive and negative predictive values for IGT were 34%, 86%, 25%, and 86% and those for IFG were 24%, 86%, 19%, and 86% respectively. IGT sensitivity was greater than IFG sensitivity. xi Conclusion: There was a high prevalence of IGT, IFG and undiagnosed type 2 diabetes specifically among female patients. The ten percent difference of sensitivity between the two tests showed that the WHO diagnostic criteria produced more patients with the pathology than the ADA diagnostic criteria do. Patients attending the outpatient department of a level one hospital in Barkley West are at high risk of developing type 2 diabetes and remain unidentified, undetected, unscreened, undiagnosed and untreated. Obesity at primary health care level in the rural community of Barkley West needs to be addressed. . Keywords: Impaired glucose tolerance, prevalence, diabetes, screening, anthropometric measurements

Bakgrund En mer stillasittande livsstil med ett högre kaloriintag ökar riskerna för övervikt och andra metabola sjukdomar. För att förebygga och behandla dessa sjukdomar behöver vi bland annat förstå hur hungerkänslor regleras hos människan. Hur stor inverkan blodglukosnivåer har på hungerregleringen är dock omdiskuterat. Syfte Syftet med denna studie var att undersöka hur hungerkänslor och blodglukosnivåer förändras efter en måltid, jämfört med fasta. Kan den upplevda hungern påverkas genom periodisk fas-ta? Hur påverkar en invand måltidsrytm hungern? Hur påverkas hunger och blodglukos i för-väntan på en måltid? Metod Tolv friska testpersoner (7 män, 5 kvinnor) där sju stycken var vana vid periodisk fasta och fem inte var det, randomiserades in i två grupper där ena gruppen (Pi) fick äta en 600 kcal pizza medan den andra gruppen fick fasta (F). Blodglukosvärden och hungeruppskattningar registrerades var 30:e minut, förutom första värdet som registrerades 15 minuter innan pizzor-na serverades. Testpersonerna visste inte vilken grupp de skulle hamna i förrän 10 minuter innan pizzorna serverades. Resultat Fem timmar efter måltiden kunde ingen signifikant skillnad i blodglukossänkning observeras mellan grupperna. Hungern skiljde sig inte heller signifikant mellan grupperna. Endast Pi ökade dock signifikant i hunger (P = 0,05) jämfört med sina startvärden. Fastevana bidrog inte till en förbättrad hungerkontroll. Beskedet om vilken grupp testpersonerna skulle hamna i resulterade i att blodglukosnivåerna skiljde sig signifikant mellan grupperna (P = 0,05) när pizzorna serverades. Då sänktes blodglukosnivåerna hos Pi samtidigt som de höjdes hos F. Fyra av fem testpersoner i F och en testperson i Pi blev tydligt hungrigare vid tidpunkter då de vanligtvis brukade äta på. Slutsats Samband mellan absoluta blodglukosnivåer och hunger kunde inte hittas. Stark hunger kunde uppstå fastän dietär energi sannolikt fortfarande absorberades i tarmarna.Våra resultat indikerade därför att akut energitillgänglighet utgör en relativt liten del i den totala hungersignaleringen. En invand måltidsrytm såg ut att påverka hungern mer än vad måltiden i den här studien gjorde. Större fokus vid hungerreglering bör därför ligga på en re-gelbunden måltidsrytm. / Background The increasingly sedentary lifestyle of our society combined with a constantly rising caloric intake has elevated the risk of developing obesity and other metabolic diseases. There is a need to understand the underlying mechanisms of hunger regulation to effectively prevent and treat these diseases. The magnitude of which an active regulation of blood glucose has an influence on hunger regulation is rather controversial. Objective The objective of this study was to investigate how the changes in hunger and blood glucose levels may differ after a mixed meal compared to the fasting state. Research questions include: Does intermittent fasting reduce general hunger? How does an entrenched meal-pattern affect hunger? How does hunger and blood glucose change in anticipation of a meal? Method Twelve healthy subjects (7 men, 5 women), of which seven subjects regularly practiced intermittent fasting and the remaining five did not, were randomized into two groups, one group was eating pizza (Pi), and the other group was fasting (F). Blood glucose levels and hunger ratings were collected every 30 minutes, with exception of initial values that were collected 15 minutes prior to the serving of the pizzas. The subjects were unaware of which group they would be designated to until 10 minutes prior to the serving of the pizzas. Results Decline in blood glucose did not significantly differ between groups during the 5 hour window following the meal ingestion. Hunger ratings differed significantly between individuals but not between groups. However, only Pi had significantly elevated hunger ratings in the end of the test period compared to their initial ratings. In anticipation of the meal a significant change in blood glucose was observed between the groups (P = 0.05), where values dropped for Pi and rose for F. Four out of five subjects in F and one subject in Pi were considerably hungrier during time periods they reported as habitual eating occasion. Conclusion Correlations between absolute blood glucose levels and hunger could not be found. An equal rise in hunger appear regardless if subjects were fed or fasting, meaning significant hunger can appear although dietary energy still is absorbed into the blood stream. Thus our results indicate that the acute availability of dietary energy is only a relatively small part of the total hunger signaling process. A disrupted meal pattern seemed to affect hunger feelings more than the ingestion of the served meal. Thus we conclude that more research should focus on meal-pattern regulation to enable better hunger control.

This ex post facto correlational study seeks to identify if a relationship between blood glucose values and vasomotor instability intensity exists. The population consisted of a convenience sample of seven type 2 diabetic postmenopausal women experiencing vasomotor instability living in Southern Alberta. This study hypothesizes that a significant negative correlation would be identified between these two variables based on research done by Dormire and Reame (2003). The correlational results suggest that a small to moderate significant positive relationship exists between blood glucose and vasomotor instability: increased vasomotor instability was associated with increased blood glucose values. Overall, this study suggests a relationship exists between blood glucose and vasomotor instability but causality or direction of this relationship cannot be determined. Further research studies are recommended to clarify and validate this research. In particular, such a study should include type 1 diabetic postmenopausal women, a larger sample size, and sampling a wider geographical area. / ix, 109 leaves ; 29 cm.