Thesis (M.S.)--Oregon State University, 2005. / Printout. Includes bibliographical references (leaves 80-87). Also available via the World Wide Web.

Thesis (M. Nurs.)--University of Hong Kong, 2006.

Thesis (MFamMed)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Introduction: Diabetes is the most prevalent endocrinology problem encountered in primary care practice. If recent trends showing a dramatic increase in prevalence (believed to be a consequence of a decline in physical activity and excessive caloric intake) continue, then the condition will soon affect nearly 20 million people in the U.S a reflection of the global trend. Effective management requires care that is thoughtful and meticulous, incorporating intensive patient education. Euglycemic control, with the level of glycosylated haemoglobin (HbA1c) kept below 7.0mmol/L, has emerged as a major treatment objective because of its association with a marked reduction in the risk for micro vascular complications. The primary physician is in the unique position to provide comprehensive care to the diabetic patient. Setting: The aim of this study is to evaluate the profile of complications arising due to diabetes mellitus among adult diabetics attending internal medicine outpatient department and family medicine/primary care outpatient department in the Dora Nginza hospital, PE hospital complex. Method: The study is a descriptive retrospective study in which names of patients were collated from clinic records of both clinics, files sought at the records department covering the period between Jan 2007 and Jan 2008 inclusive. Prevalence of statistical variables was generated using frequency tables, bar graphs, cross tabulations and chi square test. Results: Hyperglycemia was the major complication which predominantly was associated with high haemoglobin A1c (HbA1c) levels. However, some hyperglycaemic cases were also found to be associated with normal HbA1c. Complications were found to be more in type 2 diabetics. Patients with hypertension, obesity, smoking and alcohol use were observed to have a higher risk of developing diabetic complications. The findings on retinopathy in this study was inconclusive in view of the fact that patients sent for fundoscopy did not return with documented results from the sister hospital PE provincial hospital. Family Medicine outpatient department overall did better in patient care compared to the Internal Medicine outpatient department. Conclusion: The challenge for the primary care physician is to design a therapeutic program that is safe practical and acceptable to the patient. The ultimate goal of therapy is the prevention of micro vascular and macro vascular complications, consequence of diabetes that makes the condition a major risk factor for cardiovascular disease, stroke, visual impairment, renal failure, impotence, peripheral neuropathy, limb loss and ultimately death. These can be averted through appropriate education of both hospital staff, patients and their care givers. The recommendations made are based on the findings of the study. / AFRIKAANSE OPSOMMING: Nie beskikbaar.

Made available in DSpace on 2014-06-11T19:27:44Z (GMT). No. of bitstreams: 0 Previous issue date: 2002Bitstream added on 2014-06-13T19:56:28Z : No. of bitstreams: 1 mascaro_ms_me_botfm.pdf: 349154 bytes, checksum: 7d7d2cd1ba98286e5abaf0798106ddfd (MD5) / A CTG anteparto é o teste mais utilizado para avaliar o bem-estar fetal, nas gestações complicadas pelo diabete, e seus resultados têm sido relacionados à qualidade do controle metabólico materno e ao prognóstico perinatal. Objetivos - Relacionar a qualidade do controle metabólico com os resultados da cardiotocografia (CTG) anteparto e avaliar sua capacidade preditiva no prognóstico perinatal de gestações associadas ao diabete. Sujeitos e Método - Estudo retrospectivo de 125 gestantes, portadoras de diabete gestacional ou clínico, no qual se relacionou a última CTG anteparto (intervalo máximo de 48 horas) à qualidade do controle metabólico materno e aos resultados perinatais. A qualidade do controle metabólico foi definida pela média glicêmica do dia do exame (MGd) e da gestação (MG) e pelo comportamento da requisição de insulina (R/insulina). Para os resultados perinatais foram analisados os índices de Apgar de 1º e 5º minutos, a classificação peso/idade gestacional, o tempo de internação, a necessidade de cuidados de UTI e a ocorrência de óbito neonatal (ONN) precoce. A capacidade diagnóstica da CTG anteparto foi avaliada pelos índices de sensibilidade (SENS), especificidade (ESP) e valor preditivo positivo (VPP) e negativo (VPN). Resultados - A MGd adequada (<120 mg/dL) evidenciou 2,9% dos resultados de CTG anteparto alterados e a inadequada ( 120 mg/dL), 26,1% (p<0,005). A MG mantida inadequada na gestação se relacionou a 13,7% de CTG anteparto alterada e a adequada, a apenas 2,7% (p<0,005). O comportamento da requisição de insulina não interferiu nos resultados da CTG anteparto. E, do mesmo modo, os índices de Apgar de 1º e 5º minutos, a necessidade de cuidados de UTI e a ocorrência de ONN não dependeram do último traçado da CTG anteparto... / The antepartum non-stress test (NST) is the most commonly used test to evaluate fetal well-being in pregnancies complicated by diabetes; its results being related to the quality of maternal metabolic control and perinatal prognosis. Objectives - To relate the quality of metabolic control to the results of the NST and to evaluate the predictive capacity for the perinatal prognosis of pregnancies associated with diabetes. Patients and Methods - This is a retrospective study of 125 pregnant women with gestational or clinical diabetes in which the last NST (maximum interval of 48 h) was related to the quality of maternal metabolic control and perinatal results. Quality of metabolic control was defined by the glycemic mean on the test day (GMd), glycemic mean during pregnancy (GM), and behavior of insulin requirement (Insulin/R). For the perinatal results, the following were evaluated: the 1st and 5th min Apgar scores; the gestational weight/age classification; the length of hospitalization; the use of neonatal ICU; and the occurrence of early neonatal death (END). Diagnostic capacity of the NST in relation to the perinatal results was evaluated by sensitivity and specificity values, positive predictive value (PPV), and negative predictive value (NPV). Results - The adequate GM (<120mg/dL) on the test day showed that 2.9% of the NST results were abnormal; the inadequate GM ( 120mg/dL) 26.1% (p<0.005). The maintained inadequate GM during pregnancy was related to 13.7% of abnormal NST; the adequate to only 2.7% (p<0.005). Insulin requirement behavior did not interfere with the NST. In addition, the 1st and 5th min Apgar scores, use of ICU, and occurrence of neonatal death did not depend on the last NST result. This test influenced the length of newborn (NB) hospitalization: the normal, 46.4% were discharged up to the 3rd day after birth ...(Complete abstract, click electronic access below)

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, 2013. / Submitted by Alaíde Gonçalves dos Santos (alaide@unb.br) on 2014-01-28T10:06:55Z No. of bitstreams: 1 2013_LeonardoGarciaMiranda.pdf: 1071732 bytes, checksum: 51442d23774396c03cd945e92d7948e2 (MD5) / Approved for entry into archive by Patrícia Nunes da Silva(patricia@bce.unb.br) on 2014-01-29T20:21:33Z (GMT) No. of bitstreams: 1 2013_LeonardoGarciaMiranda.pdf: 1071732 bytes, checksum: 51442d23774396c03cd945e92d7948e2 (MD5) / Made available in DSpace on 2014-01-29T20:21:33Z (GMT). No. of bitstreams: 1 2013_LeonardoGarciaMiranda.pdf: 1071732 bytes, checksum: 51442d23774396c03cd945e92d7948e2 (MD5) / Introdução / Objetivo: O presente estudo avaliou os efeitos do Sistema de Infusão Contínua de Insulina (SICI) na prática clínica do controle glicêmico, principalmente em pacientes diabéticos tipo 1 previamente tratados com múltiplas doses de insulina (MDI) comparando a hemoglobina glicada (A1C) e episódios de hipoglicemia antes e após o início terapia com o SICI. Pacientes e Métodos: Oitenta diabéticos (49 feminino, 31 masculino), com idade [média ± DP] 27,9 ± 15,4 anos, duração do diabetes de 13,6 ± 9,1 anos e índice de massa corporal (IMC) de 22,6 ± 3,7 kg / m²) participaram deste estudo de coorte clínica, observacional e prospectivo. Resultados: A coorte que mostrou diminuição na A1C após transferência do tratamento anterior MDI (8,1 ± 1,4%) para o SICI (7,3 ± 0,9%, P <0,0001), teve redução de 0,8%, favorecendo a terapia com o SICI. A coorte com diminuição (64% da coorte total) demonstrou redução na A1C (P <0,0001) de 8,73 ± 1,33% para 7,35 ± 0,99%, uma diferença de 1,4%. A média da A1C na coorte estável (9%) foi de 7,1%. A coorte com aumento (14%) teve piora da A1C de 6,87% para 7,54%. Hipoglicemia (eventos/paciente/mês) foi avaliada em 66 indivíduos antes e em uso do SICI. Na terapia com o SICI, as hipoglicemias graves diminuíram entre 61% na coorte total e 79% no grupo de A1c estável. Conclusão: A terapia com o SICI alcançou redução significativa dos episódios de hipoglicemia e melhora do controle glicêmico em curto prazo de acompanhamento e de sua implementação no Sistema Único de Saúde (SUS). Este estudo sugere que a terapia com o SICI é segura e eficaz em pacientes com diabetes e, quando bem selecionados, podem se beneficiar substancialmente do uso, razão pela qual o acesso a este não deve ser negado. _______________________________________________________________________________________ ABSTRACT / Introduction / Objective: This study examined effects of Continuous Subcutaneous Infusion (CSII) in clinical practice on glycemic control mainly in type 1 diabetic patients previously treated with multiple daily injection (MDI) comparing the glycosylated hemoglobin (A1c) and hypoglycemic episodes before and after initiation CSII therapy. Patient and Methods: A total of 80 patients (49 female, 31 male, age [mean ± SD] 27.9±15.4 years, duration of diabetes 13.6±9.1 years and body mass index (BMI) 22.6±3.7 kg/m²) participated in this observational prospective cohort study. Results: The data were analyzed for the entire cohort and 3 subgroups (decreases, stable, or increased A1C) stratified according to a ≥0.5% change in A1C. The total cohort demonstrated a decrease in A1C comparing previous MDI (8.1±1.4%) to CSII therapy (7.3±0.9% P < 0.0001), a difference of 0.8% favoring CSII therapy. The decreased cohort (64% of the total cohort) demonstrated a significant decrease in A1C (P < 0.0001) from 8.73±1.33% to 7.35±0.99%, a difference in A1C of 1.4%. The mean A1C of the stable cohort (9%) was 7.1%. The increased cohort (14%) had an increase in A1C from 6.87% to 7.54%. The rate of Hypoglycemia (events/patient/month) was verified in 66 subjects before and on CSII therapy. On CSII therapy, the rate of severe hypoglycemia decreased among 61% in the total cohort and 79% in the stable A1C group. Conclusion: CSII therapy achieved significant hypoglycemia reduction and glucose control in the short term follow-up of its implementation in Unified Health System (UHS). This study suggests that CSII therapy is safe and effective in patients with diabetes and, when properly selected, can benefit substantially from the use of CSII, which is why access to this treatment should not be denied.

Class of 2006 Abstract / Objectives: To examine the manner in which the DTSQ was used with a variety diabetic populations in different countries. The DTSQ is an 8 item questionnaire assessing satisfaction with diabetes treatment (6 items) and 2 items on glycemic control. Methods: Intensive search of published scientific literature was conducted to identify studies in which the DTSQ has been used in different countries. Data was extracted from each study on the following variables: country, ethnicitiy, DTSQ scores, Hg A1cgender, treatment, type of diabetes, and education level. Results: A total of twenty-four studies reporting the use of the DTSQ were identified. The majority studies (14/24) were treatment comparisons. The other studies were various other questions investigated. T he DTSQ was used for studies ranging in size from 15 to 1918 (mean 436.3 (SD=541.4) The DTSQ was used with patients who had thye 1, type 2, and gestational diabetes. Average HgA1c level was 7.6, and average DTSQ score was 29.9. Most studies did not describe the educational or ethnic background of their study participants. Most of the studies (18) were done in Europe with ten in the United Kingdom, two were in the USA, one in New Zealand, one in Nigeria, one in Canada, and one in Israel and Slovenia combined. Conclusions: The DTSQ appears useful with a variety of patient populations, although little information was presented on population characteristics.

Chronic diabetic patients have a higher incidence of and mortality from cardiac disease. A wide spectrum of cardiac problems plague the chronic diabetic including coronary artery disease, congestive heart failure and diabetic cardiomyopathy. Cardiac disease in the diabetic is not simply due to accelerated atherosclerosis alone, but is also due to a combination of microangiopathy, autonomic neuropathy, and various other factors which produce biochemical, functional and structural alterations in the heart. Recently, cardiac function was studied in animals with experimentally-induced diabetes and cardiac-dysfunction was reported in acute as well as chronic phases of experimental diabetes. Since cardiac disease is a consequence of long-standing diabetes in diabetic patients, investigation of myocardial function at various time points after induction of experimental diabetes would yield information regarding the development and progression of cardiac dysfunction in diabetes. We. therefore investigated cardiac function and pharmacology in isolated perfused working hearts obtained from 7, 30, 100, 180, 240 and 360-day alloxan and streptozotocin (STZ) diabetic and age-matched control hearts. Diabetes was induced in the rat by injecting either alloxan (65 or 40 mg/kg) or STZ (50 or 60 mg/kg) into the tail vein. Diabetic and age-matched control rats were sacrificed at various time points after the induction of diabetes and hearts were isolated and perfused on a working heart apparatus. Cardiac function was studied at various left atrial filling pressures and was expressed in terms of left ventricular developed pressure (LVDP), rate of rise of left ventricular pressure (positive dP/dt) and rate of decline of left ventricular pressure (negative dP/dt). Dose-response curves to carbachol and isoproterenol were also performed. Blood samples were collected at the time of sacrifice, serum was separated and analyzed for insulin and glucose content. Both alloxan and STZ produced diabetes in the rat as shown by fasting hypoinsulinemia and hyperglycemia. Cardiac function was not altered in 7-day alloxan and STZ diabetic rats. Depressed function at various left atrial filling pressures was seen in hearts isolated from 30-day alloxan diabetic rats but not in 30-day STZ diabetic rats. Hearts isolated from 100-day alloxan and STZ diabetic rats, 180- and 360-day STZ diabetic rats and 240-day alloxan diabetic rats, all exhibited cardiac functional abnormalities. Cardiac functional abnormalities observed in d.iabetic rats were, depressed >LVOP and -positive«.and negative dP/dt at high left atrial filling pressures. Diabetic rat hearts exhibited no change in either sensitivity or responsiveness to the negative inotropic effect of carbachol at 7 and 30 days after induction of the disease. A sub-sensitivity to carbachol was observed in diabetic rat hearts at 100 days after induction of diabetes as compared to age-matched control rat hearts. However, 180- and 240-day diabetic rat hearts exhibited supersensitivity to the negative inotropic effect of carbachol. Isoproterenol produced an identical positive inotropic effect in control as well as diabetic rat hearts at all of the time points studied. However, the maximum changes produced by isoproterenol in negative dP/dt of diabetic rat hearts were depressed at various time points as compared to those in age-matched control rat hearts. We also studied the effect of isoproterenol on the cyclic AMP content and phosphorylase a activity in hearts obtained from 3 and 100 to 120 day control and diabetic rats. Basal cyclic AMP content and phosphorylase a activity were not altered in acute and chronic diabetic and age-matched control rat hearts. Isoproterenol produced similar time- and dose-dependent changes in cyclic AMP content and positive and negative dP/dt in isolated perfused working hearts obtained from 3 and 100 to 120 day control and diabetic rats. However, isoproterenol caused a significantly greater activation of phosphorylase enzyme in hearts isolated from 3 and 100 to 120 day diabetic rats as compared to age-matched controls. Diabetic rat hearts had a significantly higher total phosphorylase activity at 100 to 120 days as compared to age-matched controls. Prostaglandin E₁, a drug which increases cyclic AMP content without altering phosphorylase a activity in perfused rat hearts, increased phosphorylase a activity in acute as well as chronic diabetic rat hearts but not in control rat hearts. Cholinergic muscarinic receptors in the ventricles obtained from 180-day control and STZ diabetic rats were studied by performing radioligand binding studies. [³H]NMS was used as a radioligand to stereospecifically label all of the muscarinic receptor binding sites present in the ventricular membrane preparation. There was no change in either the receptor density or in the binding constants for antagonists and agonists at the muscarinic receptor site in 180-day diabetic rat hearts as compared to control. Ventricular noradrenaline content was estimated using an HPLC method, in 180-day alloxan and STZ diabetic and age-matched control rat hearts. There was no significant change in the noradrenaline content of diabetic rat hearts. Results obtained in the above studies demonstrate that various functional, pharmacological and biochemical alterations occur in the heart in experimental diabetes. Depressed cardiac performance was observed in isolated perfused diabetic rat hearts at various time points after the induction of diabetes and may represent the preclinical ventricular dysfunction phase of a developing diabetic cardiomyopathy. Changes noticed in the sensitivity of the.diabetic myocardium towards the negative inotropic effect of carbachol may represent various stages of a parasympathetic autonomic neuropathy of the heart in diabetes. The unaltered positive inotropic effect of Hsoproterenol and unchanged noradrenaline content in diabetic rat hearts indicate the absence of a sympathetic autonomic neuropathy. The depressed cardiac relaxant effect (maximum changes produced in negative dP/dt) of isoproterenol in diabetic rat hearts suggest defects in cardiac muscle relaxation, Ca²⁺ handling by the sarcoplasmic reticulum and perhaps ATP production and utilization. The enhanced sensitivity of the phosphorylase enzyme to agonists in diabetic rat hearts may be an outcome of alterations in Ca²⁺ homeostasis and other acute metabolic derangements in the heart caused by diabetes. All these changes could contribute to the pathogenesis of a diabetic cardiomyopathy. / Pharmaceutical Sciences, Faculty of / Graduate

Diabetic individuals have been found to have consistently higher levels of a minor hemoglobin component, HbAIc, than non-diabetic individuals. Previous investigators have suggested that variation in these high levels of HbAIc may be a reflection of the degree of diabetic hyperglycemia, of hypertriglyceridemia in diabetes, and of diabetic control. To date, evaluation of HbAIc as a clinically useful parameter has been hampered by the complexity of the method of measurement, the inconsistency in ranges of normal values reported, and the lack of a broad data base for comparison with new results. This investigation began with a critical appraisal of the methods currently in use for measurement of HbAIc, followed by a simplification and standardization of theJ assay. Then the levels of HbAIc in 16 non-diabetics and 47 diabetics were determined and the mean values for these 2 groups compared. The relationships between HbAIc levels in the diabetics and selected clinical data |fasting blood sugar, 24-hour urinary sugar, age,duration of illness, dietary record, insulin dosage, and family history of diabetes) were examined. Finally, the degree of diabetic control in each of the diabetic patients was estimated by the attending physician on a scale of 1 to 5 (1=very good, 2=good, 3=fair, 4=poor, 5=very poor) and was compared with the HbAIc measurement. Results of the investigation have shown that the chromatographic measurement of HbAIc is unusually sensitive to the pH of developers used and also somewhat variable with respect to the length of storage time and the optical density at which samples are read. The comparison of mean values of HbAIc for diabetics and non-diabetics has confirmed the approximately twofold higher concentration of HbAIc in diabetics. Significant correlations were found between HbAIc and fasting blood sugar (r = .442), fat content of diet (r=-. 300) , family history of diabetes (r=-.312) and degree of diabetic control (r=.529). Thus, HbAIc values tend to be higher in patients whose fasting blood sugar is high, whose diet contains relatively little fat, whose relatives are diabetic and /or whose diabetic control is poor. Correlations between HbAIc and duration of diabetes, HbAIc and insulin dosage or HbAIc and 24-hour urinary sugar were not statistically significant (r=-.131, r=-.264, r=„067, respectively). The HbAIc level appears to be an accurate reflection of fasting blood sugar levels averaged over a prolonged period of time (r=.587). In conclusion, HbAIc levels were found to provide an objective measure of diabetic control. The improved assay method makes it a practical and valuable tool for the clinician as well as the investigator. Measurement of HbAIc levels in diabetics presents a considerable advantage over currently available measures of diabetic control in assessing the long-term effectiveness of diabetic management. / Land and Food Systems, Faculty of / Graduate

Thesis (MPH) -- University of Limpopo, 2015 / BACKGROUND: Diabetes mellitus (DM) is a chronic lifestyle disease without a cure, and medical emphasis is on management to avoid short and long term diabetes related problems/complications. It is very important for patients to be knowledgeable on the role of diet, physical exercise and self-monitoring. The main objective of this study was to determine the knowledge, attitudes and practices of the diabetes mellitus patients about the benefit of physical activity. METHODOLOGY: The was a cross sectional descriptive study that assessed the knowledge, attitudes and practices amongst diabetes mellitus patients on physical activity at Block 6 clinic in Gaborone, Botswana. The researcher administered questionnaires with individual patients to investigate how well they understood their condition, their attitude towards exercise and the extent to which they have adopted exercise as part of their diabetes control. A total of 140 diabetic patients participated in the study. RESULTS: The results of the study revealed that participants had good knowledge of symptoms of diabetes (97.9%), complications that can result when diabetes is not well controlled (76.4%) and urine analysis test (65%). The results also showed that majority of the participants had fair knowledge (62.1%) and only (20.0%) had good knowledge; (89.4%) had positive attitude, and only 10.6% had negative attitude towards physical exercise. The results show that 59.6% had low level of physical activity, 31.3% did not exercise, whilst only 9.1% reported that they exercised adequately. CONCLUSION The study reveals a variation between diabetes related health knowledge, attitude, and practice in among those who are affected by diabetes. The knowledge and practice levels were relatively low. Nevertheless majority of the study participants had positive attitude towards Physical Activity. Keywords: Diabetes, knowledge, attitude, Practice, Physical

Individuals with diabetes face many multifaceted issues when integrating their plan of care into their daily lives, which can become burdensome and lead to inadequate diabetes control. Due to the persistent demands of diabetes management, screening for psychosocial factors that can impact control, such as depression, anxiety, and diabetes-related distress (DRD) should occur routinely (American Diabetes Association [ADA], 2017). DRD is distinctly different from depression in that the focus is on the burden experienced due to the rigorous treatment regimen associated with diabetes. DRD focuses on the self-management demands, complications, comorbidities, and lack of perceived social support (ADA, 2019). DRD can affect treatment compliance and lead to negative health outcomes, including more frequent hospitalizations and higher healthcare costs. Therefore, early screening and detection of psychosocial factors influencing management is essential to prevent health complications and deterioration. The purpose of this practice improvement project was to implement DRD screening in a rural North Dakota clinic. Rural providers were educated on DRD and the use of an evidenced-based screening tool called the Problems Areas in Diabetes (PAID) scale. This self-report scale allows providers to make appropriate referrals to diabetes educators, dieticians, and mental health professionals, which may result in individualized treatment plans and improved outcomes. The project implementation was comprised of an educational session focused on DRD that included a pre- and post-test, as well as return skill demonstration where attendees were asked to score a mock patient’s PAID scale. Following the educational session, the PAID scale was implemented at diabetic appointments for a three-month period. Positive PAID scale results were monitored to determine if the positive screenings resulted in a referral or additional resources. Twenty-four scales were completed by patients during the project, resulting in 30 referrals for additional support. Additionally, an increase in healthcare provider knowledge related to DRD evaluation and management was identified. The provision of DRD education and implementation of the PAID scale in this rural primary care clinic enabled patients within the community to receive evidence-based, individualized care, which may potentially reduce complications, as well as improve diabetes control and overall patient health.