Bakgrund: Diabetes typ 1 är en autoimmun sjukdom som främst drabbar barn och ungdomar. Sjukdomen innebär total insulinbrist och behandling sker främst genom egenvård i form av blodsockerkontroller och administrering av insulin. Sjuksköterskan spelar en stor roll i diabetesvården och genom motivation, kost- och motionsrådgivning samt undervisning ges bättre förutsättningar för egenvården.  Syfte: Syftet med denna litteraturstudie var att beskriva tonåringars upplevelser av att leva med diabetes typ 1 samt att beskriva hur vald litteratur presenterar undersökningsgrupperna i studierna. Metod:En deskriptiv litteraturstudie. Tolv artiklar med både kvalitativ och kvantitativ ansats har analyserats och delats upp i teman och subteman.   Huvudresultat: Många tonåringar beskrev en svårighet i att acceptera sin diabetes. De upplevde en känsla av att vara annorlunda som innebar att de undvek att sköta sin diabetes offentligt. Känslan att vara annorlunda försvann när tonåringarna umgicks med personer som också hade diabetes. Många tonåringar upplevde även en känsla av oro, främst för hypoglykemi. Gällande egenvården upplevde många tonåringar en önskan om självständighet som togs över av osäkerhet och okunskap i egenvård. Tonåringarna hade också en önskan om en personlig kontakt med sitt diabetesteam inom vuxenvården.  Slutsats: Tonåringar uttrycker ett behov av en personlig relation i vården samt en förståelse för sjukdomen i vardagen. Genom en ökad förståelse kan sjuksköterskan möta tonåringarnas behov och genom detta få en bättre vårdrelation. En god vårdrelation kan innebära att tonåringar med trygghet kan uttrycka sina behov på ett bättre sätt. Tryggheten kan också innebära att tonåringen har en större acceptans för sjukdomen samt vågar vara mer öppen med sin sjukdom.

Magister Public Health - MPH / This study determined the affordability of medicines for diabetic patients attending the diabetic clinic of the University of Nigeria Teaching Hospital (UNTH), Enugu. The Study was a cross-sectional time-delimited, descriptive study of affordability of Medicines for diabetic patients aged >18 year s 18 years and who pay for medicines out of pocket. A structured questionnaire was used to collect sociodemographic information about patients and the prescription was assessed in terms of conformity with essential medicines list (EML), cost and ability to be completely filled by the patient. Data was analysed using EPI Info software.the results show that medicines prescribed for diabetes are unaffordable to the majority of patients who attend the UNTH diabetic clinic. / South Africa

Determina la efectividad de un programa educativo en el nivel de conocimientos sobre prevención de la diabetes mellitus tipo 2 en niños del nivel primario. Estudio de enfoque cuantitativo, nivel aplicativo y diseño pre-experimental. La población conformada por 113 niños del nivel primario de la Institución Educativa Newton, San Martin de Porres Lima, de los cuales 50 son del cuarto grado y 63 del quinto grado. Se utiliza como técnica la encuesta y como instrumento un cuestionario para determinar el nivel de conocimiento que tiene como valores finales: alto, medio y bajo. Proporciona información válida y confiable a la institución educativa a fin de que puedan continuar con el programa y favorecer conductas y hábitos saludables para prevenir enfermedades metabólicas en los escolares. / Tesis

A prominent finding in the diabetic rat heart is a decrease in the rate at which the ventricular muscle can contract and relax. Since cardiac sarcoplasmic reticulum is thought to be intimately involved in muscle contraction and relaxation we studied the ability of diabetic rat cardiac sarcoplasmic reticulum to transport Ca²⁺ . Hearts were obtained from female Wistar rats 7, 30, 42, and 120 days after the induction of diabetes by a single i.v. injection of either alloxan (65 mg/kg) or streptozotocin (60 mg/kg). At all Ca²⁺ concentrations tested (0.2 μM-5.0 μM free Ca²⁺) cardiac sarcoplasmic reticulum obtained from 42 and 120 day diabetic rats showed a significant decrease in the rate of ATP-dependent tns-oxalate facilitated ²⁺ransport. This was accompanied by a decrease in Ca²⁺ -ATPase activity. The levels of long chain acylcarnitines associated with the microsomal sarcoplasmic reticulum preparation from 42 and 120 day diabetic rats were significantly higher than those present in sarcoplasmic reticulum from control rats. Palmitylcarnitine, the most abundant of the long chain acylcarnitines, in concentrations < 7 μM was found to be a potent time-dependent inhibitor of both Ca²⁺ transport and Ca²⁺ -ATPase in both control and diabetic rat sarcoplasmic reticulum preparations; inhibition of Ca²⁺ transport was found to be more marked in the control preparations. This would indicate that a degree of inhibition produced by the high endogenous levels of palmitylcarnitine may already be present in the diabetic rat heart preparations. Cardiac sarcoplasmic reticulum prepared from acutely diabetic rats (7 days) did not show any decrease in Ca²⁺ transport ability. Levels of long chain acylcarnitines associated with the microsomal preparation enriched in sarcoplasmic reticulum were also unchanged. Insulin treatment of diabetic rats could significantly increase the ability of cardiac sarcoplasmic reticulum to transport Ca²⁺, although at the time period obtested (30 days) the SR Ca²⁺ transport activity was only slightly depressed as compared to control. Insulin treatment also resulted in a slight, but non-significant, lowering of the levels of long chain acylcarnitines associated with the sarcoplasmic reticulum microsomal preparations. These findings suggest that the alteration in sarcoplasmic reticulum function in chronically diabetic rats may be due to the buildup of cellular long chain acylcarnitines which inhibit sarcoplasmic reticulum Ca²⁺ transport. The absence of any significant change in Ca²⁺ transport activity or levels of long chain acylcarnitines at 7 and 30 days suggests that the alterations in 42 and 120 day diabetic rats must be of gradual onset. Cardiac sarcoplasmic reticulum is known to be regulated by a number of factors, among them calmodulin, cAMP-dependent protein kinase, and K⁺. Since Ca²⁺ transport activity in cardiac sarcoplasmic reticulum from chronically diabetic rats is depressed, the role that these regulators play was investigated. Calmodulin (0.61 μM), cAMP (10 μM) plus cAMP-dependent protein kinase (0.2 mg/0.5 ml), and K⁺ (0-110 mM) all stimulated Ca transport in both control and streptozotocin-treated diabetic rats to the same degree. This suggests that the depression observed in sarcoplasmic reticulum function from diabetic rats is not due to altered regulation by these putative mediators of Ca²⁺ uptake. A number of studies suggest that carnitine administration may lower myocardial levels of long chain acylcarnitines in the diabetic rat. Therefore, D,L-carnitine (1 g/kg/day, orally) was administered to 120 day diabetic rats for a 30 day period. The elevated levels of long chain acylcarnitines normally seen in diabetic rats were significantly reduced in the diabetic rats administered carnitine. Carnitine administration, however, could not reverse the previously noted depression in diabetic rat heart function, as measured on an isolated working heart apparatus. In an effort to prevent the onset of the diabetic cardiomyopathy D,L-carnitine was administered (3 g/kg/day, orally) 3 days after the induction of diabetes for a 42 day period. As previously mentioned, sarcoplasmic reticulum Ca²⁺ transport activity was depressed in diabetic rats, as compared to control rats, at all free Ca²⁺ concentrations tested (0.1 μM-3.5 μM). Similarly, sarcoplasmic reticulum levels of long chain acylcarnitines were significantly elevated in these diabetic rats. The diabetic rats treated with carnitine did not show any depression in Ca²⁺ transport activity; long chain acylcarnitine levels were also similar to control. The carnitine-treated diabetic rats, however, showed no improvement in heart function compared to untreated-diabetic rats. These data suggest that although the long chain acylcarnitines are inhibiting cardiac sarcoplasmic reticulum function in chronically diabetic rats other factors must also be contributing to the depression in heart function. / Pharmaceutical Sciences, Faculty of / Graduate

The nature and extent of myocardial ischemic injury (Mil) produced either by coronary artery ligation/reperfusion or by injection of isoproterenol (ISO) was studied in the 10-week alloxan-diabetic rabbit. Prior to the induction of ischemic injury, investigation of the left ventricles of the diabetic rabbit after 10-weeks revealed significant magnesium depletion and inhibition of myofibrillar and sarcoplasmic reticulum ATPase activities. In addition, the activity of the lysosomal enzyme, N-acetyl-β-glucosaminidase was significantly increased in diabetic left ventricular homogenates. Ultrastructural studies revealed significant lipid and glycogen accumulation, dilatation of the sarcoplasmic reticulum and damage to the mitochondria in left ventricles of the diabetic animals. Administration of ISO to both control and diabetic animals resulted in atrial tachycardias and ventricular fibrillation. The severity of the arrhythmias and the overall mortality was the same in both groups of animals. Serum analyses revealed significantly greater increases in blood glucose, free fatty acids, total cholesterol and creatine kinase activity in the ISO-treated diabetic animals relative to ISO-treated controls. ISO treatment of both control and diabetic animals produced similar increases in heart weight, left ventricular weight and myocardial water content. Analyses of various subcellular organelle marker enzyme activities indicated a significantly greater decrease in the K⁺ ,Ca²⁺ -stimulated sarcoplasmic reticulum ATPase of ISO-treated diabetic animal hearts. In addition, significantly greater increases in Ca and hydroxyproline and decreases in the levels of ATP were evident in the ISO-treated diabetic animal hearts. Ultra-structural studies revealed significant damage to the mitochondria in both ISO-treated control and diabetic hearts, the magnitude of the damage being greater in the diabetic animals. Mitochondria from both groups of animals showed swelling and fragmentation, myofibrils appeared as a homogeneous mass and did not show the characteristic Z-lines. Glycogen depletion and lipid accumulation was observed in both groups of animals. In addition, both groups of animals showed amorphous dense bodies in the mitochondria after ISO-treatment. After 40-minutes occlusion of the left circumflex coronary artery followed by 60-minutes of reperfusion, hemodynamic measurements revealed significant decreases in the left ventricular and systemic arterial pressures in the diabetic animals relative to controls. Analyses of subcellular organelle enzymes from the ischemic tissue revealed that sarcolemmal Na⁺ ,K⁺ -ATPase, mitochondrial ATPase and sarcoplasmic reticulum ATPase activities were decreased after coronary occlusion in both control and diabetic animals. However, upon reperfusion, unlike the control, no recovery of the mitochondrial ATPase was observed in the diabetic animals. In addition, a further depression of both the sarcolemmal and sarcoplasmic reticulum ATPase activities were seen in the diabetic animals compared to controls on reperfusion. Ion measurements revealed a significant accumulation of calcium in both control and diabetic animals, the magnitude of the increase being greater in the diabetic animals. Similarly, both tissue ATP levels and the ability of the mitochondria to generate ATP were depressed in the diabetic animals as compared to controls following coronary artery occlusion and reperfusion. Following coronary artery ligation and reperfusion, the diabetic animals showed a significantly higher incidence of ventricular fibrillation and cardiogenic shock as compared to controls. Ultrastructural studies revealed myocardial damage to both control and diabetic hearts following coronary artery ligation and reperfusion. However, the diabetic myocardium showed a higher incidence and frequency of hypercontraction bands, an increase in the amorphous dense bodies and slightly greater damage to the mitochondria. Coronary artery ligation in conscious control, 6 and 12 week-diabetic rats resulted in post-ligation arrhythmias (especially ventricular fibrillation), the incidence of which was much greater in the diabetic animals. The mortality rate of 12-week diabetic rats undergoing coronary ligation was 100% within 1-7 minutes following ligation. No differences in occluded or infarcted zones of the surviving 6-week diabetic and control rats were detected. Analyses of ionic composition revealed a significant magnesium deficiency in the diabetic hearts as compared to controls. These data indicate that the diabetic animals show a greater susceptibility of the myocardium to ischemic injury. Although numerous metabolic and chemical alterations are present in the diabetic myocardium, it is possible that magnesium deficiency may be a factor determining the higher incidence of arrhythmias and ischemic injury in diabetic animals. / Pharmaceutical Sciences, Faculty of / Graduate

Diabetes is known to result in a large number of alterations which affect various systems and organs. One of the more prominent disorders associated with diabetes is that of cardiac disease. Clinically, diabetics suffer from morbidity and mortality of cardiac origin to a greater extent than the nondiabetic population. Various functional studies have also revealed that the efficiency of diabetic hearts to function as pumps is lower than that of normal hearts. Experimentally, myocardial function of either rats or dogs made diabetic with either streptozotocin (STZ) or alloxan has been studied and a depression clearly demonstrated in both the species. The abnormalities of cardiac function in experimental diabetes are accompanied by depression of various enzyme systems in the heart. These include the ability of the sarcoplasmic reticulum (SR) to take up calcium; the myosin and actomyosin ATPase activities; and the Na⁺, K⁺ ATPase activity. All these changes can be prevented and reversed by insulin treatment suggesting that the myocardial problems seen in STZ or alloxan diabetic animals are due to diabetes and not direct toxicities of the drugs. It is not known whether the beneficial effects of in vivo insulin treatment are due to its direct myocardial effects or whether they are secondary to its effects mediated via normalisation of metabolism in diabetic animals. Thus, in the first part of the present investigation, we examined the direct effects of insulin on hearts from either control or diabetic rats using the isolated working heart preparation. Rats made diabetic with STZ (55 mg/kg) were sacrificed either 3 days or 6 weeks after induction of the disease and their hearts isolated and perfused in the working heart mode. Glucose concentrations varying from 5mM to 20mM were used in the perfusion medium, either in the presence or absence of insulin (5mU/mL). Left ventricular function was expressed as left ventricular developed pressure (LVDP) and the rates of contraction and relaxation (positive and negative dP/dt respectively) at various left atrial filling pressures. Three days after injecting STZ into rats, the animals exhibited hypoinsulinemia, hyperglycemia and their body weights although not significantly different from those of control animals, tended to be lower than the body weights of controls. Animals treated in this manner did not exhibit depression of cardiac function when compared with the myocardial function of control rats. Hearts from control rats exposed to regular insulin in the presence of 5mM glucose exhibited values of contractility which were significantly greater as compared with those obtained from control rat hearts not exposed to the hormone. When insulin was perfused along with a higher concentration of glucose (10mM), function of control rat hearts was affected to a significant extent. As opposed to the effects on control rat hearts, insulin failed to increase contractility in hearts from 3 day diabetic rats when either 5 or 10mM glucose was used in the perfusion medium. The study was then repeated using animals which had been diabetic for six weeks. At the time of sacrifice, these animals were hypoinsulinemic, hyperglycemic and weighed significantly less than their age-matched controls. Analysis of cardiac function revealed a significant depression in diabetic rats as compared with controls. Increasing glucose concentrations from 5 to 20mM in the perfusion medium did not affect the function of either control or diabetic rat hearts. Perfusion with regular insulin increased contractility in control rat hearts; the increase in contractility was not affected by increasing the glucose concentration from 5 to 10mM. However, contractility of diabetic rat hearts was not affected by insulin perfusion when either 5 or 10mM glucose was used in the perfusion medium. In order to eliminate the possibility of involvement of glucagon (which may contaminate commercial insulin preparations) in the effects of insulin on control rat hearts, part of the study was repeated using glucagon - free insulin. While the glucagon - free insulin increased contractility in control rat hearts, diabetic rat hearts were not affected. These results are identical to those obtained with regular insulin, suggesting that the effects of insulin observed were due to insulin itself. Although insulin treatment prevents and reverses diabetes - induced myocardial alterations in the rats, due to its widespread metabolic effects, it is not a good tool for investigating the specific factors which cause the cardiac abnormalities. In addition, a major problem with insulin treatment clinically is the fact that hypoglycemia can be associated with it, inadequate control occurs in some diabetics and secondary complications, such as myocardial problems, occur despite insulin treatment. It is thus desirable to have treatments which selectively affect certain aspects of diabetes so that the suspected underlying causes can be corrected specifically and their significance in causing the myocardial problems assessed. It would also be useful to have drug treatments which could either substitute for insulin or could be used in addition to the peptide. We have thus studied the effectiveness of certain treatments in preventing diabetes - induced myocardial alterations. The first one used was methyl palmoxirate, a fatty acid analog which is reported to reduce blood glucose levels in diabetic rats and dogs. The glucose - lowering effect is mediated via inhibition of fatty acid metabolism due to inhibition of carnitine acyl transferase resulting in inhibition of acyl carnitine formation and eventually inhibition of fatty acid transport across the mitochondrial membrane. Rats were treated with the drug (25mg/kg/day p.o.) three days after they were injected with either STZ or buffer. The treatment was carried out for 6 weeks and cardiac performance was then assesed. Untreated and treated diabetic rats were hypoinsulinemic, hyperglycemic and hyperlipedemic at the time of sacrifice. Cardiac function, which was depressed in diabetic animals, was still depressed despite the methyl palmoxirate treatment. However, the ability of the myocardial sarcoplasmic reticulum (SR) to take up calcium, which was depressed in diabetic rats, was normal in treated diabetic rats. Also, the levels of long chain acyl carnitines (LCAC) in the myocardial SR were normalised by methyl palmoxirate treatment in diabetic rats. In an effort to normalise diabetes - induced myocardial alterations in rats, we then attempted a combination of either methyl palmoxirate or carnitine (as both can prevent the depression of SR calcium uptake) with thyroid hormone treatment (as it can normalise myosin ATPase depression in diabetic rat hearts). The treatment protocol was identical to that described above (30µg/kg/day s.c. T₃ was used). Although the general features of both control and diabetic animals were not affected by either of the combination treatments, cardiac dysfunction in diabetic rats was prevented by methyl palmoxirate and T₃ treatment. Carnitine and T₃ treatment, on the other hand, affected the function of diabetic rat hearts only at the lower left atrial filling pressures. These results suggest that the combination treatment of methyl palmoxirate and T₃ affect parameters besides SR calcium uptake and myosin ATPase. This is because the combination of carnitine and T₃, which also supposedly affects same parameters as the other combination, could not prevent the myocardial alterations. One of the possible reasons for the effectiveness of the combination of methyl palmoxirate and T₃ could be that animals treated with methyl palmoxirate derived at least part of their metabolic energy (especially at higher left atrial filling pressures) from glucose and thus reduced the oxygen demand at higher filling pressures as opposed to the untreated diabetic rat hearts which depended completely on fatty acids for their metabolic energy demands. / Pharmaceutical Sciences, Faculty of / Graduate

Orientador: Vera Maria Santoro Belangero / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-07-20T19:39:24Z (GMT). No. of bitstreams: 1 Britto_AnnaCristinaGervasiode_M.pdf: 2910677 bytes, checksum: c8c413dd7402885eebaa91537dcecad5 (MD5) Previous issue date: 1995 / Resumo: Com o objetivo de se determinar os valores discriminatórios de normalidade para a excreção urinária de albumina em concentração não detectável por métodos habituais, designada de excreção de microalbuminúria, foram avaliadas 76 crianças de ambos os sexos, com 6 a 16 anos de idade. Para serem incluídas no estudo, além da permissão da família, era necessário que tivessem peso, altura e pressão arterial adequados à idade e sexo, não presentassem qualquer antecedente de doença renal, possuissem níveis séricos normais de creatinina e tivessem o sedimento urinário normal na época da coleta de urina para avaliação a microalbuminúria. Esta, foi avaliada em duas amostras noturnas através do método de radioimunoensaio de duplo anticorpo. Os resultados mostraram que a distribuição das frequências dos valores das amostras não apresentava um padrão de distribuição do tipo normal (teste de Kolmogorov Smimov- KS) o que foi modificado quando se utilizaram os respectivos valores dos 10garitmos (KS). Embora tenha.havido variação entre os valores das duas amostras para um mesmo indivíduo, estas diferenças não foram estatísticamente significativas, permitindo que se utilizasse a média aritmética dos valores das duas amostras para outras comparações. Desta forma não houve diferenças significativas entre os sexos, ocorrendo, no entanto, diferença significativa quanto à faixa etária. Considerando-se o percentil 95 como discriminatório, os valores de normalidade para crianças de 6 a 11 anos, inclusive, foi de 8,70 Ilglmin e para crianças de 12 a 16 anos inclusive, de ambos os sexos foi de 10,85 Ilglmin, ressaltando-se que estes são valores que correspondem à média de duas amostras. A aplicação destes resultados a um grupo de 42 crianças diabéticas de 6 a 16 anos de idade e com tempo de doença de 1 a 10 anos, acompanhadas no Ambulatório de Diabetes Infantil do HC-UNICAMP, mostrou que a prevalência de pacientes microalbuminúricos foi de 3/42 (7,1 %), sendo que nestes 3 casos o tempo de doença foi maior que 5 e menor que 10 anos e a idade mínima dos pacientes foi de 11 anos / Abstract: Seventy six healthy children aged 6 to 16 years were studied to estimate the discriminatory levels of urinary albumin excretion rate (AER). They all have normal weight, height, blood arterial pressure, serum creatinine and urinary sedimento The urinary albumin excretion was determined in two overnight urine samples, by double-antibody radioimmunoassay (Pharmacia, Albumin-RIA). Since the results of the urinary albumin excretion rate were not normally distributed, they were logarithmically transformed before statistical analysis. So, the Kolmogorov - Smirnov two sample test showed that the distribuition became as normal. To compare the samples by the same subject was used the Wilcoxon test. All tests used the significance level of 5%. Urinary albumin excretion rate was not related to the sex of the subjects, but there was significantly difference between children aged 6 to II and that ones 12 to 16 years. It was considered as discriminatory the values of the 95th percentil. So, for healthy children aged 6 to 11, for both sexes, this value was 8,70 ug/min and it was of 10,85 ug/min for those ones aged 12 to 16 years. These results were defmed as the mean of two samples of AER. Applying these results in a group of diabetics pacientes aged 6 to 16 years, with 1 to 10 years of disease, of the Diabetic Ambulatory of the Clinical Hospital of UNICAMP, it was met 3 pacients as "microalbuminurics". All of them were more than 11 years old and their disease last from 5 to 10 years / Mestrado / Pediatria / Mestre em Medicina

A incidência do Diabetes Mellittus apresenta-se crescente no mundo todo, principalmente, devido à mudança no estilo de vida. A atividade física associada à alimentação balanceada é o tratamento mais indicado para o controle do diabetes, porém ainda há divergências nas recomendações e evidências científicas sobre a prescrição do exercício para indivíduos diabéticos. Esta pesquisa teve como objetivo comparar os efeitos fisiológicos do treinamento em esteira e do treinamento resistido na intensidade do limiar anaeróbio em indivíduos diabéticos tipo 2, com ênfase na monitorização contínua da glicose. Para isso, três grupos de diabéticos tipo 2 foram selecionados: um grupo foi submetido à seis semanas de treinamento em esteira na intensidade do limiar anaeróbio (18 sessões de 30 minutos), um grupo foi submetido à seis semanas de treinamento resistido na intensidade do limiar anaeróbio (10 sessões de seis exercícios) e um grupo foi controle. Foram analisadas as seguintes variáveis antes e após a intervenção: hemoglobina glicada, glicemia de jejum, frutosamina, cinética da glicose intersticial monitorizada continuamente, colesterol, triglicérides, intensidade do limiar anaeróbio em esteira, intensidade máxima do teste ergoespirométrico, consumo de oxigênio na intensidade do limiar anaeróbio, consumo máximo de oxigênio e volume do teste de fadiga. Também foram verificadas a frequência cardíaca, a percepção subjetiva do esforço e a glicemia casual antes, durante e após as sessões de treinamento. Foram encontradas diminuições significativas nas concentrações da glicemia de jejum e de frutosamina após o treinamento em esteira, diminuições significativas nas concentrações de triglicérides após o treinamento resistido e reduções significativas nos níveis de colesterol dos dois grupos de treinamento. O consumo de oxigênio na intensidade do limiar anaeróbio, bem como a intensidade do mesmo, aumentaram significativamente no grupo que treinou em esteira e o volume do teste de fadiga apresentou-se maior após os dois protocolos de treinamento. As médias das diferenças da frequência cardíaca e da percepção subjetiva do esforço iniciais e finais nas sessões de treinamento demonstram-se maiores no grupo de treinamento em esteira e as médias das diferenças entre a glicemia casual antes e após as sessões de treinamento apresentaram-se iguais para os dois grupos de treinamento. Não foram encontradas reduções significativas na área sob a curva da glicose monitorizada continuamente nos três grupos. Conclui-se que, para os protocolos de treinamento aplicados, o treinamento em esteira demonstrou-se mais eficaz para o controle glicêmico e para o aumento da capacidade aeróbia dos indivíduos diabéticos tipo 2. A monitorização contínua da glicose parece não ser um bom método para a verificação do controle glicêmico após treinamento físico se não for combinado ao controle alimentar. / The incidence of Diabetes Mellittus presents increasing worldwide, mainly due to the change in lifestyle. Physical activity associated with balanced diet is the best treatment to control diabetes, but there are still differences in recommendations and scientific evidence on the prescription of exercise for diabetics. This research aimed to compare the physiological effects of treadmill and resistance training in the intensity of anaerobic threshold in type 2 diabetic subjects with emphasis on continuous glucose monitoring training. For this, three groups of type 2 diabetic patients were selected: one group underwent six weeks of treadmill training on anaerobic threshold intensity (18 sessions of 30 minutes), one group underwent six weeks of resistance training intensity threshold anaerobic (10 sessions, six exercises) and one group was control. The following variables were analyzed before and after the intervention: glycated hemoglobin, fasting plasma glucose, fructosamine, interstitial glucose kinetics monitored continuously, cholesterol, triglycerides, anaerobic threshold intensity treadmill, maximum intensity of the cardiopulmonary exercise test, oxygen consumption in the intensity of anaerobic threshold, maximal oxygen consumption and volume of the fatigue test. The heart rate, perceived exertion and blood glucose levels were also checked before, during and after training sessions. Significant decreases were found in concentrations of fasting glucose and fructosamine after treadmill training, significant decreases in triglyceride concentrations after resistance training and significant reductions in cholesterol levels of the two training groups. The oxygen consumption at anaerobic threshold intensity and its intensity increased significantly in the group who trained on a treadmill and the volume of the fatigue test was higher after the two training protocols. The mean differences in heart rate and subjective perception of the initial and final effort in training sessions show up higher in the treadmill training and the mean differences between blood glucose levels before and after the training sessions had to be equal for the two groups of training. No significant reductions were found in the area under the curve of glucose monitored continuously in all three groups. We conclude that, for the training protocols applied , treadmill training has shown to be more effective for glycemic control and increased aerobic capacity of type 2 diabetic subjects. Continuous glucose monitoring does not seem to be a good method for the verification of glycemic control after physical training if not combined with diet control.

A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Doctor of Philosophy December 2017. / Gestational diabetes mellitus (GDM) is characterized by high blood glucose levels that first develop during pregnancy. GDM has been linked with many adverse short and long term health outcomes for the developing foetus as well as for the mother. The Developmental Origins of Health and Disease (DOHaD) concept suggests that in the presence of adverse stimuli, the foetus will adapt, through epigenetic mechanisms, to ensure its immediate survival. For this reason, epigenetic modifications are emerging as mediators linking early environmental exposures during pregnancy with programmed changes in gene expression that alter offspring growth and development. The objective of this research study was to explore the role of altered gene expression and methylation in the development of GDM and determine whether these alterations are inherited by the exposed foetus. Transcriptome sequencing was performed on mRNA extracted from blood samples collected from six women with GDM and from six controls; as well as from exposed (N=6) and unexposed placenta (N=6). Genes that displayed significant (p<0.005) differential expression (log2 fold change >2 and <-2) between cases and controls were identified from the blood (N=60) and placenta (N=56) datasets. Gene ontology and enrichment was performed using DAVID and PANTHER with the aim to narrow down the candidate gene lists. The ten most likely candidate genes for differential gene expression from the blood dataset were G6PD, DCXR, TKT, ALDOA, PGLS, KCNQ1, C14orf80, KCNQ1, SLC25A22 and GSK3A. Gene enrichment revealed that five of these significantly under-expressed genes (G6PD, DCXR, TKT, ALDOA and PGLS) encode enzymes in the pentose phosphate pathway (PPP). In the placental dataset the top ten candidate genes were CXCR1, CXCR2, G6PD, TKT, IGFBP-1, IGFBP-2, IGFBP-6, GGT3P, MMP12 and GLT1D1. The direction and fold change of differential expression of all twenty genes were validated using TaqMan qPCR probes. Of these twenty genes, the five most promising biological candidates (G6PD, TKT, IGFBP-1, IGFBP-2 and IGFBP-6) were identified and the level of promoter region methylation was assessed using EpiTech Methyl II PCR Assays. The level of methylation in the promoter region of G6PD in both blood and placenta tissue was found to be significantly higher (p=1.90 x 10-5 and p=1.2 x 10-11 respectively) in the case groups, correlating with decreased mRNA expression levels. There was a significant negative correlation between G6PD mRNA expression in the blood and placenta with the level of maternal glucose at fasting (p=0.006 and p=0.001, respectively), 1-hr (p=0.016 and p=0.007, respectively) and 2-hr post OG (p=0.045 in placenta). We observed a significant positive correlation between G6PD promoter region methylation in both blood and placental tissues with maternal glucose levels at fasting (p=0.023 and p=0.001, respectively) and at 1-hr post OG (p=0.001 and p=0.004, respectively). IGFBP-1 was found to be significantly under-expressed in exposed placental tissue and hypermethylated (p=1.1 x 10-6) at the promoter region when compared to unexposed samples. There was a significant negative correlation between the expression of IGFBP-1 mRNA in the blood and placenta with foetal birth weight (p=0.005 and p=0.017, respectively). Our results suggest that high glucose levels, an important characteristic of GDM, result in the disturbance of the pentose phosphate pathway, a pathway linked closely to glycolysis, and the IGF-axis, which is important in foetal growth and development. In GDM there is suppression of G6PD mRNA expression in both the blood and placental tissue which influences the pentose phosphate pathway. We hypothesize that this is mediated through an epigenetic mechanism since it is correlated with increased methylation of the G6PD promoter region. Down regulation of G6PD would suppress the PPP and reduce the levels of NADPH production, which may in turn lead to an increase in oxidative stress and an adverse outcome in the mother and foetus. With regard to the IGF-axis, our results demonstrated that IGFBP-1 and IGFBP-2 mRNA expression in the placenta may be inhibited due to the presence of high glucose and insulin levels and this decrease in mRNA expression is likely implicated in the abnormal foetal growth which is often associated with GDM. This study has provided novel insights into gene expression and DNA methylation changes in the blood of women with GDM and the placenta of their female offspring that involve genes in the PPP and the IGF-axis. / LG2018

Managing medical care for patients with diabetes mellitus requires a comprehensive approach that includes empowering the patient to be an active participant in the management of their disease as lifestyle management, in addition to medical therapy, is a crucial component in the care of the diabetic patient. The objective of this project was to determine if implementing diabetic care cards in a family medicine residency clinic would increase patient engagement with their care in the form of knowledge concerning A1C values and subjectively feeling in control of their diabetes. The initial phase of the project involved providing diabetic patients a brief anonymous survey concerning their A1C and asking if they felt in control of their diabetes; these surveys were collected for several months. The next phase consisted of an educational lecture during formal resident physician didactic time where diabetic guidelines were discussed, diabetic care cards were introduced, and the resident physicians were encouraged to utilize the cards with their diabetic patients. After several months of implementation of the diabetic care cards in the clinic, the same anonymous survey was repeated with diabetic patients. A total of 93 anonymous patient surveys were collected prior to formal resident physician education concerning diabetic care cards and a total of 40 anonymous surveys were collected after formal resident physician education. The data from the pre and post educational surveys were then reviewed and compared and data was analyzed. Overall, A1C values did not significantly differ between the pre- and post-survey groups. Although there was a slightly higher percentage of patients who reported knowing their A1C level after the diabetic card implementation, this was not statistically significant and there was not a statistically significant difference in the percentage of patients that felt in control of their diabetes between survey groups. It was found that higher A1c values were associated with patients feeling less in control of their diabetes. A limitation of this study was realized with the methodology; it is not known if every patient who completed a survey also directly encountered the diabetic care card. The study yielded some valuable insight into patient perspective of diabetes control. It was found that an A1C less than or equal to 7%, which is the A1C goal for most diabetic patients, did not necessarily correlate with diabetic patients feeling in control of their diabetes. It was felt that this indicated that there is room for improvement in patient education concerning A1C goal. It also revealed a need for further investigation of the factors that influence whether a patient feels they are in control of their diabetes.