African American men are more likely to have diagnosed or undiagnosed diabetes than non-Hispanic White Americans and are less likely to adhere to treatment. Culture in the African American community plays a key role in how this community copes with illness and the health care system. The purpose of this study was to examine the lived experiences of social and cultural determinants of Type 2 diabetes self-management among African American men. Bandura's social cognitive theory provided the theoretical framework for the study. The research question sought to identify cultural and social factors that contribute or protect how African American men manage Type 2 diabetes. The study had a qualitative research design with a phenomenological approach. A purposive sample of 11 African American men ages 48 to 76 with Type 2 diabetes volunteered to participate in in-depth interviews. Interviews were audiotaped, transcribed, inductively coded, and analyzed for emergent themes using NVivo 12 software. Thematic analyses led to the development of 8 themes and 8 subthemes. The lived experiences of the participants were classified into personal factors (self-efficacy, knowledge, outcomes, expectations, and attitudes); environmental factors (modeling, social norms, perceived support, facilitation, dietary choices, and accessibility); and behavioral factors, which differed in terms of consumption, goal setting, and behavior toward health care. Positive social change implications of the study may include further education on disease management, recommendations to healthcare professionals, community stakeholders, and African American families on specific factors that can enhance knowledge, attitudes, and behaviors to improve management of Type 2 diabetes among African American men.

Combination therapy has proven to be a popular treatment strategy for tighter diabetes control. Since the preliminary evidence is suggestive of complementary actions of American (AG) and Korean Red Ginseng (KRG) in improving glycemia, this project was designed to investigate the therapeutic potential of AG and KRG in combination. Following a randomized, double-blind, placebo-controlled parallel design in a population with diabetes at two centres, the combined use of AG and KRG for 12 weeks was safe, but did not significantly affect glycemic control, blood lipids or blood pressure. However, there was a trend toward lower glycated hemoglobin by 0.7% (p=0.1) and office systolic blood pressure by 5 mm Hg (p=0.052) compared to placebo. These findings encourage further investigation of the mechanism and roles of AG, KRG and their effective components. They also highlight limitations in ginseng research and the need to impose strict regulations to facilitate its standardization.

Combination therapy has proven to be a popular treatment strategy for tighter diabetes control. Since the preliminary evidence is suggestive of complementary actions of American (AG) and Korean Red Ginseng (KRG) in improving glycemia, this project was designed to investigate the therapeutic potential of AG and KRG in combination. Following a randomized, double-blind, placebo-controlled parallel design in a population with diabetes at two centres, the combined use of AG and KRG for 12 weeks was safe, but did not significantly affect glycemic control, blood lipids or blood pressure. However, there was a trend toward lower glycated hemoglobin by 0.7% (p=0.1) and office systolic blood pressure by 5 mm Hg (p=0.052) compared to placebo. These findings encourage further investigation of the mechanism and roles of AG, KRG and their effective components. They also highlight limitations in ginseng research and the need to impose strict regulations to facilitate its standardization.

The management of patients hospitalised with diabetes mellitus is neglected in South Africa. The research on which this thesis is based assessed factors contributing to glycaemic control as well as evaluated an intervention aimed at improving of such control in diabetic inpatients. A survey of doctors and nurses measuring their perceptions, knowledge and attitudes regarding care of diabetic inpatients was done. This indicated a need for special training in inpatient diabetes care, where 90.5% of respondents realised that diabetes is a serious condition and 92.2% valued the importance of tight glycaemic control. Despite these perceptions, the knowledge of doctors and nurses caring for diabetic inpatients was suboptimal. A before and after study regarding an intervention to improve glycaemic control of diabetic inpatients consisted of a training programme and the introduction of an inpatient management protocol. The mean blood glucose on day one of admission after the intervention was significantly higher than before the intervention (p < 0.001). A significant improvement in mean blood glucose from day 1 to day 7 of hospitalisation was seen after the intervention (p < 0.001), which was not significant before (p = 0.33). The proportion of patients achieving glycaemic control did not significantly differ before and after the intervention (43.0% versus 43.7%, p = 0.97). A double blind randomised controlled trial to assess superiority of Ringer’s lactate solution compared to 0.9% Sodium chloride solution in the normalisation of pH in patients with diabetic ketoacidosis was done. The outcome of this study indicated that the time to normalisation of venous pH (pH > 7.32) (HR: 1.863, CI: 0.937 to 3.705, p = 0.758) was not significantly different between the two resuscitation fluid groups The time to reach a blood glucose of 14 mmol/L was significantly longer in the Ringer’s lactate group (p = 0.044) and patients needed significantly more insulin (p = 0.02). The overall conclusion of this study is that there is no significant benefit in using Ringer’s lactate solution as initial resuscitation fluid compared to the currently advised 0.9% Sodium chloride solution. / Thesis (PhD)--University of Pretoria, 2012. / Internal Medicine / unrestricted

Title: Physical education of individuals with type 2 diabetes mellitus Objectives: The aim of this thesis is to evaluate the effect of physical education of individuals with type 2 diabetes mellitus cured in diabetologic outpatient clinic of Genereal University Hospital in Prague. The physical education was focused on nordic walking. Methods: Eight patients of diabetological outpatient clinic were chosen by the doctor for this survey. The physical examination was carried out with seven patients. It involved anthropometrical measurements (weight, waist circumference) and blood collection for biochemical parameters assessment (glycemia, glycated hemoglobin). Two-minute step test was chosen for assessment of subject's physical fitness. Results: The physical activity education of individuals with type 2 diabetes mellitus doesn't increase the amount of their physical activity. The physical activity of type 2 diabetes mellitus individuals is rather low as well as their exercise adherence. Nordic walking exercise program can improve anthropometrical parametres (weight, waist circumference) and can reduce HbA1c levels. Lower health-related quality of life in physical and physological aspects wasn't proved in type 2 diabetes patients. Key words: nordic walking, physical activity, type 2 diabetes management,...

Approximately 8.3% of the U. S. population has type 2 diabetes. Preventing the onset and improving the management type 2 diabetes are crucial for health care professionals. The purpose of this project was to develop and evaluate a type 2 diabetes prevention and management education program in a primary care setting using group medical appointments (GMAs). The chronic care model provided the framework for the study. The education program consisted of information from the Centers for Disease Control on the management of type 2 diabetes to be delivered by clinic staff using a GMA approach, a timeline for implementing the education program, and evaluation strategies for assessing patient health outcomes. Staff participants included 9 females and 1 male. One week after the presentation, staff responded to open-ended questions addressing the plan for prevention and management of type 2 diabetes. Findings indicated that staff unanimously approved the content of the program, thought the program could realistically be implemented, thought the proposed evaluation methods were appropriate, and thought the program would have a positive influence on patient health outcomes. Prevention and management education programs using a GMA approach may be used to reduce incidence and improve management of type 2 diabetes.

Les diètes faibles en glucides (Low-Carbohydrate Diet [LCD]; moins de 30 % de l'énergie provenant des glucides) gagnent en popularité chez les personnes atteintes de diabète de type 1 (DbT1). Cependant, l’impact de ces diètes sur le contrôle glycémique et le risque cardiovasculaire (CV) est controversé. Objectif : Évaluer les associations entre le score LCD, le contrôle glycémique et des facteurs de risque CV chez les adultes atteints de DbT1 par le biais d’un registre de DbT1 au Québec (Canada). Méthodologie : Il s’agit d’une étude transversale des données du registre BETTER, utilisant les rappels alimentaires de 24 heures afin de calculer les scores LCD et incluant les données suivantes : mesures anthropométriques auto-rapportées ou mesurées (ex. tour de taille), questionnaires sur les antécédents d’épisodes d’hypoglycémies modérées (nombre d’épisodes dans le dernier mois) et sévères (présence d’au moins un épisode dans la dernière année), perception altérée des symptômes de l’hypoglycémie (score Clarke ≥4) et données biochimiques (HbA1c, cholestérol LDL et cholestérol non-HDL). Un score de 0 à 10 points a été attribué pour chaque macronutriment pour un total de 30 points. Pour les glucides, les participants avec l’apport le plus faible ont reçu 10 points, et l’attribution des points a été inversée pour les lipides et protéines, les participants ayant les apports les plus élevés recevant 10 points. Les participants ont été divisés en quartiles (Q) en fonction de leur score LCD. Résultats : 285 adultes (âgés de 48,2 ± 15,0 ans ; durée du DbT1 de 25,9 ± 16,2 ans) ont été inclus. Dans l’ensemble, les participants ont rapporté des apports faibles en glucides et en fibres et un apport élevé en lipides comparativement aux recommandations. L'apport moyen en glucides contribuait à 31,2 ± 6,9 % (Q1) à 56,5 ± 6,8 % de l'apport énergétique total (Q4). Par rapport au Q4, plus de personnes au Q1 ont signalé une HbA1c ≤ 7 % (Q1 : 53,4 % vs Q4 : 29,4 %; p = 0,011). Les participants au Q3 ont rapporté moins souvent d’avoir un antécédent d’hypoglycémie sévère que le Q1 (Q1 : 60,0 % vs Q3 : 31,0 %; p = 0,004). Il n’y avait aucune différence entre les quartiles pour la fréquence d’évènements d’hypoglycémies modérées, l’altération de la perception des symptômes de l’hypoglycémie et le profil lipidique : cholestérol LDL et cholestérol non-HDL. Conclusions : Les participants avec un faible apport en glucides sont plus nombreux à atteindre la cible d’HbA1c et moins nombreux à présenter des antécédents d’hypoglycémie sévère comparativement à ceux ayant un apport plus élevé en glucides. Cependant, la LCD n’est pas associée à une fréquence de l’hypoglycémie modérée, à une altération de la perception des symptômes de l’hypoglycémie, ni aux facteurs de risque CV. / Low-carbohydrate-diets (LCD; less than 30% of energy from carbohydrates) are gaining popularity in individuals with type 1 diabetes (T1D). However, the impact of such diet on glycemic control and cardiovascular (CV) risk factors is debated. Objective: To evaluate associations between LCD score, glycemic control and CV risk factors in adults with T1D using a registry in Québec (Canada). Research Design and Methods: This is a cross-sectional study using data from the BETTER registry, using 24-hour dietary recalls to calculate LCD scores and including the following data: self-reported or measured anthropometric data (e.g. waist circumference), questionnaires on history of moderate (number of episodes in the last month) and severe (experienced at least one episode in the last year) hypoglycemic episodes, impaired awareness of hypoglycemia (Clarke score ≥4) and biochemical data (HbA1c, LDL-cholesterol and non-HDL-cholesterol). A score of 0 to 10 points was given for each macronutrient for a total of 30 points. For carbohydrates, participants with the lowest intake received 10 points, and the point allocation was reversed for fat and protein, meaning participants with the highest intakes received 10 points. Participants were divided into quartiles (Q) based on LCD score. Results: 285 adults (aged 48.2 ± 15.0 years; T1D duration of 25.9 ± 16.2 years) were included. Overall, participants reported low carbohydrate and fiber intakes and high fat intake compared to recommendations. Mean carbohydrate intake ranged from 31.2 ± 6.9 % (Q1) to 56.5 ± 6.8 % of total energy (Q4). Compared to Q4, more people in Q1 reported HbA1c ≤7 % (Q1: 53.4 % vs Q4: 29.4 %; P = 0.011). Participants in Q3 reported less often having a history of severe hypoglycemia than Q1 (Q1: 60.0 % vs Q3: 31.0 %; P = 0.004). There were no differences between quartiles for frequency of moderate hypoglycemia events, impaired awareness of hypoglycemia and lipid profile: LDL-cholesterol and non-HDL-cholesterol. Conclusions: Participants with low carbohydrate intake are more likely to reach HbA1c target and less likely to have a history of severe hypoglycemia compared to those with a higher carbohydrate intake. However, LCD is not associated with moderate hypoglycemia frequency, impaired hypoglycemia awareness or CV risk factors.

No description available.

Thesis (MMed) -- Stellenbosch University, 2010. / Bibliography / Introduction: Diabetes in Africa has been described as a pandemic, with the prevalence in South Africa estimated at 4.5% of the population. Despite clear national guidelines from the Society of Endocrinology, Metabolism and Diabetes of South Africa, an unpublished quality improvement cycle in 2007 has shown poor patient knowledge with associated uncontrolled glycaemic and hypertensive control in diabetic patients in a district health system. The purpose of the study was to identify possible reasons for this and to find solutions for improving diabetic care within the Wesbank/ Ilingu Lethu suburb of Malmesbury, Western Cape. Methods: A cooperative inquiry group was established, consisting of primary health care providers at a district hospital and a primary health care clinic. The inquiry completed several cycles of action-reflection over a period of eight months, and included training in diabetic related topics and critical reflection techniques. At the end of the inquiry consensus was reached on key findings by group and learning within the group. Findings: Consensus was expressed in two key findings. The group identified and prioritized continuity of care and diabetic education key areas where diabetic care could be improved in the research population. The first was addressed by initiating diabetic registries, establishment of a regular diabetic clinic, implementation of a diabetic schedule within the medical records and the forming of a diabetic team that could support continuity of relationships, clinical management and organisation of care between both facilities. The diabetic team involved non-governmental organizations, private health providers and the community to increase awareness and develop capacity to improve diabetic care. The other finding confirmed diabetic education as a critical area in diabetic self management. The diabetic team initiated a diabetic community forum for educational and informative group activities. There was also continued professional development with education sessions within the cooperative inquiry group themselves. Conclusions: Improving diabetic care through continuity of care and education is well supported in known evidence based literature. The challenge is to translate/ transfer the available knowledge and render it operational and clinical in any health setting. The co-operative inquiry process was a valuable tool to identify, prioritized and addresses unique challenges for improving diabetic care in our specific context.

Ces dernières années, la compréhension de la relation entre l'alimentation et la santé métabolique, en particulier dans le contexte du diabète de type 2 (T2D), est devenue de plus en plus importante. Les régimes riches en graisses (HFD) sont connus pour exacerber les conditions diabétiques, menant à des complications telles que l'obésité, un métabolisme déséquilibré, des problèmes cardiovasculaires et un dysfonctionnement rénal. À l'inverse, les régimes cétogènes (KD) et la supplémentation en cétones (KP), connus pour augmenter le taux de corps cétoniques dans le sang, ont attiré l'attention pour leur potentiel dans la gestion du poids, l'amélioration du contrôle de la glycémie et l'atténuation des complications associées au diabète de type 2. L'étude a pour but d'évaluer l'efficacité du KD et de KP dans la gestion de la pathogenèse du T2D et la réduction de la progression de la maladie rénale diabétique dans un modèle de souris, en se concentrant sur les changements dans les indicateurs métaboliques et de santé rénale. Cette étude a examiné les effets de diverses interventions diététiques (HFD, KD, KP) sur une série de paramètres de santé rénale dans un modèle murin de T2D. Sur une période de 15 semaines, le T2D a été induit chez les souris, suivi d'une exposition de six semaines à différents régimes. La recherche s'est concentrée sur l'évaluation des changements dans le poids corporel, la prise alimentaire, la glycémie et les niveaux de cétone, la tolérance à l'insuline et au glucose, et les fonctions cardiovasculaires et rénales. L'évaluation des fonctions rénales comprenait le rapport albumine/créatinine, l'azote uréique du sang (BUN), les niveaux de cystatine C et l'histopathologie. En outre, l'étude a examiné l'impact de ces régimes sur l'accumulation de lipides dans les tissus rénaux et les niveaux de triglycérides plasmatiques, afin de comprendre les implications métaboliques plus larges des choix alimentaires dans la gestion du T2D. Les résultats ont indiqué que les souris suivant un régime KD présentaient des améliorations significatives dans plusieurs paramètres par rapport à celles suivant un régime HFD. Cela incluait une réduction du poids corporel, une meilleure maîtrise glycémique, une sensibilité accrue à l'insuline et une meilleure santé cardiovasculaire et rénale. En revanche, la supplémentation en KP n'a pas montré d'effet aussi prononcé dans plusieurs aspects, y compris l'amélioration du contrôle glycémique et de la fonction rénale. Intéressant, bien que le régime KD ait été efficace pour réduire les niveaux de triglycérides plasmatiques, il a paradoxalement conduit à une augmentation de l'accumulation de lipides dans les tissus rénaux. En conclusion, l'étude souligne l'efficacité du régime cétogène dans la gestion du poids, l'amélioration des marqueurs métaboliques et la réduction des complications liées au diabète dans un modèle de souris de T2D. Elle met également en évidence la complexité des réponses métaboliques aux interventions diététiques, en particulier en ce qui concerne la santé rénale et le métabolisme des lipides. Les résultats suggèrent que, bien que le régime KD puisse offrir de nombreux avantages pour la santé dans le contexte du diabète, il pourrait également induire des adaptations métaboliques spécifiques à certains organes. / In recent years, understanding the relationship between diet and metabolic health, particularly in the context of type 2 diabetes (T2D), has become increasingly important. High-fat diets (HFD) are known to exacerbate diabetic conditions, leading to complications such as obesity, dysregulated metabolism, cardiovascular issues, and renal dysfunction. Conversely, ketogenic diets (KD) and ketone supplementation (KP) known to elevate ketone bodies in the blood, have been gaining attention for their potential in managing weight, improving glycemic control, and mitigating complications associated with T2D. The study aims to evaluate the effectiveness of KD and KP in managing T2D pathogenesis and reducing the progression of diabetic kidney disease in a mouse model, focusing on changes in metabolic and renal health indicators. This study investigated the effects of various dietary interventions (HFD, KD, KP) on a range of kidney health parameters in a mouse model of T2D. Over 15 weeks, T2D was induced in mice, followed by a six-week exposure to different diets. The research focused on evaluating changes in body weight, food intake, blood glucose and ketone levels, insulin and glucose tolerance, and cardiovascular and renal function. Renal assessment included albumin-to-creatinine ratio, Blood urea nitrogen (BUN), Cystatin C levels, and histopathology. Additionally, the study examined the impact of these diets on lipid accumulation in renal tissues and plasma triglyceride levels, aiming to understand the broader metabolic implications of dietary choices in T2D management. Results indicated that mice on a KD exhibited significant improvements in several parameters compared to those on an HFD. These included reductions in body weight, enhanced glycemic control, improved insulin sensitivity, and better cardiovascular and renal health. In contrast, the KP supplementation group did not show as pronounced an effect in several aspects, including glycemic control and renal function improvement. Interestingly, while KD was effective in reducing plasma triglyceride levels, it paradoxically led to increased lipid accumulation in renal tissues. In conclusion, the study underscores the effectiveness of a ketogenic diet in managing weight, improving metabolic markers, and mitigating diabetes-related complications in a mouse model of T2D. It also highlights the complexity of metabolic responses to dietary interventions, especially concerning renal health and lipid metabolism. The results suggest that, while the KD diet may offer many health benefits in the context of diabetes, it may also induce organ-specific metabolic adaptations.