The dissertation aims to examine the potential for diabetes self-management education (DSME) technology interventions to be used by underserved adults in routine clinical practice and issues regarding its use that may be unique to this population. In Chapter One, the problems of providing sufficient access and appropriate DSME to underserved adults with type 2 diabetes mellitus (T2DM) is introduced and their significance is described. In Chapter Two, a systematic review of the literature and meta-analysis synthesizes data from 3,257 subjects that participated in 13 randomized controlled trials that examined the effect of health information technology (HIT) DSME interventions on glycemic control in medically underserved adults. Chapter Three presents the general and technology-related characteristics of the urban, underserved sample of adults with type 2 diabetes mellitus from eight federally qualified health centers who participated in the Mobile Diabetes Detective (MoDD) randomized controlled trial. It also describes the technology training required to support use and engagement during the MoDD intervention period. In Chapter Four, the potential for broad dissemination of a novel HIT DSME intervention, MoDD, into everyday clinical practice is examined using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance). In Chapter Five the findings of these studies are summarized and the overarching conclusions are presented, which include the strengths, limitations and implications for practice, policy and future.

by Li Chi Yeung. / Thesis submitted in: November 2004. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (leaves 151-176). / Abstracts in English and Chinese. / Thesis Committee --- p.i / Acknowledgement --- p.ii / Abstract (English Version) --- p.iii / Abstract (Chinese Version) --- p.v / Content Page --- p.vii / List of Tables --- p.xiii / List of Figures --- p.xv / Abbreviation --- p.xvii / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Diabetes Mellitus --- p.1 / Chapter 1.1.1 --- Epidemiology --- p.1 / Chapter 1.1.2 --- Economic Impact --- p.3 / Chapter 1.2 --- "Digestion, Absorption and Metabolism of Carbohydrates" --- p.4 / Chapter 1.2.1 --- Carbohydrate Digestion --- p.4 / Chapter 1.2.2 --- Carbohydrate Absorption --- p.6 / Chapter 1.2.3 --- Insulin Secretion --- p.6 / Chapter 1.3 --- Pathophysiology of Diabetes Mellitus --- p.7 / Chapter 1.3.1 --- Insulin-Dependent Diabetes Mellitus (lDDM) --- p.7 / Chapter 1.3.1.1 --- Genetics --- p.8 / Chapter 1.3.1.2 --- Autoimmunity --- p.9 / Chapter 1.3.2 --- Non-Insulin-Dependent Diabetes Mellitus (NlDDM) --- p.11 / Chapter 1.3.2.1 --- Insulin Resistance --- p.11 / Chapter 1.3.2.2 --- Impaired Insulin Secretion --- p.14 / Chapter 1.4 --- Management of Diabetes Mellitus --- p.15 / Chapter 1.4.1 --- Sulfonylureas --- p.15 / Chapter 1.4.2 --- Biguanides --- p.16 / Chapter 1.4.3 --- Problems Encountered in the Management of Diabetes --- p.16 / Chapter 1.4.4 --- Role of Dietary Fiber in the Management of Diabetes Mellitus --- p.18 / Chapter 1.4.4.1 --- Dietary Fiber and Gastric Emptying Time --- p.19 / Chapter 1.4.4.2 --- Dietary Fiber and Glucose Absorption in Small Intestine --- p.20 / Chapter 1.4.5 --- Other Natural Products used for Diabetes Treatment…… --- p.22 / Chapter 1.5 --- Mushrooms --- p.22 / Chapter 1.5.1 --- The Definition of Mushrooms --- p.23 / Chapter 1.5.2 --- Nutritional Values of Mushrooms --- p.24 / Chapter 1.5.3 --- Production of Mushrooms --- p.25 / Chapter 1.6 --- Medicinal (Antidiabetic) Properties of Mushrooms --- p.28 / Chapter 1.6.1 --- Ganoderma lucidum --- p.29 / Chapter 1.6.2 --- Tremella aurantia --- p.33 / Chapter 1.6.3 --- Auricularia auricula --- p.36 / Chapter 1.6.4 --- Grifola frondosa --- p.37 / Chapter 1.7 --- Medicinal Uses of Hericium erinaceus --- p.39 / Chapter 1.7.1 --- HeLa Cell Proliferation Inhibitors --- p.39 / Chapter 1.7.2 --- Induction of Growth of Nerve Cells --- p.42 / Chapter 1.7.3 --- Antitumour Activity --- p.42 / Chapter 1.7.4 --- Antidiabetic Effect --- p.43 / Chapter 1.8 --- Objectives --- p.45 / Chapter Chapter 2 --- Materials and Methods --- p.46 / Chapter 2.1 --- Extraction of Polysaccharides from the Fruiting Body of H. erinaceus --- p.46 / Chapter 2.1.1 --- Small-scale Extraction --- p.46 / Chapter 2.1.2 --- Large-scale Extraction --- p.47 / Chapter 2.2 --- Physico-Chemical Characterization of HE-polysaccharides --- p.52 / Chapter 2.2.1 --- Carbohydrate Content: Phenol-Sulfuric Acid Method --- p.52 / Chapter 2.2.2 --- Protein Content: Lowry Assay --- p.52 / Chapter 2.2.3 --- Uronic Acid Content --- p.53 / Chapter 2.2.4 --- Molecular Weight Determination by High Pressure Liquid Chromatography (HPLC) --- p.55 / Chapter 2.2.5 --- Determination of Monosaccharide Composition of Non-Starch Polysaccharides by Gas Chromatography (GC) --- p.56 / Chapter 2.2.5.1 --- Acid Depolymerisation --- p.56 / Chapter 2.2.5.2 --- Neutral Sugar Derivatisation --- p.56 / Chapter 2.2.5.3 --- Determination of Neutral Sugar Composition by Gas Chromatography (GC) --- p.57 / Chapter 2.2.6 --- Structural Study of Polysaccharides by Methylation --- p.59 / Chapter 2.2.6.1 --- Preparation of dry Dimethyl Sulfoxide (DMSO) --- p.59 / Chapter 2.2.6.2 --- Preparation of Methylsulfinyl Methyl Sodium (CH3SOCH2-Na+) from the dry DMSO and Sodium Hydride --- p.59 / Chapter 2.2.6.3 --- Methylation Procedure --- p.60 / Chapter 2.2.6.4 --- Preparation of Partially Methylated Alditol Acetates (PMAAs) --- p.61 / Chapter 2.2.6.5 --- Analysis of the PMAAs by GC --- p.62 / Chapter 2.2.7 --- The Measurement of Viscosity --- p.62 / Chapter 2.3 --- In vitro Hypoglycemic Tests of HE-Polysaccharides --- p.64 / Chapter 2.3.1 --- Glucose Dialysis Retardation Index (GDRl) --- p.64 / Chapter 2.3.1.1 --- Experimental Setup --- p.64 / Chapter 2.3.1.2 --- Measurement of Glucose in the Dialysate --- p.65 / Chapter 2.3.2 --- Inhibition of Amylolysis --- p.66 / Chapter 2.3.2.1 --- Experimental Setup --- p.66 / Chapter 2.3.2.2 --- Measurement of Maltose in the Dialysate --- p.66 / Chapter 2.4 --- In vivo Hypoglycemic Evaluation of HE-Polysaccharides --- p.67 / Chapter 2.4.1 --- Oral Glucose Tolerance Test (OGTT) --- p.67 / Chapter 2.4.2 --- Induction of Type l Diabetes in Normal BALB/c Mice --- p.69 / Chapter 2.4.2.1 --- lnduction Protocol --- p.69 / Chapter 2.4.2.2 --- Measurement of Plasma Glucose Level --- p.70 / Chapter 2.4.3 --- Hypoglycemic Test on Normal and Diabetic BALB/c Mice --- p.71 / Chapter 2.4.4 --- Measurement of Insulin Level by Enzyme-Linked Immunoadsorbent Assay (ELlSA) --- p.72 / Chapter 2.4.4.1 --- Plasma Samples used in ELlSA --- p.72 / Chapter 2.4.4.2 --- Assay Procedure --- p.73 / Chapter 2.5 --- Statistical Evaluation --- p.74 / Chapter Chapter 3 --- Results and Discussion --- p.75 / Chapter 3.1 --- Yield of Polysaccharides extracted from H. erinaceus --- p.75 / Chapter 3.2 --- Physico-chemical Properties of HE Polysaccharides --- p.79 / Chapter 3.2.1 --- "Carbohydrate, Protein and Uronic Acid Content" --- p.79 / Chapter 3.2.2 --- Monosaccharide Compositions --- p.83 / Chapter 3.2.3 --- Molecular Weight of the HE polysaccharides --- p.85 / Chapter 3.2.4 --- Structure of HE polysaccharides --- p.90 / Chapter 3.2.5 --- Conclusion for the Physico-chemical Properties of HE-Polysaccharides --- p.96 / Chapter 3.2.6 --- Viscosity of HE Polysaccharides --- p.99 / Chapter 3.3 --- In vitro Study of the Hypoglycemic Effect of HE-Polysaccharides --- p.101 / Chapter 3.3.1 --- Glucose Dialysis Retardation Index (GDRl) --- p.101 / Chapter 3.3.2 --- Inhibition of α-Amylase Activity --- p.105 / Chapter 3.4 --- In vivo Hypoglycemic Evaluation of HE-Polysaccharides --- p.109 / Chapter 3.4.1 --- In vivo Oral Glucose Tolerance Test (OGTT) in Normal Mice --- p.109 / Chapter 3.4.1.1 --- Oral Glucose Tolerance Test --- p.109 / Chapter 3.4.1.2 --- Effect of Change of Viscosity of HE Polysaccharide in the Gl Tract of Mice --- p.114 / Chapter 3.4.2 --- Establishment of a Diabetic Murine Model --- p.120 / Chapter 3.4.3 --- Hypoglycemic Activity of HE-polysaccharides in Normal Mice --- p.123 / Chapter 3.4.4 --- Hypoglycemic Activity of HE-polysaccharides in Diabetic Mice --- p.126 / Chapter 3.4.5 --- Change of Plasma Insulin Level in the Hypoglycemic Test --- p.132 / Chapter 3.4.6 --- Comparison of Hypoglycemic Activity of HE-Polysaccharides in Normal and Diabetic mice --- p.139 / Chapter 3.4.6.1 --- Severity of Diabetic Conditions lnduced --- p.139 / Chapter 3.4.6.2 --- Change in Insulin Secretion --- p.140 / Chapter 3.4.6.3 --- Glucose Transporter --- p.140 / Chapter 3.5 --- Other Factors that Affect in vivo Hypoglycemic Activity of the HE-polysaccharides --- p.141 / Chapter 3.5.1 --- Route of Administration: Oral Feeding and Intraperitoneal Injection --- p.141 / Chapter 3.5.2 --- Molecular Mechanisms of Hypoglycemic Activity --- p.142 / Chapter 3.5.3 --- Glucose Toxicity --- p.144 / Chapter 3.5.3.1 --- Insulin Resistance --- p.144 / Chapter 3.5.3.2 --- Impaired Insulin Secretion --- p.145 / Chapter Chapter 4 --- Conclusions and Future Works --- p.147 / References --- p.151

Thesis (PhD (Biomedical Sciences))--Cape Peninsula University of Technology, 2017. / The use of medicinal plants in the management of various health problems date back to the ancient times. However, only in recent years, researchers are starting to focus on the use of natural plant products as alternative treatment in disease control. Basella alba (Ba), commonly called Ceylon or Indian spinach is one of such medicinal plants, wildly cultivated and consumed mostly as vegetable. Studies have established many beneficial effects of Ba, including androgenic effects as well as antidiabetic effects which have been described in rats following oral administration of the leave extract. However, the actual mechanisms underlying the antihyperglyceamic effect of Ba have not been reported in any study and little or no research details are yet available on the potential beneficial effects of Ba in reproductive dysfunction resulting from diabetes mellitus. This study was aimed at investigating the mechanisms underlying the antidiabetic effect of Ba and the possibility of a role for the plant in correcting diabetic-induced reproductive dysfunctions in male Wistar rats. The first part of the study involved comparing of three different solvent extracts of Ba leaves namely ethyl acetate, methanolic and aqueous extracts for their antioxidant potentials, after which the aqueous extract was selected for further use in the experiments. Animal experimentation involved male rats (n=40) aged 8-10 weeks, randomly divided into four equal groups as follows: Healthy Control, Diabetic Control, Healthy Treatment and Diabetic Treatment. Diabetes was induced via a single intraperitoneal injection of streptozotocin (55mg/kg) and all animals subsequently received treatment via gavage (Rats in Control groups received 0.5ml/100g normal saline daily and treatment groups received 200mg/kg plant extract daily) for a period of four weeks. Fasting blood sugar and body weights were recorded weekly throughout the study. Animals were sacrificed upon completion of the treatment and blood samples and tissues collected for further analysis which included computer aided sperm analysis, Luminex® technology and enzyme-linked immunosorbent hormonal assays, inflammatory cytokine assays, analysis of oxidative stress markers and Histopathological analysis. The single intraperitoneal injection of a high streptozotocin dose resulted in hyperglycaemia, weight loss, subnormal sperm parameters, negative balance of inflammatory cytokines and endogenous antioxidants and degenerative changes in the pancreas, testes and epididymis as observed in the diabetic control rats. Oral administration with the aqueous extract of Ba for four weeks in diabetic treatment rats led to a significant reduction in blood sugar and improvement of sperm parameters by modulating the production of gonadal hormones, in vivo antioxidants and inflammatory cytokines. There was also significant recovery of normal islet histology and reduction in testicular and epididymal degeneration in the diabetic treatment rats when compared to their diabetic control counterparts. It was concluded from the findings of this study that the antidiabetic and profertility effects of Ba are largely dependent on the modulation of in vivo production of antioxidants, gonadal hormones and inflammatory cytokines, probably stimulated by one or more phytochemical component(s) that can be isolated in the aqueous extract of the plant

Master of Public Health / OBJECTIVES: In Australia, diabetes causes significant morbidity and mortality. Whilst the need to prevent diabetes and its complications has been widely recognised, the capacity of health care systems - which organise diabetes care - to facilitate prevention has not been fully established. METHODS: A series of seven population-based case-control studies were used to examine the effectiveness of the Australian health care system and its capacity to manage diabetes. Six of the studies compared the patterns of care of patients who had developed advanced diabetes complications in 2000 (cases), to similar patients who remained free of the condition (controls) across Australia and for various risk groups. A secondary study investigated the role of treating GPs in the development of the outcome. RESULTS: A strong relationship between the patterns of care and the development of advanced diabetes complications was found and is described in Chapter 4. In Chapter 5, this same relationship was investigated for each Australian state and territory, and similar findings were made. The study in Chapter 6 investigated whether late diagnosis or the patterns of care was the stronger risk factor for advanced diabetes complications, finding that the greatest risk was associated with the latter. In Chapter 7 the influence of medical care during the pre-diagnosis period was explored, and a strong relationship between care obtained in this period and the development of advanced complications was found. In Chapter 8, which investigated the role of socio-economic status in the development of advanced complications, found that the risk of advanced diabetes complications was higher in low socio-economic groups. Chapter 9 investigated geographic isolation and the development of advanced diabetes complications and found that the risk of advanced complications was higher in geographically isolated populations. Finally, Chapter 10, which utilised a provider database, found that some GP characteristics were associated with the development of advanced diabetes complications in patients. CONCLUSION: A number of major risk factors for the development of advanced complications in Australia was found. These related to poorer diabetes management, later diagnosis, low socioeconomic status and geographic isolation. Strategies must be devised to promote effective diabetes management and the early diagnosis of diabetes across the Australian population.

published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Public Health / Master / Master of Public Health

M. Tech. Polymer Technology / Type II diabetes afflicts more than 300 million people worldwide. The pursuit for improved targeted drug delivery systems has led to the development of highly improved biomaterials with enhanced biocompatibility and biodegradability properties. Hydrogels are of particular interest for drug delivery applications due to their ability to address targeted drug delivery, in addition to their good biocompatibility, tunable network structure needed to control the diffusion of drugs and their ability to imbibe drugs within their mesh network structure. Hydrogels are promising candidates for advanced anti-diabetic applications. They were prepared by application of free-radical polymerization of acrylamide (AAm) in the presence of partially and thermally reduced graphene oxide (rGO) and wheat protein isolate (WPI). The incorporation of two (or more) different drugs onto a single delivery vehicle and the realization of combination therapy is a challenging, just as it is an important aspect for smart drug delivery. Thus, the development of dual drug delivery systems that can control the release behaviours of each drug is highly pertinent. This project aims to develop a dual drug delivery system with smart polymers, exploiting stimuli responses to be utilized as a carrier vehicle to aid in proffering a cure for diabetes. Also, it aims at proffering a solution to the lingering issue of combination therapy; by comparing the effect of the test drugs individually and in combination as anti-diabetic drugs.

University of Macau / Institute of Chinese Medical Sciences

This ethnobotanical project screened and evaluated the use of traditional medicine of the Cree Nation of Quebec as part of a study directed at preventing complications associated with Type 2 diabetes (T2D). Antidiabetic plants used by the Cree that treat T2D symptoms were identified. Quantitative ethnobotany and analysis of antioxidant activity were conducted. Results from Whapmagoostui were compared with those found in Mistissini and also the literature. Twenty-one plant species were cited during the survey. Although Cree medicine throughout Quebec and Canada is homogenous, geographical and vegetation gradients show some variations. Medicinal plants have better antioxidant potential than non-medicinal plants and have a higher phenolic content. Rankings based upon the ethnobotany, the bioassays and the quantitative tools showed positive correlations. This evidence supports the beneficial effects of Cree TM and medicinal plants selected by the Cree Nation in the prevention of T2D and its complications.

Diabetes in Indigenous Australians occurs at a younger age and at almost four times the rate of non-Indigenous Australians. While the cause for this health disparity is multi-factorial, recent studies suggest that nutrition, and particularly magnesium intake, may play a role in onset of diabetes and related pathologies. No study has ever examined whether there is any relationship between diabetes and magnesium intake in Indigenous Australians, and the present study therefore sought to establish whether any such interrelationship existed. As part of this study, dietary magnesium intake was estimated in an urban cohort of Aboriginal and Torres Strait Islander subjects and compared to the average Australian dietary intake. An ecological study then explored environmental correlates, and specifically the magnesium level in drinking water, to diabetes mortality. Finally, total and free serum magnesium concentrations were determined to identify any differences in magnesium status between diabetic and non-diabetic Indigenous and non-Indigenous Australians, and also to compare which of the two parameters was a more sensitive measure of magnesium status and diabetic risk. All Aboriginal and Torres Strait Islander people that were recruited for this study were patients of the Townsville Aboriginal and Islander Health Services, Townsville, North Queensland, who presented for health monitoring and subsequently required fasting blood tests as part of that routine care. Additional non-Indigenous people were recruited from five GP practices in the Townsville area. Inclusion criteria included persons over the age of 15 (Tanner Stage 5) who had lived in the Townsville area for at least ten days. Exclusion criteria included chronic diarrhoea, alcoholism or binge drinking in the past two weeks, use of diuretics, consumption of magnesium supplements, reduced renal function (urinary albumin to creatinine ratio exceeding > 2.5 mg/mmol in men and > 3.5 mg/mmol in women), severe mental illness, pregnancy, or breastfeeding. Our results indicated that 60% of the Indigenous people assessed in this study had a dietary intake of magnesium that was below the estimated average magnesium requirement for half the national population. Additionally, the average magnesium intake in Indigenous Australians was significantly less than the intake of non-Indigenous Australians (p<0 .001). A significant negative correlation was found between the incidence of diabetes related mortality and the concentration of magnesium in drinking water in Queensland, confirming previous reports from the USA that drinking water magnesium may be an important factor in development of diabetes. The needs assessment study confirmed that diabetes in both Indigenous and non-Indigenous Australians was associated with reduced levels of total serum magnesium, and more importantly, that total serum magnesium was lower in Indigenous Australians who did not have diabetes compared with their non-Indigenous counterparts (p=<0.001). In the absence of diabetes, the prevalence of hypomagnesaemia was 17.2% for the non-Indigenous but 36.9% for the Indigenous subjects. Finally, the ionic serum magnesium analysis confirmed the results of the total serum magnesium study, and demonstrated that ionic magnesium was strongly correlated to the total magnesium concentration (r: 0.75. p < 0.001), with the relationship being apparent irrespective of either diabetic (r: 0.66 to 0.81. p<0.001) or ethnicity (r = 0.71 to 0.81. p<0.001)." We conclude that although not causal, the evidence suggests that magnesium may be a significant contributing factor to diabetes in Australia, especially for Aboriginal and Torres Strait Islander peoples, and that further investigation of the potential relationship between magnesium and diabetes in the Australian Indigenous populations, and possible corrective interventions, is highly warranted. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1348469 / Thesis (Ph.D.) - University of Adelaide, School of Medical Sciences, 2008