Background Literature supports a relationship between low income status and poor diabetes control. However this relationship has not been assessed in Botswana. Aim To determine the relationship between socio-economic status and diabetes control in patients presenting to PMH. Objectives To measure the degree of glycaemic control; to determine the relationship between glycaemic control and monthly income as well as between glycaemic control and lifestyle modification factors;to describe the relationship between glycaemic control and core social welfare indicators. Methods A cross-sectional study, conducted over a 3 months in Gaborone, The questionnaire assessed self-care activities, monthly household earnings and core social welfare indicators among diabetes patients attending PMH. A total of 240 patients were randomly selected to complete the questionnaire. Routine HbA1c values were studied alongside questionnaire responses. Results A total of 58 (24%) participants with HbA1c between 4.0%-7.0% were well controlled, 96 (40%) of participants were poorly controlled (7.1%-9.0%) and 86 (36%) in the very poorly controlled category with HbA1c >9.0%. Of the well-controlled category, 59% lived on a monthly income between P0- P5000(the lowest income bracket). Only 3% participants in this category earned above P20000 monthly (the highest income bracket). Of the 40% poorly controlled participants, 69% fell in the lowest income bracket. No participants in this poorly controlled category earned above P20000 monthly. There were 40% participants in the very poorly controlled category. Of these, 63% earned between P0 - P5000. Only 2 participants with HbA1c values of 9.1 earned above P20000. Conclusion In this study high HbA1c percentages were associated with low monthly income levels and low scores in lifestyle modification factors. Participants with poor access to core welfare indicators also had poor glycaemic control. This study suggests that poor socio-economic status is directly related to poor glycaemic control in patients attending PMH diabetes clinic.

The incidence of type 2 diabetes has greatly increased in the U.S. population over the last decade and continues to increase each year. Over 90% of those with diabetes have type 2 diabetes, for which obesity, diet, and inadequate physical activity remain the strong nongenetic determinants. In Virginia between 1994 and 1996, the estimated number of people with diabetes was 220,000 and another 75,000 were estimated to have the disease, but did not know it (http://www.vahealth.org accessed 7/10/01). A study has been conducted that involves two separate surveys. The Community Diabetes Education Survey (CDES) was an interview questionnaire or mailed questionnaire for assessing community diabetes education resources and was completed by Extension Nutrition and Wellness Specialty Agents and five Area EFNEP/FSNEP coordinators located throughout Virginia. The Diabetes Patient Survey was a client interview questionnaire assessing the attitudes, behaviors, and knowledge of persons with diabetes. This survey was conducted by FSNEP Program Assistants. More than 150 low-income adults who have type 2 diabetes and were enrolled in FSNEP at the time of data collection were interviewed. The results from this study showed hospitals were the main health agency to fill out CDES-II. Most diabetes education done by extension is delivered through a combination of methods like group classes, individual counseling sessions, phone or e-mail, and providing handouts. Almost all of the health agencies offer diabetes diagnosis and treatment for adults. Results from this study showed on gender, age, and race, the study sample was similar to the total FSNEP population, except that the percentage of African Americans was higher among the diabetes patients than among the general FSNEP population. The African American subjects also had diabetes longer (12 years vs. 8 years), although their current mean age was the same as Caucasians. The study did not reveal substantial differences in African Americans and Caucasians regarding recommendations they had received on dietary practices. Forty-nine percent of study's participants were physically active. Most participants exercised two to three times per week, for only 15 to 30 minutes at a time. The purpose of this research was to assess the extent to which diabetes education is available and easily accessible to the low-income adult population in Virginia and to assess FSNEP clients regarding attitudes, behaviors, and knowledge that may affect their management of diabetes. / Master of Science

Thesis (M.S.)--Wake Forest University. Dept. of Health and Exercise Science, 2002. / Vita. Includes bibliographical references (leaves 98-106).

Mild thiamin deficiency is prevalent in diabetes, and high dose thiamin ameliorates some diabetic complications, but there are no definitive studies addressing thiamin intake, diabetes control and thiamin status in diabetes. Subjects were 113 people with diabetes (58 type 1, 55 type 2), 43 with and 70 without thiamin supplementation. Dietary thiamin was estimated by 24-hour recall, diabetes control by HbA1c. Age, BMI, albumin excretion, activity level and smoking status did not correlate with red cell thiamin (RCT) in either group. RCT correlated with serum thiamin (ST) (p < 0.01). In those unsupplemented, adequate dietary thiamin did not ensure normal RCT, with 15.7 % of subjects below the reference range. Supplementation to intake > 4 mg/d, was significantly associated with normal RCT (p = 0.028), with 97.7% of supplemented subjects having normal RCT. Supplementation was also significantly associated with elevated serum thiamin 24 hours post supplementation, contrary to other reports. HbA1c was not significantly associated with RCT. Conclusions: In diabetes, adequate dietary thiamin does not ensure normal red cell thiamin, but supplementation to > 4 mg/day does, raising questions about actual thiamin requirements in diabetes and supporting evidence that thiamin deficiency in diabetes is not primarily due to dietary deficiency. Diabetes control was not significantly related to thiamin status.

Diabetes is a rapidly growing health issue in the United States and across the globe, and is currently the seventh leading cause of death in the United States. Uncontrolled diabetes can lead to other health complications, including coronary heart disease, stroke, kidney disease, vision loss, and Alzheimer’s disease. Diabetes also attributes to a large financial burden in the United States, costing an estimated $245 billion among individuals diagnosed with diabetes in 2012 and a 41 percent increase from 2007. Blood glucose control is essential to reducing diabetes complications and related health care costs. Social resources are central to adherence of these self-management practices, particularly in middle-aged and older adults. Past research has examined the effect of social resources on health behaviors and health outcomes, but little has been done to examine the role of chronic stress on this relationship. Chronic stress is important to diabetes control because stress can impair an individual’s ability to perform diabetes self-management behaviors. The purpose of this research was to fully identify: 1.) predictors of four diabetes control typologies, 2.) if chronic stress mediates the relationship between social embeddedness and diabetes control, and 3.) whether perceived social support moderates the relationship between chronic stress and diabetes control. Data from the 2006-2012 waves of the Health and Retirement Study, a nationally-representative study of adults in the United States, was utilized for these analyses. Study 1 found that perceived diabetes control predicted objective diabetes control. Multinomial logistic regression was employed to determine that age, race, income, self-rated health, perceived control over health, presence of ADLs and IADLs, duration of diabetes, restless sleep, smoking status, and taking oral medication and insulin to treat diabetes were significant predictors of at least one of the four diabetes control typologies, 1.) truly controlled, 2.) falsely controlled, 3.) falsely uncontrolled, and 4.) truly uncontrolled. The results of Study 1 suggest that other factors are associated with the disconnect between perceived and objective diabetes control. Study 2 found limited evidence of a relationship between social embeddedness and 1.) perceived and 2.) objective diabetes control. Generalized structural equation modeling was used to examine the mediating effect of 1.) number of chronic stressors and 2.) perceived stress on the relationship between social embeddedness and both types of diabetes control. One social embeddedness factor, contact with children through meeting in person and speaking on the phone, was fully mediated by perceived stress in its relationship with perceived diabetes control. However, perceived stress did not mediate the association between this social embeddedness factor and objective diabetes control. The results of Study 2 suggest that social embeddedness does not impact diabetes control in the presence of chronic stress, but that support from a social network may. Study 3 examined the relationship between perceived stress and five diabetes control outcomes, 1.) perceived diabetes control, 2.) objective diabetes control, 3.) use of oral medication to treat diabetes, 4.) use of insulin to treat diabetes, and 5.) insulin compliance based on doctor’s recommendation. This study also explored the moderating effect of perceived social support on the relationship between perceived stress and the five diabetes control outcomes. Overall, the findings from Study 3 suggest that perceived negative social support in the presence of high stress may hinder diabetes control and control-related behaviors, and that total social support from a spouse in the presence of high stress was predictive of insulin compliance. The project ultimately illustrated how perceptions of stress and support may impact perceptions of diabetes control and control-related behaviors, but not objective control. However, results of this study should be interpreted with caution because many of the psychosocial measures analyzed were not from validated survey instruments. Overall, future research must focus on how perceptions, whether of control, stress, or support, impact diabetes-related behaviors, and ultimately objective diabetes control. Public health programming can help to improve accurate perceptions of diabetes control by strengthening access to social resources and mitigating the impact of chronic stressors. / Public Health

Poorly controlled diabetes is common among the majority of youth with type 1 diabetes and can lead to adverse health outcomes at an early age. There is a need to change this to minimise the risk of negative long-term consequences. The onset of complications from diabetes can be prevented or delayed with good management as demonstrated by blood glucose being kept close to or within the normal range. Diabetes control is challenging for young people due to a combination of physiological and psychological factors. Diabetes control needs to be monitored both at an individual level and also at a population level, in order to optimise health outcomes and provide important information for health service provision. There are gaps in knowledge relating to the current level of diabetes control at a population level and of the epidemiological characteristics of youth with type 1 diabetes in the Canterbury region in New Zealand. There has been no research of this nature in the Canterbury region since 2003. There are also gaps in knowledge and a lack of national and international research that investigates psychosocial characteristics of youth with type 1 diabetes and the impact these may have on diabetes control. There is a potentially promising intervention, namely, Motivational Interviewing (MI), that although previous research investigating it with diabetes has shown some promise, methodological problems have limited the conclusions that can be drawn. This thesis, within the New Zealand context, addresses some of these gaps and adds to the body of knowledge of research concerning diabetes control and youth with type 1 diabetes, and investigates MI intervention for youth with poorly controlled diabetes. The thesis encompasses three studies. The first study is an audit that provides up-to-date information on epidemiological characteristics and clinical outcomes for the youth population with type 1 diabetes residing in the Canterbury region. The second study is a cross-sectional study that investigates the relationship between glycaemic control and key psychosocial characteristics: illness beliefs, self-efficacy, and quality of life in youth with type 1 diabetes in Canterbury. The third study is a longitudinal study that investigates the efficacy of MI as an intervention for youth with poorly controlled type 1 diabetes, and explores its impact on diabetes outcomes using statistical and clinical analyses. The first study showed that from 2003 to 2010 the prevalence of adolescents and young adults with type 1 diabetes in Canterbury has increased; there is therefore an increased demand on health resources. In addition, in 2010 glycaemic control at a population level was in the poorly controlled diabetes range and this had remained unchanged since 2003. This suggests the need for more intensive interventions. The second study found that poor diabetes control in youth with type 1 diabetes is influenced by a number of factors, including negative views on diabetes, lower perceived personal control, higher diabetes-related concerns, and lower levels of worry about complications. These findings provide a new understanding of the importance of balancing worries about diabetes complications and the perception of diabetes as a threatening condition. The third study showed that the MI intervention was generally successful in improving diabetes outcomes – clinical, psychosocial, and behavioural changes were observed. Statistically and clinically significant positive changes were found across multiple variables: glycated haemoglobin (HbA1c), glycaemic variability, adherence, and psychosocial functioning. Taken together, the findings of the three studies indicate that majority of youth with type 1 diabetes in the Canterbury region had poor glycaemic control, which suggests that additional interventions may be required to improve management of their condition, especially interventions targeting psychosocial functioning (e.g., illness perceptions) and diabetes self-management. Motivational Interviewing may be a viable option, and therefore further research into this approach is recommended.

PrediXcan, an imputed gene expression-trait association method, was compared to multiple linear regressions (MLR) of single nucleotide polymorphisms (SNPs) using the quantitative phenotypes serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL) and triglycerides (TG). The gene expression prediction models were trained using transcriptome- and genome-wide data from Depression Genes and Networks (DGN whole blood) and Genotype-Tissue Expression (GTEx) Project (GTEx whole blood, GTEx pancreas and GTEx liver). Linear combinations of the effect sizes derived using elastic net or least absolute shrinkage and selection operator (LASSO) with genotypes from 1304 European patients from the Diabetes Control and Complications Trial (DCCT) were used to estimate the genetically regulated expression (GReX) for genes. Different gene expression predictors were present in each training set. The 10-fold cross-validated predictive performance, estimated GReX, and p values from associations for matched genes were weakly correlated across training sets and strongly correlated for models derived using elastic net and LASSO. MLR models had more significant associations than PrediXcan models and larger inflation factors for p values. A comparison of p values for matched genes between PrediXcan and MLR models showed weak correlations but strong evidence for LDL and HDL associations with genes at locus 1p13.3 and 16q13, respectively. / Thesis / Master of Science (MSc)

Introduction: Physical activity should be part of our everyday life. However, for people with Type 1 Diabetes Mellitus it is the most common cause of hypoglycemia. To control diabetes in the right way, it is therefore necessary to follow certain rules and recommendations that help preventing hypoglycemia while the physical activity remains beneficial at the same time. Aim of the work: The main aim of this study is to clarify the influence of physical activity in connection to long-term control of Type 1 Diabetes Mellitus. Methods: 102 respondents with diagnosed Type 1 Diabetes Mellitus in the age of 19-69 years participated in a quantitative analysis. This research was conducted in a form of multicentric examination at two independent medical centers. The data collection was done through questionnaires focused on physical activity and daily regime. The data from questionnaires were then compared to the values of glycated hemoglobin (HbA1C), HDL cholesterol and the total daily dose of insulin of certain patients. For statistical evaluation, analytical tools of Microsoft Office program were used (F-test and t-test). Results: We found correlation between HbA1C values in patients physically active for less than 2 hours/week compared to those who are physically active for more than 2 hours/week (62,72...

Indiana University-Purdue University Indianapolis (IUPUI) / Medication adherence remains a problem among Type-2 diabetes (T2D) patients despite availability of effective treatments. Three analyses of extant data sets were conducted to examine barriers to using medication as prescribed as an alternate method to assess medication adherence: 1) development and psychometric evaluation of the Murage-Marrero-Monahan-Medication barriers (4M) scale to assess patients’ perceived barriers; 2) patient demographic factors associated with barriers to using medication as prescribed, and 3) the association between patients’ perceived barriers to medication use and cardiovascular disease (CVD) risk factor control.Twelve focus groups and a cross-sectional study of 362 T2D patients contributed to develop and evaluate psychometric properties of the 4M scale. A cross-sectional survey of 964 T2D patients was used for the other two studies. Analysis of covariance identified demographic factors associated with reported barriers. Multivariable logistic regression was used to identify barriers associated with CVD risk factors (glucose, blood pressure and lipids) categorized as either poor or good control. Exploratory factor analysis with Varimax rotation resulted in a 19-item 4M scale with acceptable psychometric properties. As a five-domain (or single-domain) structure, coefficient alpha ranged from 0.70 to 0.83 (0.92). Both structures demonstrated discriminant validity and known-group validity. Age was inversely associated with all identified barriers while income was inversely associated with poor communication with providers and side effects. A unit increase in the overall barrier mean score on the 4M scale was associated with 92% increase in the odds of having poor control of two or more CVD risk factors compared to good control of all three risk factors (adjusted OR=1.92, 95% CI: 1.16–3.17; p<0.05). The 4M scale demonstrated acceptable psychometric properties in assessing barriers to using medication among T2D patients. Poor medication adherence has been previously associated with CVD risk. In this study, greater barriers were associated with poorer control of CVD risk factors making barriers a potential alternative to medication adherence, whose current assessment methods are limited. The 4M scale has the advantage to identify specific barriers inhibiting medication use that can facilitate patient-provider discussions and the development of targeted interventions. / Some parts of this dissertation work were jointly funded by Program Announcement 04005 from the Centers for Disease Control and Prevention (Division of Diabetes Translation) and the National Institute of Diabetes and Digestive and Kidney Diseases. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the funding agency(s).