Thesis (MHSc--Health Science) -- Auckland University of Technology, 2004. / Also held in print (218 leaves, col. ill., 30 cm.) in Akoranga Theses Collection (T 616.46200996 SIM)

Thesis (Ph. D.)--University of California, San Diego, and San Diego State University, 2004. / Vita. Includes bibliographical references (leaves 58-64).

Thesis (M.S.)--University of Michigan, 1996. / Includes bibliographical references.

Source: Masters Abstracts International, Volume: 46-04, page: 2087. Adviser: Jeanne B. Martin. Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1996. / Includes bibliographical references.

Background: Worldwide one in twelve people are living with diabetes and one in two people do not know they have diabetes. Currently large numbers of the older people live in residential care homes in the UK, and up to one in four older people living in residential care homes present with diabetes. Low vision is one of the complications associated with diabetes in older people. In those aged 75 and over, one in five, and in those aged over 90, one in two people are affected by low vision and they are at an increased risk of developing other eye diseases. Within 20 years of diagnosis nearly all people with Type 1 and almost two thirds of people with Type 2 diabetes (60%) have some degree of diabetic retinopathy. Aims and Objectives: This study aimed to investigate the issues and problems faced by older people living in residential care homes with low vision and diabetes; to evaluate health professionals’ knowledge and understanding of the impact of low vision associated with diabetes in older people living in residential care homes; and to develop an educational toolkit which aimed to educate health care assistants about low vision and diabetes. Methods: This study is an exploratory investigation of older people living in residential care homes with low vision and diabetes. Adopting an open-ended qualitative approach using focus groups, interviews and a health professional’s survey, 116 participants were involved. These included GPs, ophthalmologists, nurses, optometrists, health care assistants and older people with low vision and diabetes. The data was analysed thematically. The educational toolkit was developed in the second part of this study, and 20 healthcare assistants were trained using this toolkit. Their knowledge was tested before the training, immediately after the training and one month after the initial training. Following Kirkpatrick’s model, the skills and practical use of the educational toolkit was assessed using an open-ended qualitative approach. Results: The results found that many older people and the health care assistants had the perception that low vision was a normal ageing process and could not be rectified. The study found that there was evidence to suggest that eye health was not considered to be a priority; instead, it was considered to be a natural part of the ageing process. The results found that 82% of the HCAs had not had any training in the area, and more than half of the nurses and GPs did not have sufficient knowledge of low vision and diabetes. After training, however, their knowledge was increased. This suggested that low vision and diabetes toolkit training could be used to educate healthcare assistants on a regular basis. The study also found that knowledge does decline over time, and therefore regular training for HCAs is required in order to maintain eye health and diabetes in older people, as well as improving their quality of life. Conclusion: In the research findings it was found that 50% to 70% of low vision was preventable or treatable if detected in its early stages and could be avoided by simply wearing appropriate spectacles, or possible surgery. However, in order to identify these 50% to 70% with low vision, everyone concerned should be able to recognise the signs and symptoms of preventable low vision, particularly health care assistants, as according to this study, health care assistants spent large amount of time in the residential care homes compared to the other health professionals.

Type 1 diabetes in pregnancy is associated with higher rates of maternal and infant complications. The complications are associated with maternal hyperglycaemia. Thus, the main goal of treatment for these women is to optimise glycaemic control and thereby improve clinical outcomes for themselves and for their baby. This thesis examines glycaemic control in the mothers and infants of pregnancies affected by type 1 diabetes. I present the first home studies of closed-loop insulin delivery in this population. The aim of these studies was to assess the feasibility, efficacy, and utility of overnight and then day-and-night closed-loop insulin delivery in pregnant women with type 1 diabetes. The overnight study, which examined 16 pregnant women (mean age 34.1 years, HbA1c 6.8%, 14.4 weeks gestation), compared overnight use of the closed-loop system with sensor-augmented pump therapy in a 2x4-week randomised crossover design. We found that closed-loop therapy was associated with a 15% improvement in overnight time spent with target glucose concentration (3.5-7.8 mmol/L; 74.7% during closed-loop use vs 59.5% during sensor-augmented pump therapy use). The day-and night study also examined 16 pregnant women (mean age 32.8 years, HbA1c 8.0%, 16.4 weeks’ gestation) using a 2x4-week randomised crossover design to compare continuous day-and-night use of closed-loop insulin delivery with sensor-augmented pump therapy. This study enrolled a more diverse range of participants than the overnight study, but found that closed-loop therapy was associated with comparable glucose control and significantly less hypoglycaemia than sensor-augmented pump therapy. Chapter 4 examines women’s experiences of using the closed-loop system during pregnancy. While the system was generally well-received by participants, individual interactions and perceptions of the system varied markedly, and often did not align with biomedical measures of glycaemic response. After participation in either crossover study, participants could choose to continue using the technology until delivery (overnight study), or until 6 weeks post-partum (day and night study). Those data are presented in Chapters 2 and 3. The combined data from the women who used the closed-loop system during labour and delivery in either study are presented in Chapter 5. Tight glycaemic control during labour and delivery has traditionally been considered important for reducing rates of neonatal hypoglycaemia. However, despite very tight maternal glycaemic control in the women who used closed-loop insulin delivery, rates of neonatal hypoglycaemia were high. In order to better characterise the relationship between maternal glucose control in type 1 diabetes pregnancy and neonatal hypoglycaemia, Chapter 6 details an observational study in which continuous glucose monitoring was used to measure maternal and neonatal glycaemic control in 16 mother-infant pairs. The study found that, while neonatal hypoglycaemia was very frequent, it was generally, but not always, detected and treated effectively. Together, these studies suggest that a novel management tool, closed-loop insulin delivery, can improve overnight glycaemic control, and perhaps reduce hypoglycaemia during type 1 diabetes-affected pregnancies above what is possible with currently available treatments. However, complication rates remain high for these women and their babies. Further research is needed both to further develop treatments that can improve maternal glycaemic control, and to better understand the pathogenesis of diabetes-related pregnancy complications, with the ultimate goal of improving outcomes for women and their children. A definitive trial to assess the clinical efficacy, patient acceptability, and cost effectiveness of closed-loop is now warranted.

No description available.

The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from PDF of title page (University of Missouri--Columbia, viewed on April 1, 2010). Vita. Thesis advisor: Habib Zaghouani. "May 2008" Includes bibliographical references.

Thesis (Ph.D.)--University of Melbourne, Dept. of General Practice and Centre for Health and Society, 2007. / Typescript. Includes bibliographical references (leaves 252-278).