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.

Differences in Mexican American ethnicity, family and friend social support, and importance of diabetes self-management as related to diabetes management in the older adult population were evaluated with the University of Michigan Health and Retirement Study (HRS) 2003 Diabetes Study. Comparisons were made between Mexican Americans with Type II diabetes and similar non-Hispanic Caucasian and African American individuals with Type II diabetes. Neither family/friend social support nor importance of diabetes self-management were significant predictors of HbA1c levels. Results did not support the idea that perception of receiving support from family/friends or placing importance on diabetes self-management covaried with lower HbAlc level (family/friend: beta = -.13, t = -1.47, p = .143; self management: beta = .08, t = .55, p = .584).