Statement of Problem: Aboriginal youth are at greater risk of Type 2 Diabetes (T2D) compared to non-Aboriginal youth. Diabetes prevention strategies need to consider cultural factors that are embedded within an ecological perspective. Methods: Photovoice was used to explore the meanings of T2D and the Aboriginal Youth Mentorship Program (AYMP). Also, a non-randomized crossover experimental trial was performed on children. Grade 4 students were offered a 5 month intervention led by high school mentors. The main outcome measures were WC and BMI z score. Results: Results indicate that youth were very hopeful that T2D can be prevented or managed through nutrition and physical activity. They believe that AYMP can help with T2D prevention, through learning positive health behaviors, but also by enhancing social determinants of health related to education, employment and social support networks. After the intervention, the change in WC was significantly lower in the intervention group compared to the control group (p <0.05). Conclusion: Findings from this research study show that AYMP may be a successful program in teaching positive lifestyle behaviors while supporting social determinants of health; the combined biological and social outcomes can benefit students in reducing their risk for T2D. / October 2015

Autoimmune diabetes is a disorder in which the (3-cells in the pancreatic islets of Langerhans are specifically destroyed resulting in absolute insulin deficiency; typically this is a childhood-onset disease, Type 1 Diabetes (T1D). Type 2 Diabetes (T2D) is a metabolic disorder usually developing in adults resulting from defects in insulin secretion and action. Latent Autoimmune Diabetes in Adults (LADA) is a form of diabetes that shares autoimmune disease pathology with T1D but a clinical presentation similar to T2D; LADA patients develop diabetes as adults (>25 years) and do not immediately require insulin treatment for survival. They are therefore often misdiagnosed with T2D. The aims of this work were to characterise immunological and genetic aspects of LADA using a large cohort collected from various patient repositories the United Kingdom to determine if it is a separate disease entity or an age-related extension of T1D. Both T1D and LADA are characterised by autoantibodies to the islet cell protein glutamic acid decarboxylase 65 (GADA) at diagnosis. The persistence and titre of GADA post-diagnosis in LADA was examined at 0.5, 3 and 6 years. GADA persisted in 93% of patients for 6 years; GADA litres decreased between 0.5 and 3 years post-diagnosis and either stabilised or increased again between 3 and 6 years. GADA titre was not associated with age at diagnosis, glycaemic control, β-cell function or other clinical features. GADA titre at 0.5 years was associated with a greater likelihood of requiring more intensive antihyperglycaemic therapy but did not predict therapy or insulin requirement at 3 and 6 years. Autoantibodies against IA-2 plus GADA compared to GADA alone at diagnosis predicted increased therapy requirement by 3 and 6 years and insulin requirement by 3 years postdiagnosis. Variants of the Human Leukocyte Antigen (HLA) genes DRB1 and DQB1, are associated with susceptibility for T1 D. An analysis of these variants in LADA (n = 378) revealed that the predisposing and protective variants in LADA are similar to those reported in T1D; DR3 (in linkage disequilibrium, LD with DQ2) and DR4 (in LD with DQ8) were the main predisposing variants whereas DR2 (in LD with DQ6) was most the protective against LADA. 85% of LADA patients possessed the DR3 and DR4 specificities, compared with 95% seen in T1D, suggesting a reduced predisposition in LADA compared with T1D. Synergistic effects of the DR3 and DR4 specificities occurred in LADA and the DRB1*0401 allele within the DR4 specificity was predisposing to disease, as seen in T1D. No other predisposing variants were identified in LADA. As reported for T1D, DR11, DR13, DQ5, DQ7 and DQ9 were protective against LADA; DQ6 was positively correlated with age at diagnosis. Association analysis of the insulin gene region in LADA (n = 400) showed that the variable number of tandem repeats (VNTR) locus primarily confers susceptibility to disease. Overall, the short Class I alleles predisposed to disease whereas longer Class III alleles conferred dominant protection, as reported in T1D. Fine-structure analysis showed that the Class I haplotypes 'IC+/ID+' and 'ID-' both conferred susceptibility for LADA - unlike in T1D, where the ID- haplotype has been reported to have protective effects. The Class III 'Protective' and Very Protective' haplotypes, conferred equal protection in LADA, as reported forTID. In conclusion; GADA persist post-diagnosis but are not markers for disease progression of LADA. Patterns of susceptibility at the HLA and insulin gene regions in LADA are similar to that reported for T1 D. LADA is likely to represent an age-related extension of T1D rather than a separate disease entity.

Thesis (MSc(Biomedical Technology))--Cape Peninsula University of Technology, 2019 / Background: Maturity Onset Diabetes of the Young (MODY) is a monogenic type of diabetes caused by a single gene mutation. Up to date 14 different MODY subtypes have been identified. Mutations in the glucokinase (MODY 3) and hepatic nuclear factor 1 alpha (HNF1A) (MODY 2) are the most frequent causes of MODY in all populations studied. Patients with MODY are misdiagnosed with type 1 or type 2 diabetes. Identifying patients with MODY is important as it affects treatment, for example, MODY 2 patients need no treatment, whereas those diagnosed with MODY 3 are very sensitive to low doses of sulphonylureas. To date, no data is available on the prevalence of MODY in populations from Africa. Thus, we aimed to investigate and report on the incidence of MODY, specifically mutations in the HNF1A gene in a population from the Western Cape. Methods: In this study, we screened for HNF1A MODY (MODY 3) mutations (rs115080759, rs140491072 rs137853245, and rs142318174) in 1639 (males = 406) individuals using real-time PCR. Positive MODY samples were confirmed by subsequent sequencing. All individuals underwent an oral glucose tolerance test. Results: The mean age of participants was 47.1±15.6 in males and 49.9±15.1 females. We identified 12 (0.73%) individuals with HNF1A gene polymorphisms; 12/1642 of rs115080759. Seven participants with a SNP in rs115080759 presented with normoglycemia, one with prediabetes, and four with diabetes. No polymorphism was detected in three SNPs; rs140491072, rs137853245 and rs142318174. Discussion and conclusion: To our knowledge, this is the first African study on MODY, and the incidence is similar to that reported in other studies. The results suggest that MODY is misdiagnosed with other types of diabetes in Africa; therefore, our findings support the introduction of diagnostic genetic testing for MODY in South Africa.

Thesis (Ph.D.)--University of Alberta, 2009. / A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Nutrition and Metabolism, Agricultural, Food and Nutritional Science. Title from pdf file main screen (viewed on September 25, 2009). Includes bibliographical references.

Studies investigating the use of behavioral techniques in the treatment of health-related problems have recently received considerable emphasis. Problems such as enuresis (Atthowe, 1972; Nordquist, 1971), obesity (Stuart, 19137), alcoholism (Miller, 1972; Sobell and Sobell, 1973), chronic pain (Fordyce, Fowler, Lehman, and DeLateur, 1975·), and asthma (Neisworth, 1972; Renne and Creer. 1976) have been treated by the use of behavioral techniques. Katz and Zlutnick (1975) mention two critical areas in which behavior analysis is particularly applicable to health care: a) rehabilitation, and b) patient management. Rehabilitation involves learning behaviors related to specific physical disabilities, for example stroke patients relearning walking skills, and amputees learning various self-care and vocational skills. Patient management involves increasing or decreasing specific patient behaviors to ensure they follow prescribed treatment plans. Patients with chronic dieases such as diabetes or multiple sclerosis must often be placed on stringent medical regimens. Thus, compliance with physicians 1 requests to take medication, follow diets, or engage in exercise is a vital component of patient management and must be maintained if a patient is to sustain optimal health. In view of these considerations, knowledge of the conditions under which

An estimated 215,000 children and adolescents younger than 20 years old were diagnosed with Type 1 or Type 2 diabetes in 2011. Management of children with Type 2 diabetes requires 24-hour care provided by health care providers, parents, and school nurses. Guided by the health belief model (HBM), the purpose of this qualitative case study was to explore and describe beliefs, attitudes, and practices of school nurses who manage children with Type 2 diabetes. A pilot study with 2 nurses was conducted to finalize interview guide. Volunteer school nurses were recruited through an e-mail announcement from their school district. Face-to-face, in-depth interviews with 10 female school nurses were conducted. School nurse work experience ranged from 4 to 20 years, selected from 4 school districts, including 8 European, 1 Asian, and 1 Hispanic American. Transcripts from digitally recorded interviews were analyzed using NVivo software version 11. Thematic analysis led to 5 themes of communication, education, management, perceived barriers (multiple schools assigned/student demand), and enablers (school aides). Individually and collectively, themes reflect a synergistic positive attitude in management of children with Type 2 diabetes. HBM constructs elucidated school nurses' behaviors and attitudes regarding severity and susceptibility to illness, benefits students received from preventive care, and barriers they encountered. The positive implications for social change include recommendations for increasing the number of school nurses per district to meet the demand in managing children with chronic diseases, and intensification of positive attitude interventions in diabetes management.

Diss. (sammanfattning) Umeå : Umeå universitet, 2010. / Härtill 4 uppsatser. Även tryckt utgåva.

This study is about young people (age 11-16) with diabetes. Based on fieldwork in a paediatric diabetes centre in Scotland, it describes the ways diabetes is lived and done by young people, their health carers and insulin pumps. This enactment is contrasted with other ways of doing diabetes, as observed on short fieldwork trips to paediatric centres in Brussels, Gothenburg and Boston. I explore the dynamics of diabetes care on two levels. I consider the interaction between health carers and patients. Comparative data from various paediatric centres make apparent how culturally and socially informed approaches towards adolescence, health and illness shape both care practices and patients' experiences, resulting in different medical outcomes. Concretely in the Scottish centre, a non-hierarchical holistic care approach by health carers emphasizing quality of life over health, informs the young people's perspective on diabetes. Being a free adolescent takes priority over managing diabetes, with the results of ill health and possible future complications. The existing dynamics in this care framework change as a third actor enters the scene: the insulin pump, a pager-sized technological device continuously attached to the body. I explore the balancing act between young people and their pumps. As the adolescents actively engage with their pumps not to search for better health but rather to pursue a better quality of life, the guiding question becomes: how can a technological device for insulin injection double as a tool towards a desired identity and a different illness? This work then, can be read as a concrete case study of how a uniform technological device is embedded and used in a specific cultural and social context. It can also be read as an argument for a re-orientation of paediatric diabetes care in the Scottish centre: care centred on collaboration and inclusion rather than focused on merely containing underlying conflict (between adults and adolescents, diabetes and life, health and quality of life). Centres in Brussels, Gothenburg and Boston, and the insulin pump concretely, show how collaboration can lead to good health and quality of life. To leave us to wonder: is 'doing diabetes differently' synonymous with 'doing a different diabetes'?