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Medicinal plants, as part of traditional ingestion practices, may contain antioxidants to combat the oxidative stress which is implicated in prediabetes as well as many of the complications of diabetes, As Indigenous Peoples move further from their traditional lifestyles, and therefore their use of medicinal plants, incidence of diabetes has increased dramatically, Those medicinal plants of the boreal forest that have been used for 3 or more symptoms of diabetes or its complications were selected for analysis. Three different assays (DPPH, NBT/xanthine oxidase and DCF/APPH) determined the antioxidant activity of 35 medicinal plant species. The majority of the species (89%) had free radical scavenging activity significantly greater than the market produce tested (Tukey, P < 0.05), 63% had superoxide scavenging activities similar to vitamin C, and eight species had free radical scavenging activity similar to green tea. Considering that many of these species are also used for food or beverage they represent an antioxidant benefit to the traditional lifestyle. Among the parts used medicinally, roots and barks were used the most frequently with activity in the order of fruit > bark > leaves > roots. The perennials selected had activity in rank trees > shrubs > herbs and the activity associated with habitat found rocky areas > woodland > wet/boggy habitats. Species used for symptoms such as diarrhea, rheumatism, tonic and heart/chest pain were typically high in antioxidant activity. Using cluster analysis it was determined that species used for diarrhea and heart disease as well as those used for a combination of tonic, sores, urinary, blood, pregnancy and boils could also be species with high antioxidant activity. The greater the number of symptoms a species was used for, the greater the activity. Three species with high antioxidant activities, Rhus hirta, Cornus stolonifera and Solidago canadensis, inhibited TNF production in human macrophage cells suggesting a po

Health coaching is a promising approach to support self-management of chronic conditions like type 2 diabetes; however, there aren’t enough coaching practitioners to support those in need. Advances in Artificial Intelligence (AI) and Machine Learning (ML) have the potential to enable innovative, automated health coaching interventions, but important gaps remain in applying AI and ML to coaching interventions. This thesis aims to identify computational approaches and interactive technologies that enable automated health coaching systems. First, I utilized computational approaches that leverage individuals’ self-tracking and health data and used an expert system to translate ML inferences into personalized nutrition goal recommendations. The system, GlucoGoalie, was evaluated in multiple studies including a 4-week deployment study which demonstrated the feasibility of the approach. Second, I compared human-powered and automated/chatbot approaches to health coaching in a 3-week study which found that t2.coach — a scripted, theoretically-grounded chatbot designed through an iterative, user-centered process — cultivated a coach-like experience that had many similarities to the experience of messaging with actual health coaches, and outlined directions for automated, conversational coaching interventions. Third, I examined multiple AI approaches to enable micro-coaching dialogs — brief coaching conversations related to specific meals, to support achievement of nutrition goals — including a knowledge-based system for natural language understanding, and a data-driven, reinforcement learning approach for dialog management. Together, the results of these studies contribute methods and insights that take steps towards more intelligent conversational coaching systems, with resonance to research in informatics, human-computer interaction, and health coaching.

Thesis (MNutr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Introduction: Intensive lifestyle intervention in people with Type 2 Diabetes Mellitus (T2DM) is associated with weight loss, significant reductions in HbA1c% and a reduction in cardiovascular disease risk factors. Small towns unfortunately experience a deficit of dieticians, thus limiting access to lifestyle intervention. Furthermore, a limited number of South African studies have evaluated the effect of dietary habits, anthropometric status, activity level (AL) and dietician-led medical nutrition therapy (MNT) on glycaemic control in patients with T2DM. This study thus aimed to identify the association between glycaemic control and lifestyle habits in adults with T2DM living in Thabazimbi. The role of the dietician with regard to optimal glycaemic control was also investigated with great interest. Methods: Individuals (>18 years) with T2DM who had a recent HbA1c test result and no acute infection/illness were included in the study over a 7 month recruitment period. Weight, height and waist circumference were measured, AL and dietetic contact evaluated, and dietary habits assessed by means of a structured questionnaire. Six home-measured post-prandial glucose (PPG) measurements and HbA1c% were used to evaluate glycaemic control. Results: A total of 62 (59.7% males) patients were included. The mean age was 60.13 ±10.85 years and mean T2DM disease duration was 121 ±96.56 months. Only 6.45% of participants had a normal Body Mass Index classification. Most (90.32%) participants had a substantially increased waist circumference (WC). Half of the participants had a sedentary/low AL, whilst 48.39% had an active/moderately active AL. Almost all (95%) participants indicated it was necessary for persons with DM to consult a dietician for MNT, however only 63% of participants actually consulted one. Mean dietary compliance was 74.53 ±10.93%. The average HbA1c% and PPG of participants were respectively 7.50 ±1.62% and 8.90 ±3.21mmol/l. A significant negative association (r=-0.31; p=0.02) was found between HbA1c% and percentage dietary compliance. The number of dietetic sessions completed and average PPG were also significantly [(r=0.40; p=0.001), (r=-0.34; p=0.01)] associated with percentage dietary compliance. In turn PPG had a significant positive (r=0.30; p=0.02) association with DM disease duration. Both the good HbA1c and good PPG control groups had significantly (p=0.01, p=0.04) better dietary habits than the poor HbA1c and PPG control groups. When compared to the poor PPG group, the good PPG group made significantly (p=0.04) better dietary decisions with regard to the main meal’s carbohydrate quality and quantity. Body Mass Index, WC, AL and extent of dietetic contact didn’t play a significant role in the glycaemic classification (good vs. poor) of participants. Conclusion: The longer T2DM is present, the worse PPG control becomes. Optimal dietary habits play a significant positive role in both the long- and short term glycaemic control of people with T2DM in Thabazimbi. The choice and portion size of the main meal’s carbohydrates has been identified to be the most important dietary role-player in the glycaemic control of this study population. This study also shows that if individuals with DM spend enough time with a dietician, it could potentially contribute to better dietary compliance and subsequent better glycaemic control. / AFRIKAANSE OPSOMMING: Inleiding: Intensiewe leefstyl intervensie onder diegene met Tipe 2 Diabetes Mellitus (T2DM) word geassosieer met gewigsverlies, beduidende verlaging in HbA1c% asook ’n vermindering in verskeie kardiovaskulêre-siekte risiko faktore. Plattelandse dorpies beleef egter ’n tekort aan dieetkundiges, wat gevolglik toegang tot leefstyl intervensie beperk. Daar is ook ’n beperkte hoeveelheid Suid-Afrikaanse studies wat die impak van eetgewoontes, antropometriese status, aktiwiteitsvlak en dieetkundige-begeleide dieetterapie op glisemiese beheer in T2DM pasiënte evalueer. Die doel van die studie was dus om die verband tussen glisemiese beheer en leefstyl gewoontes in volwassenes met T2DM in Thabazimbi te bepaal. Die rol van die dieetkundige met betrekking tot optimale glisemiese beheer was ook met groot belangstelling nagevors. Metodes: Diegene (>18 jaar) met T2DM wat oor ’n onlangse HbA1c toets uitslag beskik het en nie enige akute siektes/infeksie gehad het nie, is oor ’n 7 maande werwingsperiode ingesluit. Gewig, lengte en middel-omtrek was gemeet, aktiwiteitsvlak en dieetkundig-kontak bepaal, en eetgewoontes geassesseer m.b.v. ’n gestruktueerde vraelys. Ses tuis-bepaalde na-ete bloedsuiker lesings en HbA1c% was gebruik om glisemiese beheer te evalueer. Resultate: Twee-en-sestig (59.7% mans) pasiënte het aan die studie deelgeneem. Die gemiddelde ouderdom was 60.13 ±10.85 jaar en die gemiddelde T2DM duurte 121 ±96.56 maande. Slegs 6.45% van die deelnemers het ’n gesonde Liggaam-Massa-Indeks gehad. Meeste (90.32%) deelnemers se middel-omtrek was ook ruimskoots verhoog. Die helfte van die deelnemers het ’n passiewe/lae aktiwiteitsvlak gehad, terwyl 48.39% ’n aktief/matig-aktiewe aktiwiteitsvlak gerapporteer het. Amper al (95%) die deelnemers het aangedui dat mense met T2DM ’n dieetkundige moet raadpleeg vir dieetterapie. Slegs 63% van die deelnemers het egter werklik ’n dieetkundige vir diabetes dieetterapie geraadpleeg. Gemiddelde dieet-gehoorsaamheid was 74.53 ±10.93% en die gemiddelde HbA1c % en na-ete bloedsuiker vlakke van deelnemers was onderskeidelik 7.50 ±1.62% en 8.90 ±3.21mmol/l. Daar was ’n beduidende negatiewe verband (r=-0.31; p=0.02) tussen HbA1c % en persentasie dieet-gehoorsaamheid. ’n Beduidende verband was ook tussen persentasie dieet-gehoorsaamheid en die hoeveelheid voltooide dieetterapie sessies (r=0.40; p=0.001) asook die gemiddelde na-ete bloedglukose vlak (r=-0.34; p=0.01) geïdentifiseer. Na-ete bloedglukose het ook ’n beduidende positiewe (r=0.30; p=0.02) verband met die duurte van diabetes getoon. Beide die goeie HbA1c en goeie na-ete glukose groepe het beduidend (p=0.01, p=0.04) beter eetgewoontes as die swak HbA1c en swak na-ete glukose groepe gehad. Die goeie na-ete glukose groep het veral beduidend (p=0.04) beter dieet keuses m.b.t die hoofmaal se koolhidraat kwaliteit en kwantiteit gemaak. Lengte-Massa-Indeks, middel-omtrek, aktiwiteitsvlak en die mate van dieetkundige kontak het nie ’n beduidende rol in die glisemiese klassifikasie (goed teenoor swak) van deelnemers gespeel nie. Gevolgtrekking: Na-ete bloedsuiker beheer word al hoe slegter hoe langer T2DM teenwoordig is. Optimale eetgewoontes speel ’n beduidende positiewe rol in beide die lang- en kort-termyn glisemiese beheer van mense met T2DM in Thabazimbi. Die keuse en porsie grootte van die hoofmaal se koolhidrate blyk die belangrikste dieet rolspeler in die glisemiese beheer van die studie populasie te wees. Die studie dui ook aan dat as mense met T2DM genoeg tyd saam met ’n dieetkundige deurbring, dit moontlik kan bydra tot beter dieet-gehoorsaamheid en gevolglik beter glisemiese beheer.

The aim of this study was to assess the dietary intake, diet-related knowledge and metabolic control in children with Type 1 Diabetes Mellitus between the ages of 6-10 years attending the Paediatric Diabetic Clinics at Grey’s Hospital, Pietermaritzburg and Inkosi Albert Luthuli Central Hospital, Durban, KwaZulu-Natal. This was a cross sectional observational study that was carried out in a total of 30 subjects out of a possible 35 subjects that qualified for inclusion in the study from both the Grey’s Hospital clinic (n=8) and IALCH clinic (n=22). The dietary intake was assessed in a total of 25 subjects using a three day dietary record (n=20) and a 24 hour recall of the third day of the record (n=16). Diet-related knowledge was assessed using a multiple choice questionnaire. Metabolic control was assessed using the most recent HbA1c and the mean HbA1c results over the previous 12 months from the date of data collection. Height and weight measurements were also carried out. Information on socioeconomic status and education status of the caregivers was obtained from 22 caregivers through follow-up phone calls. All measurements except for dietary intake were obtained from all subjects participating in the study. The mean percentage contribution of macronutrients to total energy was very similar to the International Society for Pediatric and Adolescent Diabetes (ISPAD) Consensus Guidelines (2002). The mean percentage contribution of macronutrients to total energy from the 3 day dietary records and the 24 hour recalls were as follows: carbohydrate (52% and 49%); sucrose (2% and 2%); protein (16% and 17%); fat (32% and 34%). Micronutrient intake was adequate for all micronutrients except for calcium and vitamin D which showed low intakes. The mean diet-related knowledge score for the sample was 67% with significantly higher scores in children older than 8 years of age. The latest HbA1c for the sample was 9.7% and the mean HbA1c over the previous 12 months from the date of data collection was 9.6%. There was a significant positive correlation between age of the participant and the latest HbA1c (r = 0.473; p=0.008) and a significant negative correlation between the education level of the caregivers and the latest HbA1c (r = - 0.578; p=0.005) and the mean HbA1c over 12 months (r = - 0.496; p=0.019). Significant differences were found between African and Indian children respectively for HbA1c, with higher values in African children. There was no correlation between BMI for age and latest HbA1c (r = 0.203, p=0.282) or mean HbA1c over 12 months (r = 0.101, p=0.594). Z score for BMI for age was also not correlated with latest HbA1c (r = 0.045, p=0.814) or mean HbA1c over 12 months (r = - 0.012, p=0.951). Children from the Grey’s Hospital Clinic were found to have higher HbA1c values (p=0.001) and lower diet-related knowledge scores as compared to the children from the IALCH Clinic (p=0.038). It should be noted that the ethnic and racial composition of the children attending these two clinics differed. In conclusion the macronutrient intake in this sample was found to be similar to the ISPAD Consensus Guidelines (2002) while calcium and vitamin D intakes were low. Overall this sample displayed good diet-related knowledge while metabolic control was found to be poor. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2007.

Indiana University-Purdue University Indianapolis (IUPUI) / A recent review of randomized controlled trials found that trivalent chromium (Cr3+) supplementation significantly improved glycemia among patients with diabetes, consistent with a long-standing appreciation that this micronutrient optimizes carbohydrate metabolism. Nevertheless, a clear limitation in the current evidence is a lack of understanding of Cr3+ action. We tested if increased AMP-activated protein kinase (AMPK) activity, previously observed in Cr3+-treated cells or tissues from Cr3+-supplemented animals, mediates improved glucose transport regulation under insulin-resistant hyperinsulinemic conditions. In L6 myotubes stably expressing the glucose transporter GLUT4 carrying an exofacial myc-epitope tag, acute insulin stimulation increased GLUT4myc translocation by 69% and glucose uptake by 97%. In contrast, the hyperinsulinemic state impaired insulin stimulation of these processes. Consistent with Cr3+’s beneficial effect on glycemic status, chromium picolinate (CrPic) restored insulin’s ability to fully regulate GLUT4myc translocation and glucose transport. Insulin-resistant myotubes did not display impaired insulin signaling, nor did CrPic amplify insulin signaling. However, CrPic normalized elevated membrane cholesterol that impaired cortical filamentous actin (F-actin) structure. Mechanistically, data support that CrPic lowered membrane cholesterol via AMPK. Consistent with this data, siRNA-mediated AMPK silencing blocked CrPic’s beneficial effects on GLUT4 and glucose transport regulation. Furthermore, the AMPK agonist 5-aminoimidazole-4-carboxamide-1-ß-D-ribonucleoside (AICAR) protected against hyperinsulinemia-induced membrane/cytoskeletal defects and GLUT4 dysregulation. To next test Cr3+ action in vivo, we utilized obesity-prone C57Bl/6J mice fed a low fat (LF) or high fat (HF) diet for eight weeks without or with CrPic supplementation administered in the drinking water (8 µg/kg/day). HF feeding increased body weight beginning four weeks after diet intervention regardless of CrPic supplementation and was independent of changes in food consumption. Early CrPic supplementation during a five week acclimation period protected against glucose intolerance induced by the subsequent eight weeks of HF feeding. As observed in other insulin-resistant animal models, skeletal muscle from HF-fed mice displayed membrane cholesterol accrual and loss of F-actin. Skeletal muscle from CrPic-supplemented HF-fed mice showed increased AMPK activity and protection against membrane cholesterol accrual and F-actin loss. Together these data suggest a mechanism by which Cr3+ may positively impact glycemic status, thereby stressing a plausible beneficial action of Cr3+ in glucose homeostasis.

Diabetes and related complications are one of the leading causes of death for Mexican American women. Although dietary behavior is a critical component of diabetes management, research is lacking in relation to the interplay of food habits, culture, and diabetes among this population. The specific aims of this ethnographic study were to: (1) explore the relationships between culture, food habits, and type 2 diabetes as experienced by low income Mexican American women; (2) examine the role of food in the cultural identity of low-income Mexican American women; (3) examine how trying to adhere to the ADA dietary guidelines for people with diabetes impacts the relationship between food and culture of low income Mexican American women with type 2 diabetes. This sample consisted of 16 Mexican American women between the ages of 39 to 60 years. Twelve of the sixteen had experienced diabetes for at least 10 years, and were considered experts in the management of their illness. The remaining four had experienced diabetes for a shorter period of time and were considered novices. Individual interviews were conducted with each informant. All interviews were audiotaped with the exception of one. The interviews, observations, and field notes were analyzed for data. The analysis of data rendered 6 themes: (1) “la dieta,” (2) the location and fluidity of food (3) confidence-defiance self-management connection, (4) negotiating sociocultural and biomedical expectations, (5) eating for diabetes is a family affair, and (6) strategies for self-care. In addition, preliminary comparisons were conducted between experienced and more novice individuals with diabetes. / text