This thesis reviews and augments existing evidence surrounding the psychosocial aspects of living with Type 2 diabetes. There is a specific emphasis on the factors which underpin diabetes distress in individuals with Type 2 diabetes, which pertains also to the influence of partners or spouses on psychological adjustment to diabetes. This research develops and presents a conceptual framework of the key determinants of diabetes distress, providing focus and content for an intervention to address distress among couples living with Type 2 diabetes. Chapter 1 introduces the concept of diabetes distress; including prevalence, clinical relevance, and the cognitive, interpersonal and behaviour factors which are believed to drive this condition-specific distress. There is also an emphasis on existing strategies to improve both psychological and medical outcomes in Type 2 diabetes, which identified a need to evolve psychosocial support for individuals who are struggling to manage diabetes. Importantly, this chapter provided a rationale and direction for the studies reported in prospective chapters. Chapter 2 broadens the focus of psychosocial support in diabetes, to consider also the importance of considering partners or spouses in interventions to improve health outcomes in the context of different chronic physical conditions. This systematic review conveys the benefits of partner inclusion in interventions and highlights a number of shortcomings pertaining to couples intervention work. In particular, the review identifies a scarcity of couples intervention work in the context of Type 2 diabetes. The cross-sectional questionnaire study in Chapter 3 captures the predictive influence of illness perception clusters, coping styles, and relationship quality on diabetes distress in individuals with Type 2 diabetes. Of note, this work identifies negative belief and coping patterns which coincide and exacerbate distress, and presents a novel method of distinguishing those most at risk of elevated diabetes distress. Chapter 4 investigates the influence of partners’ diabetes beliefs on diabetes distress over time. This study demonstrates the moderating influence of partners’ illness perceptions on the association between persons with Type 2 diabetes illness perceptions and diabetes distress, and reveals that such effects persist overtime. Furthermore, Chapter 5 explores narratives of diabetes distress among couples living with Type 2 diabetes and among healthcare professionals, by means of individual semi-structured interviews and focus groups. Expanding on the findings of Chapters 3 and 4, this qualitative work compares experiences of distress from the perspectives of individuals with diabetes and those who support them in a personal and professional capacity, in an attempt to understand how communication and interpersonal conflicts might emerge in day to day life. Importantly, Chapter 5 discerns a perceived need for an intervention to reduce diabetes distress in individuals with Type 2 diabetes and their loved ones, and provides direction for the design and implementation of an intervention of this nature. Chapter 6 draws upon existing and primary evidence pertaining to the cognitive, interpersonal, and behavioural factors which underpin diabetes distress, and provides recommendations for the design and implementation of an intervention to address diabetes distress in couples living with Type 2 diabetes. The feasibility study described in Chapter 7 assesses the acceptability, potential effectiveness, and practical implementation of a brief psychoeducational intervention to address diabetes distress in people with Type 2 diabetes and their partners or family members. The findings of Chapter 7 highlight important strengths and shortcomings of providing an intervention of this nature, which are expanded on in the main discussion in Chapter 8. Chapter 8 provides a broad overview of the rationale for this PhD research and reflects on the primary work undertaken to date. Crucially, this discussion chapter provides recommendations on how key strengths of the feasibility study described in Chapter 7 can be enhanced and how observed shortcomings can be addressed in future studies. Finally, there is consideration of how aspects of the intervention described in Chapters 6 and 7 may feasibly be incorporated into existing programmes of diabetes support.

Thesis (Ph. D.)--University of Hong Kong, 2007. / Title proper from title frame. Also available in printed format.

Thesis (M.Nurs.)--University of Hong Kong, 2008. / Includes bibliographical references (p. 115-120)

Thesis supervisor: David B. Watson. Includes bibliographical references (p. 175-181).

Thesis (Ph. D.)--Duke University, 2008. / Includes bibliographical references.

No description available.

This thesis offers a rethinking of the role for education as critical workplace pedagogy in complex problems of health care. Taking the case of paediatric diabetes, the study explored how health-care professionals learn the work of supporting children, and their parents, to self-manage the condition. By reconceptualising work problems as sociomaterial learning struggles, this research contributes new understandings of informal professional learning in everyday health-care provision. Data were generated through fieldwork in an outpatient clinic. Particular challenges of supporting self-management in this case were the difficulties of balancing policy aspirations for empowerment with biomedical knowledge about risks to immediate and long-term health. Tracing the materialisation of learning as it unfolded in moments of health-care practice showed professionals handling multiple and contradictory flows of information. Particular challenges were posed by insulin-pump technologies, which have specific implications for professional roles and responsibilities, and introduce new risks. A key insight is that professionals were concerned primarily with the highly complicated perpetual discernment of safe parameters within which children and their parents might reasonably be allowed to contribute to self-management. Such discernment does not readily correspond to the notion of empowerment circulating in the policies and guidelines intended to enable professionals to accomplish this work. As a result, this thesis argues that the work of discernment is obscured. Learning strategies evolve, but could be supported and extended by explicit recognition of the important work of learning as it unfolds in everyday practices of supporting self-management in paediatric diabetes. Most importantly, workplace pedagogies could be developed in ways that attune to the profound challenges and uncertainties that are at stake in these practices.

Resume af ph.d afhandling, Uppsala Universitet.

n-3 polyunsaturated fatty acids (n-3 PUFA) have been postulated to improve the insulin resistance associated with type 2 diabetes since the 1960s when observational studies in the Alaskan Inuit noted a reduced prevalence of type 2 diabetes when this population consumed a traditional diet. These findings were supported by animal studies but results of human intervention studies have been variable with most showing no change in glucose metabolism. More recent studies in growing farm animals suggested that muscle membrane phospholipids required to be enriched to a minimum of 14% n-3 PUFA in order for a change in insulin sensitivity to occur. This study sought to establish the effect of long-term (9 month) high-dose (3g/day) supplement of the n-3 PUFA eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on insulin sensitivity of glucose and protein metabolism. Thirty-three subjects with impaired glucose regulation underwent hyperinsulinaemic-euglycaemic-euaminoacidaemic clamps pre- and postintervention of n-3 PUFA or a control (maize) oil. A second cohort who all received n-3 PUFA supplementation underwent pre- and post-intervention muscle biopsies. Secondary outcomes included an assessment of inflammatory status and determining whether erythrocyte membrane phospholipid could act as a surrogate for muscle membrane phospholipid. In the clamp cohort, there were no changes in glucose metabolism postintervention; however, there was an increase in insulin-stimulated protein metabolism following the fish oil intervention. In the biopsy cohort, no subject achieved 14% PUFA enrichment in muscle membrane phospholipids; however, all subjects who received n-3 PUFA supplementation did achieve a minimum of 14% enrichment of n-3 PUFA in erythrocyte membrane phospholipid. In agreement with the majority of the literature, n-3 PUFA did not affect glucose metabolism. Insulin-stimulated protein metabolism was improved supporting the findings of another recent human study. These changes in protein metabolism may reduce the sarcopenia associated with aging, potentially delaying the progression of frailty.

Thesis (Ph.D.)--George Washington University, 2005. / Includes bibliographical references (leaves 57-62).