Titel: Att leva med diabetes mellitus typ 2.  Bakgrund: Diabetes mellitus typ 2 (DMT2) är ett globalt problem och fler personer insjuknar årligen. Egenvård är en central del av behandlingen för dessa personer. Att förstå livsstilsförändringar, behandlingar och egenvården hos dessa personer bidrar till ökad kunskap inom hälso- och sjukvården.   Syfte: Att beskriva personers erfarenheter av att leva med diabetes mellitus typ 2.   Metod: Litteraturöversikt med artiklar av kvalitativ design baserad på 12 vetenskapliga artiklar från databaserna Cinahl och MedLine.   Resultat: Resultatet presenteras i två huvudteman egenvård och information vid diabetes mellitus typ 2 och påverkan av diabetes mellitus typ 2 i livet med respektive underkategorier. Det fanns erfarenhet av bristande och otillräcklig information av hälso- och sjukvården. Erfarenheter fanns av att närstående gav bra information och under gruppbaserad utbildning reflekterades erfarenheter av att leva med DMT2. Resultatet visade att egenvården innefattade en del svårigheter som ändrade kostvanor, fysisk aktivitet, kulturella aspekter och förändrad livsstil.   Slutsats: DMT2 är en global och livslång sjukdom där livsstilsförändringar bör genomföras. Erfarenheter av att det var svårt att genomföra livsstilsförändringar där kostvanor visade sig vara det svårast att anpassa sin DMT2 till. Vidare forskning kring erfarenheter hos personer med DMT2 bidrar till ökad kunskap för sjuksköterskan men även allmänheten. Vidare forskning av personer med DMT2 och hur kultur påverkar egenvården kan ge ökad kunskap till sjuksköterskan och allmänheten.   Nyckelord: Diabetes mellitus typ 2, diabetes typ 2, livsstil, patienters erfarenheter, egenvård. / Title: Living with diabetes mellitus type 2.    Background: Type 2 diabetes mellitus (DMT2) is a global problem and more people are getting sick every year. Self-care is a central part of the treatment for these people. Understanding the lifestyle changes, treatments and self-care of these people contributes to increased knowledge in health care.  Aim: Describing people's experiences of living with type 2 diabetes mellitus.  Method: A qualitative literature review. Based on 12 scientific articles collected from Cinahl and MedLine.    Results: The results are presented in two main themes of self-care and information in diabetes mellitus type 2 and the impact of diabetes mellitus type 2 in life with the respective subcategories. There was experience of inadequate and insufficient information from the health service. There was experience that close relatives provided good information and during group-based training, experiences of living with DMT2 were reflected. The results showed that self-care included some difficulties such as changing dietary habits, physical activity, cultural aspects and changing lifestyles.  Conclusion: DMT2 is a global and lifelong disease where lifestyle changes should be implemented. Experiences that it was difficult to implement lifestyle changes where dietary habits proved to be the most difficult to adapt your DMT2 to. Further research on the experiences of people with DMT2 contributes to increased knowledge for the nurse but also the public. Further research of people with DMT2 and how culture affects self-care can provide increased knowledge to the nurse and the public.   Keywords: Diabetes mellitus type 2, diabetes type 2, lifestyle, patient experience, self care.

Bakgrund: Diabetes mellitus typ-2 är en av de vanligaste folksjukdomar världen över, i Sverige uppskattas det till att ca 300 000 människor lider av sjukdomen. En stor del av behandlingen för människor med diabetes typ-2 är att ändra sina matvanor, fysisk aktivitet och att medicinera sig själva, detta kallas för egenvård. En stor del av sjuksköterskors arbete med diabetes typ-2 patienter är att motivera och ge stöd till patienterna så att de efterlever de livsstilsråd som ges i den mån det går. Hur patienterna upplever sin egenvård ser olika ut, några menade att eftersom sjukdomen är genetisk är det inget som kunde styras medan andra menade att egenvården och sjukdomen kunde vara svår att hantera och att stödet från sjukvården är viktigt.  Syfte: Syftet med studien var att beskriva sjuksköterskans erfarenheter av egenvård hosdiabetes mellitus typ-2 patienter  Metod: En litteraturstudie med beskrivande design som totalt innefattar 10 artiklar av kvalitativ ansats från databasen Pubmed. Huvudresultat: Resultatet visade att sjuksköterskorna ofta upplevde sina patienter som omotiverade i deras egenvård och att de hade svårt att efterfölja de livsstilsråd som gavs, detta var ett vanligt förekommande tema. Sjuksköterskorna använde sig av olika metoder till att förbättra egenvården och motivationen hos deras patienter. Det framkom även i resultatet att sjuksköterskorna upplevde stress och minskad arbetsglädje relaterat till att de inte kunde ge den bra diabetesvård de ville då de kände att de inte fick något gehör från patientens sida.  Slutsats: Föreliggande litteraturstudie visade att sjuksköterskor kunde behöva stöd och verktyg till att ge rätt egenvårdsstöd till deras patienter. Detta kunde därmed leda till att sjuksköterskor kan känna sig mer nöjda med det arbete de åstadkommit och därmed även främja arbetsglädjen. / Background: Diabetes mellitus type-2 is one of the most common public diseases worldwide, in Sweden it is estimated that about 300,000 people suffer from the disease. A large part of the treatment for people with type 2 diabetes is to change their eating habits, physical activity and to medicate themselves, this is called self-care. A large part of nurses' work with type 2 diabetes patients is to motivate and provide support to the patients so that they comply with the lifestyle advice given as far as possible. How patients experience their self-care looks different, some believe that because the disease is genetic it is not something that could be controlled while others thought that self-care and the disease could be difficult to manage and that support from health care is important.   Aim: The aim of the study was to describe the nurse's experiences of self-care in diabetes mellitus type-2 patients   Method: A literature study with descriptive design that includes a total of 10 articles of qualitative approach from the database Pubmed.   Results:  The results showed that nurses often perceived their patients as unjustified in their self-care and that they had difficulty following the lifestyle advice given, this was a common theme. Nurses used various methods to improve the self-care and motivation of their patients. It also emerged from the results that the nurses experienced stress and reduced job satisfaction, related to the fact that they could not provide the good diabetes care they wanted as they felt that they did not get any hearing from the patient.   Conclusion: The present literature study shows that nurses may need support and tools to provide the right self-care support to their patients. This can thus lead to the nurses feeling more satisfied with the work they have accomplished and thus also promote job satisfaction.

Bakgrund: Diabetes Mellitus typ 2 är ett stort folkhälsoproblem som påverkar personers fysiska och psykiska hälsa. För att kunna leva med en kronisk sjukdom som typ 2-diabetes måste personer hantera sjukdomen genom att anpassa sitt dagliga liv och tillämpa egenvårdsaktiviteter för att uppnå god hälsa. Sjuksköterskan kan stötta i att hantera denna förändring och uppnå en god egenvård genom utbildning och motiverande samtal. Syfte: Syftet var att beskriva erfarenheter kring barriärer och möjliggörande faktorer för egenvård vid typ 2-diabetes. Metod: Denna studie är en kvalitativ litteraturöversikt. De femton artiklar som omfattas i studien hittades i två olika databaser, CINAHL och PubMed. Innehållsanalys tillämpades för att analysera data. Resultat: Två kategorier beskriver erfarenheterna av egenvårdsförmågan vid typ 2-diabetes; 1) Lyckad egenvård med subkategorier: att erhålla stöd från närstående, att erhålla stöd från sjukvårdspersonal, kunskapens betydelse för livsstilsförändringar och bedömning om hälsorisker samt motivation som verktyg. 2) Utmaningar med egenvård med subkategorier: behov av stöd från närstående, behov av ökad kunskap, utmaningar i möte med sjukvårdspersonal samt utmaningar i det dagliga livet. Slutsats: Typ 2-diabetes är en utmanande sjukdom för personen att både leva med och hantera. Nya och strikta egenvårdsaktiviteter måste implementeras i det dagliga livet för att upprätthålla en god hälsa. Stöd från närstående och sjukvårdspersonal, kunskap om förändringar kring livsstil samt motivation som ett redskap för uppfyllelse av egenvårdsbehov är betydelsefullt för att personen ska lyckas med egenvården. Sjuksköterskan är av stor vikt vid förbättringen av personers egenvårdsförmåga, då handledning och förmedling av kunskap är aktuellt. / Background: Type 2 Diabetes Mellitus is a major public health problem that affects a person's physical and psychological health. To be able to live with a chronic disease such as type 2 diabetes, people must manage the disease by adapting their daily lives and applying self care activities to achieve good health. The nurse can support in dealing with this change and achieve good self care through training and motivational conversations. Aim: The aim was to describe experiences about barriers and enabling factors for self care in type 2 diabetes. Method: This study is a qualitative literature review. The fifteen articles covered in the study were found in two different databases, CINAHL and PubMed. Content analysis was applied to analyze data. Results: Two categories describe the experiences of the self care ability in type 2 diabetes; 1) Successful self care with subcategories: to receive support from close ones, to receive support from healthcare professionals, the importance of knowledge for lifestyle changes and assessment of health risks and motivation as a tool. 2) Challenges with self care with subcategories: need for support from relatives, need for increased knowledge, challenges in meeting healthcare professionals and challenges in daily life. Conclusion: Type 2 diabetes is a challenging disease for the person to both live with and manage. New and strict self care activities must be implemented in daily life in order to maintain good health. Support from relatives and healthcare professionals, knowledge of lifestyle changes and motivation as a tool for meeting self care needs is important for the person to succeed with self care. The nurse is of great importance in improving people's self care ability, as supervision and dissemination of knowledge is relevant.

Chronic exposure of humans or rodents to high calorie diets leads to hypertriglyceridemia and ectopic lipid deposition throughout the body, resulting in metabolic disease. Cellular lipids are stored in organelles termed lipid droplets (LDs) that are regulated by tissue-specific LD proteins. These proteins are critical for lipid homeostasis, as humans with LD protein mutations manifest metabolic dysfunction. Identification of novel components of the LD machinery could shed light on human disease mechanisms and suggest potential therapeutics for Type 2 Diabetes. Microarray analyses pinpointed the largely unstudied Hypoxia-Inducible Gene 2 (Hig2) as a gene that was highly expressed in obese human adipocytes. Imaging studies demonstrated that Hig2 localized to LDs in mouse hepatocytes and the human SGBS adipocyte cell line. Thus, this work examined the role of Hig2 as a LD protein in liver and adipose tissue. Hig2 deficiency reduced triglyceride deposition in hepatocytes; conversely, ectopic Hig2 expression promoted lipid deposition. Furthermore, liver-specific Hig2-deficient mice displayed improved glucose tolerance and reduced liver triglyceride content. Hig2 deficiency increased lipolysis and -oxidation, accounting for the reduced triglyceride accumulation. Similarly, adipocyte-specific Hig2-deficient mice displayed improved glucose tolerance, reduced adipose tissue weight and brown adipose tissue that was largely cleared of lipids. These improvements were abrogated when the animals were placed in thermoneutral housing and brown adipocyte-specific Hig2-deficient mice also displayed improved glucose tolerance, suggesting that active brown fat largely mediates the metabolic phenotype of Hig2 deletion. Thus, this work demonstrates that Hig2 localizes to LDs in liver and adipose tissue and promotes glucose intolerance.

Background. Diabetes requires significant disease management, patient-provider communication, and interaction between patients, family members, caregivers, and care teams. Emerging patient-facing technologies, such as cellular-enabled glucose meters, can facilitate additional care support and improve diabetes self-management. This study evaluated patient acceptability, feasibility, and efficacy of a diabetes care support program facilitated by cellular-enabled glucose meters. Methods. A two-phase study approach was taken. Get In Touch – Phase 1 (GIT-1) was a 1-month pilot involving patients with type 1 and type 2 diabetes. Get In Touch – Phase 2 (GIT-2) was a 12-month randomized controlled crossover trial involving patients with poorly-controlled type 2 diabetes. Results from GIT-1 and preliminary results from GIT-2 are presented. Results. GIT-1 participants with type 1 (n=6) and type 2 (n=10) diabetes reported the intervention and cellular-enabled glucose meter were easy to use and useful while identifying potential areas of improvement. GIT-2 participants in both the intervention (n=60) and control (n=60) groups saw significant improvements in treatment satisfaction and A1c change, with intervention participants experiencing slightly greater improvements in each after 6 months (p=0.09 and p=0.16, respectively) compared to control participants. Conclusions. Patients reported favorable acceptability of the intervention. Preliminary results from a randomized trial demonstrated potential of intervention to improve patient-reported and physiological health outcomes. Future studies should evaluate feasibility and efficacy over a longer period of time, with a greater number of participants, and targeting different populations of patients with diabetes. Provider perspectives and changes in provider behavior, clinical work flow, and caregiver burden should also be assessed.

Purpose: This qualitative descriptive study was undertaken to describe Eastern Woodlands Native adult perspectives, health care beliefs and type 2 diabetes management experiences. Specific Aims: The specific aims were to 1) explore and describe perceptions of type 2 diabetes among Eastern Woodland Native adults and how they relate to their understandings about the cause and treatment approaches to the disease, 2) describe how family, friends, and community intersect with type 2 diabetes management, 3) describe relationships with health care providers and 4) determine resources that would help diabetes-self management within their community. Framework: The PEN-3 Model by Airhihenbuwa was the initial framework used for the study. Methods: A qualitative descriptive design with maximum variation and snowball sampling was used and data was analyzed using qualitative content analysis. Results: The overarching theme of Together We Can Return To Balance comprised five sub-themes: Coming to Know Life Paths with T2DM, Negotiating My Way Forward, Making Important Connections, Acknowledging the Imbalance, and Sticking Closer to Mother Earth illustrating physical, spiritual, and environmental health factors influencing DSM capacities. Conclusion: Native perspectives should be viewed as a crucial contextual variation for type 2 diabetes care when developing DSMES and for improving DSM capacities in these populations.

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Obesity accounts for $168 billion in annual medical expenses and increases the risk of cardiovascular disease, cancer, and type-2 diabetes, three diseases responsible for over 50% of deaths in the United States. It is well established that the pattern of adiposity is an important factor in the relationship with disease risk and that visceral adiposity, which favors hypertrophy (characterized by enlarged cells) is more dangerous than subcutaneous adiposity, which tends to be hyperplastic (characterized by an increase in cell number). Hypertrophy is associated with inflammation and insulin resistance, and hyperplasia (adipogenesis, i.e., the formation of new adipocytes), is associated with improved insulin sensitivity. Tumor necrosis factor-alpha (TNF-alpha) is a potent pro-inflammatory cytokine that activates a nuclear factor-kappa B (NFKB) intracellular pathway that is an important mediator of obesity-associated insulin resistance and increased risk of type-2 diabetes. Interestingly, obesity has been positively associated with both low vitamin D status and elevated levels of TNF-alpha. Our studies focused on examining the influence of the active vitamin D hormone, 1,25-dihydroxyvitamin D, and TNF-alpha on adipogenesis and inflammation in human primary adipocytes and determining whether the balance of these two factors influences the extent to which adipocytes accumulate lipid or express pro-inflammatory cytokines. We found no effect of 1,25-dihydroxyvitamin D on adipogenesis or pro-adipogenic gene expression despite a clear upregulation of a vitamin D responsive gene, 24-hydroxylase, in response to treatment with 1,25-dihydroxyvitamin D. TNF-alpha clearly inhibited adipogenesis and expression of PPAR-gamma and C/EBP-alpha and enhanced expression of the pro-inflammatory cytokines IL-6 and MCP-1, but not IL-8. There was a trend towards a dose-dependent downregulation of MCP-1 by 1,25-dihydroxyvitamin D in three individuals; however, this effect was not statistically significant. While we found no interaction between TNF-alpha and 1,25-dihydroxyvitamin D on adipogenesis, there is a potential anti-inflammatory action of 1,25-dihydroxyvitamin D in human primary adipocytes. Future studies into this potential are warranted in light of the growing obesity epidemic and the interest in finding nutritionally modifiable treatment or prevention strategies to mitigate the negative consequences of obesity.