Islet transplantation has found its niche in diabetes treatment. It has contributed to a better quality of life and better glycemic control of patients with diabetes suffering from severe hypoglycemia that are not eligible for vascularized pancreas transplantation. Islet isolation is a technically challenging procedure. The different studies within this doctoral thesis aim to improve and standardize different steps in the isolation procedure. They are in particular looking to improve human pancreas preservation during cold storage, to optimize islet release from the exocrine tissue and to assess whether the isolated islet yield can be predicted from a biopsy. We found that pancreas preservation with pre-oxygenated perfluorodecalin (two-layer method) did not improve the ischemic tolerance of the human pancreas as compared to cold storage with the University of Wisconsin (UW) solution. Furthermore, in pancreas with long cold ischemia time (CIT) (>10 hours), Histidine-Tryptophan-Ketoglutarate (HTK) had a limited preservation capacity as compared with the UW solution with respect to isolation outcome. We also found that during enzymatic pancreas digestion, Vitacyte HA was able to provide a similar islet yield and quality as Serva NB1 with less collagenase activity and shorter digestion time. We further describe the first experience with a new GMP manufactured enzyme called Liberase MTF-S for successful human islet isolation. Finally, we found that the isolated islet yield could not be predicted from a biopsy taken from the head of the pancreas concerning solely morphological parameters of the islets tissue. The improvement of pancreas preservation will allow for marginal organs with prolonged cold ischemia time to expand the donor pool. Better knowledge of how the pancreatic extracellular matrix is digested by collagenase will lead to a fast and predictable islet release from the exocrine tissue. By standardizing the isolation procedure and improving organ selection we will increase the success rate in human islet isolation, thereby making islet transplantation available for more patients.

The purpose of this study was to explore the feasibility of using human patient simulation (HPS) to teach Type 1 diabetes (T1DM) management to grandparents of grandchildren with T1DM. Thirty grandparents (11 male, 19 female) of young grandchildren (aged 12 and under) with T1DM were recruited from an urban medical center. Experimental group (n = 14) grandparents received hands-on visual T1DM management education using an HPS intervention, and control group (n = 16) grandparents received similar education using a non-HPS intervention. Post-intervention, researchers interviewed twelve grandparents (50% HPS, 50% non-HPS) who scored highest and lowest on the Hypoglycemia Fear Survey. Using a mixed-method design, researchers integrated study instrument data and post-intervention interview data to describe grandparent’s experience learning T1DM management. Post-intervention, grandparent scores for knowledge, confidence, and fear showed no significant difference by group assignment, however, all grandparent scores showed improvement from Time 1 to Time 2. Grandparents described how taking part in T1DM education heightened their awareness of T1DM risks. GP T1DM knowledge gains aided GPs to make sense of T1DM risks. Newfound T1DM knowledge enhanced GP T1DM management confidence. Improved T1DM knowledge and confidence helped to defuse T1DM management fear. Although study instruments did not measure significant difference between grandparents who received the HPS intervention and those who did not, the consistency of larger HPS-taught grandparent score improvement is suggestive of a benefit for HPS.

Background The incidence of type 2 diabetes has increased dramatically, particularly among Latinos. While several studies suggest the beneficial effect of lowering glycemic index and glycemic load in patients with type 2 diabetes, no data exists regarding this issue in the Latino population. The purpose of this study was to determine the effect of lowering glycemic index and glycemic load on diabetes control, lipid profiles and anthropometrics among Latinos with type 2 diabetes. Methods Subjects participated in a 12 month randomized clinical trial. The intervention targeted diabetes knowledge, attitudes and behavioral capabilities related to diabetes self management with content including nutrition and physical activity. The nutrition protocol emphasized reduction in glycemic index, fat, salt and portion size and increase in fiber. The control group was given usual care. Measurements included Hba1c, fasting glucose, total cholesterol (TC), low density lipoproteins (LDL) and high density lipoproteins (HDL), HDL:LDL ratio, TC:HDL ratio, waist circumference and BMI and were collected at baseline, 4 and 12-months. Results Two hundred fifty two Latino adults with type 2 diabetes participated in the study. Baseline mean HbA1C was 8.98% (SD=1.87), BMI was 34.76 kg/cm (SD=6.94), age was 56 (SD=11.18) years and 76% were female. Reduction in glycemic index was positively associated with a reduction in logHbA1c (p=0.006), HDL:LDL ratio (p=0.037) and waist circumference (p=0.003) overtime, but not with fasting glucose, TC, LDL and HDL, TC:HDL ratio, body weight or BMI. No significant associations were found between glycemic load and any measures. Conclusion Results suggest that lowering glycemic index may have a positive effect on some markers of diabetes control, lipid profiles and anthropometrics among Latinos with type 2 diabetes, but not others. While statistically significant reductions in GI and GL were noted, the actual reduction was small. Thus, greater reduction in GI and GL may be needed for clinical significance and greater effect on metabolic outcomes. Future research should target populations with higher baseline GI and GL.

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Background: Oral contraceptives are common among female athletes. Still, its effects on athletic performance are poorly investigated. Research in the area has increased in recent years. However, the study qualities and designs are often insufficient and with small sample sizes. Women are currently underrepresented in sport research, and to recruit more women in future studies and to facilitate female athletes’ choices about contraceptives, the impact of oral contraceptives on performance must be better understood. Aim: The aim was to investigate whether monophasic, combined oral contraceptive phases affected maximal muscle strength, anaerobic performance and the corresponding blood lactate response, or perceived mental and physical energy level among young women. Method: The study used a cross-over design where six participants were tested on two occasions. The participants were healthy women between 18 and 29 years old who had beenusing monophasic combined oral contraceptives for at least three months prior to the study. No criteria for training level was set. The Isometric mid-thigh pull (N) was used as an indicator ofmaximal muscle strength; and the Wingate anaerobic test (W) measured anaerobic performance and power with corresponding blood lactate levels (mmol/L) measured at 0, 3 and 5 minutes after termination of the test. The participants rated their current physical and mental energy level on both test occasions using a visual analog scale (0-10). Statistical analyses were madeusing Wilcoxon signed-ranked test. Results: Nine participants were recruited, of which six performed tests on both occasions. The participants had a mean (SD) age of 22.3 (1.8) years, a BMI of 23.3 (2.6) and all reached WHO’sphysical activity recommendations. No statistically significant differences in muscle strengthor anaerobic performance were found regarding peak force (p=0.60), peak power (p=0.35) oraverage power (p=0.60) between oral contraceptive phases. Neither were there any differencesin the blood lactate response to the Wingate test directly after (p=0.92), 3 minutes after (p=0.17) or 5 minutes after (p=0.60) the test. No differences in perceived mental energy level (p=0.35)or perceived physical energy level (p=0.17) between oral contraceptive phases were evident. Conclusion: Oral contraceptive phases did not affect maximal muscle strength, anaerobicperformance, blood lactate response or perceived mental or physical energy levels. Accordingly, there is no need to adapt training to oral contraceptive phases and women can berecruited in future research without consideration of oral contraceptive phases.

Type 1 diabetes (T1D) is a complex chronic disease without treatment. When anindividual is diagnosed with T1D they are taught how to monitor blood glucoselevel as well as external insulin administration. While this management strategyhelps prolong the individual’s life, there are other lifestyle factors not consideredthat negatively impact the patients’ life. This thesis aims to investigate the types of data that can be gathered to benefit T1D patients and healthcare specialists by improving life quality. To do so, the work employs a literature review and its qualitative analysis, aninterviewing process and its qualitative analysis as well as overall findings analysiswhere data is interpreted in order to identify areas of interest, common topics andtrends. 43 literature publications, 3 healthcare professionals and 3 T1D patientsparticipated in this study. Results show initial education is limited leaving patients to initiate their ownresearch which could be a cause for stress. Technological integration does not seemchallenging provided the right training of more complex solutions. Education asa means to reduce stress seems effective both for patients but also for their socialnetworks. Finally, there are currently useful data markers not being used that couldprovide a wider range of information to healthcare specialists aiding in better patientcare and improved T1D patients’ Quality of Life (QOL). To conclude, T1D is a complex chronic disease that requires both clinical andnon-clinical interventions. It is not sufficient to only address its clinical implicationsbut is important to investigate factors that impact the lifestyle and quality of life. Byextracting proper data markers, collecting and analyzing them, it is believed thattechnology can assist healthcare and ultimately improve T1D patient’s quality oflife. / Diabetes typ 1 är en komplex kronisk sjukdom som inte har en behandling. När enindivid blir diagnostiserad med Diabetes typ 1 lär dem att mäta blodsocker nivåernasamt externa insulin administering. Medan denna strategi hjälps förlänga individensliv, finns där andra livsstilsfaktorer som inte är övervägd. Denna avhandling syfta mot att kunna undersöka datatyper som kan insamlas tillfördel för Diabetes typ 1 patienter och värdpersonal genom att förbättra livskvalitet. För att kunna utföra detta genomfördes en litteratursammanställning med en kvalitativ analys, intervjuer med en kvalitativ analys samt ett övergripande rön där datantolkas för att kunna identifiera områden som kan vara intressanta, allmänna temanoch trender. 43 litteratur publikationer, 3 vårdpersonal och 3 diabetes typ 1 patienterdeltog i undersökningen. Resultatet visar inledande utbildning är begränsad vilket leder till att patienterinitiera egen fördjupning. Detta kan bidra till stressnivåerna. Teknologisk integrering verka inte vara en utmaning för patienter om dem få rätt utbildning för komplexa lösningar. Utbildning som metod för att bekämpa och minska stressnivåernaverka effektivt både för patienterna och vårdpersonal men även för deras sociala nätverk. Slutligen, finns där användbara data markörer som inte används men kan förse bredare information till vårdpersonal vilket kan förbättra vården samt patientenslivskvalitet. Slutligen är diabetes typ 1 en komplex sjukdom som kräver både klinisk menäven icke-kliniska ingripande. Det är inte tillräcklig att enbart ta itu med dem kliniska ingripande men det är även viktigt att undersöka faktorer som påverkar livsstiloch livskvalitet. Genom att excerpera lämplig data markörer samt samla och analysera dem, är det tänkt att teknologi kan assistera vårdpersonal och till slut förbättralivskvaliteten av diabetes typ 1 patienter

Current research shows moderate alcohol consumption is associated with decreased risk of diabetes and excessive consumption or binge drinking can cause insulin resistance and diabetes. In 2010, diabetes was the seventh leading cause of death in the United Statesand was responsible for significant health complications: blindness, kidney failure, and limb amputations, and is a large national economic burden. Fasting blood glucose (FBG) is a tool used to help diagnose diabetes. Abnormally high FBG, ≥100 mg/dl, is indicative of diabetes and pre-diabetes. Few studies have observed diabetic prevalence among young adults or college students. Studying young adults can help provide added information about early risk factors for diabetes and pre-diabetes, facilitating public health efforts to stem the rising tide of the diabetes epidemic. This study aimed to research the associations between alcohol consumption (numbers of days alcohol consumed in the past month and binge alcohol consumption in the past month) and FBG in a college population as part of the FLASH cohort study. FBG levels were measured in 141 young adult participants and alcohol consumption was determined by self report. Other individual-level characteristics and potential confounding variables were also collected. The association between alcohol consumption and FBG followed a J-shaped curve whereby students who reported drinking 6-8 days within the last 30 days showed significantly lower FBG levels than those who did not drink and those who consumed alcohol on nine or more days (p=0.04). Binge drinking did not have a significant association with FBG (p=0.4). Sex and body mass index were also significantly associated with FBG. In conclusion, moderate frequency of alcohol consumption is found to have an inverse relationship with FBG and excessive drinking can reverse these effects.

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