Master of Public Health / Human Nutrition / Richard R. Rosenkranz / Background: Type 2 diabetes mellitus (T2DM) is a costly and burdensome lifelong disease, and without proper glycemic control, severe life-threatening complications result. In Southeast Asia, the prevalence of T2DM is forecast to increase markedly from 2000 to 2030. Although literature reviews on lifestyle modification for glycemic control are available, these are mainly for the Western context, and there is a dearth of evidence for Southeast Asians who are at greater risk of T2DM and have differing patterns of diet, physical activity and body composition than Western populations. Objective: To systematically review literature on the effectiveness of lifestyle modification interventions for glycemic control in T2DM patients from Southeast Asia. Methods: Randomized controlled trials (RCT) with interventions ≥ 8 weeks that compared HbA1c or blood glucose for intervention (lifestyle modification) versus control groups were identified from searches in Cochrane Library, CINAHL, PubMed, ProQuest, Science Direct, SPORTDiscus, Scopus and Web of Science. Results: Seven RCTs (679 participants) meeting inclusion and exclusion criteria were identified. There was a significant reduction in HbA1c% (MD = -0.56%; 95% CI = -0.95,-0.16%; p = 0.006; n = 5 studies) and in blood glucose mg/dl (MD = -16.76 mg/dl; 95% CI = -31.36, -2.17 mg/dl; p = 0.02; n = 4 studies) over 3 months for lifestyle modification intervention groups. Lifestyle interventions included diet (n = 2), exercise (n = 2), and general lifestyle interventions (n = 3). Duration of interventions ranged from 12 weeks to 6 months. Studies included populations from Thailand (n = 5) and Malaysia (n = 2). Conclusion: Overall, lifestyle modification interventions are effective for the glycemic control of T2DM patients in countries of Southeast Asia.

Patients’ perceptions of health care and support is a key determinant in self-efficacy and active participation in the management of chronic conditions. Nurses play a significant role in Diabetes Self-Management Education by providing clients with tools, empowerment and knowledge to self-manage their condition. The purpose of this study was to examine and describe diabetes patients’ perceptions of nurses’ support for self-management in Botswana. The aim was to improve clients’ skills in self-management and to strengthen diabetes health care management. This study was carried out at the Diabetes Clinic of Excellence, in the city of Francistown, the second largest city in Botswana. The study population comprised of Type 2 Diabetes patients registered at the Diabetes Clinic for their follow-up. All were aged 18 years and above. Three hundred and fifty-four (354) patients participated in the study. The study used a non-experimental, descriptive, quantitative design. Probability sampling method was used to recruit diabetes patients from the selected clinic. Data were were collected using a structured, researcher developed, questionnaire mostly in face-to-face interviews, a few participants completed the questionnaire. The Quantitative data analysis included descriptive and inferential statistics using SPSS (Statistical Package for Social Science Software (version 25). Spearman rho was used to determine statistical correlation between patients’ perceptions and their self-management practices. The findings showed that generally, patients’ perceptions of professional support was positive regarding most of the constructs measured. However, there were areas that showed less satisfaction with the support such as foot-care, risk control, and ability to identify signs of low and high blood sugar level and carrying of Identification Band (ID). Perceptions of nurses’ motivational behaviour showed varied responses. Patients’ self-care activities were sub-optimal and showed some variations which tended to correspond with their perceptions of professionals support. The Spearman's correlation results ranged from strong, moderate, and weak positive correlation. A few demographic variables showed some impact on self-care activities. Based on the findings, the study concludes that professional support through DSME and DSMS, self-management and patients’ perceptions of care play a significant role in diabetes management. / Health Studies / M.A. (Nursing Science)

Made available in DSpace on 2017-07-10T14:17:09Z (GMT). No. of bitstreams: 1 Gisele Toyama.pdf: 2839416 bytes, checksum: 2f5dbd1ea8e1b9c003fdb5d06ee443c4 (MD5) Previous issue date: 2014-02-14 / Type 2 diabetes (DM2) and periodontal disease are closely related. DM2 is a risk factor for periodontal disease whereas periodontitis increases hyperglicemia. Although it is known that the treatment of periodontitis improves glycemic control, there is no consensus of what type of treatment is best for diabetics. Objective: Evaluate different types of periodontal treatment in diabetics. Methodology: Two different researches were performed: 40 patients, aged 30 to 60, who were divided into 2 groups: group 1: controlled mechanical + basic periodontal treatment, Group 2: controlled mechanical + basic periodontal treatment + Doxycycline 100 mg orally for 14 days. In the first study, the analyses were made after 0, 3 and 6 months, including probing depth, level of clinical attachment, bleeding on probing. Glycated hemoglobin (HbA1c), fasting glucose and microbiological analysis (FG) were also taken. In study 2, a clinical analysis and an expression of isoforms of interleukin IL1β (IL-1β) test was performed. 20 patients were selected for the second part of the research. They were divided as follow: 1) Conventional periodontal treatment with scaling and root planning + Mechanical control and group 2) Periodontal Treatment (one-stage full-mouth disinfection) + Mechanical control . In this research, the analysis was performed after 0, 3 and 6 months including clinical evaluation, HbA1c and FG tests. The expression of isoforms of interleukin IL1β (IL-1β) were analyzed in the beginning of the study and after 6 months. Results: In the first article, it was shown an improvement in all clinical periodontal parameters evaluated as well as the level of HbA1c in both treated groups after 6 months. In the doxycycline group, there was a greater improvement in gingival index and test of glycated hemoglobin, as well as a smaller amount of Gram- .The second study showed a significant decrease in the expression of IL1- in gingival crevicular fluid in patients in treatment with Doxycycline. In the second research, after 6 months, it was observed better levels of FG, clinical periodontal parameters and gingival crevicular fluid in both groups. Nevertheless, no statistical significance was observed in the expression of IL-1β after 180 days. Conclusion: It is suggested that the basic periodontal therapy associated with the use of doxycycline is more efficient for clinical, glycemic and microbiological control in patients with type 2 Diabetes Mellitus with periodontal disease, as well as in the reduction of IL1- in gingival crevicular fluid. When different types of periodontal treatments are compared, it is possible to observe that the conventional periodontal treatment is the first choice in one-stage full-mouth disinfection for both glycemic control and periodontal parameters related to bleeding on probing and gingival crevicular fluid as well as the relation of variation envolving the expression of IL1-β even in the absence of significant difference among initial and final parameters in each group / O diabetes mellitus tipo 2 (DM2) e a doença periodontal possuem entre si uma relação íntima. O diabetes é um fator de risco para periodontite, assim como, a periodontite aumenta a hiperglicemia. O tratamento da periodontite pode melhorar o controle glicêmico, entretanto, não existe consenso de qual tratamento periodontal é o melhor em diabéticos. Objetivo: Avaliar diferentes modalidades de tratamento periodontal em diabéticos. Metodologia: Foram realizadas duas pesquisa, na primeira, foram selecionados 40 pacientes com DM2, e estes divididos em dois grupos: Grupo 1: Controle mecânico + Tratamento periodontal básico; Grupo 2: Controle mecânico + Tratamento periodontal básico + Doxiciclina 100 mg via oral por 14 dias. No primeiro artigo foram realizadas análises aos 0, 3 e 6 meses, incluindo Profundidade de sondagem, Nível de inserção clínica e Sangramento a sondagem, juntamente com a avaliação de hemoglobina glicada (HbA1c), glicemia em jejum (GJ) e análise microbiológica. No artigo 2, foram realizadas as análises clínicase a análiseda expressão das isoformas da interleucina IL1β (IL-1β). Na segunda pesquisa foram selecionados 20 pacientes com DM2, os quais foram divididos em dois grupos: Grupo 1: Tratamento periodontal básico (RAR) + Controle mecânico (Técnica de Bass + fio dental); Grupo 2: Tratamento periodontal básico (Desinfecção Total de Boca em Estágio Único - DBEU) + controle mecânico (Técnica de Bass + fio dental). Nesta pesquisa as análises também foram realizadas aos 0, 3 e 6 meses, com avaliação clínica periodontal e a avaliação de HbA1c e GJ. A expressão das isoformas de IL-1β foram analisadas no início e após 6 meses. Resultados: No primeiro artigo, houve uma melhora de todos os parâmetros clínicos periodontais e dos níveis de HbA1c em ambos os grupos tratados após 6 meses. No grupo que usou doxiciclina, houve uma melhora mais expressiva do índice gengival e daHbA1c, bem como uma quantidade menor de microrganismos Gram-. O segundo artigo evidenciou uma expressão significantemente menor de IL1- no fluido crevicular gengival dos pacientes em uso de doxiciclinina ao final do experimento. Na segunda pesquisa, após 6 meses, houve uma melhora da GJ, dos parâmetros clínicos periodontais e da quantidade de fluido crevicular gengival em ambos os grupos. Entretanto, não houve diferença estatisticamente significativa na expressão de IL-1β após 180 dias.Conclusão: Foi possível observar que a terapia periodontal básica associada ao uso de doxiciclina é mais eficiente para o controle clínico, glicêmico e microbiológico de pacientes portadores de DM2 e doença periodontal, bem como na menor expressão de IL1- no fluido crevicular gengival deste pacientes. Quando comparado os tipos de tratamento periodontal, foi possível observar que o tratamento periodontal convencional é superior à desinfecção total em estágio único, tanto em relação ao controle glicêmico, quanto em relação aos parâmetros periodontais de sangramento a sondagem e área de fluido gengival, bem como em relação a variação dos valores de expressão de IL1-β, apesar de não haver diferença significativa entre os valores iniciais e finais em cada grupo

Made available in DSpace on 2017-07-10T14:57:29Z (GMT). No. of bitstreams: 1 Dissertacao corrigida - finalizada (16 de abril)a.pdf: 1391478 bytes, checksum: 48ccd69d69cf234b54e5fd0bda78b5ff (MD5) Previous issue date: 2015-02-20 / Fundação Araucária / Aim: Recent studies demonstrate Diabetes Mellitus (DM) as a risk factor for the impairment of periodontal health and a growing body of evidence has been supporting periodontal disease (PD) as having an adverse effect on glycemic control and on the pathophysiology of the diabetes-related complications. This study aims to evaluate the effect of periodontal therapy immoderately compensated and decompensated type 2 diabetic patients. Subjects and methods: 40 patients with DM2 and periodontal disease were selected and divided into two groups: Group 1: Moderately compensated; Group 2: Decompensated. Of these 40 patients, only 35 participated in the study. The analyses were performed at 0, 3 and 6 months after scaling and root planning and including clinical periodontal parameters and the quantification of gingival crevicular fluid (GCF). Glycated hemoglobin (HbA1c), fasting glucose (FG) and IL1-β expression were measured. Results: Both groups presented improvement in all clinical periodontal parameters as well as quantification of gingival crevicular fluid and in the expression of IL-1ß present in the fluid after 6 months. However, no statistically significant difference was found in the levels of HbA1C in the first group after 6 months, although a significant increase was found after six months in the other group. While in relation to the FG, a great improvement was found in the first group and a significant increase in the second group after six months. Conclusion: It was possible to observe that conventional periodontal treatment (scaling and root planing) is more effective for moderately compensated type 2 diabetic patients glycemic control rather than for the decompensated patients. / Estudos recentes demonstraram o Diabetes Mellitus (DM) como um fator de risco para o comprometimento da saúde periodontal e crescentes evidências apontam que a doença periodontal (DP) tem um efeito adverso sobre o controle glicêmico e uma participação ativa na fisiopatologia das complicações relacionadas ao DM. Objetivo: Avaliar o efeito do tratamento periodontal em pacientes portadores de Diabetes Mellitus tipo 2 moderadamente compensados e descompensados. Metodologia: Foram selecionados 40 pacientes com DM2 e periodontite, estes foram divididos em dois grupos: Grupo 1: moderadamente compensados; Grupo 2: descompensados. Destes 40 pacientes, apenas 35 participaram do estudo. As análises foram realizadas aos 0, 3 e 6 meses após raspagem e alisamento radicular, incluindo parâmetros clínicos periodontais e a quantidade de fluido crevicular gengival (GCF). Foram dosadas a hemoglobina glicada (HbA1c), a glicemia em jejum (GJ) e a expressão IL1β. Resultados: Houve uma melhora de todos os parâmetros clínicos periodontais avaliados em ambos os grupos, assim como da quantidade de GFC e dos níveis de IL-1ß presentes no fluído após um período de 6 meses. No entanto, em relação aos níveis de HbA1c, estatisticamente, não houve alteração ao final dos 6 meses no grupo moderamente compensado, enquanto nos descompensados, houve um aumento significativo ao final dos 6 meses. Já com relação à GJ, houve uma melhora significativa no primeiro grupo e um aumento significativo no segundo grupo ao final dos 6 meses. Conclusão: Sendo assim, pode-se concluir que o tratamento periodontal básico (raspagem e alisamento radicular convencional) foi mais efetivo para o controle glicêmico dos pacientes com diabetes tipo 2 moderadamente compensados do que nos descompensados.

Studies demonstrate localized neuro-retinal dysfunction in patients with diabetes and no visible diabetic retinopathy (DR). Poor glycemic control is a strong risk factor for DR. We hypothesized that poor glycemic control predicts increased areas of localized neuro-retinal dysfunction in patients with diabetes. Forty-eight adolescents with diabetes and 45 controls were tested using the standard (103 hexagons) multifocal electroretinogram (mfERG). Negative binomial regression analysis was conducted with number of abnormal hexagons (delayed responses) as the dependent variable and glycated hemoglobin (HbA1c), disease duration, age and sex as covariates. Results indicate that a one-unit increase in HbA1c predicts an 80% (p = 0.002) increase in the number of abnormal hexagons when controlling for age. Increased areas of neuro-retinal dysfunction are predicted by worsening glycemic control in patients with no visible DR. Standard mfERG may be useful in monitoring patients with diabetes and identifying those who may be at risk of developing DR.

Studies demonstrate short-wavelength cone pathway dysfunction in patients with diabetes and no clinically visible DR. Poor glycemic control, as measured by hemoglobin A1c (HbA1c), is a strong risk factor for DR. We hypothesized that raised HbA1c was associated with short-wavelength cone sensitive visual evoked potential (S-VEP) and electroretinogram (sERG) dysfunction. Forty adolescents with diabetes and 39 controls were tested using the S-VEP. Latencies to a short-wavelength stimulus were delayed in patients at low contrasts. Patient S-VEP latencies were not associated with HbA1c when controlling for age and time since diagnosis. Twenty-one adolescents with diabetes and 19 controls were tested using the sERG. Implicit times of the b-wave were delayed but not associated with HbA1c when controlling for time since diagnosis.Patient PhNR amplitudes were reduced. A one-unit increase in HbA1c was associated with a 15% sERG PhNR amplitude reduction (p=0.004). The sERG PhNR may be a potential biomarker for DR.

Studies demonstrate localized neuro-retinal dysfunction in patients with diabetes and no visible diabetic retinopathy (DR). Poor glycemic control is a strong risk factor for DR. We hypothesized that poor glycemic control predicts increased areas of localized neuro-retinal dysfunction in patients with diabetes. Forty-eight adolescents with diabetes and 45 controls were tested using the standard (103 hexagons) multifocal electroretinogram (mfERG). Negative binomial regression analysis was conducted with number of abnormal hexagons (delayed responses) as the dependent variable and glycated hemoglobin (HbA1c), disease duration, age and sex as covariates. Results indicate that a one-unit increase in HbA1c predicts an 80% (p = 0.002) increase in the number of abnormal hexagons when controlling for age. Increased areas of neuro-retinal dysfunction are predicted by worsening glycemic control in patients with no visible DR. Standard mfERG may be useful in monitoring patients with diabetes and identifying those who may be at risk of developing DR.

Studies demonstrate short-wavelength cone pathway dysfunction in patients with diabetes and no clinically visible DR. Poor glycemic control, as measured by hemoglobin A1c (HbA1c), is a strong risk factor for DR. We hypothesized that raised HbA1c was associated with short-wavelength cone sensitive visual evoked potential (S-VEP) and electroretinogram (sERG) dysfunction. Forty adolescents with diabetes and 39 controls were tested using the S-VEP. Latencies to a short-wavelength stimulus were delayed in patients at low contrasts. Patient S-VEP latencies were not associated with HbA1c when controlling for age and time since diagnosis. Twenty-one adolescents with diabetes and 19 controls were tested using the sERG. Implicit times of the b-wave were delayed but not associated with HbA1c when controlling for time since diagnosis.Patient PhNR amplitudes were reduced. A one-unit increase in HbA1c was associated with a 15% sERG PhNR amplitude reduction (p=0.004). The sERG PhNR may be a potential biomarker for DR.

Diabetes disproportionately affects minority populations. Social support, and more specifically marriage, has been found to buffer the negative effects of diabetes and depression. Data collected from African Americans with type 2 diabetes in Atlanta and NHANES data were compared to examine whether marriage affects health status and mental health. Approximately, 1742 African Americans aged 18-80 were included in this study. Chi square analysis revealed that married men had lower rates of depression (15.9% vs. 24.7%) compared to unmarried men (p < 0.05), but the same effect was not found in women. The findings show that marriage was not associated with HbA1c, but was associated with rates of depression. The lack of association of HbA1c with marriage may be because marriage may not be the best proxy of social support in the African American community. Future research should focus on alternative forms of social support such as cohabitation, extend family, and friend.

Tyrimo tikslas – ištirti sąsajas tarp paauglių, sergančių cukriniu diabetu, psichosocialinio prisitaikymo ir tėvų pastangų kontroliuoti savo vaikų ligą. Tyrime dalyvavo 11–16 metų paaugliai, kurie serga cukriniu diabetu ilgiau nei vienerius metus, ir jų tėvai (vienas iš tėvų). Iš viso buvo apklausti 73 paaugliai (36 vaikinai ir 37 merginos) ir 73 jų tėvai (21 vyras ir 52 moterys). Paauglių psichosocialinis prisitaikymas buvo matuojamas R. Goodman Galių ir Sunkumų klausimynu, kurį sudaro 25 teiginiai apie teigiamas ir neigiamas savybes, iš kurių susideda 6 klausimyno skalės: socialumas, hiperaktyvumas, emociniai simptomai, elgesio problemos, problemos su bendraamžiais ir bendra sunkumų skalė. Tėvų ligos kontrolė buvo matuojama L. Gonder-Frederick Hipoglikemijos baimės klausimynu (tėvų versija), kurį sudaro 26 teiginiai apie tėvų, kurių vaikai serga cukriniu diabetu, elgesį, kad išvengtų hipoglikemijos ir nerimavimus, kad jų vaiką gali ištikti hipoglikemija; ir vertinama glikemijos kontrolė, kurią parodo glikuoto hemoglobino koncentracija kraujyje. Tyrimo rezultatai parodė, kad vaikinų ir merginų psichosocialinis prisitaikymas skiriasi. Vaikinų grupėje labiau išreikštas socialumas susijęs su didesnes tėvų hipoglikemijos baime, o labiau išreikštos elgesio problemos susijusios su mažesne tėvų hipoglikemijos baime. Merginų grupėje psichosocialinis prisitaikymas su tėvų hipoglikemijos baime nesusijęs. Vaikinų ir merginų geresnė glikemijos kontrolė susijusi su didesne tėvų... [toliau žr. visą tekstą] / The aim of the study was to assess the relationships between psychosocial functioning in youth with type 1 diabetes mellitus, parental fear of hypoglycemia and glycemic control. The subject of the study was 11-16 years-old youths with type 1 diabetes mellitus diagnosed more than 1 year ago and one of their parents. Overall there were 73 youth (36 boys and 37 girls) and 73 their parents (21 men and 52 women). Psychosocial functioning was assessed with Strengths and Difficulties Questionnaire of R. Goodman. It has 25 items about good and bad habits which turn into 6 scales: prosocial, hyperactivity, emotional symptoms, conduct problems, peer problems and total difficulties. Parental fear of hypoglycemia was assessed with Hypoglycemia Fear Survey (patent version) of L. Gonder-Frederick. It has 26 items about parent’s behavior in order to avoid hypoglycemia and worries of child having a low. Glycemic control was evaluated by glycated hemoglobin concentration. The results of the study showed that psychosocial functioning is different in boys and girls. Higher prosocial in boys was related to higher parental fear of hypoglycemia, higher conduct problems was related to lower parental fear of hypoglycemia. No relations were found in girls psychosocial functioning and parental fear of hypoglycemia. Greater glycemic control was related to higher parental fear of hypoglycemia in both boys and girls. Higher hiperaktivity, emotional symptoms, conduct problems and total difficulties in... [to full text]