Indiana University-Purdue University Indianapolis (IUPUI) / Introduction: Increasing obesity in children leads to an increase in the risk of Type 2 diabetes (T2D). Therefore, it is important to promote healthier lifestyles in youths and encourage their caregivers(s) to provide a healthy lifestyle environment. The PowerHouse program focuses on improving food choices, increasing physical activity, and adopting behavior changes for the reduction of obesity and the prevention of T2D. Method: The aim of this study was to assess the effects of implementing the PowerHouse program on both clinical and quality of life outcomes in high-risk, low-income youth and their caregivers. Primary outcomes were BMI standard deviation and BMI percentile in youths. Secondary outcomes included physical activity of youths and quality of life for both youths and their caregivers. Attendance rates were also calculated. Linear effect mixed models were used to test for time effects for all outcomes. Results: Clinical outcomes did not improve over time, except for youth HbA1c (p-value = 0.0447). Some improvements in youth quality-of-life outcomes were noted: specifically, the Sports Index score of the Fels Physical Activity Questionnaire for Children (adjusted p-value = 0.0213) and the Physical Summary (p-value = 0.0407), Psychosocial Summary (p-value = 0.0167), and Total score (p-value = 0.0094) for the youth-reported Pediatric Quality of Life Inventory. Quality of life did not change over time for caregivers. For attendance, there was an improvement after the intervention was modified to improve access to fresh produce (p-value = 0.0002). Conclusion: HbA1c and quality of life improved over time for youth; however, there was not an improvement in caregiver outcomes over time. The data suggest that more time may be needed to see the full effects of the intervention, and/or that a booster intervention may be needed.

Thesis (M. A. Medicine (Family Medicine)) -- University of Limpopo, 2021 / Diabetes is a rising problem globally. The World Health Organization (WHO) has classified diabetes as an epidemic. The major impact of the disease is felt in low- and middle-income countries. The literature has emphasised the fact that most patients living with diabetes are undiagnosed, and those who are diagnosed are poorly controlled. The complications associated with diabetes usually occur over a long period of time and are mainly influenced by poor glycaemic control. In South Africa, diabetes is a major cause of morbidity and mortality and a burden to the already overstretched health system in the country. In this study, factors that impair a patient’s ability to achieve good glycaemic control are investigated. ' Methods In this cross-sectional, descriptive study was conducted at the general outpatients department (GOPD) of the Mankweng hospital in the Capricorn District of the Limpopo Province. A total number of 97 participants formed part of the study. An HbA1c test was used to classify patients into a well-controlled glycaemic group (HbA1c ≤ 7%) or a poorly controlled group (HbA1c > 7%). Factors for poor glycaemic control were investigated. The following factors were investigated to identify characteristics of poorly controlled diabetes patients: demographic data; adherence to treatment; and, clinical measurements characteristics. Frequency tables, univariate logistic regression models and chi-square tests were used to determine factors influencing glycaemic control. Results Of the 97 patients, only 63 (64.9%) had an HbA1C measurement done (measurable outcome). Of these patients, only 13 (15.7%) had well controlled diabetes, while diabetes in 50 patients was poorly controlled. Patients on oral treatment only comprised the bulk of the patients who were well controlled. Following multivariate analysis, being male was found to be a significant predictor of good glycaemic control. Conclusions Most patients who had an HbA1C done were poorly controlled. As a secondary observation, management of diabetes was suboptimal. Male patients treated with oral medication alone were more likely to have good glycaemic control. Key concepts Diabetes mellitus, HbA1C, glycaemic, hospital, general out-patient department, Limpopo

Patient nonadherence to physicians' prescribed therapeutic regimen is the greatest challenge in the effective treatment of patients with diabetes worldwide. Scientific evidence has revealed that nonadherence to prescribed medication could result in diabetic complications such as cardiovascular disease, retinopathy, nephropathy, and neuropathic diabetic foot ulcers. The purpose of this study was to explore predictive relationships between levels of adherence to antidiabetic medications, patient HbA1c levels, and diabetic complications among Jamaicans, an understudied population. The research question that guided this study was: Do the patient level of adherence and HbA1c levels have any predictive relationship with the severity of diabetic complications (cardiovascular disease, retinopathy, nephropathy and neuropathic foot ulcer) among Jamaicans after controlling for age and gender? The theory of planned behavior was used to guide the study. Data regarding diabetic complications were collected from 119 records during a cross-sectional review of patient dockets. Level of adherence was determined from an interviewer-administered Morisky 8-item adherence scale. A multiple regression analysis revealed that lower levels of patient adherence to treatment and higher HbA1c levels predicted greater severity of cardiovascular disease (p = .000; p = .000), retinopathy (p = .009; p =.090), nephropathy (p =.007; p =.001) and diabetic neuropathic foot ulcers (p =.027; p =.001). Findings from this study will contribute to the knowledge base on diabetic medication nonadherence and may encourage health care professionals to advocate for better medication adherence strategies among people with diabetes.

Bakgrund: Diabetesbörda innefattar emotionella aspekter kopplade till diabetes och är korrelerat till sämre glykemisk kontroll samt suboptimal sjukdomshantering. Diabetesbörda är ett lågt prioriterat problem i diabetesvården och det föreligger ett stort mörkertal, därtill berörs diabetesbörda sparsamt i de svenska nationella riktlinjerna för diabetesvård. Syfte: Syftet var att undersöka samband mellan diabetesbörda och glykemisk kontroll, diabetesduration samt demografisk data hos personer med Diabetes mellitus typ 1.  Metod: Kvantitativ deskriptiv tvärsnittsstudie. Totalt inkluderades 69 personer. Examensarbetet utfördes på två diabetesmottagningar i Sverige. Studiedeltagarna besvarade enkäten Swe-PAID-20 samt frågor avseende kön, ålder och diabetesduration och aktuellt HbA1c registrerades. Data analyserades med icke-parametriska metoder. Resultat: Förhöjd diabetesbörda upplevdes av 20% av studiedeltagarna och 45% rapporterade något diabetesrelaterat problem som ganska allvarligt respektive mycket allvarligt. Högt HbA1c var korrelerat med behandlingsrelaterade problem samt stödrelaterade problem. Samband mellan diabetesbörda och övriga variabler samt skillnader mellan subgrupper påvisades inte.  Slutsats: Diabetesbörda är ett relativt vanligt förekommande problem i den undersökta populationen. Högt HbA1c påvisades vara en prediktor för behandling- och stödrelaterade problem. Ökad kunskap om diabetesbörda kan bidra till ökad personcentrering i diabetesvården, minskat lidande för den enskilde individen samt en resursbesparing för samhället genom att minska risken för komplikationer. Screening av diabetesbörda hos samtliga individer med T1D kan vara av värde, då diabetesbörda inte är mer vanligt förekommande i någon specifik grupp av personer. / Background: Diabetes distress includes emotional aspects linked to diabetes and correlates to poor glycemic control and suboptimal self-management. There is many unreported cases and diabetes distress is currently a low priority problem and is sparsely addressed in the Swedish national guidelines for diabetes care. Aim: The aim was to investigate the correlation between diabetes distress and glycemic control, duration of diabetes, and demographic data in people with Diabetes mellitus type 1. Method: A quantitative descriptive cross-sectional study. A total of 69 people were included. Data was collected from two diabetes clinics in Sweden. The participants answered the Swe-PAID-20 questionnaire and questions regarding gender, age, and diabetes duration and current HbA1c was noted. Data were analyzed using non-parametric methods. Main results: Increased diabetes distress was experienced by 20% of the participants and 45% reported a diabetes-related problem as a “somewhat serious problem” or a “serious problem”. Higher HbA1c correlated with treatment-related problems as well as support-related problems. Associations between diabetes distress and other variables and differences between subgroups were not detected. Conclusion: Diabetes distress was a relatively common problem in the studied population. Elevated HbA1c values indicated treatment and support related problems. Increased knowledge about diabetes distress can contribute to a more person-centered diabetes care, reduce suffering for the individual and save resources for society by reducing the risk of complications. Screening is important as diabetes distress is not more common in any specific population and helps to identify people in need of support.

Using data from a purposive sample of 78 parents of children with type 1 diabetes, relationships were examined between the level of metabolic control of the child with diabetes (as measured by the HbA1c percentage), parents' marital conflict, caregiver burden, and use of psychological control. Also explored were family income and the education levels of mothers and fathers. Differences between mothers and fathers were also considered. Better metabolic control (lower HbA1c) was related to lower levels of fathers' caregiver burden. Marital conflict was also associated with mothers' and fathers' caregiver burden. Finally, mothers' caregiver burden predicted mothers' use of psychological control, and fathers' caregiver burden predicted fathers' use of psychological control. Fathers' paths were stronger from marital conflict to caregiver burden and from caregiver burden to psychological control than the mothers' paths. Only fathers had a significant path from HbA1c to caregiver burden.

No description available.

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.

Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterized by consistently high blood glucose, resulting from a combination of insulin resistance and reduced capacity of β-cells to secret insulin. While the exact causes of T2DM is yet unknown, obesity is known to be a major risk factor as well as co-morbidity for T2DM. As the global prevalence of obesity continues to increase, the association between obesity and T2DM warrants further study. Traditionally, mathematical models to study T2DM were mostly empirical and thus fail to capture the dynamic relationship between glucose and insulin. More recently, mechanism-based population models to describe glucose-insulin homeostasis with a physiological basis were proposed and offered a substantial improvement over existing empirical models in terms of predictive ability. The primary objectives of this thesis are (i) examining the predictive usefulness of semi-mechanistic models in T2DM by applying an existing population model to clinical data, and (ii) exploring the relationship between obesity and T2DM and describe it mathematically in a novel semi-mechanistic model to explain changes to the glucose-insulin homeostasis and disease progression of T2DM. Through the use of non-linear mixed effects modelling, the primary mechanism of action of an antidiabetic drug has been correctly identified using the integrated glucose-insulin model, reinforcing the predictive potential of semi-mechanistic models in T2DM. A novel semi-mechanistic model has been developed that incorporated a relationship between weight change and insulin sensitivity to describe glucose, insulin and glycated hemoglobin simultaneously in a clinical setting. This model was also successfully adapted in a pre-clinical setting and was able to describe the pathogenesis of T2DM in rats, transitioning from healthy to severely diabetic. This work has shown that a previously unutilized biomarker was found to be significant in affecting glucose homeostasis and disease progression in T2DM, and that pharmacometric models accounting for the effects of obesity in T2DM would offer a more complete physiological understanding of the disease.

<p>This thesis examines parental condition, how it is traded off against reproduction and how it is displayed in a secondary sexual trait. The studies were performed on nest-box breeding collared flycatchers Ficedula albicollis on the island of Gotland, in the Baltic Sea. Early breeding and high fitness were found to be associated with high levels of glycosylated haemoglobin possibly governed by migratory exertion and infectious disease. In order to test if immune function is expressed in secondary sexual traits and how it is traded off against reproductive effort a series of experiments were performed, in which birds were challenged with an antigen, via a vaccine containing neutralised paramyxovirus. The forehead patch of the male collared flycatcher serves as a badge of status and is under sexual selection. Good condition, as reflected in strong immune response and low levels of blood parasites was found to be associated with bigger patch size. Patch size was also found to vary in size within the same breeding season in a pattern predictable from immune response data. Immune response, in itself, was found to be costly in terms of reduced survival, confirming that trade-offs involving suppression of immune response may increase fitness. Mating effort was found to be traded off against immune function and moult. Experimental brood size manipulations revealed a trade-off females between number of offspring and immune function. Thus I suggest a set of parameters useful for condition estimation. I also show that immune response is costly and, second, that pathogen resistance probably plays an important role in the shaping of secondary sexual traits and life-history decisions.</p>

This thesis examines parental condition, how it is traded off against reproduction and how it is displayed in a secondary sexual trait. The studies were performed on nest-box breeding collared flycatchers Ficedula albicollis on the island of Gotland, in the Baltic Sea. Early breeding and high fitness were found to be associated with high levels of glycosylated haemoglobin possibly governed by migratory exertion and infectious disease. In order to test if immune function is expressed in secondary sexual traits and how it is traded off against reproductive effort a series of experiments were performed, in which birds were challenged with an antigen, via a vaccine containing neutralised paramyxovirus. The forehead patch of the male collared flycatcher serves as a badge of status and is under sexual selection. Good condition, as reflected in strong immune response and low levels of blood parasites was found to be associated with bigger patch size. Patch size was also found to vary in size within the same breeding season in a pattern predictable from immune response data. Immune response, in itself, was found to be costly in terms of reduced survival, confirming that trade-offs involving suppression of immune response may increase fitness. Mating effort was found to be traded off against immune function and moult. Experimental brood size manipulations revealed a trade-off females between number of offspring and immune function. Thus I suggest a set of parameters useful for condition estimation. I also show that immune response is costly and, second, that pathogen resistance probably plays an important role in the shaping of secondary sexual traits and life-history decisions.