Aim/Objectives: There were two aims; improving type II diabetes glycaemic control; and enhancing the role of community pharmacists by engaging them in type II diabetes medicine management. Methods: This quantitative study collected data from both community pharmacists and patients. In a premises survey, 426 self-administered questionnaires were distributed to community pharmacies. In a knowledge survey, 125 questionnaires were distributed to community pharmacists. In a clinical trial, 40 community pharmacies were randomly assigned to be control (18) and intervention (22) premises. Each pharmacy recruited 4 or 5 patients with type II diabetes. 225 patients were recruited and assigned to receive usual pharmacist care (n=100) or a pre-defined pharmacist intervention (n=125). Results: Community pharmacists had good knowledge of diabetes with average scores 21/29 (±3.18). The differences between control and intervention groups in patients' HbA1c and FPG changes were not significant. In the intervention group patients' diabetes knowledge was significantly improved (p=0.031). In the intervention group HbA1c and FPG improved significantly and in the control group FPG improved significantly and HbA1c did not. Patients' self-reported self-management activities improved significantly around blood glucose measurements (p<0.001) and physical exercising (p=0.001). Attitudes around the value of tight control of diabetes improved (p<0.001). Conclusion: The findings suggest that community pharmacists in Libya may have the ability to improve type II diabetes care. The primary outcomes were not improved in intervention versus control. The before/after analysis showed significant improvement in primary outcomes in the intervention group and also in one of the primary outcomes in the control group. Patients' self-reported self-care activities and attitudes improved significantly in the intervention group.

The purpose of this integrated review of the literature was to explore the effects of social support on diabetes-related stress, conflict, and metabolic control in adolescents with type 1 diabetes mellitus (T1DM). Social support was examined in four subgroups: adolescents with T1DM, family caregivers, peers, and teachers. Relevant findings in the literature revealed a significant deficiency of research devoted to adolescent males with diabetes as well as fathers as primary and secondary caregivers. Studies highlighted the importance of fostering autonomy and positive self-image in adolescents with T1DM and described effective interventions to improve diabetes-related stress, reduce disease-related conflict, and improve metabolic control. Findings suggested that nurses caring for adolescents with T1DM and their families should foster positive, open communication, while identifying barriers to problem solving, coping, stress, and optimal glycemic control. Interventions that educate caregivers and peers on how to better communicate and provide support are critical in fostering positive psychological and physiological outcomes in the adolescent with T1DM. The findings of this study may provide guidance in the way that nurses assess, identify, and counsel adolescents with TIDM regarding their disease management and access to support systems.

Au Liban, le diabète est évalué à 12%, il est appelé à doubler d’ici l’an 2025. Devant cette augmentation, il est pertinent d’évaluer les effets d’une intervention éducative auprès de personnes présentant un DT2 sur leur sentiment d’auto-efficacité et leur capacité d’auto-soins afin de rendre leur adhésion thérapeutique la plus optimale possible. Le devis est expérimental avant/après 3 mois. L’adhésion a été évaluée à l’aide de l’HbA1c à <7 % et de du SDSCA pour les comportements d’auto-soins, du DMSES pour l’auto-efficacité. L’échantillon formé : 71 GE et 65 GC. Le GE s’est amélioré au niveau des comportements d’auto-soins, l’application des recommandations, du sentiment d’auto-efficacité et du taux d’HbA1c. Ainsi une éducation infirmière favorise l’adhésion chez les DT2. Cette étude a pu contribuer au développement du savoir infirmier et au renouvellement des pratiques cliniques. / In Lebanon, diabetes is estimated at 12%, it is expected to double by the year 2025. In front of this increase, it is relevant to assess the effects of an educational intervention with people with T2DM their sense self-efficacy and self-care capacity to make their most optimal therapeutic adherence. This study use an experimental design: before / after 3 months. Adherence was assessed using the HbA1c <7% and the SDSCA for self-care behaviors of DMSES for self-efficacy. The formed sample: 71 65 GE and GC. GE has improved the level of self-care behaviors, the implementation of recommendations, the feeling of self-efficacy and HbA1c. As a nurse education promotes adhesion among T2DM. This study could contribute to the development of nursing knowledge and renewal of clinical practices.

研究目的：本研究使用共通信念模式，以瞭解第二型糖尿病患者持有的疾病表徵對自我照護行為的預測關係。過去的研究顯示，糖尿病患者的「控制」表徵能夠有效預測患者的自我照護行為和糖化血色素值；也就是，患者相信疾病能被控制的程度愈高，在自我照護行為的表現愈好，糖化血色素值愈低。但是，「結果」表徵與「情緒」表徵無法顯著一致的預測患者的自我照護行為。透過回顧與健康行為相關的理論發展與文獻，考量慢性疾病的自我調節歷程中，除了疾病表徵以外，還需要納入與自我意識有關的人格特質。為此，本研究目的有四:(1)先檢驗在台灣糖尿病患者的疾病表徵建構，是否與國外使用疾病共通信念模式的研究結果一致，有相同的因素結構。(2)檢定台灣第二型糖尿病患者，其持有的疾病表徵對自我照護行為與血糖控制的預測，是否與Harvey和Lawson(2009)的研究結果一致。(3)評估糖尿病患者的人格特質對自我照護行為與糖化血色素值的影響。(4)探索第二型糖尿病患者反芻反思特質，在疾病表徵影響自我照護行為上的調節效果。 研究方法：本研究以立意取樣的方式，邀請新竹某教學醫院門診的第二型糖尿病患者為受試。排除漏答與亂填者，共有142位符合資格的受試者；每位受試者皆需完成受試者同意書、背景資料、糖尿病自我照護量表、疾病表徵問卷與中文版反芻反思量表。根據研究目的，以階層回歸和羅吉斯回歸分析等統計方法進行假設考驗。 研究結果：(1)臺灣第二型糖尿病患者的疾病表徵結構與國外患者相似，共包含：「認同」、「病因」、「時間感急慢性」、「時間感循環性」、「結果」、「情緒」和「控制」表徵。(2)研究結果與Harvey和Lawson(2009)的研究結果一致，「控制」表徵可以顯著預測整體自我照護行為和糖化血色素值。(3)第二型糖尿病患者的反芻反思特質，無法單獨預測自我照護行為與糖化血色素值。(4) 第二型糖尿病患者的反芻反思特質會與病表徵產生交互作用，共同調節各種自我照護行為的表現。 結論：本研究資料與其他使用共通信念模式的研究資料一致，亦即控制表徵能預測自我照護行為和糖化血色素值。此外，本研究發現，不同自我照護行為會受到疾病表徵與反芻或反思特質的交互作用而影響。由於，增加自我照護行為的執行度，是目前糖尿病治療與衛教的首要目標。建議未來從事糖尿病照護的實務工作者，能提供疾病表徵與反芻反思特質的專業心理評估；以協助建立個別評估與個別介入的個別化治療方案，進而提高患者在自我照護行為的執行度、增加臨床治療的效果。 / Background and Aims. It is increasingly being used to understand and predict individuals' coping with and subsequent self-care of chronic illness is Leventhal and colleagues' the common sense model. This model postulates that it is the individual's illness representation is the proximal determinant of coping behavior. The role of personality in determining self-care behavior has been relatively ignored, possibly because of the lack of convergence in concepts and measures. Due to the lack of research in the area of interest, the present study attempt to resolve this issue. We investigated, (a) using subjects of Type-II diabetes in Taiwan, are the results of present study similar as others studies directed by common sense model to identify the factors of illness representation, (b) discussing the influences of illness representation to self-care behavior and glycemic control (HbA1c); like as Harvey and Lawson(2009)’s study, (c) assessing whether traits of normal personality are associated with variations in self-care behavior and glycemic control in patients with type 2 diabetes, (d) examining whether personality moderate the relationships between illness representations and self-care behavior. Methods. Patients were eligible if they had Type 2 diabetes, were aged 20 years or more at diagnosis. Before we collect data, a physician will invite patient to enter the study. Patient want to join this study, they be giving an informed consent and be asked to complete four questionnaires. A total 142 patients completed the demographic survey ( age, educational level, diabetes duration et al.), Diabetes Self-Care Scale, the Revised Illness Perception Questionnaire(IPQ-R), the Chinese version of Rumination- Reflection Questionnaire. Analysis were concluded using multiple regression analysis, logistic regression and so on. Results. The results revealed that: (1) as our hypothesis, the structures of the IPQ-R in type 2 diabetes in Taiwan were similar as other foreign studies directed by common sense model. (2) Control representation can induce main effect on self care behavior. Higher control representation was significantly positive associated with self care behavior, and it was significantly negative associated with HbA1c. (3) Self reflection and self rumination were inconsistently associated with self care behavior and HbA1c. (4) Personality moderated the relationships between illness representations and self-care behavior. Conclusions. This study supports the Common Sense Model (CSM) of illness representation when considering type 2 diabetes in Taiwan. Based on our results, we found personality traits may offer new insights in to variations in self-care in patients with type 2 diabetes undergoing standard management. Personality refers as self-reflection and self-rumination which moderated the relationships between illness representations and self-care behavior. Therefore, CSM could become the theoretical framework for psychological interventions in type 2 diabetes. Furthermore, according to the study result, we suggested the practitioners paying attention to the different interaction when representation and personality are together in diabetes’ each self-care behavior.

Background: The prevalence of diabetes and obesity has been on the rise for many years and the search for new and effective dietetic solutions aiming at reducing calories, reducing body mass and improving diabetes has been ongoing. Currently, the intermittent fasting diet - the practice of alternating periods of eating and fasting - is gaining popularity. One of them is Time-restricted feeding (TRF), which time-limits energy intake within a defined window of time up to 10 hours per day without necessarily altering diet quality or quantity. A reduction in calorie intake, bodyweight, blood pressure, oxidative stress, inflammation biomarkers and triglycerides are evident with TRF studies conducted so far. Aim: The aim of the thesis is to investigate the effects of time-restricted feeding on glycemic biomarkers in human studies. Methods: A literature study is conducted with six chosen experimental studies which are primarily randomized controlled trials or randomized crossover trials with a TRF window of maximum 10 hours per day and predominantly with participants with overweight/obesity, prediabetes, type 2 diabetes and metabolic syndrome. Results: Compared to either baseline and/or control group, fasting glucose was reduced in 3 out of 6 TRF studies, while fasting insulin was reduced in 3 out of 5 TRF studies and HbA1C was decreased in 1 out of 2 TRF studies. For postprandial response, 1 out of 2 TRF studies found a reduction in glucose and likewise for insulin. Mean glucose levels were reduced in 1 out of 3 TRF studies. Insulin resistance was reduced in 3 out of 4 TRF studies while insulin sensitivity was reduced in the one study measuring this. Beta cell function improved in 2 out of 2 TRF studies compared to the control group or baseline. Conclusion: There are indications that TRF has an effect on glycemic biomarkers and thus potentially being able to reduce the risk and/or improve the treatment of type 2 diabetes. But in order to give a more definite answer more studies need to be conducted. In general, these studies should preferably have more participants and be methodologically stronger when it e.g. comes to the control of the dietary regimen.

No description available.

Studies have identified metabolic health factors to be a major concern in Mexican-Americans, including Mexican immigrants to the United States (U.S.). Acculturation stress has been hypothesized to be a factor in the development of many health-related concerns in this population. Specifically, previous studies have shown that acculturation stress contributes to health concerns, including metabolic health concerns (e.g., diabetes, metabolic syndrome). The primary purpose of this study was to examine the relationship between cultural orientation, a measure of acculturation designed to provide more information than traditional acculturation measures, and metabolic health outcomes. Specific acculturation-related stressors (social support, job-related stress, and depression) were hypothesized mediators in this relationship among a convenience sample of 98 foreign-born Mexicans living in Utah County, Utah controlling for age, gender, socio-economic status (SES), and years in the U.S. Data were collected twice with a three year interval to examine change over time. Changes in these constructs were examined through the use of Growth Modeling with Bayesian estimation. The Acculturation Rating Scale for Mexican-Americans (ARSMA-II) was used to measure Anglo Cultural Orientation and Mexican Cultural Orientation. Standard blood analyses were used to measure metabolic health outcomes, which included glycosylated hemoglobin (HbA1c), insulin, and glucose. The Interpersonal Support Evaluation List (ISEL-12) was used to measure social support, the Job Content Questionnaire (JCQ) was used to measure job-related stress, and the Center for Epidemiological Studies-Depression Scale (CES-D) was used to measure depression. No change was identified in Anglo Cultural Orientation or Mexican Cultural Orientation over time in the majority of subjects. A positive relationship between Anglo Cultural Orientation and HbA1c was found, as was a negative relationship between Mexican Cultural Orientation and HbA1c. Mediation analyses showed a mediation effect of depression on the relationship between Anglo Cultural Orientation and glucose. Implications of findings, limitations, and directions for future research are discussed.

No description available.

The physical complications of Type 1 diabetes mellitus (T1DM) have been understood as an accelerated ageing process (Morley, 2008). Do people with T1DM also experience accelerated cognitive and brain ageing? Using findings from research of the normal cognitive and brain ageing process and conceptualized in theories of the functional brain changes in cognitive ageing, a combination of cognitive testing and functional magnetic resonance imaging (fMRI) techniques were used to evaluate evidence of accelerated cognitive and brain ageing in middle-aged adults with T1DM. The first part of this thesis comprises a cognitive study of 94 adults (≥ 45 years of age) with long duration (≥ 10 years) of T1DM. Participants completed cognitive assessment and questionnaires on general mood and feelings about living with diabetes. Findings highlighted the importance of microvascular disease (specifically retinopathy) as an independent predictor of cognitive function. The incidence and predictors of mild cognitive impairment (MCI) were then explored. Results indicate a higher percentage of the group met criteria for MCI than expected based on incidence rates in the general population, providing initial evidence of accelerated cognitive ageing. Psychological factors were explored next. The relationship between the measures of well-being, diabetes health, and cognitive function highlighted the need for attention to patient's psychological well-being in diabetes care. Finally, a subgroup of 30 participants between the ages of 45 and 65 who differed on severity of retinopathy were selected to take part in an fMRI study. Blood oxygen level dependent (BOLD) activity was evaluated while participants were engaged in cognitive tasks and during rest. The findings provided evidence that the pattern of BOLD activation and functional connectivity for those with high severity of retinopathy are similar to patterns found in adults over the age of 65. In line with the theories of cognitive ageing, functional brain changes appear to maintain a level of cognitive function. Evidence of accelerated brain ageing in this primarily middle-aged group, emphasizes the importance of treatments and regimens to prevent or minimize microvascular complications.

Reduction in dopamine receptor D2, has been associated with insufficient brain reward, food addiction, obesity, and type 2 diabetes (T2D). Our aim was to assess whether the genetic variability responsible for this reduction is associated with poor dietary compliance and life style habits in T2D patients. Genetic-analysis was done for 109 T2D individuals who completed a 24-week randomized clinical trial and were assigned to follow either a low-GI or a high-fibre diet. Polymorphisms of TaqIA and C957T were compared with physical and biochemical measures. Regardless of dietary treatments, individuals with the C957T-T allele and the TaqIA-A2 allele were significantly associated with blood pressure reduction. Carriers of the T allele significantly lowered their body mass index (BMI) over the 24-week trial. Our findings suggest that the presence of the TaqIA-A2 allele is associated with a decrease in blood pressure. The C957T-T allele was associated with decrease in pressure and body weight.