No description available.

Thesis (MTech (Biomedical Technology))--Cape Peninsula University of Technology, 2011. / Studies have shown that oxidative stress (OS) is a major pathological risk factor in various diseases, including type 2 diabetes mellitus (T2DM). Hyperglycemia independently is a generator of free radicals, hence increases the level of OS in T2DM subjects. The oxidation of LDL is suggested to play a significant role in the pathogenesis of macrovascular complications observed in diabetic patients. In subjects with hyperglycemia or normoglycemia we investigated the relationship between MDA-protein adducts, HNE-protein adducts and auto-antibodies against oxLDL, and cardiovascular profile as measured by hs- CRP. From an epidemiological study that screened a high risk urban population for diabetes using oral glucose tolerance test, 98 hyperglycaemie and 79 normoglycaemic individuals were selected for this study. Enzyme linked immuno-sorbent-assay methods were used to determine the levels of serum MDA-protein adducts, HNE-protein adducts or auto-antibodies against oxLDL. High sensitive CRP was measured by nephelometry.

Eine gezielte bewegungstherapeutische Intervention verbessert den Glukosestoffwechsel, reduziert den Grad der Adipositas und belegt einen antiinflammatorischen Effekt. Ungeklärt ist dabei, in welchem Zeitintervall sich die jeweiligen Risikoparameter Adipositas, Glukosestoffwechsel und chronische Entzündungsreaktionen, in einer 12-monatigen Kontroll-Interventionsstudie bei Patienten mit gestörter Glukosetoleranz (IGT) im Vergleich zu einer Rosiglitazontherapie und einer unbehandelten Kontrollgruppe adaptieren. In der vorliegenden Untersuchung wurden 60 Patienten aus einer Population von 500 Probanden mittels 2-Stunden oralem Glukose Toleranztest (2h-oGTT) als Patienten mit gestörter Glukosetoleranz identifiziert und randomisiert den zwei Therapiearmen, Rosiglitazon- und Bewegungstherapie, sowie einer Kontrollgruppe zugeführt. Es werden dabei die Effekte einer 3-mal wöchentlichen Bewegungstherapie auf den Body Mass Index (BMI), Waist Hip Ratio (WHR), Fasting Plasma Insulin (FPI), Fasting Plasma Glukose (FPG), HbA1c, 2h-oGTT, maximale Sauerstoffaufnahme (VO2max) sowie Interleukin 6 (IL6) und C-reaktives Protein (CrP) nach 1, 6 und 12 Monaten untersucht. Die Bewegungstherapie erzielt nach 1 Monat eine signifikante Verbesserung der Adipositas und des Glukosestoffwechsels. Eine Reduzierung der chronischen Entzündungsreaktion via IL6 konnte nach 12 Monaten erreicht werden. Im vergleichbaren Zeitraum zeigt die Kontrollgruppe keine statistischen Änderungen des BMI, des WHR und der inflammatorischen Parameter. Die Insulinsensitivität verminderte sich in der Kontrollgruppe signifikant innerhalb von 12 Monaten. Unter Applikation von täglich 4 mg Rosiglitazon verbessert sich der Glukosestoffwechsel nach 6 Monaten. Änderungen des Grades der Adipositas und der chronischen Entzündungsreaktion konnten nicht erzielt werden. Die Untersuchungen belegen den hohen Stellenwert der Bewegungstherapie in der Behandlung von IGT-Patienten als Standardtherapieoption. Die Bewegungstherapie sollte mindestens 3-mal wöchentlich als kombiniertes Kraft- und Ausdauertraining bei einer Intensität von 70 - 85 % VO2max und 70 - 85 % 1RM erfolgen.

Eine gezielte bewegungstherapeutische Intervention verbessert den Glukosestoffwechsel, reduziert den Grad der Adipositas und belegt einen antiinflammatorischen Effekt. Ungeklärt ist dabei, in welchem Zeitintervall sich die jeweiligen Risikoparameter Adipositas, Glukosestoffwechsel und chronische Entzündungsreaktionen, in einer 12-monatigen Kontroll-Interventionsstudie bei Patienten mit gestörter Glukosetoleranz (IGT) im Vergleich zu einer Rosiglitazontherapie und einer unbehandelten Kontrollgruppe adaptieren. In der vorliegenden Untersuchung wurden 60 Patienten aus einer Population von 500 Probanden mittels 2-Stunden oralem Glukose Toleranztest (2h-oGTT) als Patienten mit gestörter Glukosetoleranz identifiziert und randomisiert den zwei Therapiearmen, Rosiglitazon- und Bewegungstherapie, sowie einer Kontrollgruppe zugeführt. Es werden dabei die Effekte einer 3-mal wöchentlichen Bewegungstherapie auf den Body Mass Index (BMI), Waist Hip Ratio (WHR), Fasting Plasma Insulin (FPI), Fasting Plasma Glukose (FPG), HbA1c, 2h-oGTT, maximale Sauerstoffaufnahme (VO2max) sowie Interleukin 6 (IL6) und C-reaktives Protein (CrP) nach 1, 6 und 12 Monaten untersucht. Die Bewegungstherapie erzielt nach 1 Monat eine signifikante Verbesserung der Adipositas und des Glukosestoffwechsels. Eine Reduzierung der chronischen Entzündungsreaktion via IL6 konnte nach 12 Monaten erreicht werden. Im vergleichbaren Zeitraum zeigt die Kontrollgruppe keine statistischen Änderungen des BMI, des WHR und der inflammatorischen Parameter. Die Insulinsensitivität verminderte sich in der Kontrollgruppe signifikant innerhalb von 12 Monaten. Unter Applikation von täglich 4 mg Rosiglitazon verbessert sich der Glukosestoffwechsel nach 6 Monaten. Änderungen des Grades der Adipositas und der chronischen Entzündungsreaktion konnten nicht erzielt werden. Die Untersuchungen belegen den hohen Stellenwert der Bewegungstherapie in der Behandlung von IGT-Patienten als Standardtherapieoption. Die Bewegungstherapie sollte mindestens 3-mal wöchentlich als kombiniertes Kraft- und Ausdauertraining bei einer Intensität von 70 - 85 % VO2max und 70 - 85 % 1RM erfolgen.:1 Hintergrund und Ziel der Arbeit 2 Studiendesign und Methoden 3 Ergebnisse 3.1 Einfluss der Bewegungstherapie auf den Gewichtsverlust 3.2 Einfluss der Bewegungstherapie auf den Glukosestoffwechsel 3.3 Einfluss der Bewegungstherapie auf chronische Entzündungsreaktionen 3.4 Einfluss des IL6-Polymorphismus IL6-SNP -174G/C 4 Schlussfolgerung 5 Literaturverzeichnis 6 Publikation Long-term exercise training decreases interleukin-6 (IL6) Serum levels in subjects with impaired glucose tolerance: effect of the -174G/C variant in IL6 gene 7 Zusammenfassung 8 Anhang Erklärung über die eigenständige Abfassung der Arbeit Lebenslauf und wissenschaftlicher Werdegang Danksagung

No description available.

Thesis (MPH.) -- University of Limpopo, 2014 / Objective: The purpose of this study was to determine the prevalence of impaired glucose tolerance, impaired fasting glucose, undiagnosed type 2 diabetes and its associated risk factors among adults patients attending the outpatient department of a level one hospital in a rural community of Barkley West, South Africa. Research methodology: This was a cross-sectional survey conducted by a simple random sampling of adults patients F 30 years old. Patients were screened using the American Diabetes Association and the World Health Organisation criteria. First, patients underwent the 75g oral glucose tolerance test and secondly, the 12-hours fasting plasma glucose tests after pre-test results of 5.5 mmol/L were obtained considered as positive for screening. To determine the prevalence of IGT, IFG, and undiagnosed type 2 diabetes; tests were conducted using both the capillary finger puncture and the laboratory methods. To ensure validity and reliability, each patient underwent two tests (fasting and random) by the capillary finger puncture method and two tests (fasting and random) by the laboratory method. Results: Eighty-five (85) questionnaires were distributed, supervised and returned by a research assistant, which brought the response rate to 100%. All patient known living with diabetes mellitus was not included in the study. The prevalence of IGT was 34.1% [34% for females and 9.4% for males] and that for IFG was 23.6% [25% for females and 6.0% for males]. The prevalence of undiagnosed type 2 diabetes discovered during the survey was 9.3% by 2-hours 75g glucose tolerance test [8.2% for females and 1.1% for males] and that by 12-hours fasting plasma glucose, the prevalence was 5.8% [4.7% for females and 1.1% for males].The associated risk factors were physical inactivity, overweight and obesity, unhealthy diet, alcohol consumption, hypertension, smoking habit, family history of diabetes, social deprivation and poverty. The prevalence of hyperglycaemia was also high among female patients due to a higher BMI with 25% overweight (females 18% overweight, males 7% overweight) and 75% obese (females 54% of obesity, males 21% of obesity); higher waist circumference with higher abdominal fat (females 71.7% had a W/C F 88 cm, males 28% had a W/C F 102 cm.); and a larger waist-to-hip ratio (females 61.1% had WHR > 0.85, males 7% had a WHR > 1.0). The sensitivity, specificity, positive and negative predictive values for IGT were 34%, 86%, 25%, and 86% and those for IFG were 24%, 86%, 19%, and 86% respectively. IGT sensitivity was greater than IFG sensitivity. xi Conclusion: There was a high prevalence of IGT, IFG and undiagnosed type 2 diabetes specifically among female patients. The ten percent difference of sensitivity between the two tests showed that the WHO diagnostic criteria produced more patients with the pathology than the ADA diagnostic criteria do. Patients attending the outpatient department of a level one hospital in Barkley West are at high risk of developing type 2 diabetes and remain unidentified, undetected, unscreened, undiagnosed and untreated. Obesity at primary health care level in the rural community of Barkley West needs to be addressed. . Keywords: Impaired glucose tolerance, prevalence, diabetes, screening, anthropometric measurements

<p>The appropriateness of universal screening for gestational diabetes mellitus (GDM) has been strongly questioned, since it does not satisfy ethical principles for screening. </p><p> The aims of these studies were to determine the prevalence of GDM, expressed in terms of impaired glucose tolerance (IGT) and diabetes mellitus (DM), to evaluate different screening models using traditional anamnestic risk factors and repeated random B-glucose, to determine whether GDM increases risks for maternal complications such as preeclampsia, and to determine whether IGT during pregnancy, if left untreated, is associated with increased maternal or neonatal morbidity. </p><p> Of 4,918 pregnant non-diabetic women attending maternal health care, 73.5% agreed to have a 75 g oral glucose tolerance test (OGTT). GDM was diagnosed in 1.7%, IGT in 1.3% and DM in 0.4%. Traditional risk factor criteria were fulfilled by 15.8%. Prior GDM and a prior macrosomic infant showed the highest association with GDM. No selective or two-step universal screening model would have detected all cases of GDM. A constructed model comprising prior GDM, a prior LGA/macrosomic infant, or a cut-off random B-glucose level of 8 mmol/l as an indication for OGTT reduced the need for OGTT to 7.3% compared to the selective screening model with traditional risk factors. Such a universal two-step screening model had 100% sensitivity for DM, and 44.7% sensitivity for IGT.</p><p> The Swedish Medical Birth Register was used to evaluate GDM as risk factor for preeclampsia. GDM occurred in 0.8% and preeclampsia in 2.9% of 430,852 singleton pregnancies. There is an independent and significant association between GDM and preeclampsia. Obesity is a major confounding factor, but cannot explain the total excess risk. </p><p> In a prospective population-based case-control study 213 women with untreated IGT during pregnancy were identified. For each case, four controls were recruited from the same delivery department. The analyses confirmed that maternal and fetal morbidity were increased in the cases in terms of cesarean section rate, pre-term delivery, Erb’s palsy and admission to NICU. There was a marked, independent increase in the proportion of LGA infants (OR 7.3; 95% CI 4.1-12.7). To determine whether treatment has an effect when IGT is diagnosed during pregnancy, a randomized study is required.</p>

The appropriateness of universal screening for gestational diabetes mellitus (GDM) has been strongly questioned, since it does not satisfy ethical principles for screening. The aims of these studies were to determine the prevalence of GDM, expressed in terms of impaired glucose tolerance (IGT) and diabetes mellitus (DM), to evaluate different screening models using traditional anamnestic risk factors and repeated random B-glucose, to determine whether GDM increases risks for maternal complications such as preeclampsia, and to determine whether IGT during pregnancy, if left untreated, is associated with increased maternal or neonatal morbidity. Of 4,918 pregnant non-diabetic women attending maternal health care, 73.5% agreed to have a 75 g oral glucose tolerance test (OGTT). GDM was diagnosed in 1.7%, IGT in 1.3% and DM in 0.4%. Traditional risk factor criteria were fulfilled by 15.8%. Prior GDM and a prior macrosomic infant showed the highest association with GDM. No selective or two-step universal screening model would have detected all cases of GDM. A constructed model comprising prior GDM, a prior LGA/macrosomic infant, or a cut-off random B-glucose level of 8 mmol/l as an indication for OGTT reduced the need for OGTT to 7.3% compared to the selective screening model with traditional risk factors. Such a universal two-step screening model had 100% sensitivity for DM, and 44.7% sensitivity for IGT. The Swedish Medical Birth Register was used to evaluate GDM as risk factor for preeclampsia. GDM occurred in 0.8% and preeclampsia in 2.9% of 430,852 singleton pregnancies. There is an independent and significant association between GDM and preeclampsia. Obesity is a major confounding factor, but cannot explain the total excess risk. In a prospective population-based case-control study 213 women with untreated IGT during pregnancy were identified. For each case, four controls were recruited from the same delivery department. The analyses confirmed that maternal and fetal morbidity were increased in the cases in terms of cesarean section rate, pre-term delivery, Erb’s palsy and admission to NICU. There was a marked, independent increase in the proportion of LGA infants (OR 7.3; 95% CI 4.1-12.7). To determine whether treatment has an effect when IGT is diagnosed during pregnancy, a randomized study is required.

Diabetes typ 2 ökar i hela världen, beräkningar har visat att prevalensen troligen kommer att öka till det dubbla år 2030. Att identifiera och behandla patienter som riskerar att utveckla sjukdomen är angeläget då personer med diabetes typ 2 löper ökad risk för att få komplikationer och andra sjukdomstillstånd som leder till stort lidande och förtida död. Syftet med denna litteraturstudie var att utifrån distriktssköterskans ansvarsområde beskriva primärpreventiva åtgärder och dess effekter för att förebygga diabetes typ 2 hos personer med nedsatt glukostolerans. En litteraturstudie med analys av 14 vetenskapliga artiklar genomfördes och resultatet visade att studier som innehöll både kost och motionsintervention inklusive individuell eller gruppbaserad rådgivning hade goda långtidseffekter på riskfaktorerna för insjuknande av diabetes typ 2. Patienter med nedsatt glukostolerans har behov av stöd för att förändra sina levnadsvanor i strävan mot att förebygga eller skjuta upp insjuknande i diabetes typ 2.

INTRODUÇÃO: A diabetes mellitus tipo 2 (DM) é uma doença metabólica caracterizada pela presença de hiperglicemia crônica. Estudos prévios demonstraram que pacientes com pré-diabetes (PDM) têm uma história natural de progressão para DM. A neuropatia diabética é a complicação mais comum da DM e avanços recentes na neurofisiologia clínica trouxeram um refinamento das técnicas de avaliação. Entre estas estão à resposta cutânea simpática (SSR) e o teste sensorial quantitativo (QST). Biomarcadores como Enolase Neurônio-Específica (NSE) e a Proteína S100-Beta (S100B) vem sendo descritos por muitos autores como associados a danos em células do sistema nervoso. OBJETIVO: O objetivo deste estudo é avaliar parâmetros neurofisiológicos e compará-los com achados clínicos e bioquímicos (S100B e NSE) em pacientes com DM, PDM e controles saudáveis. MÉTODOS: Pacientes dos ambulatórios de Neurologia e Endocrinologia foram randomizados em um estudo transversal. Os participantes foram submetidos a uma bateria de testes clínicos e neurofisiológicos que englobaram condução nervosa, Onda-F, SSR e QST. Níveis séricos de NSE e S100B foram quantificados através de ensaio ELISA (Enzyme-linked immunosorbent assay). RESULTADOS: A avaliação clínica e os estudos de condução nervosa e Onda-F foram similares nos grupos estudados. Já os limiares QST calor (QSTc) e QST dor (QSTd) foram significativamente elevados nos pacientes PDM e DM com relação aos controles (P<0.05 para todas as comparações). No entanto, estes parâmetros não foram capazes de distinguir pacientes DM vs. PDM (P >0.1 para todas as comparações). O SSR foi capaz de diferenciar o grupo DM do controle (P <0,01) embora não tenha mostrado diferença entre os grupos PDM e controle (P = 0,6). Não houve diferença entre os níveis de S100B (P = 0.6) e NSE (P = 0.2) entre os grupos DM, PDM e controles. CONCLUSÃO: O QST e SSR são testes úteis para a avaliação de pacientes com diferentes graus de tolerância a glicose. Este estudo não encontrou diferenças entre os biomarcadores NSE e S100B em indivíduos com DM e PDM. / BACKGROUND: Type 2 diabetes mellitus (DM) is a metabolic disease characterized by the presence of chronic hyperglycemia. Previous studies demonstrated that patients with prediabetes states (PDM) have a natural history of progression to DM. Neuropathy is the most common and disabling complication of diabetes and recent advances in neurophysiology have enabled a refinement of neurophysiological diagnostic techniques such as sympathetic skin response (SSR) and quantitative sensory testing (QST). Biomarkers like Neuron-specific Enolase (NSE) and S100- Beta Protein (S100B) has been described for many authors as associated with damage at nervous system cells and are related with severity of injury as well as clinical outcomes. OBJECTIVE: The aim of this study is to evaluate neurophysiological findings and compare them with clinical and biochemical findings (S100B and NSE) in patients with DM, PDM and healthy controls. METHODS: Patients at the outpatient Neurology and Endocrinology service were randomized in a cross-sectional study. Participants underwent a battery of clinical and neurophysiological tests that encompassed nerve conduction studies, F-wave, SSR and QST. ELISA (enzyme-linked immunosorbent assay) were perform to quantify serum levels of NSE and S100B. RESULTS: There were no difference regarding clinical evaluation, nerve conduction studies and F-wave were between groups. The QST thresholds of warm (QSTw) and QST pain (QSTp) were significantly elevated in patients with PDM and DM compared to controls (P <0.05 for all comparisons). However, these parameters were not able to distinguish among DM and PDM (P > 0.1 for all comparisons). The SSR was able to differentiate DM from control group (P <0.01) but did not show difference between PDM and control groups (P = 0.6). There was no difference on levels of S100B (P = 0.6) and NSE (P = 0.2) between the DM, PDM and control groups. CONCLUSION: The QST and SSR are useful tests to evaluating patients with different degrees of glucose tolerance. This study found no differences between biomarkers NSE and S100B in subjects with DM and PDM.