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No description available.

Thesis (Ph. D.)--University of Texas at Austin, 2002. / Vita. Includes bibliographical references. Available also from UMI Company.

Introduction: Historically, type 2 diabetes (T2DM) has been regarded as a progressive and degenerative disease and only minority of patients can have disease remission with conventional treatment. It was noticed that gastrointestinal surgery could induce complete remission of T2DM in most of morbidly obese patients. Compared to the West, the development of bariatric and metabolic surgery is slow in Hong Kong. It is unknown whether the knowledge and attitudes of medical doctors and patients towards surgical treatment for T2DM have impacts on the development in this field. The novel procedure sleeve gastrectomy (SG) had been shown to be effective in inducing T2DM remission in obese human. Duodenal jejunal bypass (DJB) and ileal transposition (IT) were reported to be effective for ameliorating T2DM in non-obese diabetic animal model. The anti-diabetic potency of DJB and IT is unknown in comparing to SG particularly in non-obese subjects. Currently, SG is the main procedure for morbidly obese patients with or without T2DM in the authors’ institution. Aims: The aims of the present thesis were to investigate the knowledge and attitudes of medical doctors and patients toward using surgery as a treatment for T2DM, to compare the anti-diabetic effect of SG, DJB and IT in non-obese T2DM animal model, and lastly, to review of outcomes of morbidly obese patients who underwent SG in authors’ institution. Methods: Survey was conducted using questionnaire for interview of both doctors and patients to investigate their knowledge and attitudes toward surgical treatment of T2DM. The anti-diabetic effects of novel surgical procedures SG, DJB and IT were compared using non-obese T2DM animal model (Goto Kakizaki rats). The outcomes were evaluation by measuring fasting glucose and glycosylated haemoglobin (HbA1c) levels. Other parameters including alteration in gut hormones and lipid profile were also analyzed. The outcomes of morbidly obese patients who underwent laparoscopic SG in last 5 years in the authors’ institution were retrospectively reviewed. Results: The knowledge of bariatric and metabolic surgery was inadequate both in medical doctors and patients. The attitude and pattern of referral from medical doctors depends on the amount of knowledge. Patients’ attitudes were positive and they accept surgery as a treatment option for T2DM as long as they were provided with adequate information. This implies that tremendous educational works are required both for medical doctors and patients for the development of bariatric and metabolic surgery in Hong Kong. All 3 procedures (SG, DJB and IT) significantly improved glucose homeostasis and the effect was more potent and durable in DJB and IT than SG. The improved glucose homeostasis in IT was resulted from increased GLP-1 and PYY secretion (hindgut theory). In DJB, GIP, GLP-1 and PYY were raised and the anti-diabetic effect could be explained both by the foregut and hindgut theories. SG reduced the diet triglyceride absorption. DJB reduced cholesterol absorption whereas IT reduced cholesterol but increase triglyceride absorption. The outcomes of SG for T2DM for morbidly obese patients were promising. More than 90% patients had T2DM ameliorated and 70% had complete remission. SG can effectively control the body weight of morbidly obese patients. Conclusion: Education, both to doctors and patients, was crucial to overcome the potential obstacles for the development of this newly specialty. The anti-diabetic effects of DJB and IT were more potent than SG in non-obese diabetic animal model. The lipid absorption varied in different surgical procedures. Application of these procedures in non-obese T2DM patients warrants individual consideration and further investigation. SG in the authors’ institution was effective to induce T2DM remission in morbidly obese patients. / published_or_final_version / Surgery / Doctoral / Doctor of Philosophy

Objective: To systematically review the effect of self-management education on diabetic control in type 2 diabetes Research design and methods: PubMed was searched for English-language articles published between 2010 and 2013. All the studies were original articles selected manually and used randomized control trials generating results of self-management education in people with type 2 diabetes referring to diabetic control. Relevant data were divided and tabulated into factors of population characteristics, interventions and outcomes. Interventions were classified into three sections as collaborative information intervention, lifestyle intervention, and skills teaching intervention based on the patterns of education. Outcomes were categorized into glycemic control, cardiovascular disease (CVD) risk factors and nephropathy risk factors. Results: A total of 24 studies were identified of initial 41 articles for this review. Effects of self-management education on glycemic control were demonstrated to be positive both in short-term (<10 months) and long-term (>10 months) follow-up, but more positive effects in short-term follow-up. The same effectiveness happens to CVD risk factors, including lipids, weight and blood pressure. On the other hand, with short-term follow-up, teaching skills intervention of self-management education is more effective than collaborative information intervention and lifestyle intervention on reducing glycemic control and CVD risk factors. Also with long-term follow-up, teaching skills intervention of self-management education had more effectiveness than collaborative information intervention and lifestyle intervention on reducing glycemic control. However, few studies including CVD risk factors in the long-term follow-up, so it is difficult to evaluate the effectiveness of on CVD risk factors with long-term follow-up. Conclusions: Evidences supports the positive effectiveness of self-management education with collaborative information intervention, lifestyle intervention and skills teaching intervention among type 2 diabetes patients on diabetic control, in both short-term follow-up and long-term follow-up, but short-term follow-up is more effective than long-term follow-up. Further research is needed to develop self-management interventions to maintain long-term follow-up effects on glycemic control, CVD risk factors and other diabetes complications. / published_or_final_version / Public Health / Master / Master of Public Health

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No description available.

Thesis (M.A.)--University of Hawaii at Manoa, 2001. / Includes bibliographical references (leaves 92-101). Also available on microfiche.

Thesis (M.A.)--University of Adelaide, 1989. / Includes bibliographical references (leaves 191-204).

Thesis (M.S.) in Food Science and Human Nutrition--University of Maine, 2007. / Includes vita. Includes bibliographical references (leaves 69-74).