Indiana University-Purdue University Indianapolis (IUPUI) / Objectives: The purpose was to evaluate pain scores (SF-36 BPS) among pre-diabetic patients on metformin or placebo to determine if patients on metformin therapy report less pain (higher SF-36 BPS) than patients on placebo. Study design: A descriptive retrospective review of pain scores was conducted using secondary data analyses of the Diabetes Prevention Program (DPP) and Diabetes Prevention Program Outcomes Study (DPPOS) conducted from 1996 to 2008. Patients were randomly assigned to placebo, low (850 mg/day) or high dose (1700 mg/day) metformin groups. Pain scores using the SF-36 BPS standard version were taken before randomization and annually (year one through four). Results: Out of 3,819 patients that participated in the original study, 1,056 patients met the current study criteria. The metformin group included 506 patients and the placebo group included 550 patients. With an alpha level of 0.05 for all analyses, baseline pain scores between the metformin group and placebo group showed no significant difference. Year two showed significance between placebo and metformin pain scores (75.2 vs 78.6). All other years were not significant. Comparing low and high dose metformin and placebo groups, years one, two and three displayed significant differences in pain scores. In years one and two, the high dose metformin group reported less pain than the placebo group (80.7 vs 77.7; 80.1 vs 75.2) and the low dose metformin group (80.7 vs 71.8; 80.1 vs 68.6). In year three, the high dose metformin group had less pain than the low dose metformin group (78.4 vs 70.5).

Thesis (M Nursing)--Montana State University--Bozeman, 2008. / Typescript. Chairperson, Graduate Committee: Christina Sieloff. Includes bibliographical references (leaves 47-51).

While the strict boundaries and ideal measurement of prediabetes remain contested internationally, health officials and private donors in the health sector in Mexico have promoted its diagnosis and treatment as a key strategy in the nation’s fight against diabetes. This dissertation examines the circumstances under which officials have come to view prediabetes diagnosis as a feasible strategy for the Mexican context and the implications of treating individuals, situated across deep lines of social inequality, who are not yet sick, but deemed at risk of developing disease. Set against Mexico’s chronic disease crisis, where diabetes was declared a national sanitary emergency in 2016 and where experts suggest up to 40% of adults likely have prediabetes, this dissertation engages the prediabetes diagnosis as a lens through which to illuminate the social forces, values, and assumptions currently at work in Mexican health politics. The project foregrounds the dilemmas raised by highly medicalized and clinic-based approaches to chronic disease prevention and mobilizes the case of prediabetes in Mexico to illustrate the broader convergence of the fields of biomedicine and public health. Centered in Mexico City, field research for this project was carried out over 30 months, employing multi-sited ethnographic methods, including 106 in-depth interviews (47 of which were with individuals diagnosed with prediabetes and their families), observations of 382 medical exams, and attendance at 71 scientific, community health, and activist-hosted events. Alongside the powerful influence of the pharmaceutical industry, my findings bring to the fore a new set of actors and circumstances involved in the circulation of predisease diagnosis to this developing country context. These include (1) the epistemological limits imposed by “projectification” in global health science, (2) the influence and ideologies of an elite-mega philanthropist and his Foundation’s conviction that technological innovation will foster better health, and (3) local and global imaginaries that endorse the power of Big Data analytics to solve a plethora of development challenges. Further, in tracing the enactment of the prediabetes diagnosis across public and private clinics, I show that the pre-disease condition that economic elites experience when they are diagnosed contrasts sharply with that experienced by working class and low-income patients—I argue that in practice, prediabetes is multiple and its diagnosis amplifies existing social inequities. I also show that the emotional and ethical responses to the diagnosis among patients can differ substantially, particularly across socioeconomic divides. I argue that in Mexico, increased access to risk knowledge does not foster a spirit of “optimization” among the majority of Mexicans, but rather an alternative ethic, which I term “strategic preservation.” Finally, I show that many health experts in Mexico share a common set of values and norms in thinking about diabetes risk. On a macro level, they discursively link the looming threat of prediabetes, diabetes risk, and diabetes itself to the nation’s potentially disastrous macroeconomic future, effectively charging individuals with the responsibility to mitigate this threat through behavior and lifestyle modification. Health experts in this arena also frequently communicate the notion that the Mexican body itself is a key source of diabetes risk. I point to other elites in Mexico who, relying on a similar conception of the Mexican body, are investing in molecular technologies to better detect embodied diabetes risk, and to expand the reach and precision of medicalized prevention strategies in the future. These findings have implications for developing countries globally, which now bear the highest burden of chronic disease. Developing countries are already or will soon grapple with a similar epidemiological crisis and, as this occurs, Mexico’s strategies and experience will set precedents and establish key paradigms for public health action globally. With this in mind, I call for the disentanglement of expertise between the fields of biomedicine and public health and for a turn toward more structural, indeed socially radical, policies for chronic disease prevention at the population level.

Submitted by Jean Medeiros (jeanletras@uepb.edu.br) on 2018-05-11T11:39:10Z No. of bitstreams: 1 PDF - Thaisy Garcia de Oliveira.pdf: 24734749 bytes, checksum: c809add18e9f0408b53a222d75f4fddd (MD5) / Approved for entry into archive by Secta BC (secta.csu.bc@uepb.edu.br) on 2018-05-23T16:49:58Z (GMT) No. of bitstreams: 1 PDF - Thaisy Garcia de Oliveira.pdf: 24734749 bytes, checksum: c809add18e9f0408b53a222d75f4fddd (MD5) / Made available in DSpace on 2018-05-23T16:49:58Z (GMT). No. of bitstreams: 1 PDF - Thaisy Garcia de Oliveira.pdf: 24734749 bytes, checksum: c809add18e9f0408b53a222d75f4fddd (MD5) Previous issue date: 2016-05-31 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Introduction: Type 2 diabetes mellitus (DM2) has reached an increasing number of children and adolescents worldwide. In Brazil, there are few studies related to the prevalence of high risk for diabetes (prediabetes) and associated factors in this public. Objective: To determine the prevalence of prediabetes and risk factors for type 2 diabetes mellitus among adolescent and characteristics associated with this condition. Methods: Transversal research with a quantitative approach, involving 553 adolescents (15-19 years) from public high schools in the city of Campina Grande, Paraíba. Data collection was conducted from September 2012 to June 2013, through the application form for obtaining demographic data, behavioral factors (sedentary lifestyle and physical activity) and family histor y of type 2 diabetes; conducting anthropometric (weight, height and abdominal circumference); measurement of blood pressure and blood collection (Glycated hemoglobin, fasting blood glucose and lipid profile). It was considered prediabetes the presence of HbA1c ≥ 5.7 and / or fasting glucose ≥ 100 mg / dL and, for evaluation of the presence of risk factors, it was adopted the criteria mentioned by the American Diabetes Association (ADA) and by the European Association for Diabetes Study. For classification of the group at risk for the development of T2DM it was considered the criteria adopted by ADA. Data were double entered and submitted for validation through the Epi Info 6.04 validate sub-program. Through the Statistical Package for Social Sciences (SPSS, version 22.0), a descriptive analysis of all variables was performed using the measurements of absolute and relative frequency. The distribution of these variables and association analysis took place according to the nutritional status and the presence or absence of abnormal HbA1C (prediabetes) among adolescents, using the chi-square test. For those variables that were associated with the prediabetic state, it was analyzed their independence in determining this condition, through the multivariate logistic regression test. All statistical analyzes considered the 95% confidence interval. Results: Among the adolescents evaluated, 19.3% were overweight / obese. Prediabetes was more common among those who were overweight (8.4%), but it was also present among those who were eutrophic (4.9%). In relation to the lifestyle, 53.4% were sedentary and 60.2% physically inactive. Among the risk factors recommended by the ADA, the most frequent were low HDL cholesterol (42.3%) and total cholesterol (21.0%). Only high triglyceride level was associated with prediabetes, but it did not appear as a predictor of this condition. Conclusions: The finding of a considerable prevalence of type 2 prediabetes among adolescents, including the eutrophic one, reinforces the importance of screening of this condition in this age group, regardless of nutritional status. It is important to conduct longitudinal studies to assess causality and the risk of developing type 2 diabetes among those with prediabetes. / Introdução: O diabetes mellitus tipo 2 (DM2) tem atingido um número crescente de crianças e adolescentes em todo o mundo. No Brasil, ainda são poucos os estudos relacionados à prevalência do risco elevado para o diabetes (pré-diabetes) e fatores associados nesse público. Objetivo: Verificar a prevalência de pré-diabetes e fatores de risco para Diabetes Mellitus tipo 2 em adolescentes e características associadas a esta condição. Material e Métodos: Pesquisa de caráter transversal, com abordagem quantitativa, envolvendo 553 adolescentes (15-19 anos) de escolas públicas de ensino médio do município de Campina Grande, Paraíba. A coleta dos dados foi realizada no período de setembro de 2012 a junho de 2013, através da aplicação de formulário para obtenção dos dados sociodemográficos, fatores comportamentais (sedentarismo e atividade física) e história familiar para o diabetes tipo 2; realização de antropometria (peso, estatura e circunferência abdominal); aferição da pressão arterial e coleta sanguínea (hemoglobina glicada A1C; glicemia de jejum e perfil lipídico). Considerou-se pré- diabetes a presença de HbA1c ≥ 5,7 e/ou glicemia de jejum ≥ 100mg/dL e, para avaliação da presença de fatores de risco, foram adotados os critérios mencionados pela American Diabetes Association (ADA) e pela Associação Europeia para o Estudo do Diabetes. Para classificação do grupo de risco para o desenvolvimento do DM2 foi considerado o critério adotado pela ADA. Os dados foram duplamente digitados e submetidos à validação no subprograma Validate do Epi Info 6.04. Através do Statistical Package for the Social Sciences (SPSS, versão 22.0), foi realizada uma análise descritiva de todas as variáveis, utilizando-se as medidas de frequência absoluta e relativa. A distribuição destas variáveis e análise de associação ocorreu de acordo com o estado nutricional e com a presença ou não de HbA1C alterada (pré-diabetes) entre os adolescentes, através do teste qui-quadrado. Para aquelas variáveis que apresentaram associação com o estado de pré-diabetes, analisou-se a independência delas na determinação dessa condição, utilizando-se o teste de regressão logística multivariada. Todas as análises estatísticas consideraram o intervalo de confiança de 95%. Resultados: Dos adolescentes avaliados, 19,3% tinham sobrepeso/obesidade. O pré- diabetes foi mais frequente entre os que tinham excesso de peso (8,4%), porém esteve presente entre os que eram eutróficos (4,9%). Em relação ao estilo de vida, 53,4% eram sedentários e 60,2% inativos fisicamente. Entre os fatores de risco preconizados pela ADA, os mais frequentes foram o colesterol HDL baixo (42,3%) e o colesterol total (21,0%). Apenas o triglicerídeo elevado esteve associado ao pré-diabetes, mas não se apresentou como fator preditor dessa condição. Conclusões: O achado de uma considerável prevalência de pré- diabetes tipo 2 entre os adolescentes, inclusive nos eutróficos, reforça a importância da triagem dessa condição nessa faixa etária, independente do estado nutricional. É importante a realização de estudos com delineamento longitudinal para avaliação de causa lidade e do risco de desenvolver o diabetes tipo 2 entre os que têm pré-diabetes.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2010. / Härtill 4 uppsatser.

Bakgrund Förekomsten av diabetes typ-2 har ökat dramatiskt och cirka en halv miljard människor världen över har diabetes. Prediabetes är en av de riskfaktorer som ökar risken för att utveckla diabetes typ-2. Många studier har visat att livsstilsförändringar kan minska risken eller fördröja uppkomsten av diabetes typ-2. Syfte: Diabetessköterskors upplevelser och erfarenheter av att arbeta med metoder och insatser inom primärvården för att förhindra utveckling av diabetes typ-2 hos patienter med prediabetes Metod: Kvalitativ studie med semistrukturerade intervjuer. Resultat: Resultatet visade att screening och remittering till diabetessjuksköterskor för samtal med levnadsvanor och uppföljningar användes. Fem kategorier identifierades utifrån deras erfarenheter av förebyggande arbete: 1-upplevelser av att känna organisatoriskt stöd ger förutsättningar för preventivt arbete. 2-Upplevelser av att ha organisatoriska begränsningar eller hinder i patientarbete. 3-Rådgivning och stöd nämndes som mycket viktig del i deras patientarbete med livsstilsförändringar.4-Att ha verktyg underlättar preventionsarbete. 5-Upplevelser av att ha olika utmaningar och svårigheter i patientkommunikation- och information Slutsatser: Studien visade diabetessjuksköterskor hade olika erfarenheter avseende preventionsarbete utifrån de organisatoriska förutsättningar och förhållande de hade samt hur deras patientklienter såg ut vilket skulle kunna påverka deras preventionsarebete. Resursbrist och avsaknad av rutiner försvårade deras arbete. Därför är det viktigt att diabetessköterskor arbetsförhållande förbättras. Även utbildningar om befintliga rekommendationer eller riktlinjer avseende hälsofrämjande åtgärder är nödvändiga. / <p>Betyg i Ladok  210625.</p>

Evidence is limited regarding whether periodontal treatment improves hemoglobin A1c (HbA1c) among people with prediabetes and periodontal disease, and it is unknown whether improvement of metabolic status persists >3 mo. In an exploratory post hoc analysis of the multicenter randomized controlled trial “Antibiotika und Parodontitis” (Antibiotics and Periodontitis)—a prospective, stratified, double-blind study—we assessed whether nonsurgical periodontal treatment with or without an adjunctive systemic antibiotic treatment affects HbA1c and high-sensitivity C-reactive protein (hsCRP) levels among periodontitis patients with normal HbA1c (≤5.7%, n = 218), prediabetes (5.7% < HbA1c < 6.5%, n = 101), or unknown diabetes (HbA1c ≥ 6.5%, n = 8) over a period of 27.5 mo. Nonsurgical periodontal treatment reduced mean pocket probing depth by >1 mm in both groups. In the normal HbA1c group, HbA1c values remained unchanged at 5.0% (95% CI, 4.9% to 6.1%) during the observation period. Among periodontitis patients with prediabetes, HbA1c decreased from 5.9% (95% CI, 5.9% to 6.0%) to 5.4% (95% CI, 5.3% to 5.5%) at 15.5 mo and increased to 5.6% (95% CI, 5.4% to 5.7%) after 27.5 mo. At 27.5 mo, 46% of periodontitis patients with prediabetes had normal HbA1c levels, whereas 47.9% remained unchanged and 6.3% progressed to diabetes. Median hsCRP values were reduced in the normal HbA1c and prediabetes groups from 1.2 and 1.4 mg/L to 0.7 and 0.7 mg/L, respectively. Nonsurgical periodontal treatment may improve blood glucose values among periodontitis patients with prediabetes (ClinicalTrials.gov NCT00707369).

Amid the global pandemic, it becomes more apparent that diabetes is a pressing health concern because racial/ethnic minorities with underlying diabetes conditions have been disproportionately affected. The study proposes a multiyear examination to document the role of the Affordable Care Act (ACA) in racial/ethnic disparities in diabetes health. Using the Behavioral Risk Factor Surveillance System from 2011 to 2019, the study with a pre-post design investigated changes in access to care and diabetes health among non-White minorities compared with Whites before and after the ACA by conducting multivariable linear regression, with state-fixed effects and robust standard errors. Compared with Whites, racial/ethnic minorities showed significant improvements in health insurance coverage, having a personal doctor, and not seeing a doctor because of cost. Blacks (3.2% points,  ≤ 0.000), Hispanics (1.6% points,  = 0.001), and "other" racial/ethnic group (1.5% points,  = 0.003) experienced a greater increase in diagnosed prediabetes than Whites, whereas no and small differences were found in diagnosed diabetes and obesity, respectively. The yearly comparisons of changes in diagnosed prediabetes showed that Blacks compared with Whites had a growing increase from 1.2% points ( = 0.001) in 2014 to 3.3% points ( = 0.001) in 2019. Insurance coverage has declined after 2016, and obesity had an increasing trend across race/ethnicity. The ACA had a positive role in improving access to care and identifying those at risk for diabetes to a larger extent among racial/ethnic minorities. However, the policy impacts have been diminishing in recent years. Continued efforts are needed for sustained policy effects.

Síndrome do túnel do carpo (STC) está associada à diabetes mellitus (DM), mas a associação não está claramente demonstrada com pré-diabetes (PD). Objetivo: Determinar a prevalência de PD e fatores de risco associados em pacientes com STC. Métodos: Foi realizado estudo transversal incluindo 115 pacientes com STC idiopática e 115 controles pareados por idade, gênero e índice de massa corporal (IMC). Avaliação clínica, laboratorial e neurofisiológica foi realizada em todos os indivíduos para confirmar o diagnóstico e gravidade da STC de acordo com a classificação neurofisiológica de STC. PD foi definido usando critérios estritos. Resultados: A prevalência de PD foi similar no grupo STC e controles (27% vs. 21,7%, P=0,44). Sintomas noturnos (91,3%) e classificação moderada de STC (58,3%) foram os mais frequentemente observados. Pacientes com STC com PD apresentaram média de idade significativamente mais alta comparada à pacientes com STC sem PD (53,8 +- 10,2 vs. 49,5 +- 8,6 anos, P=0,027). Tendência de média mais alta de IMC (30,6 +- 4,1 vs. 28,7 +- 4,8 kg/m2, P=0,059) e duração dos sintomas (21,5 +- 29,6 vs. 14,8 +- 20,6 meses, P=0,062) e menor frequência de gênero feminino (80,6% vs. 92,9%, P=0,057) foram observados em pacientes com STC com PD. Frequências de pacientes com STC com PD e idade > 60 anos (29,0% vs. 8,3%, P=0,04) e IMC > 30 kg/m2 (64,5% vs. 33,3%, P=0,03) foram significativamente mais altas que em pacientes com STC sem PD. Não foram observadas diferenças significativas em ambos os grupos com relação aos sintomas (P > 0,05) e classificação neurofisiológica da STC (P > 0,05). Conclusões: Nossos achados apóiam fortemente a noção de que a STC não está associada à PD, mas está intimamente ligada a idade e sobrepeso / Carpal tunnel syndrome (CTS) is associated to Diabetes mellitus (DM) but not clearly demonstrated to Prediabetes (PD). Objective: Determine prevalence of PD and risk factors in CTS. Methods: A cross-sectional study including 115 idiopathic CTS patients and 115 age-, gender- and body mass index (BMI)- matched controls was performed. Clinical, laboratorial and neurophysiological evaluations were performed in all subjects to confirm CTS diagnosis and severity according to CTS classification. PD was defined using strict criteria. Results: Prevalence of PD was similar in CTS and control groups (27% vs. 21.7%, P=0.44). Nocturnal symptoms (91.3%) and moderate classification of CTS (58.3%) were most frequently observed in CTS patients. CTS with PD had a significant higher mean age compared to CTS without PD (53.8 +- 10.2 vs. 49.5 +- 8.6 years, P=0.027). A trend of higher mean BMI (30.6 +- 4.1 vs. 28.7 +- 4.8 kg/m2, P=0.059) and duration of symptoms (21.5 +- 29.6 vs. 14.8 +- 20.6 months, P=0.062) and lower female gender frequency (80.6% vs. 92.9%, P=0.057) were observed in CTS with PD. Frequencies of CTS with PD patients with age > 60 years (29.0% vs. 8.3%, P=0.04) and BMI > 30 kg/m2 (64.5% vs. 33.3%, P=0.03) were significantly higher than CTS without PD. No significant differences were observed in both groups regarding each symptoms (P > 0.05) and neurophysiological classifications of CTS (P > 0.05). Conclusions: Our findings strongly supports the notion that CTS is not associated with PD but is closely linked to age and overweight

Síndrome do túnel do carpo (STC) está associada à diabetes mellitus (DM), mas a associação não está claramente demonstrada com pré-diabetes (PD). Objetivo: Determinar a prevalência de PD e fatores de risco associados em pacientes com STC. Métodos: Foi realizado estudo transversal incluindo 115 pacientes com STC idiopática e 115 controles pareados por idade, gênero e índice de massa corporal (IMC). Avaliação clínica, laboratorial e neurofisiológica foi realizada em todos os indivíduos para confirmar o diagnóstico e gravidade da STC de acordo com a classificação neurofisiológica de STC. PD foi definido usando critérios estritos. Resultados: A prevalência de PD foi similar no grupo STC e controles (27% vs. 21,7%, P=0,44). Sintomas noturnos (91,3%) e classificação moderada de STC (58,3%) foram os mais frequentemente observados. Pacientes com STC com PD apresentaram média de idade significativamente mais alta comparada à pacientes com STC sem PD (53,8 +- 10,2 vs. 49,5 +- 8,6 anos, P=0,027). Tendência de média mais alta de IMC (30,6 +- 4,1 vs. 28,7 +- 4,8 kg/m2, P=0,059) e duração dos sintomas (21,5 +- 29,6 vs. 14,8 +- 20,6 meses, P=0,062) e menor frequência de gênero feminino (80,6% vs. 92,9%, P=0,057) foram observados em pacientes com STC com PD. Frequências de pacientes com STC com PD e idade > 60 anos (29,0% vs. 8,3%, P=0,04) e IMC > 30 kg/m2 (64,5% vs. 33,3%, P=0,03) foram significativamente mais altas que em pacientes com STC sem PD. Não foram observadas diferenças significativas em ambos os grupos com relação aos sintomas (P > 0,05) e classificação neurofisiológica da STC (P > 0,05). Conclusões: Nossos achados apóiam fortemente a noção de que a STC não está associada à PD, mas está intimamente ligada a idade e sobrepeso / Carpal tunnel syndrome (CTS) is associated to Diabetes mellitus (DM) but not clearly demonstrated to Prediabetes (PD). Objective: Determine prevalence of PD and risk factors in CTS. Methods: A cross-sectional study including 115 idiopathic CTS patients and 115 age-, gender- and body mass index (BMI)- matched controls was performed. Clinical, laboratorial and neurophysiological evaluations were performed in all subjects to confirm CTS diagnosis and severity according to CTS classification. PD was defined using strict criteria. Results: Prevalence of PD was similar in CTS and control groups (27% vs. 21.7%, P=0.44). Nocturnal symptoms (91.3%) and moderate classification of CTS (58.3%) were most frequently observed in CTS patients. CTS with PD had a significant higher mean age compared to CTS without PD (53.8 +- 10.2 vs. 49.5 +- 8.6 years, P=0.027). A trend of higher mean BMI (30.6 +- 4.1 vs. 28.7 +- 4.8 kg/m2, P=0.059) and duration of symptoms (21.5 +- 29.6 vs. 14.8 +- 20.6 months, P=0.062) and lower female gender frequency (80.6% vs. 92.9%, P=0.057) were observed in CTS with PD. Frequencies of CTS with PD patients with age > 60 years (29.0% vs. 8.3%, P=0.04) and BMI > 30 kg/m2 (64.5% vs. 33.3%, P=0.03) were significantly higher than CTS without PD. No significant differences were observed in both groups regarding each symptoms (P > 0.05) and neurophysiological classifications of CTS (P > 0.05). Conclusions: Our findings strongly supports the notion that CTS is not associated with PD but is closely linked to age and overweight