Background Due to population growth, aging, urbanisation, increasing prevalence of obesity and physical inactivity, diabetes mellitus (DM) has become one of the most important and prevalent chronic diseases. Glycated haemoglobin A1c (HbA1c) assessment is currently being used all over to monitor glycaemic control as a cornerstone of diabetes care. It might also be a useful screening tool for non–insulin dependent DM, also known as type 2 DM (T2DM). Elevated HbA1c can be linked with long–term risk of cardiovascular complications. Aim The aim of the study was to determine whether HbA1c can be used as reliable screening tool for early detection of T2DM in an African population. Methods This study was a cross–sectional study and was part of the South African, North–West Province (SANWP) leg of the 12–year Prospective Urban and Rural Epidemiological (PURE) study. Baseline data was collected from March to December 2005. A total of 2010 volunteers were recruited from randomly selected households. Data was collected on socio–demographic characteristics, physical activity, dietary intakes, blood pressure and anthropometry. HbA1c, fasting plasma glucose (FPG), liver enzymes and HIV status were determined. Ethical approval for the PURE study was obtained in July 2004. Oral glucose tolerance tests (OGTT) were also done for a sub–group of 465 subjects. The Statistical Consultation Services of the North–West University were consulted to analyse data with SPSS 17.0 and STATISTICA 9.0. Results The HbA1c values within the diabetic FPG groups were 7.46% for men and 8.08% for women. HbA1c values increased significantly progressively from the normal FPG groups to the groups with impaired FPG and the diabetic FPG groups for both men and women. No significant increases were found in HbA1c between the OGTT groups (normal 2 hour plasma glucose (PG), impaired 2–hour PG and diabetic 2–hour PG). Total cholesterol, triglycerides, body mass index and FPG increased significantly and high–density lipoprotein cholesterol decreased significantly with an increase in HbA1c values in men and women. In addition, systolic blood pressure increased significantly in women with increased HbA1c. Thus, with an increase in HbA1c, an increase in the number of risk factors was observed. When using HbA1c and FPG in combination, 43 subjects of the whole population were detected with having a risk of developing T2DM. However, when considering the commonality of subjects identified to be diabetic or at risk by the OGTT, FPG and HbA1c individually, only one subject was identified by all the methods as having diabetes or being at risk to develop diabetes. Discussion and conclusions An increase in HbA1c and FPG was associated with an increase in risk factors and therefore with metabolic syndrome (MS). MS is associated with an increased risk of developing T2DM and therefore it can be concluded that HbA1c was useful for detecting in this population individuals at increased risk of developing T2DM. The use of FPG and HbA1c in combination was considered a better screening tool when compared to HbA1c alone. Factors other than what were measured in this study might be the cause of the unexpected results obtained in the participants with impaired OGTT. / Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2011.

To accurately predict the outcome of a late phase study, pharmacometric models can help in drug development. Making informed decision on which models to use will also facilitate drug development. This can depend on the mechanism of action for the drug as well as stability and runtime factors. This is an investigation of four published semi-mechanistic pharmacometric models to predict glycosylated red blood cells (HbA1c) in a late phase study of an anti-diabetic drug together with an assessment of their stability and power to detect drug effects. Mean plasma glucose (MPG), fasting plasma glucose (FPG) or FPG and fasting serum insulin (FSI) are used together with HbA1c as drivers for change in the models. We find that less complex models, with fewer differential equations, are quicker to run and more stable, and that MPG alone is superior to FPG or FPG and FSI to detect a drug effect. The findings are useful for drug development in the anti-diabetic area, and show that a less mechanistic model performs well under these conditions.

Coffee consumption has consistently been associated with a reduction in risk of type 2 diabetes mellitus (T2DM), although the mechanism for this association remains unknown. Sub-clinical inflammation, non-alcoholic fatty liver disease (NAFLD), and lipoprotein abnormalities characterize and predict T2DM. Limited evidence suggests that coffee may have a beneficial role in these disorders but further investigation is warranted. Our aim therefore was to investigate the associations of caffeinated and decaffeinated coffee with markers of inflammation, liver injury, and lipoproteins, in a non-diabetic cohort. No significant associations of caffeinated or decaffeinated coffee with inflammatory markers or lipoproteins were identified. Caffeinated coffee consumption however was inversely associated with alanine aminotransferase (β= -0.09, p= 0.0107) and aspartate aminotransferase (β= -0.05, p= 0.0161) in multivariate analysis. Decaffeinated coffee was not associated with liver enzymes. These analyses suggest that caffeinated coffee’s beneficial impact on NAFLD may be a potential mechanism for its inverse association with T2DM.

Coffee consumption has consistently been associated with a reduction in risk of type 2 diabetes mellitus (T2DM), although the mechanism for this association remains unknown. Sub-clinical inflammation, non-alcoholic fatty liver disease (NAFLD), and lipoprotein abnormalities characterize and predict T2DM. Limited evidence suggests that coffee may have a beneficial role in these disorders but further investigation is warranted. Our aim therefore was to investigate the associations of caffeinated and decaffeinated coffee with markers of inflammation, liver injury, and lipoproteins, in a non-diabetic cohort. No significant associations of caffeinated or decaffeinated coffee with inflammatory markers or lipoproteins were identified. Caffeinated coffee consumption however was inversely associated with alanine aminotransferase (β= -0.09, p= 0.0107) and aspartate aminotransferase (β= -0.05, p= 0.0161) in multivariate analysis. Decaffeinated coffee was not associated with liver enzymes. These analyses suggest that caffeinated coffee’s beneficial impact on NAFLD may be a potential mechanism for its inverse association with T2DM.

Adult Oral Health Programme: The Effect of Periodontal Treatment and the Use of a Triclosan Containing Toothpaste on Glycaemic Control in Diabetics Abstract Aim: The aim of the research study is to establish an adult oral health programme for diabetics in Majuro, Republic of the Marshall Islands in order to determine the impact of non-surgical periodontal treatment followed by the use of a triclosan containing dentifrice on the maintenance of periodontal health and glycaemic control in type 2 diabetic patients. Hypothesis: Non-surgical periodontal treatment results in improved periodontal health and better glycaemic control in diabetics and use of a triclosan containing toothpaste is effective in maintaining this improvement in diabetics. Methods: An adult oral health programme was created, within which was conducted a two-group randomised clinical trial to address the hypothesis that non-surgical periodontal treatment results in improved periodontal health and better glycaemic control in type 2 diabetics and that the use of a triclosan containing toothpaste is effective in maintaining this improvement in diabetics. In this double blind controlled trial, sixty adult patients (aged 35 to 65 years) with type 2 diabetes mellitus having a minimum of 16 teeth received non-surgical periodontal treatment. Half of the patients were randomly assigned to use a triclosan containing toothpaste, Colgate Total, and the other group a non-triclosan toothpaste, Colgate Fluoriguard. The study evaluated the improvement in periodontal health by recording Probing Pocket Depth (PPD) on 6 sites of each tooth, and the number of sites bleeding on probing (BOP) at baseline, and at 6 months and 12 months after treatment. The second part of the study evaluated the impact of improvement of periodontal health on glycaemic control in type 2 diabetics by measuring HbA1c and RBS, and also assessing the levels of C-Peptides and CRP at baseline, and at 6 months and 12 months after treatment. The study also evaluated the effectiveness of a triclosan containing toothpaste in maintaining the improvement in periodontal health after non-surgical periodontal treatment. Results: The results showed that it was feasible to establish an oral health programme for the diabetics and could improve their periodontal health, and that toothpaste containing triclosan is effective in maintaining the improved periodontal heath in type 2 diabetics. Mean PPD dropped from 2.35mm to 1.95mm in the triclosan group and from 2.49mm to 2.24 mm in the non-triclosan group and the mean number of BOP sites dropped from 4.9 to 2.8 in the triclosan group and from 4.7 to 3.2 in the fluoriguard at 12 month visits. However, the results did not show improvement of HbA1c nor RBS levels in either group. C-Peptide levels increased and C-Reactive Protein levels decreased in both groups, however, not to significant levels at 12 month visits. Conclusion: The results of this research study lead to the conclusion that treating periodontal infection has effect of periodontal health of type 2 diabetic patients and following-up with simple personal oral hygiene of regular tooth-brushing helps maintain their periodontal health. This programme also proved that this type of oral health programme is feasible and valuable for diabetics in isolated places like the Marshall Islands, where infrastructure, personnel and resources are limited to treat microvascular and macrovascular complications of diabetes. As for the effectiveness of treating periodontal infections on glycaemic control of diabetics, this study failed to support the hypothesis that non-surgical treatment plus triclosan containing toothpaste would lead to better glycaemic management through improved periodontal health.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.

Thesis (Ph. D.)--University of Washington, 1995. / Vita. Includes bibliographical references (leaves [188]-209).

Includes bibliographical references and index.

Type 2 diabetes mellitus (T2DM) is a chronic and debilitating disease contributing to the rise in healthcare associated costs in the United States (ADA, 2013a; USDHHS, 2013). T2DM management is complex and requires an ongoing multi-system approach (Goderis et al., 2010). In this quality improvement project, the DNP student led a team in a family care practice setting through a systematic quality improvement process, the PDSA cycle, for the improvement of performance rates of quality indicators including A1C testing, LDL testing, and performance of comprehensive foot examinations. The QI team developed a multi-component intervention to include utilization of an electronic type 2 diabetes mellitus (T2DM) decision support tool. The expected outcome was to increase current performance rates of A1C testing, LDL testing, and comprehensive foot examinations at a family care practice by at least 10% within four weeks of implementing the intervention. A1C testing improved from a pre-intervention median of 70.97% to a post-intervention median of 91.38%, an increase of 20.41%. LDL testing improved from a pre-intervention median of 74.19% to a post-intervention median of 91.38%, an increase of 17.19%. Comprehensive foot examinations improved from a pre-intervention median of 58.06% to a post-intervention median of 84.48%, an increase of 26.42%. While results demonstrate a trend of improvement, the duration of the intervention was insufficient for statistical significance. The QI project served as a first systematic change process for the family care practice and a model for future change processes at the clinic. This project highlights the DNP's role in utilizing evidence-based research and applying a systematic change model for quality improvement in the primacy care practice setting.