Type 2 diabetes (T2D) is increasing in the United States, currently affecting 11.3% of the nation. The Developmental Origins of Health and Disease Hypothesis suggests that environmental stresses in utero and in early stages of life, such as preterm birth (age), can lead to development of adulthood diseases, including T2D. However, research on the association between preterm birth and T2D is sparse and predominantly based on European ancestry populations. We examined this association in postmenopausal women (N = 85,356) from the Women’s Health Initiative, a nationwide prospective cohort. Logistic regression models were used to examine the association between self-reported preterm birth and T2D status, adjusting for demographic and lifestyle covariates. Preterm birth was significantly and positively associated with odds of T2D at baseline (unadjusted: OR=1.51, 95% CI 1.24, 1.83; P

Diabetes is one of the most common chronic medical conditions with 34.2 million people affected in the US. It costs $327 billion in medical expenses, lost work, and wages. Diabetics are at higher risk of major medical complications. 90 to 95% of 30 million Americans with diabetes are classified as type 2 (Centers for Disease Control and Prevention, 2020). Management of diabetes is within the scope of OT practice as it is part of health management and maintenance. It is described as how a person develops, manages, and maintains routines and habits for health and wellness promotion. A 2018 online survey was conducted with US-based Occupational Therapy (OT) and Occupational Therapy Assistant (OTA) program directors. Nearly half of the OT and more than half of the OTA program directors reported only 1.5–>3hrs is devoted to diabetes care and management in their curriculum. A 2019 online survey was disseminated to OT practitioners to ascertain their self-reported competence and knowledge about type 2 diabetes mellitus and its lifestyle management. OT clinicians reported minimal to somewhat skilled in educating and training clients in self-help skills related to diabetes management. OT practitioners are suggested to take training and courses that are relevant to their practice and domain for long-term retention of content and tasks (Custers, 2010). The American Occupational Therapy Association encourages OT practitioners to include health-promoting tasks in their practice as the profession’s roots and values are aligned with the health promotion (Wood, et al., 2013).

The purpose of this thesis was to determine the perceived risk of falling and its relationship to balance and falls in older community-dwelling adults with type 2 diabetes mellitus (DM2). Study One was a systematic review of published literature on risk factors for falling in older adults with DM2. Study Two was a prospective cohort study for parameter estimation, the goal was to determine the test-retest reliability, internal consistency, construct validity and factor structure of a falls Risk Perception Questionnaire in older community-dwelling adults with DM2. Study Three was also a prospective cohort study; the goals of this study were to determine the association between perceived of falling and balance in older adults with DM2 and to determine whether older adults alter their perceived risk of falling after receiving feedback about their balance. The information gained from these studies will be used to guide subsequent research as well as falls risk assessment and prevention in older adults with DM2. / Thesis / Master of Science (MSc)

None / Introduction: As the prevalence of diabetes continues to rise in Canada, South Asians, as the largest visible minority group in Canada, are at higher risk for developing diabetes than the general population. Although diabetes self-management education (DSME) interventions for South Asians with type 2 diabetes (T2DM) have been researched, these interventions have not been assessed for their cultural congruency. Methods: This systematic review examined the effectiveness of DSME interventions for South Asians with T2DM. Electronic databases (MEDLINE, EMBASE, Cochrane CENTRAL and CINAHL) were searched since inception, along with relevant reviews and guidelines. Title and abstract and full text screening were conducted independently by two reviewers; data extraction was done by one reviewer and confirmed by another. Quality assessment of the included studies was completed using the Cochrane Risk of Bias tool; cultural congruency was assessed using Leininger’s Sunrise Model. All results were synthesized narratively. Results: A total of 1259 studies were found in the search, of which only four randomized controlled trials (RCT) met the inclusion criteria. All studies were consistent in showing a reduction in A1C following the intervention; however only one study reported statistically significant reductions in A1C. Interventions were conducted in person, with follow-up periods ranging from six months to two years, with the use of South Asian community link workers in most interventions. Bias was identified across all studies for sequence generation, allocation concealment and blinding. All studies had limited evidence of cultural congruency, particularly for gender roles and responsibilities. Conclusions: This review found limited effectiveness of culturally specific DSME interventions for South Asians with T2DM. Furthermore, the interventions were scant in their description of cultural congruency. Future research ought to begin with designing interventions for cultural congruency and improved methodologies for DSME research to improve internal and external validity. / Thesis / Master of Science (MSc) / South Asians are the largest visible ethnic minority group in Canada and are at high risk of developing type 2 diabetes (T2DM). This research project aims to understand how diabetes self-management education (DSME) and support (DSMS) is delivered to South Asians with T2DM and how these practices are culturally tailored. The scientific literature was searched using electronic databases to find 1259 research studies, of which four examined the effectiveness of DSME/DSMS provided to migrant South Asians with T2DM. Only one study showed significant improvements in blood glucose control. All of the four studies contained several DSME/DSMS components and they all failed to address differences in gender roles and responsibilities in relation to South Asian culture. Thus, there is a need for future studies to design DSME/DSMS interventions that are culturally tailored to improve blood glucose control and thus, improve the health and well-being of South Asians with T2DM.

OBJECTIVE: The 10th leading cause of death in the United States is heart disease. Most of the deaths by heart disease has a correlation with an occlusion of the coronary arteries. While diabetes mellitus is currently the 7th leading cause of death, which is a chronic condition that affects more than 37 million people in America. The global epidemic of obesity largely explains the dramatic increase in the incidence and prevalence of type 2 diabetes (T2D) over the past 25 years. Statins are well known drugs to decrease LDL for individuals who suffer from hypercholesterinemia; however, there is also an increased risk of developing diabetes mellitus. An estimation of 10-20 per 10,000 patients per year demonstrated an excess risk of T2D with the long-term use of statin. Here we examine the effects of simvastatin and pitavastatin on pancreatic ß-cell function to determine whether altered insulin secretion may contribute to an increased risk of T2D. METHODS: The experiments were performed using clonal pancreatic ß-cells (INS-1). The cells were grown in 4 mM glucose in RPMI media. Cells were grown for three days before adding the different types of statins: simvastatin and pitavastatin for one day. Then the cells were used to perform the glucose-induced insulin secretion (GSIS) experiment. Insulin secretion and insulin content were assay using a fluorescence-based immunoassay. The study was calculated using Microsoft Excel. Standard variance and standard error were used to assess the difference sets of data. RESULTS: INS-1 cells responded to acute glucose stimulation after chronic culture in both low (4 mM) and high (11 mM) glucose. Secretion from cells cultured at 4 mM glucose was higher than cells cultured at 11 mM glucose at all glucose concentrations tested, characteristic of the effects of glucolipotoxicity (GLT). Insulin content in cells cultured at high glucose was decreased 8.6-fold compared to cells cultured at the more physiological low glucose condition. When normalized to basal secretion cells cultured at high glucose exhibited basal hypersecretion and increased GSIS compared to those in low glucose. Simvastatin (100 nM, 24 hrs) increased basal insulin secretion to a greater extent than Pitavastatin. The effects of pitavastatin on basal insulin secretion were less consistent than seen with simvastatin. Simvastatin was also shown to inhibit GSIS from cells cultured at 4 mM glucose, while pitavastatin increased GSIS. CONCLUSION: Both pitavastatin and simvastatin alter insulin secretion from pancreatic ß-cells. The effect of simvastatin to both increase basal and decrease GSIS, characteristic of GLT suggests pitavastatin may be the statin of choice to reduce the risk of statin-induced T2D.

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