Low carbohydrate diets have been studied for many years as nutritional therapy for treating patients with type 2 diabetes mellitus (T2DM). Type 2 diabetes is an inflammatory disease that is defined by high blood glucose and HbA1c, lipid levels, BMI, central adiposity, and cholesterol levels, are some among the many indicators that can signal risk for diabetes or help to diagnose diabetes. These indicators are used in studies to evaluate the effectiveness of the nutritional therapy in producing positive health outcomes. Many medications are available for the treatment of T2DM; however, they have a host of side effects, and nutritional therapy has been shown to at least help reduce the dosage of these medications needed by the patients. There are other forms of nutritional therapy besides low carbohydrate diets, and some controversy remains about low carbohydrate diets that in the long term, replacing carbohydrates with fats and proteins could result in increased cholesterol and lipid levels, creating an increased risk for cardiovascular disease. Although some studies have found that low carbohydrate diets, especially very low carbohydrate ketogenic diets (VLCK), do result in increased cholesterol, it is generally an increase in HDL, which is considered good cholesterol and not harmful. Overall weight loss benefits from reduced central adiposity, BMI, and reduced HbA1c levels outweigh the increase in HDL as a side effect. A few different variations of low carbohydrate diets are compared in this review, such as very low carbohydrate ketogenic diets, moderate carbohydrate calorie restricted diets, and moderate carbohydrate low (MCD) Glycemic Index (GI) diets. Due to the ability to exchange carbohydrates with high GI for carbohydrates with low GI, the MCD with low GI sounds promising for good adherence and positive health outcomes in the long run. Although very low carbohydrate ketogenic diets produce many positive health outcomes, the nutritional therapy must be very well designed and followed up, and care must be taken that fiber and nutrients are maintained in the diet. Adherence is a key part of the success of nutritional therapy and a study design plays a major role in that. Providing behavioral development classes, nutritional information classes, and intermittent classes focused on physical activity and healthy habit formation leads to overall increased positive affect which is better for the patient and thus, for the study as well. The easier the nutritionist or dietician can make the therapy transition for the participant, the more likely they are also to stay and try to stick with it. For example, in the studies where the study coordinator provided some small food provisions at the beginning or throughout the study seemed to be successful because the patients were less likely to fall to making their own choices poorly and being inconsistent. Although there were many diets that resulted in many positive health outcomes, ultimately a well-designed, adherence focused, very low carbohydrate ketogenic diet seemed to be the most effective at decreasing HbA1c and producing other positive health outcomes as well. In the long term however, a VLCKD, may be unsustainable for the patient and the body, given the extreme reduction in important carbohydrates.

Bakgrund: Diabetes typ 2 är en utav de vanligaste folksjukdomarna både i Sverige och globalt. Sjukdomen uppmärksammas långt efter att personen drabbats. Därmed har också diabetes typ 2 ökat senaste decennierna vilket i sin tur kan leda till svåra komplikationer och förtidig död. Till grund ligger ohälsosamma levnadsvanor relaterat till utveckling av diagnosen vilket globala organisationer och svenska myndigheter strävar efter att förebygga. Vid diabetes typ 2 kan utveckling av kunskap om egenvård samt livsstilsförändringar behöva genomföras för att främja hälsa. Utifrån det ökade antalet av individer som utvecklar sjukdomen samt vikten av livsstilsförändringar utforskas personers upplevelser av dessa förändringar.  Syfte: Syftet var att belysa hur personer med diabetes typ 2 upplever information om- samt genomförandet av livsstilsförändringar.           Metod: En kvalitativ litteraturöversikt baserat på elva originalartiklar från åtta länder i fyra världsdelar.            Resultat: Fyra övergripande teman identifierades; Information, Självhantering, Känslor och Stöd. Varje tema delades sedan in i 13 kategorier. Även om upplevelserna varierade i hög grad upplevde en majoritet av personerna med diabetes typ 2 svårigheter att förändra sina levnadsvanor samt att förstå informationen. Två bifynd i arbetet var socio-ekonomiska begränsningar och stöd utifrån, vilka beskrevs som viktigt samtidigt som det kunde ha en negativ inverkan på personernas självhantering av sjukdomen.                 Slutsats: Individanpassad information och inkludering av familjen i möten med vården är viktigt för att främja egenvårdsarbetet för personer med diabetes typ 2. Med tanke på att upplevelserna varierar finns behov av fortsatt forskning av enskilda individer med diabetes typ 2. / Background:  Type 2 diabetes is one of the most common endemic diseases in Sweden and a global health problem. The disease may be diagnosed several years after onset and that is one reason why type 2 diabetes has increased during the past decades. This in turn could lead to severe complications and even a premature death. Unhealthy eating habits and a lack of regular physical exercise are the primary causes in relation to the development of the diagnosis. Something both global organizations and Swedish authorities strive to prevent. A person diagnosed with type 2 diabetes faces big challenges. Lifestyle changes are often advised, and it is important to develop and acknowledge the need for self-care to promote health. Based on the increased number of individuals who develop the disease, and the importance of lifestyle changes, persons’ experiences of these adjustments are investigated.                        Purpose: The purpose was to highlight how persons with type 2 diabetes experience information about- and the procedure of changing their lifestyle.                      Method: A qualitative review based on eleven qualitative original articles from eight countries in four continents.             Result: Four general themes were identified; Information, Self-management, Feelings and Support. The themes were thereafter divided into 13 categories. Even if the experiences differed, the majority of persons with type 2 diabetes experienced difficulties changing their living habits and to understand the information. Two incidental findings in this review were socio-economic limitations and support from others, which were both described as important and simultaneously could have a negative impact on self-management. Conclusion: Individualized information and including family in healthcare meetings is important to promote self-care work for persons with type 2 diabetes. Considering the variation of experiences, further research on individuals with type 2 diabetes is still necessary.

Magister Artium (Sport, Recreation and Exercise Science) - MA(SRES) / Obesity is recognised as a risk factor for non-communicable diseases which has reached epidemic proportions globally. South Africa is one of the developing countries with significant statistical representation reported for these conditions. Obesity is associated with other conditions such as type 2 diabetes, hypertension and dyslipidaemia which are all part of what is called metabolic syndrome. As a strategy to reduce the levels of obesity, physical activity has been introduced to compliment clients who are on medication for diabetes.

Bakgrund: Diabetes typ 2 ökar kraftigt världen över, där förändrade levnadsvanor är en bidragande faktor till utvecklingen. Motivation krävs för att kunna genomgå livsstilsförändringar och därmed behandla diabetes typ 2 och dess komplikationer.  Syfte: Att undersöka vuxna patienters motivation till livsstilsförändring vid diabetes typ 2.  Metod: Litteraturstudie baserat på elva vetenskapliga artiklar med kvalitativ ansats. I datainsamlingen användes databaserna PubMed och CINAHL. Valda artiklar analyserades med hjälp av statens beredning för medicinsk och social utvärderings (SBU) utarbetade granskningsmall samt Fribergs modell vid resultatanalysen. Resultat: Vuxna patienters motivation till livsstilsförändring vid diabetes typ 2 delades in i två huvudkategorier; faktorer som leder till ökad motivation respektive faktorer som leder till bristande motivation. Utifrån studiens resultat i relation till syftet kunde en stor variation i motivation noteras. Stöd från omgivningen och ökad kunskap om sin sjukdom var några faktorer som ökade motivationen. Den inre motivationen sågs också vara viktig för att genomföra livsstilsförändring. Rädsla för komplikationer och motivation relaterat till vården var andra faktorer som noterades. Faktorer som ledde till bristande motivation var förnekelse och ignorering av tillståndet, besvikelse över att inte belönas med det önskade resultatet, bristande stöd från omgivningen samt yttre faktorer.  Slutsats: Alla patienter är unika individer där motivationen till att genomföra livsstilsförändring varierar. Både faktorer som leder till ökad motivation och faktorer som leder till bristande motivation förekommer. Kombinationen av dessa faktorer bidrar till denna variation. Stöd från familj, vänner och vårdpersonal ses ha en betydande roll gällande patientens motivation. Genom denna kunskap kan diabetes typ 2 behandlas och dess komplikationer förebyggas och därmed kan omfattningen av detta folkhälsoproblem minska.

This thesis explores the possibility of using the Collective System Design Methodology to design systems that will improve the health of people. The focus of the thesis is on the reversal of type-2 diabetes.

Diabetes has gained growing attendance as one of the key non communicable diseases (NCD) with the World Health Organization identifying it as the focus of the World Health Day 2016. It is reported that more than 420 million people suffer from diabetes, a number predicted to rise in the coming years. This report forms part of a broader, long term focus project that aims to establish a systems approach to type 2 diabetes (T2D), the variant that accounts for more than 90% of reported diabetes cases. The broader project objectives are to identify possible biomarkers for the onset and the progression of T2D as a precursor to enable potential future approaches to delay onset, or even reverse disease states, via active bio-compounds and/or establishment of beneficial nutritional patterns. The 6-month master’s work reported here is sub-project that focused specifically on cell level vesicle trafficking processes. These processes are believed to be crucial in understanding the formation amyloid plaques, which compromise or kill the insulin secreting beta cells. Up until now, there has been a lack of appropriate experimental techniques to directly observe this process in live cells.  Hence we have developed 2 new techniques: (i)               a method of imaging the actin and tubulin network reorganization during exocytosis of the insulin containing granules while exploring novel ways of characterizing the network. (ii)             a method of imaging the granules themselves and using particle tracking microrheology to analyze their movement patterns during stimulation with glucose. These new techniques open the door to follow up experiments which would allow development of a cell scale mathematical model or simulation correlating short term glucose dynamics to risk of amyloid plaque formation and T2D.

ABSTRACT Background: T2DM is a growing public health problem worldwide. One of the cornerstones of treating diabetes is self-care. Motivation for self-care is overshadowed in several cases by the burden of having diabetes, as well as the fact that the social situation can affect the person's sense of self-control. The literature describes that there is a lack of tools and time to address the issue of motivation for lifestyle changes, which is considered a threat to the quality of care. Purpose: To describe people's experiences of living with T2DM with a focus on motivation from a self-care perspective. Method: A meta-synthesis based on 18 articles with qualitative design. Main result: Central to the results is a reflection on different approaches regarding motivation for self-care. From the included articles, four themes emerge: Reflection within social groups / contexts, knowledge / insight through reflection, reflection on different methods / tools and self-care / lack of self-care without active reflection right now when the person has landed / stoppover in an approach for various reasons. Conclusion: Motivation for self-care at T2DM seems to be influenced by reflection within the groups / contexts the person is in to. Reflection takes place about knowledge / insight as well as about the methods / tools that are applied in self-care. The motivation can be of a different nature and is a dynamic process that sometimes stops. The person may have already incorporated lifestyle changes as part of life. Events in life can make self-care away from prioritizing or it can be a matter of unwillingness to make lifestyle changes take over and put self-care on the waiting list. Keywords: Type 2 diabetes, self-care, motivation, Self-Determination theory / SAMMANFATTNING Bakgrund: T2DM är globalt sett ett ökande folkhälsoproblem. En av hörnstenarna vid behandling av diabetes är egenvård. Motivation till egenvård skuggas i flera fall av bördan av att ha diabetes, liksom att den sociala situationen kan inverka på personens känsla av egenkontroll. Litteraturen beskriver att det saknas verktyg och tid för att angripa frågan om motivation till livsstilsförändringar, vilket anses vara ett hot mot kvaliteten på vården. Syfte: Att beskriva personers upplevelser av att leva med T2DM med fokus på motivation ur ett egenvårdsperspektiv. Metod: En metasyntes baserad på 18 artiklar med kvalitativ design. Huvudresultat: Centralt ur resultatet återkommer reflektion kring olika förhållningssätt gällande motivation till egenvård. Ur de inkluderade artiklarna framgår fyra teman. Reflektion inom sociala grupper/sammanhang, kunskap/insikt via reflektion, reflektion runt olika metoder/redskap samt egenvård/brist på egenvård utan aktiv reflektion just nu då personen landat/mellanlandat i ett förhållningssätt av olika skäl. Slutsats: Motivation till egenvård vid T2DM tycks påverkas av reflektion inom de grupper/sammanhang personen befinner sig. Reflektion sker kring kunskap/insikt liksom kring de redskap/verktyg som tillämpas vid egenvård. Motivationen kan vara av olika karaktär och är en dynamisk process som ibland stannar av. Personen kan redan ha införlivat livsstilsförändringar som en del av livet. Händelser i livet kan göra att egenvård prioriteras bort eller också kan det handla om att olust till livsstilsförändringar tar över och sätter egenvård på väntelista.  Nyckelord: Type 2 diabetes, egenvård, motivation, Self-Determenation theory

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / In this article, we propose a technological architecture that supports the remote medical care service for elderly people suffering from Type 2 Diabetes Mellitus in Peru. The problem is based on the limitations that elderly people have with compliance with medical controls, which leads to increased complications of the disease and the patient's quality of life. The design of the technological architecture is based on 6 layers: 1) devices, 2) software, 3) channels, 4) data storage, 5) data processing and 6) information visualization. Through the solution, patients are able to autonomously manage their disease through periodic glucose control and the execution of an updated treatment in real time. In the same way, the specialist doctor periodically analyzes the glucose level and it is notified in real time about the out-of-range indicators, which allows him to make treatment decisions as the anomaly occurs. The focus of the solution is to reduce the complications generated by the disease through efficient glucose control and periodic medical advice. The solution was validated in a nursing home with adults over 60 and an endocrinologist from a medical office in Lima, Peru. For the study, we measured the constancy of the glucose record, the average response time of the doctor in case of emergencies or indicators out of range, the percentage of reduction of complications and the level of satisfaction of the Telehomecare solution in older adults. The results show that patients interact more frequently as they adapt the solution as part of their daily routine. On the other hand, the response time was approximately 4.13 minutes from the anomaly record. The percentage of complication reduction was 14% and the level of satisfaction of the solution was reflected in the dimensions of the response time and understanding of the user's need. / Revisión por pares

Objective: To assess whether the prevalence of low physical activity levels and time spent watching TV differ depending on glycemia status. Methods: A secondary analysis using data from a population-based study was conducted. Two were the outcomes: physical activity levels, derived from the International Physical Activity Questionnaire, and sitting time watching TV. The exposure was glycemia status, defined based on results of the oral glucose tolerance tests (OGTT): euglycemia, dysglycemia, and T2DM. The T2DM group was further split into: aware and unaware of T2DM diagnosis. Prevalence ratios (PR) and 95% CI were reported using Poisson regression models. Results: Data of 1607 individuals, mean age 48.2 (SD: 10.6) years, 809 (50.3%) females, were analyzed. Dysglycemia and T2DM was present in 16.9% (95% CI: 15.1%–18.8%) and 11.0% (95% CI: 9.5%–12.6%) of participants, respectively. A total of 605 (37.6%; 95% CI: 35.2%–39.9%) participants had low levels of physical activity and 1019 (63.3%; 95% CI: 60.9%–65.7%) subjects spent ≥2 h per day sitting watching TV. In multivariable model, there was no significant association between glycemia status and physical activity levels (PR = 1.14; 95% CI: 0.95–1.36). Similar result was found between glycemia status and sitting time watching TV. However, those aware of T2DM diagnosis were more likely to have low levels of physical activity (PR = 1.31; 95% CI: 1.06–1.61) compared to the euglycemia group. Conclusions: We found a no relationship between glycemia status and physical activity level or sitting time watching TV, pointing out similar levels of physical (in)activity among those with euglycemia, dysglycemia and T2DM. Individuals aware of having T2DM were 30% more likely to have low physical activity levels compared to the euglycemic group. There is a need to increase physical activity levels among T2DM individuals. / Revisión por pares

Bakgrund Diabetes är en sjukdom som drabbar människor över hela världen. Sjukdomen medför många komplikationer om inte patienten får rätt behandling. En enkel åtgärd som kan fördröja eller förhindra förekomsten av komplikationer är egenvård och den utgör en stor del i behandlingen av diabetes typ 2. Det är viktigt att undersöka patienternas erfarenheter av egenvård för att sjuksköterskan ska få mer kunskap om behandling för att kunna planera omvårdnaden bättre. Syfte Syftet med denna litteraturstudie är att beskriva egenvårdserfarenheter hos patienter med diabetes typ 2. Metod En deskriptiv litteraturstudie som inkluderade 14 vetenskapliga artiklar som svarade på litteraturstudiens syfte. Dessa artiklar söktes fram genom Medline via Pubmed. Dessa artiklar har analyserats av författarna och resultatet har kategoriserats i teman. Resultat Huvudteman som framkommit i resultatet är: Erfarenheter om hinder för egenvård, erfarenheter av motiv för egenvård och erfarenheter av stödet från sjukvården. Patienterna upplevde att det fanns flera hinder som påverkade egenvården negativt bland annat bristande sjukdomsinsikt, ekonomiska hinder och rädslor för sprutor. Det sociala livet upplevdes av flera patienter som stressande då patienterna inte kan motstå att äta av maten som serverades. Oro för komplikationer och acceptans upplevdes vara motiverande för egenvård. Utbildning från sjukvården och stöd från familj och vänner visade sig också vara viktiga faktorer som underlättade vissa patienters egenvård. Slutsats Föreliggande litteraturstudie visade att patienterna upplevde olika hinder i egenvården, men utbildning, anpassad information samt stöd från familjen och från sjukvården har visat sig vara viktiga faktorer för att patienterna skulle känna motivation för egenvård och för att känna kontroll över sjukdomen. Patienterna upplevde att utbildningen inte är tillräckligt anpassad till deras behov och ville ha individanpassad information från sjukvården. / Background Diabetes is a disease that affects people all over the world. The disease causes many complications if the patient does not receive the right treatment. A simple measure to delay or prevent the frequency of complications is self-care which is a large part in the treatment of type 2 diabetes. It is important to examine patients' experiences of self-care so that the nurse can gain more knowledge about the treatment in order to plan the care. Aim The aim of this literature study is to describe self-care experiences in patients with diabetes mellitus type 2. Method A descriptive literature study that included 14 scientific articles which answered the aim of the study. The articles were searched through Medline via Pubmed. These articles have been analyzed by the authors and the results have been categorized into themes. Results The main themes that emerged in the results are Experiences about barriers to self-care, experiences of motives for self-care and experiences of support from healthcare. The patients experienced that there were several barriers that negatively affected self-care, including lack of understanding of the disease, financial barriers and fear of injections. The social life was perceived by several patients as stressful as the patients could not resist eating the food that was served. Concerns about complications and acceptance were perceived as motivating for self-care. Education from health care and support from family and friends proved to be important factors that facilitated some patients' self-care. Conclusion This literature study shows that patients experienced various barriers in self-care, but education, tailored information and support from the family and from health care have proven to be important factors for patients to feel motivated for self-care and to feel control over the disease. The patients felt that the education was not sufficiently adapted to their needs, and they wanted individualized information from the healthcare system.