Type 2 diabetes disproportionately affects low-income African American women, age 50 years and older: 30% to 40% of this population has this chronic disease. Two significant factors affecting poor diabetes practice adherence are food insecurity and depression; another is obesity. The purpose of this quantitative correlational study was to determine if either food insecurity or depression significantly affect Type 2 diabetes self-management practices; and/or if food insecurity significantly influences practice adherence indirectly, through the mediator of depression, while controlling for obesity. The research questions were aligned with the theoretical pathways posited in Matthews's reserve capacity model (RCM) and used the most current national data from the 2015 BRFSS dataset. The results of the linear regression models indicated that as hypothesized, depression was significantly associated with poor practice adherence; contrary to hypotheses, food insecurity and obesity were not. The lack of significance between food insecurity and depression eliminated the need to test for mediation. While correlational analyses revealed a significant association between obesity and depression, this relationship was no longer detected in linear regression analyses. An unanticipated finding was the significant relationship between education and Type 2 depression self-management practices, a relationship that maintained significance even with the entry of depression. These findings have implications for positive social change in the form of preventative interventions aimed at weight-loss and/or reducing depression among African American women at risk for developing Type 2 diabetes.

Minority ethnic groups have disproportionately high rates of diabetes prevalence and complications. This study examined the degree, nature, and mediation of ethnic differences in changes over time in four health outcomes: functional limitations, emotional symptomatology, psychosomatic symptomatology, and self-reported health status. The theoretical context incorporated tenets from the social characteristics and the minority status perspectives. Data were drawn from two rounds (1992 and 1996) of the Health and Retirement Survey, a national plane survey of midlife Americans. The study focused on a subsample of 744 respondents who had been diagnosed with diabetes or high blood sugar by the time of the first round. Descriptive and lag-time regression analyses were employed. Five models were used to: (1) assess the independent effects of being Black and being Hispanic on changes over time in each of the outcome variables without and with the set of mediating variables; and (2) gauge the specific manner in which mediating variables affected initial statistically significant effects among Blacks and Hispanics. The mediating variables included five social position measures (education, income, net worth, gender, and a role integration index), health insurance coverage, and four health-related lifestyle measures (body mass index, drinking, smoking, and physical inactivity). The results pointed to a complex pattern of effects between Blacks and Hispanics and across outcomes. The social characteristics hypothesis was supported in two instances: increases in functional limitations over time for Blacks and poorer self-reported health over time for Hispanics. The minority status hypothesis was supported only for increases in emotional symptomatology among Hispanics. No support for either hypothesis was observed for psychosomatic symptomatology. Critical mediating variables also differed between Blacks and Hispanics across the outcomes. The two variables mediating the Black effort for functional limitations were body mass index and gender, whereas the two variables mediating the Hispanic effect for self-reported were smoking and education.

Prior studies have unequivocally established a consistent association between osteoporotic hip fracture risk and type 2 diabetes mellitus. One reason this association still remains unclear is primarily due to the limited amount of research conducted in this area. The Utah Study of Nutrition and Bone Health (USNBH) is a case-control study conducted in Utah during the period of 1997-2001 to determine risk factors for osteoporotic hip fracture. All study participants (n = 2590) were determined from Utah residents 50-90 years of age. Cases were determined from 18 Utah hospitals during 1997-2001. Age and gender-matched controls were randomly selected from the Utah Drivers License pool if less than 65 years of age and the Medicare databases if greater than 65 years of age. Logistic regression models were used to determine the association between type 2 diabetes and hip fracture risk. Logistic regression modeling controlled for gender, body mass index, smoking status, alcohol use, physical activity, education level, and estrogen use in women. The risk of hip fracture was associated with type 2 diabetes. The significant correlation was primarily found in females in which the risk of hip fracture increased accompanying diagnosis of type 2 diabetes. Estrogen usage in females decreased (p < 0.0001) hip fracture risk in both former or current users. Physical activity significantly decreased the risk of hip fracture for females (p < 0.0001) and for males (p = 0.001). Smoking and alcohol use may increase the risk of hip fracture, especially in women. This study substantiates the hypothesis that type 2 diabetes mellitus increases the risk of hip fracture.

Bakgrund: Diabetes mellitus typ-2 är en kronisk folksjukdom som fortsätter öka över hela världen. Sjukdomen innebär en minskad insulinproduktion tillsammans med en ökad insulinkänslighet. Behandling av sjukdomen ställer krav på en strikt egenvård tillsammans med livsstilsförändringar, som dieter och motion. Kunskap och information om sjukdomen samt stöd från vårdpersonal och närstående beskrivs som viktiga komponenter för att främja egenvård. Syfte: Syftet var att beskriva personers upplevelser av egenvård vid diabetes typ-2. Metod: En strukturerad litteraturöversikt som baseras på en sammanställning av resultat från tio vetenskapliga artiklar. Samtliga artiklar är publicerade i databaserna CINAHL Complete och Pubmed. Valda artiklar analyserades och tematiserades utifrån Fribergs metodbeskrivning. Resultat: Resultatet beskriver både positiva men främst negativa upplevelser av egenvård vid diabetes typ-2, vilka presenteras under fyra huvudteman;Egenvård i vardagen, Kunskap och information, Behov av stöd och Läkemedelsbehandling. Sammanfattning: Det är vanligt att personer med diabetes typ-2 upplever svårigheter i vardagen då egenvårdshanteringen kräver tid, kunskap och anpassning. Svårigheterna kopplas främst till de livsstilsförändringar som krävs samt integreringen av nya vanor och rutiner. Många personer upplever en bristande motivation, där stödet från närstående och vårdpersonal har en avgörande roll. / Background: Type-2 diabetes mellitus is a public health chronic disease that continues to increase worldwide. The disease results from a lack of insulin production in combination with an increased insulin sensitivity. The treatment of the disease requires a strict self-care management along with lifestyle changes, such as diets and physical activity. The knowledge and information about the disease together with the support from healthcare professionals and relatives are considered as important components for promoting self-management. Aim: The purpose was to describe people´s experiences with self-management of type-2 diabetes. Method: A structured literature review based on a compilation of results from ten scholarly articles. The articles are all published in the databases CINAHL Complete and Pubmed. The content was analyzed and thematized based on the description of Friberg's analysis method. Results: The results describes both positive but mainly negative experiences in managing self-care with type-2 diabetes which was presented as four main themes; Self-management in everyday life, Knowledge and information, Need for support and Medical treatment. Conclusion: It is common for people with type-2 diabetes to experience difficulties in their everyday life because maintaining self-care management requires time, knowledge and adaptation. The difficulties are mainly linked to the required lifestyle changes together with a integration of new habits and routines. Many people experience a lack of motivation, where the support of relatives and healthcare professionals play a crucial role.

Indiana University-Purdue University Indianapolis (IUPUI) / Insulin resistance in liver, muscle, and adipose tissue almost invariably occurs during obesity. To compensate, the insulin-producing β-cell increases insulin production by expanding cellular mass. The inability of the β-cell to fully compensate leads to hyperglycemia and ultimately type 2 diabetes. The enzyme deoxyhypusine synthase (DHS) catalyzes the spermidine-dependent posttranslational modification of Lys50 of eukaryotic translation initiation factor 5A (eIF5A) to form hypusine (Hyp). Studies have demonstrated this modification of eIF5A to contribute to cellular proliferation in cancerous cells, but its role in the physiologic proliferation of islet β-cells is unknown. I hypothesized eIF5A-Hyp to be required for the proliferation of islet β cells during the early phase of insulin resistance, allowing the β-cell to respond to the increased demand for insulin to maintain glucose homeostasis. To test this hypothesis, deletion of DHS was induced post-developmentally in β-cells by crossing Dhs-fl/fl mice with MIP1-CreERT mice, and animals were fed for 1 or 4 weeks with a 60% kcal from fat diet (HFD) or normal chow diet (NCD, 16% kcal from fat diet). NCD-fed and HFD-fed animals had normal glucose homeostasis after one week feeding, regardless of genotype. However, after 4 weeks of HFD, KO mice had significantly worse glucose intolerance compared to control mice. eIF5A-Hyp levels increased in β-cells of control animals and as expected remained low in the KO mice. β-cell proliferation was significantly increased after 1 week of HFD as measured by PCNA staining, however KO mice showed no increase. Cyclin D2 protein, but not mRNA, was increased in control animals fed a HFD; this protein increase was not observed in KO animals. Furthermore, polyribosomal profile of isolated islets of 1 week HFD-fed mice showed the Ccnd2 mRNA bound to the monoribosome fractions in the KO animals compared to the controls, resulting in changes of global translation. Interestingly, Ccnd1 polyribosome to monoribosome ratio showed no changes in translation compared to Ccnd2. Taken together, these results suggest that DHS (and, consequently, eIF5A-Hyp) is necessary for the adaptive proliferative and functional response of β-cells during high fat diet induced obesity and glucose intolerance.

Indiana University-Purdue University Indianapolis (IUPUI) / Metabolic survival mechanisms that defend body weight and conserve energy are currently at odds with modernized society which has a food supply that is ubiquitous, calorie dense, and highly palatable. Chronic overnutrition leads to a metabolic syndrome of obesity, insulin resistance, inflammation, and cardiovascular diseases that is increasingly prevalent and threatens health on a global scale. The brain is both a victim and culprit of metabolic diseases, and prolonged metabolic dysfunction can exacerbate the pathological mechanisms underlying both metabolic and neurodegenerative diseases. Since neuroendocrine pathways comprise an essential feedback mechanism that detects circulating hormones and nutrients in order to regulate satiety, energy expenditure, and glucose homeostasis, our research goals were to characterize molecular mechanisms within neuroendocrine pathways that could be leveraged for treating obesity, diabetes, and Alzheimer’s disease. First, we identified the expression of a G protein-coupled receptor, Gpr17, in POMC neurons and discovered that it protects aged mice from high-fat diet (HFD)-induced metabolic derangements. We examined the electrophysiological properties of POMC neurons and found Gpr17 deficiency led to increased spontaneous action potentials. Moreover, Pomc-Cre-driven Gpr17 knockout (PGKO) mice, especially female knockouts, had increased POMC-derived alpha-melanocyte stimulating hormone and beta-endorphin despite a comparable level of prohormone POMC in their hypothalamic extracts. Second, we generated a highly insulin resistant mouse model with human GLUT4 promoter-driven insulin receptor knockout (GIRKO) in muscle, adipose, and GLUT4-expressing neuronal subpopulations. This genetic approach recapitulates the primary defect preceding type 2 diabetes (T2D) and revealed additional factors/mechanisms that drive the ultimate progression of overt diabetes. Third, we used 5xFAD mice as a model of Alzheimer’s disease and showed that they were more susceptible to HFD-induced metabolic dysregulation and expression of AD pathological markers in the hippocampus. Our results helped elucidate the molecular and cellular mechanisms responsible for increased AD pathology in high-fat diet-fed 5xFAD mice and suggest that metabolic dysfunctions are a therapeutic target to ameliorate AD pathology. In conclusion, metabolic diseases are pervasive and require nuanced approaches that target the neuroendocrine system in order to restore metabolic homeostasis and protect the brain from neurodegenerative processes that are associated with obesity and diabetes.

SAMMANFATTNING Typ 2-diabetes ökar i nästan hela världen med ohälsa och höga samhällskostnader som följd. Stora delar av diabetesvården utförs i form av egenvård, det vill säga medvetna självständiga handlingar utförda av individen själv för att reglera och förbättra den egna hälsan, bidra till ökat välbefinnande och bibehålla integritet. Syftet med litteraturstudien var att undersöka vad vuxna personer med typ 2-diabetes beskriver som främjande för egenvård. Metoden som användes var en allmän litteraturstudie med inriktning mot studier utförda i Norden. Datainsamlingen har skett via databaserna PubMed och Cinahl och vid dataanalysen ingick resultatet av 12 artiklar med kvalitativa metoder där meningsbärande enheter i resultaten tolkades och kondenserades till teman och subteman. Resultatet som framträdde vid analysen gav 4 teman och 3 subteman som beskriver hur kunskap ger kontroll och trygghet samt beskriver socialt stöd, professionellt stöd och balans mellan krav och förutsättningar som främjande för egenvård. Slutsatsen visar att överensstämmelse finns mellan det som förordas avseende patientutbildning och egenvård i riktlinjer för diabetesvård, annan forskning, diabeteslitteratur och resultatet av föreliggande litteraturstudie.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第18467号 / 人健博第21号 / 新制||人健||2(附属図書館) / 31345 / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 任 和子, 教授 横出 正之, 教授 田村 恵子 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

京都大学 / 0048 / 新制・論文博士 / 博士(人間・環境学) / 乙第12951号 / 論人博第42号 / 新制||人||178(附属図書館) / 27||論人博||42(吉田南総合図書館) / 32250 / 三重大学大学院医学系研究科生命医科学専攻 / (主査)教授 石原 昭彦, 教授 神﨑 素樹, 准教授 久代 恵介, 准教授 月浦 崇, 教授 藤野 英己 / 学位規則第4条第2項該当 / Doctor of Human and Environmental Studies / Kyoto University / DGAM

京都大学 / 0048 / 新制・論文博士 / 博士(工学) / 乙第13016号 / 論工博第4141号 / 新制||工||1650(附属図書館) / 32944 / (主査)教授 跡見 晴幸, 教授 森 泰生, 教授 梅田 眞郷 / 学位規則第4条第2項該当 / Doctor of Philosophy (Engineering) / Kyoto University / DGAM