Thesis (MSc. Medical Science (Chemical Pathology)) -- University of Limpopo, 2017 / Obesity has been associated with dyslipidaemia (increased levels of triglycerides, total cholesterol and low levels of HDL-C together with small dense lipoprotein particles) in the absence of metabolic disorders such as, type 2 diabetes mellitus and inflammation. Since community based studies in South Africa reported that obesity is more common in women, and rural Africans have a more favourable lipid profile compared to their White counterparts, the current study investigated the association of obesity in women without metabolic disorders with lipid levels and changes in proportions of small and large LDL and HDL particles. Methods The present study was part of the project “Prevention, Control and Integrated Management of Chronic Disease in a rural area, South Africa”. A total of 521 women participated in the above project. After excluding people with diabetes mellitus, insulin resistance and inflammation, 308 women were left and of these 67 were obese. Sixty seven ages matched, randomly selected non-obese women served as controls. Anthropometry variables as well as systolic and diastolic blood pressures were measured and the WHO steps questionnaire was administered to collect information on medication, lifestyle and diseases. Fasting blood levels of total cholesterol, HDL C, triglyceride, adiponectin, CRP, glucose and insulin were measured. Proportions of small and large HDL and LDL particles were determined. Results There was no significant difference in TC, TG and LDL-C levels (p=0.558, 0.087 and 0.948) between obese and non-obese women or between women with increased waist circumference (WC) and those with normal WC. The HDL-C concentration was significantly lower in obese women compared to women with non- obese (p=0.001). The lipid ratios TC/HDL-C and Apo B-100/Apo A-I were significantly higher in obese women than those with non- obese (p=0.013 and p=0.006) respectively. The same phenomenon was observed in women with xv increased waist circumference (p=0.001** and p=0.025* respectively). Adiponectin levels were significantly lower in obese women compared to non-obese women (p=0.004**) and in women with increased waist circumference compared to those with normal waist circumference (p=0.016*). The proportions of small dense HDL and LDL lipoprotein particles were similar in obese and non-obese women. Both obese and abdominally obese women had significantly higher odds ratios of low levels of HDL-C and elevated Apo B-100/Apo A-I. Adiponectin was a significant predictor of elevated TC and TG in both obese and abdominally obese women while BMI was a significant predictor of low HDL-C in obese women. Waist circumference was a significant predictor of low HDL-C in abdominally obese women. Conclusion In the current study, obesity in women was significantly associated with lipid abnormalities such as low HDL-C levels, raised lipid ratios (TC/HDL-C and Apo B 100/Apo A-I) and low levels of adiponectin, after excluding metabolic disorders / VLIR

Bakgrund: Diabetes typ 2 är ett stort folkhälsoproblem i dagens samhälle. Diabetes typ 2 för med sig stora komplikationer och riskfaktorer. Egenvård är en central del när det gäller diabetes typ 2. Kosthållning spelar stor roll när det gäller egenvård vid diabetes typ 2. För att kunna behandla sjukdomen behöver patienten ta hänsyn till kosthållningen samt sjuksköterskan bör ta hänsyn till de faktorer som påverkar kosthållningen. Det är viktigt att arbeta personcentrerat för att uppnå en god vård för alla patienter.    Syfte: Syftet med arbetet är att beskriva faktorer som påverkar följsamhet gällande kosthållning för patienter med diabetes typ 2.    Metod:​ Metoden var en litteraturöversikt med ett systematiskt urval av artiklar från två databaser PubMed och Cinahl Complete. I artiklarna användes kvalitativa, kvantitativa och mixade metoder.   Resultat: Tre teman framkom: “Kultur är en faktor som påverkar följsamhet gällande kosthållning för patienter med diabetes typ 2”, “Kunskap är en faktor som påverkar följsamhet gällande kosthållning för patienter med diabetes typ 2” och “Ekonomi är en faktor som påverkar följsamhet gällande kosthållning för patienter med diabetes typ 2”.    Sammanfattning: Resultatet visade att det finns faktorer som påverkar följsamhet gällande kosthållning för patienter med diabetes typ 2 som kultur, kunskap samt ekonomi. / Background: Diabetes type 2 is a major public health problem in today's society. Diabetes type 2 brings with it major complications and risk factors. Self-care is a central part when it comes to diabetes type 2. Diet plays a big role when it comes to self-care in diabetes type 2. In order to treat the disease, the patient needs to take diet into account and the nurse should take into account the factors that affect diet. It is important to work person-centred in order to achieve good care for all patients.    Aim: The aim of the literature review is to describe factors that influence adherence to diet for patients with type 2 diabetes.    Method: ​The method was a literature review with a systematic selection of articles from two databases PubMed and Cinahl Complete. In the articles qualitative, quantitative and mixed methods were used.   Results: Three themes emerged: "Culture is a factor that influence adherence to diet for patients with type 2 diabetes", "Knowledge is a factor that influence adherence to diet for patients with type 2 diabetes" and "Economics is a factor that influence adherence to diet for patients with type 2 diabetes".    Summary: The results showed that there are factors that influence adherence to diet for patients with type 2 diabetes such as culture, knowledge and economy.

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Background: This study was conducted to determine the association between fiber intake and insulin resistance in 264 women using a cross-sectional design. Methods: Insulin resistance was indexed using HOMA-IR (fasting insulin (μU/mL)×fasting glucose (mg/dL)/405). HOMA-IR values were log transformed. Fiber and energy consumption were assessed using 7-day weighed food records. Fiber was expressed as grams per 1000 kilocalories. Body fat percentage (BF%) was measured using the BOD POD and physical activity (PA) was ascertained using Actigraph accelerometers worn for 7 consecutive days. Results: (Mean±SD) age: 40.1±3.0 years, glucose: 86.7±5.9 mg/dL; insulin: 7.1±4.3 μU/mL; HOMA-IR: 1.5±1.0; fiber intake (g/1000 kcal), total: 9.3±2.9; soluble: 1.7±0.9; insoluble: 3.8±1.9; physical activity: 2.7044 ±0.7842 million counts; BF%: 31.7±6.9; weight (kg): 66.1±10.1; total caloric intake per day (kcal): 2054.1±320.9; and dietary fat intake (% of total kcal): 30.5±0.5. Women with high total fiber intakes had significantly less insulin resistance than their counterparts (F=4.58, p=0.0332), and women with high soluble fiber intakes had significantly lower levels of insulin resistance than other women (F=7.97, p=0.0051). Participants with high insoluble fiber intakes did not differ from their counterparts (F=0.7, p=0.6875). Adjusting for either PA or BF% weakened the relationships significantly. Controlling for BF% nullified the total fiber-HOMA-IR link (F=1.96, p=0.1631), and attenuated the association between soluble fiber and HOMA-IR by 32% (F = 6.86, p=0.0094). To facilitate interpretation of the results, odds ratios were calculated to determine the association between fiber intake and HOMA-IR with both variables treated as categorical. To create dichotomous variables, fiber intake and HOMA-IR were each divided into two categories using the median (Low and High). In women who had high soluble fiber intake (upper 50%), the odds of having an elevated HOMA-IR level was 0.58 (95% CI: 0.36-0.94) times that of women with low soluble fiber intake (lower 50%). And after controlling for all of the potential confounding factors simultaneously, the odds ratio was 0.52 (95% CI: 0.29-0.93). Conclusion: High fiber intake, particularly soluble fiber, is strongly related to lower levels of insulin resistance in women. Part of this association is a function of differences in PA and BF%.

Bakgrund: Av Sveriges befolkning har ca 2-4,5 % diagnosen diabetes. Av de diagnostiserade har 10-15% typ 1 diabetes och resterande typ 2 diabetes. Eftersom sjukdomen ständigt ökar så finns dessa patienter överallt. Det finns således stor möjlighet att som färdig sjuksköterska träffa dessa patienter både inom primärvård och slutenvård. Syfte: Syftet med den här litteraturstudien är att beskriva hur en sjuksköterska kan undervisa en patient med diabetes typ 2 för att uppnå följsamhet till egenvård. Metod: Uppsatsen är en litteraturstudie som baseras på n=10 vetenskapliga artiklar varavn= 6 kvalitativa och n=4 kvantitativa. Artiklarna har hittats i databaserna PubMed och CINAHL. Varje artikel analyserades enskilt och sammanfördes sedan till teman.Resultat: Resultatet kan visa hur sjuksköterskan kan undervisa en patient med typ 2 diabetes. Resultatet redovisas i följande fem teman: förhållningssätt mellan sjuksköterska och patient, målsättning som en del av undervisningen, patientens inställning och förståelse gällande sin sjukdom, information och undervisning, egenvård. Slutsats: Det mest centrala som framkommit i den här litteraturstudien är att undervisning av patienter med typ 2 diabetes kan utföras på olika sätt. En viktig del för sjuksköterskan är att inse att patienter har olika behov och förutsättningar för lärande. Därför är det viktigt att individanpassa undervisningen. / Background: Approximately 2-4,5% of Sweden's population is diagnosed with diabetes. Of those diagnosed 10-15% suffers of type 1diabetes and the remainder suffers of type 2 diabetes. The disease is constantly increasing (Wikblad 2012). These patients are everywhere and there is a great opportunity for nurses to meet these patients in both primary and inpatient care. Purpose: The purpose of this literature review is to describe how a nurse can educate a patient with type 2 diabetes to achieve compliance to self-care.Method: The paper is a literature review that is based on scientific literature and 10 articles from primary sources of which n=6 were qualitative and n=4 quantitative . Articles were found in PubMed and CINAHL. Each article was analyzed individually and then combined into themes.Results: The results show how the nurse can educate a patient with type 2 diabetes. The results are reported in the following five themes: approach between the nurse and patient, goal-setting as part of the education, patient attitude and understanding regarding their disease, information and education, self-care. Conclusion: The main finding of this study is that the education of patients with type 2 diabetes can be performed in different ways. The most important for the nurse is to recognize that patients have different needs and conditions for learning. Thus, it is important to individualize the education.

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BACKGROUND: The increasing prevalence of undiagnosed and diagnosed type 2 diabetes (T2D) posed a major challenge for public health and thus screening for T2D becomes essentially important. The social-demographical factors associated with the use of T2D screening have been widely studied, however, little is known about the impact of behavioral factors, mental health and chronic diseases on prevalence of screening, especially by gender and age groups. METHODS: We investigated the impact of behavioral factors, mental health and chronic diseases across gender and age groups on the usage rate of T2D screening. To analyze the likelihood of the use of T2D screening, we performed weighted binomial logistic regression analyses. RESULTS: Obesity, physical activity and smoking increased the use of T2D screening for females more than for males, and alcohol use increased screenings only for females. Serious psychological distress (SPD) was found to have a positive association with the use of T2D screening for females rather than for males; whereas hypertension and diabetes increased the use of T2D screening for males more than for females. Physical activity was an effective predictor of screening for T2D in the groups of 45-64 years and 65 years or older. Former drinking was positively associated with T2D screening for people aged 65 or older, and smoking was found to increase the odds of screening for T2D for people aged less than 65. CONCLUSIONS: Behavioral factors, mental health, and chronic diseases were significantly associated with the use of T2D screening and further demonstrated that gender differences exist in the role of above factors.

<p> </p> <p>Type-2-diabetes (T2D) is a progressive metabolic disease characterized by insulin resistance and β-cell dysfunction leading to persistent hyperglycemia. It is a multisystem disease that causes deterioration of multiple organ systems and obesity. Of interest, T2D affects the urinary system and is the leading cause of kidney disease. Both T2D and chronic kidney negatively impacts the skeletal system and increases fracture incidence in patients. Therefore, it is important to establish an animal model that captures the complex multiorgan effects that is common in T2D. In this study, we characterized the metabolic phenotype of the KK/Ay mouse model, a polygenic mutation model of T2D. We concluded that KK/Ay mice closely mimic T2D and are hyperglycemic, hyperinsulinemic and insulin resistant. KK/Ay mice have also had worsened kidney function as supported by elevated levels of blood urea nitrogen, phosphorous, creatinine, and calcium in plasma exhibiting the kidney’s inefficiency in clearing waste from the body. Even though we were able to confirm a metabolic phenotype for T2D and diabetic nephropathy, the skeletal effects of the disease were minimal and major differences in bone physiology were driven by sex differences. This study offered valuable insight into preliminary endpoints for the KK/Ay mouse mode that will decide the direction for future use of this model. We plan to use older mice in future studies to allow a longer time for skeletal effects to more prominently manifest.</p>

Type 2 diabetes mellitus (T2DM) is a chronic condition recognized as the inability to maintain glucose homeostasis, typically presenting with insulin resistance and systemic inflammation. With the prevalence of T2DM and major risk factors such as prediabetes and obesity increasing each year, there is a crucial need to identify strategies for the management and prevention of this condition. Addressing lifestyle-related risk factors through consumption of a well-balanced, nutritious diet and maintaining regular moderate- to high-intensity physical activity may provide a strategy for improving glycemic control, improving metrics of body composition, and decreasing the inflammatory response associated with metabolic dysregulation. Twenty-two overweight to obese adults with a medical diagnosis of T2DM, indicators of prediabetes, or who were metabolically healthy participated in Cal Poly’s Nutrition and Exercise in Type 2 Diabetes (CPNET) study. The study protocol included adherence to a Mediterranean-style diet, daily consumption of a high-quality whey protein supplement, and adherence to the Physical Activity Guidelines for Americans for 16 weeks. Body composition data, via dual-energy X-ray absorptiometry (DXA), and fasting blood samples were collected at baseline and following the intervention. Due to restrictions associated with the global COVID-19 pandemic, only 13 participants were able to return for the second data collection following the 16-week intervention. The prediabetic and T2DM groups exhibited reductions in fasting plasma glucose to that of normal and prediabetic levels, respectively, while the T2DM group also showed improvement in hemoglobin A1c to the prediabetic level. Additionally, the metabolically healthy, overweight group demonstrated significant improvements in adiposity, while the obese prediabetic and T2DM groups showed non-significant improvements in all measured metrics of body composition. No changes were observed in inflammatory biomarkers. Thus, our results suggest that adherence to a well-balanced nutritious diet and regular physical activity may improve parameters of glycemic control and provide benefits to body composition that help manage and prevent the development of T2DM.