Thesis (M.Sc. (Physiology)) -- University of Limpopo, 2019 / Background Type 2 diabetes mellitus (T2DM) is an increasing challenge globally, and is estimated to affect 439 million adults by 2030. This estimate is linked to an unhealthy lifestyle with characteristics such as low physical activity (PA) and high plasma glucose levels (PGLs). Studies associating PA with insulin resistance and diabetes among adults and adolescents have been conducted widely in developed countries. Such studies are scanty among rural populations, especially in Africa. Assessment of the burden of diabetes and associated lifestyle risk factors in developing countries is essential in order to encourage appropriate intervention strategies to counter the increasing prevalence. Aim and objectives The aim of this study was to investigate the relationship between PA and T2DM among rural young adults aged 22 to 30 years in Ellisras area in Limpopo Province, South Africa Methods A total of 713 young adults (349 males and 364 females) who have been part of the Ellisras Longitudinal Study participated in the current study. Physical activity data was collected using a validated questionnaire. After an overnight fast, participants provided fasting venous blood samples for determination of plasma glucose and insulin. Insulin resistance was estimated using the homeostasis model assessment of insulin resistance. Anthropometric measurements (waist circumference and height) were performed using standard procedures. Linear and logistic regressions were used to assess the relationship between PA, pre-diabetes, insulin resistance and T2DM; and the odds of having T2DM with low PA levels. Results The prevalence of physical inactivity was 67.3 and 71.0% for males and females, respectively. That of pre-diabetes was between 45.7% and 50.2%. The prevalence of diabetes was 9.6% for males and 10.1% for females while for insulin resistance was 22.9% for males and 29.3% for females. Linear regression found a significant relationship (p<0.05) between physical activity and blood glucose (ß =5.715; 95% CI 4.545; 6.885), waist circumference (ß = 37.572; 95% CI 25.970; 49.174) and waist-toheight ratio (ß = 0.192; 95% CI 0.087; 0.296). Logistic regression found a significant (p<0.05) relationship between low physical activity and T2DM (Odds ratio = 2.890; 95% CI 1.715; 4.870) and insulin resistance (Odds ratio = 1.819; 95% CI 1.266; 2.614). Conclusion Physical activity is low in this population, and is independently associated with T2DM and insulin resistance. KEY WORDS Type 2 diabetes mellitus; pre-diabetes; insulin resistance; physical activity; young adults; rural South African population. / Vrije University, Amsterdam, The Netherlands, and the University of Limpopo

Indiana University-Purdue University Indianapolis (IUPUI) / Introduction: Increasing obesity in children leads to an increase in the risk of Type 2 diabetes (T2D). Therefore, it is important to promote healthier lifestyles in youths and encourage their caregivers(s) to provide a healthy lifestyle environment. The PowerHouse program focuses on improving food choices, increasing physical activity, and adopting behavior changes for the reduction of obesity and the prevention of T2D. Method: The aim of this study was to assess the effects of implementing the PowerHouse program on both clinical and quality of life outcomes in high-risk, low-income youth and their caregivers. Primary outcomes were BMI standard deviation and BMI percentile in youths. Secondary outcomes included physical activity of youths and quality of life for both youths and their caregivers. Attendance rates were also calculated. Linear effect mixed models were used to test for time effects for all outcomes. Results: Clinical outcomes did not improve over time, except for youth HbA1c (p-value = 0.0447). Some improvements in youth quality-of-life outcomes were noted: specifically, the Sports Index score of the Fels Physical Activity Questionnaire for Children (adjusted p-value = 0.0213) and the Physical Summary (p-value = 0.0407), Psychosocial Summary (p-value = 0.0167), and Total score (p-value = 0.0094) for the youth-reported Pediatric Quality of Life Inventory. Quality of life did not change over time for caregivers. For attendance, there was an improvement after the intervention was modified to improve access to fresh produce (p-value = 0.0002). Conclusion: HbA1c and quality of life improved over time for youth; however, there was not an improvement in caregiver outcomes over time. The data suggest that more time may be needed to see the full effects of the intervention, and/or that a booster intervention may be needed.

Bakgrund Patienter med diabetes typ 2 kan reducera riskerna för framtida komplikationer som till exempel hjärtsjukdomar och stroke med hjälp av egenvård. En förbättring av följsamhet till egenvård kan leda till ett minskat lidande hos patienten och bidra till en bättre livskvalitet. Syfte Syftet är att sammanställa forskningsbaserad kunskap om vilka faktorer som påverkar vuxna patienters följsamhet till egenvårdsråd vid diabetes typ 2. Metod Examensarbetet är en strukturerad litteraturstudie med en inslag av den metodologi som används vid systematiska översikter. Databasen Cinahl har använts i artikelsökningen där 14 artiklar analyserats. Resultat Följsamhet till egenvård påverkas av olika faktorer varav tre identifierades: Informationsförmedling till patient, telekommunikation som hjälpmedel samt personliga och sociala faktorer som alla bidrog till en god följsamhet till egenvårdsråd. Slutsats Det är betydelsefullt att försöka uppmärksamma individens förutsättningar för att utbildning, digitala tjänster och involvering av familj kan ske anpassad efter den enskilde individen. Att stärka självtilltien hos individen är dessutom en avgörande faktor för en god följsamhet. / Background Patients with diabetes type 2 can reduce the risks for further complications like for instance cardiovascular disease and stroke by self-care. By improving adherence to selfcare the suffering can be decreased and in the same time contribute to improve the health and quality of life for the patient. Aim The purpose of this literature review was to describe factors that can influence adult patient´s compliance to self-care in type 2 diabetes. Method The database Cinahl has been used to this literature review with 14 scientific articles included. Results Compliance to self-care is influated by different factors which are dissemination of information to the patient, telecommunications assistance and personal and social factors. These factors all contribute to better adherence to self-care. Conclusions To notice the characteristics of patients is an important factor to adjust education, digital services and the involvment of the family. Another key factor to improve compliance is to strenghten the patients self-efficacy.

Bakgrund: År 2040 beräknas det finnas 642 miljoner diabetespatienter i världen. Sjukdomen leder till många komplikationer som kan bli allvarliga och har en negativ effekt på livskvalitén hos diabetespatienterna. Den mest förekommande av alla diabetesformer är diabetes typ 2. Diabetes typ 2 är en sjukdomstillstånd där kroppen inte producerar tillräckligt med insulin eller reagerar inte kroppens vävnader på insulinet (insulinresistens), vilket medför till att det blir en förhöjd glukoshalt i blodet. Insulin är ett peptidhormon som gör att glukos kan transporteras in i en cell och ifall inte insulinet fungerar kommer ingen glukos in i cellen och kroppen får då ingen energi. Symtom som kan uppstå är trötthet, urinering och dimsyn. Riskfaktorer som kan leda till diabetes typ 2 är stillasittande livsstil, högt blodtryck och fetma. En av metoderna som används vid diagnos av diabetes är kontroll av HbA1c-värdet. HbA1c är en mätmetod som kontrollerar blodsockervärdet under längre tid. Det är andelen glukos som fastnar på hemoglobinet som HbA1c mäter. Skulle HbA1c-värdet vara ≥ 48mmol/mol har patienten diabetes. Eftersom detta är en allt vanligare sjukdom och det inte finns något läkemedel som botar diabetes finns det ett stort behov för nya effektivare läkemedel och det är ett stort forskningsområde. ”Dualpeptider” har visat positiva resultat i djurstudier, både vad gäller glykemisk kontroll samt viktminskning hos möss. Dualpeptiderna är en kombination av två inkretinhormoner: GLP-1R (glukagonliknande peptid-1-receptor) och GIP (glukosberoende insulinotrop peptid) agonister. De nya dualpeptiderna som undersöks kallas för: ‘’LY3298176’’ och ‘’RG7697’’. Syftet med litteraturstudien var att undersöka framtida behandlingsalternativ för patienter med diabetes typ 2. Metod: I denna litteraturstudie användes PubMed för att söka efter publicerade studier. Fyra studier uppfyllde de uppställda kriterierna och undersökte effekten av nya kombinationspeptider vid behandling av diabetes typ 2. Resultat: Dualpeptiderna RG7697 och LY3298176 visade kroppsviktreducering och minskade även HbA1c-värdet. Trots den korta studietiden och en liten studiepopulation sågs signifikanta skillnader. Den glykemiska kontrollen ökade vid behandling med dualpeptiderna jämfört med placebo. Slutsats: Båda dualpeptiderna visade på glykemisk kontroll och viktminskning för patienter med diabetes typ 2 och var effektiva i fas 2 studier. Inga allvarliga biverkningar förekom i någon av studierna. Dualpeptiderna anses kunna vara mer effektiva än metformin och GLP-1 agonisterna dulaglutid (Trulicity®) och liraglutid (Victoza®). / Background: By 2040, it is estimated that there will be 642 million diabetic patients worldwide. The disease leads to many complications that may have negative effects on the quality of life of patients with diabetes. The most common of all forms of diabetes is diabetes type 2. Diabetes type 2 is a disease state where the body doesn’t produce enough insulin or the body’s tissues don’t react to the insulin (insulinresistance), this leads to an elevated level of glucose in blood. Insulin is a peptide hormone that allows glucose to be transported into a cell. If this process does not work, glucose does not enter the cell and the cell will lack a source of energy. Symptoms that may occur are fatigue, urination and blurred vision. Risk factors that can lead to type 2 diabetes are sedentary lifestyle, high blood pressure and obesity. Measuring the HbA1c is one of the methods used in diagnosing diabetes. HbA1c is a measurement method that controlls the blood sugar level for a longer period of time. It is the percentage of glucose that sticks to the hemoglobin that HbA1c measures. The patient has diabetes type 2 if the HbA1c value is ≥ 48 mmol/mol. Since there is still no treatment that can cure diabetes and the number of patients increase, there is on-going research to discover new drugs to treat diabetes in the future. ‘’Dualpeptides’’ have shown positive results in animal studies. Dualpeptides increase glycemic control and weight loss in mice. The dualpeptides are a combination of two incretin hormones: GLP-1R (glucagon-like peptide-1) and GIP (glucose-dependent insulinotropic peptide). Both are receptor agonists. The new dual peptides being studied are called: ‘’LY3298176’’ and ‘’RG7697’’. Objective: The purpose of this literature study was to investigate the future treatment alternatives for patients with diabetes type 2. Method: In this literature study PubMed was used to search for published studies. Four studies met the set criteria and were examined. The effect of new dualpeptides in the treatment of type 2 diabetes was assessed. Results: The dual peptides RG7697 and LY3298176 showed a reduction in body weight and also reduced the HbA1c value. Despite the short study-time and a small study populations, significant differences were reported. Glycemic control increased during treatment with dualpeptides compared with placebo. Conclusion: Based on the results the following can be concluded, both dualpeptides showed glycemic control and weight loss in patients with type 2 diabetes, and were effective in phase 2 studies. No serious side effects were observed in any of the studies. The dualpeptides are considered to be more effective than metformin and the GLP-1 agonists dulaglutide (Trulicity®) and liraglutide (Victoza®).

While previous health research with Aboriginal populations focused almost exclusively on Aboriginal Peoples of First Nations descent living on reserves or in isolated rural communities in Canada, this study focusing on diabetes aimed to engage Aboriginal Peoples of First Nations and Métis descent living in an urban Ontario setting. Type 2 diabetes mellitus is a progressive metabolic disorder that affects Aboriginal Peoples of Métis and First Nations descent disproportionately compared to the rest of the Canadian population. To understand this disparity in diabetes incidence and to address issues with existing diabetes prevention and management strategies, this study: a) explores the perceptions surrounding Type 2 diabetes and its prevention from First Nations and Métis community people and health service providers and policy makers; and b) informs the existing diabetes prevention, management and care strategies in light of these perceived understandings. Primary data was collected through 40 in-depth one-on-one narrative interviews with First Nations and Métis people, health service providers and policy makers. Thematic codes that emerged through the narrative analysis of this data revealed that to fully understand the social determinants of diabetes in an urban First Nations and Métis people’s context required the application of intersectionality theory, since production of First Nations and Métis diabetes is socially determined and deeply intersectional. By combining the concepts of the social determinants of health and intersectional approaches, narrative analysis of the primary data revealed that diversities in socio-economic, cultural, legal and spatial contexts determine First Nations and Métis people’s life choices and have a strong bearing on their health outcomes. First Nations and Métis participants’ narratives revealed that dimensions of marginalization were reflected not only through inadequate material resources, but also through intersections of multiple factors such as colonial legacies, stereotyping, legal statuses, and the pan-Aboriginal nature of government policies and services. First Nations and Métis community members indicated that preventive programming aimed at avoiding or managing diabetes should be grounded in balancing and restoring the positive aspects of physical, mental, spiritual and emotional health and should also balance their diverse needs, lived realities, and social circumstances. The views of health service providers and policy makers captured in this thesis tended to reflect an understanding of diabetes causation grounded in both biomedical and intersecting social determinants of health. At the pragmatic level, however, the solution to this health issue presented by health service providers and policy makers addresses only the measurable individualistic biomedical risk factors of diabetes. Policy makers also discussed the need for developing qualitative indicators of the success of presently implemented health programs. Overall, the results of this study indicated that effective diabetes prevention and management strategies for urban First Nations and Métis people must recognize and address the diversities in their historical, socio-economic, spatial and legal contexts as well as their related entitlement to health services. A comprehensive diabetes prevention strategy should target the social determinants of health that are specific to urban First Nations and Métis people and must build on community strengths.

SyfteSyftet med denna studie var att undersöka personliga tränares och fysioterapeuters träningsrekommendationer för äldre individer med osteoporos eller typ 2-diabetes samt att undersöka om rekommendationerna skiljer sig mellan dessa professioner.MetodSemi-strukturerade intervjuer genomfördes med tre personliga tränare och tre fysioterapeuter. Intervjuerna grundades på två patientfall där ena fallet innefattade en 67-årig man med typ 2-diabetes och det andra fallet innefattade en 70-årig kvinna med osteoporos. Utifrån patientfallen fick de ge sina träningsrekommendationer för att förbättra patientens sjukdomstillstånd. Efter att intervjuerna genomförts analyserades data med en innehållsanalys där meningsbärande enheter kodades och kategoriserades i teman.ResultatBåde personliga tränare och fysioterapeuter rekommenderade styrketräning som primär träningsform för typ 2-diabetes och osteoporos. Som ett komplement till styrketräningen lyfte båda professionerna fram konditionsträning i form av promenader eller liknande.SlutsatserBåda professionerna hade adekvata träningsrekommendationer för att förbättra sjukdomstillstånden men de kunde med fördel ha inkluderat powerträning (styrketräning med hög kontraktionshastighet) i sina rekommendationer vilket forskning på området visat ge god effekt på både typ 2-diabetes och osteoporos. / PurposeThe purpose of this study was to investigate personal trainers and physiotherapists training recommendations for older individuals with osteoporosis or type 2 diabetes as well as to investigate if the recommendations differ between these professions.MethodSemi-structured interviews were conducted with three personal trainers and three physiotherapists. The interviews were based on two patient cases where one case involved a 67 year old man with type 2 diabetes and the other case included a 70 year old woman with osteoporosis. From the patient cases, they were given their training recommendations to improve the patient's disease state. After the interviews were conducted, the data were analyzed with a content analysis where meaning-bearing units were coded and categorized into themes.ResultsBoth personal trainers and physiotherapists recommended strength training as primary training for type 2 diabetes and osteoporosis. As a complement to the strength training, both professions highlighted endurance training in the form of walking or similar activities.ConclusionsBoth professions had adequate training recommendations to improve disease conditions but could advantageously implement more power training in their recommendations which has been proven to have positive effect on both type 2 diabetes and osteoporosis.

The PDZ and LIM domain 5 (PDLIM5) gene may play a role in alcohol dependence (AD), bipolar disorder, and major depressive disorder; however, no study has identified shared genetic variants within PDLIM5 gene among AD, type 2 diabetes (T2D), and hypertension. This study investigated the association of 72 single nucleotide polymorphism (SNPs) with AD (1066 AD cases and 1278 controls) in the Study of Addiction - Genetics and Environment (SAGE) sample and 47 SNPs with T2D (878 cases and 2686 non-diabetic) and hypertension (825 cases and 2739 non-hypertensive) in the Marshfield sample. Multiple logistic regression models in PLINK software were used to examine the associations of genetic variants with AD, T2D, and hypertension and SNP x alcohol consumption interactions for T2D and hypertension. Twenty-five SNPs were associated with AD in the SAGE sample (p < 0.05); rs1048627 showed the strongest association with AD (p = 5.53 × 10−4). Of the 25 SNPs, 5 SNPs showed associations with both AD in the SAGE sample and T2D in the Marshfield sample (top SNP rs11097432 with p = 0.00107 for T2D and p = 0.0483 for AD) while 6 SNPs showed associations with both AD in the SAGE sample and hypertension in the Marshfield sample (top SNP rs12500426 with p = 0.0119 for hypertension and p = 1.51 × 10−3 for AD). SNP (rs6532496) showed significant interaction with alcohol consumption for hypertension. Our results showed that several genetic variants in PDLIM5 gene influence AD, T2D and hypertension. These findings offer the potential for new insights into the pathogenesis of AD, T2D, and hypertension.

Type 2 diabetes is a chronic metabolic disorder and the seventh leading cause of death in the United States. Type 2 diabetes is linked to many chronic diseases, including cardiovascular disease, stroke, and chronic kidney failure. African American adults have a high prevalence of Type 2 diabetes with early onset of diabetes complications. Poor dietary behavior is the primary cause of Type 2 diabetes and its complications, changing dietary behaviors can prevent the onset of diabetes complications or impede existing ones. The purpose of this phenomenological study was to explore patients' perceptions of diet-only therapy in the prevention of diabetes complications. Face-to-face interviews were conducted with six African American adults with Type 2 diabetes between 40 to 64 years using purposeful sampling method. Health belief model formed the conceptual framework of the study. I applied inductive coding process and manually analyze data for themes. Participants expressed fear of diabetes complications, acknowledged effectiveness of dietary therapy, physician communication and strong family support in Type 2 diabetes management. Findings can produce positive social change among African American adults with type 2 diabetes. Patients can be motivated to change their dietary behaviors to prevent disability and death from diabetes complications. Adherence to diet can reduce medical costs associated with Type 2 diabetes and its complications at the individual, family, community, and government levels. Health care providers can apply the findings in their interactions with patients to provide a more patient-centered education that integrates patients' cultural and dietary preferences to facilitate adoption of dietary interventions and long-term adherence.

Typ 2-diabetes är en utbredd sjukdom som ställer höga krav på kunskap hos patienterna som lever med sjukdomen, komplikationerna är många men påverkbara av patienten själv. Patienter diagnostiserade med typ 2-diabetes kräver undervisning för att erhålla goda egenvårdsfärdigheter, vilket minimerar uppkomsten av komplikationer. Sjuksköterskor utbildar patienterna som en del av omvårdnadsarbetet för att främja hälsa och minska komplikationer. Syftet med litteraturstudien var att belysa hur vuxna patienter diagnostiserade med typ 2-diabetes upplevde patientundervisning. Studien utfördes som en allmän litteraturstudie utifrån en induktiv ansats. Fyra kategorier uppkom i litteraturstudiens resultat: Lärandeaktiviteternas betydelse, lärares karaktär och bemötande, sjukdomsinsikt och självförtroende och informationens relevans. Både patientundervisning i gruppformat och individuellt upplevdes positivt, kritik riktades mot bristen på individanpassad undervisning. Det framkom i litteraturstudien att patienternas upplevelser av den som undervisade påverkade huruvida undervisningen var gynnsam eller ej. Patienternas egenvårdsförmåga upplevdes öka. Till stor del upplevde patienterna information given under undervisningen vara relevant. Patienternas upplevelser bör tas i beaktande vid utformning av patientundervisning, utbildning av sjuksköterskor samt av sjuksköterskor i klinisk verksamhet. Motiveringen är att undervisningen skall vara så gynnsam för patienterna diagnostiserade med typ 2-diabetes som möjligt. / Type 2-diabetes is a widespread disease that places high demands on knowledge in the patients living with the disease, the complications are many but possible to be affected by the patients themselves. Patients diagnosed with type 2- diabetes require education to obtain good self-care ability, which minimizes the onset of complications. Nurses educate patients diagnosed with type 2-diabetes as part of the nursing work to promote health and reduce complications. The purpose of the literature study was to elucidate how adult patients diagnosed with type 2-diabetes experienced patient education. The study was conducted as a general literature study, with an inductive approach. Four categories emerged in the literature study's results: The learnings activities importance, the character and attitude of the teacher, insight in the disease and self-confidence and the relevance of the information. Both patient education in group form and individually were experienced positive, criticism was directed at the lack of individualized education. It was found in the literature study that the patients' experiences of the teacher affected whether the teaching was favorable or not. Patients' self-care ability was experienced to increase. To a large extent, the patients perceived information given during the education to be relevant. Patients' experiences should be taken into account when designing patient education, training of nurses, and of nurses in clinical practice. The motivation is that teaching should be as beneficial to patients diagnosed with type 2-diabetes as possible.

Background: The elderly population is increasing, and the chronic disease type 2 diabetes is becoming more prevalent, and this affects their well-being. This results in high costs regarding managing the recommended healthy lifestyle. Patients experience both psychological and physical impact due to fear of disease complications and becoming multimorbid. Purpose: To describe elderly patients ́ experiences of living with type 2 diabetes. Method: A literature study with qualitative content analysis based on 12 original qualitative articles was conducted with focus on patients ‘experiences. Results: Three main categories and six sub-categories were emerged: Emotional experiences, Experiences of support and Need for diabetes education program. Subcategories were fear and frustration, hopelessness, Acceptance and social support, Attitudes towards the health careteam, lack of knowledge about T2D and experiences of low self-efficacy. Conclusion: Literature study has shown that patients have different experiences of living with type 2 diabetes and a more individualized diabetes care is needed. The nurse should also approach the patient from a holistic perspective by focusing on the whole person and not juston the disease. Implications: Further research is recommended to promote quality of life in elderly patients with type 2 diabetes. / Bakgrund: Den äldre befolkning ökar samtidigt som den kroniska sjukdomen diabetes typ 2 bli alltmer förekommande vilket påverkar välbefinnandet. Detta resulterar i höga kostnader föratt hantera den rekommenderade hälsosamma livsstilen. Patienter upplever både psykologisk och fysisk påverkan på grund av rädsla för sjukdoms komplikationer och att bli multi-sjuka. Syfte: Att beskriva äldre patienters upplevelser av att leva med diabetes typ 2. Metod: En litteraturstudie med kvalitativ innehållsanalys grundad på 12 original kvalitativa artiklar som genomfördes med fokus på patienters upplevelser. Resultat: Tre huvudkategorier och sex subkategorier formulerades. Huvudkategorier: Känslomässig erfarenhet, Upplevelser av stöd och Behov av diabetesutbildningsprogram. Subkategorier: Rädsla och frustration, Hopplöshet, Acceptans och socialt stöd, Attityder till hälso-sjukvård teamet, Brist på kunskap om T2D och Upplevelser av låg self-efficacy. Slutsats: Litteraturstudien har visat att patienter har olika upplevelser av att leva med diabetes typ 2 och att det behövs en mer individanpassad diabetesvård. Sjuksköterskan bör också bemöta patienten utifrån en helhetssyn genom att fokusera på hela person och inte bara på sjukdomen. Implikationer: Vidare forskning rekommenderas med avseende att främja livskvalitet hos äldre patienter som drabbas av diabetes typ 2.