SAMMANFATTNING År 2015 fanns 415 miljoner människor med diabetes i världen varav typ 2 diabetes står för 90-95 procent. Om inte utvecklingen bromsas beräknas antalet öka till 642 miljoner människor fram till år 2040. Livsstilsförändringar är hörnpelare i behandlingen av typ 2 diabetes och innefattar kost, fysisk aktivitet och rökstopp. Typ 2 diabetes kännetecknas av en insulinbrist på grund av insulinresistens och en tilltagande nedsatt insulinfrisättning från betacellerna. Utvecklingen av typ 2 diabetes går långsamt och ofta dröjer det flera år innan sjukdomen upptäcks. Behandling vid typ 2 diabetes kan dels vara farmakologisk och dels icke-farmakologisk där underliggande orsaker behandlas genom livsstilsförändringar. Regelbunden träning ger förbättrad insulinkänslighet vilket leder till lägre insulinbehov. För hälso- och sjukvårdspersonal är det en utmaning att motivera till ändrade kostvanor, viktminskning och fysisk aktivitet. Även de som når en viss viktminskning är ofta tillbaka på sin ursprungsvikt efter några år. All medicinsk behandling påverkar patienters vardag men få behandlingsformer får så stor påverkan på livet som förändrade levnadsvanor. Sjuksköterskans roll som samarbetspartner är viktig varför det är av vikt att förstå de känslor och reaktioner som ofta väcks i samband med både diagnos och behandlingskrav, där livsstilsförändringar utgör viktig del. Syftet var att belysa patienters upplevelser av att göra livsstilsförändringar med fokus på fysisk aktivitet, i samband med typ 2 diabetes. I denna litteraturöversikt inkluderades 15 vetenskapliga artiklar från databaserna Cinahl och PubMed. Artiklarna kvalitetsgranskades och därefter utfördes en innehållsanalys för att identifiera meningsbärande enheter och därefter har huvudkategorier och underkategorier framkommit. Resultatet presenterades i en integrerad analys. De huvudkategorier som framkom i resultatet var kunskap, sociala faktorer, psykiska faktorer, fysiska faktorer samt tillgänglighet till träning. Flera underkategorier framkom också. Både upplevelser av att inneha kunskap, avsaknad av kunskap om fysisk aktivitet samt hur de skulle träna framkom. Vad gäller sociala faktorer framkom både upplevelser av socialt stöd respektive avsaknad av socialt stöd. Psykiska faktorer innefattade upplevelser av välbefinnande, påverkan av attityder och självförmåga, upplevelser av eller avsaknad av motivation samt levnadsvanor. De fysiska faktorerna belyste upplevelser av att kroppen var ett hinder samt effekter på blodsockret. Vad gäller tillgänglighet till träning framstod upplevelser vad gäller miljön i närområdet, kostnader samt tidsbrist och arbetsbelastning som centrala. Dessa upplevelser påverkar på olika vis patienters möjligheter att skapa en vana av fysisk aktivitet och lyckas vidmakthålla den. För hälso- och sjukvårdspersonal är förståelse för patienters upplevelser och för vilka psykologiska faktorer som påverkar dessa betydelsefulla för att på bästa sätt kunna möta patienterna där de befinner sig och stötta dem i deras process mot att leva ett hälsosamt liv. Nyckelord: typ 2 diabetes, livsstilsförändringar, fysisk aktivitet, patientupplevelser / ABSTRACT By 2015 there were 415 million people with diabetes in the world, of which type 2 diabetes accounts for 90-95 percent. Unless development is impaired, the number is expected to increase to 642 million people by the year 2040. Lifestyle changes are the cornerstones in the treatment of type 2 diabetes and include diet, physical activity and smoking. Type 2 diabetes is characterized by insulin insufficiency due to insulin resistance and an increased reduction in insulin release from the beta cells. The development of Type 2 diabetes is slow and often it takes several years before the disease is detected. Treatment with type 2 diabetes may be pharmacologically and partly non-pharmacological where underlying causes are treated by lifestyle changes. Regular exercise provides improved insulin sensitivity, resulting in lower insulin requirements. For healthcare professionals, it is a challenge to motivate changes in dietary habits, weight loss and physical activity. Even those who reach a certain weight loss are often returned to their initial weight after a few years. All medical treatment affects the everyday lives of patients, but few treatments have such a big impact on life as changing living habits. Nursing's role as a partner is important why it is important to understand the feelings and reactions that often arise in connection with both diagnosis and treatment requirements, where lifestyle changes are important. The purpose of this literature review was to illuminate patients' experiences of making lifestyle changes focusing on physical activity, associated with type 2 diabetes. This literature review included 15 scientific articles from the databases Cinahl and PubMed. The articles were quality assessed and then a content analysis was conducted to identify meaning-bearing units and after that, main categories and subcategories emerged. The result was presented in an integrated analysis. The main categories presented in the result were knowledge, social factors, mental factors, physical factors and accessibility to training. Several subcategories also appeared. Both experiences of possessing knowledge as well as lack of knowledge about physical activity and how they would work out emerged. Regarding social factors, both experiences of social support and lack of social support emerged. Psychological factors included experiences of well-being, faktors affecting attitudes and self ability, experiences of or lack of motivation as well as living habits. The physical factors highlighted experiences that the body was a barrier and effects on blood sugar. In terms of accessibility to training, experiences with the environment in the immediate area, costs, time shortages and workload were central. These experiences in different ways affect the ability for patients to create a habit of physical activity and manage to maintain this. For health professionals, understanding the patient's experiences and the psychological factors that affect these are important in order to best meet the patients where they are and support them in their process of living a healthy life.

No description available.

Type 2 diabetes is a life-threatening condition, and it is rapidly growing in the world. If patients receive adequate education and support, they can manage their diabetes-related tasks effectively and reduce the severe complications of this disease. However, traditional self-management education and practices were not very effective in stimulating behaviour change and addressing patients’ diversified needs and expectations. Mobile text messaging is a promising method for type 2 diabetes self-management as it can provide continuous and customized support to these patients. However, there is a lack of knowledge about the optimal approach to designing and delivering mobile text messages. Hence, this dissertation aimed to define effective message strategies for mobile text messaging interventions targeting type 2 diabetes self-management. This manuscript-based dissertation consists of three complementary studies. The first manuscript includes a systematic review and a meta-analysis of tailored mobile text messaging interventions on type 2 diabetes self-management. It examines the tailoring strategies, message content, and structure and identifies the moderators of effectiveness in these interventions. The second manuscript includes a systematic review and a meta-synthesis of qualitative evidence on patients’ experiences and perspectives of mobile text messaging studies. The third manuscript consists of a prospective qualitative study to explore the text messaging design and delivery preferences of patients. In the first and second studies, the comprehensive search strategy included major electronic databases, key journal searches, and hand searches of the reference lists of related systematic reviews and meta-analyses. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane Collaboration's guidelines and recommended tools were used for data extraction, risk of bias and critical appraisal assessments, data analysis and reporting. Within a social marketing framework, the third study included semi-structured interviews and a thematic analysis of the main findings. In the first manuscript, 13 eligible trials were included for the systematic review and 11 eligible trials were further analyzed in the meta-analysis. This study concluded that tailored mobile text messaging interventions could improve glycemic control in patients with type 2 diabetes. The subgroup analyses revealed the importance of some moderators such as message delivery, message direction, message frequency, and using multi-modalities. In the second manuscript, the systematic review included 14 eligible studies, and the thematic synthesis included 13 eligible studies. Patients emphasized the importance of tailored text message design and delivery. They felt “supported” by using text messaging and improved their communication with family/friends and care providers. Mobile text messaging increased patients’ self-awareness, knowledge and control of diabetes. The third study explored that mobile text messages could be more effective if they are gain-framed and written in a standard format. Patients favoured the text messages that included simple and direct tone and provided statistical evidence. The findings demonstrated patients’ needs and expectations for advanced tailoring strategies in both message content and delivery. Together, the manuscripts fill a significant gap and inform research and practice for the development of more effective message strategies that could lead to reducing the spread of type 2 diabetes worldwide. / Graduate / 2022-05-12

Bakgrund: Diabetes typ två är en sjukdom som idag klassas som en folksjukdom, och är starkt betingat med dåliga levnadsvanor. En del i behandlingen av sjukdomen är livsstilsförändringar, såsom kostförändringar. Genom kosten kan många personer få kontroll över sina blodsockernivåer, och därmed sker en klinisk förbättring. Syfte: Att belysa erfarenheter av kostförändringar hos vuxna personer med diabetes typ två. Metod: En kvalitativ litteraturstudie.Genom strukturerade sökningar med en PEO-modell genom PubMed och Cinahl har tio artiklar identifierats och kvalitetsgranskats genom SBU:s granskningsmall, och slutligen analyserats för litteraturstudiens resultat. Resultat: Fyra huvudteman identifierades – behov av kunskap ,motivation, tillgänglighet, och sociala sammanhang. Slutsats: Kostförändringar vid diabetes ärav stor betydelse för behandlingen av diabetes typ två, och följsamheten till dessa beror mycket på personliga faktorer i individens liv. Därför är det nödvändigt för sjuksköterskan, för att kunna ge god personcentrerad omvårdnad, att ha ett holistiskt perspektiv i det stödjande och hälsofrämjande arbetet. / Background: Type 2 diabetes is a disease that is currently classified as an epidemic and is strongly linked to poor lifestyle habits. Treating the disease involves making lifestyle changes, such as dietary modifications. Through diet, many individuals can gain control over their blood sugar levels, resulting in clinical improvement. Purpose: To highlight the experiences of dietary changes among adult individuals with type 2 diabetes. Method: A qualitative literature study. Ten articles were identified and subjected to quality assessment using the SBU review template through structured searches using a PEO model via Pubmed and Cinahl. The results were then analyzed for the findings of the literature study. Results: Four main themes were identified: the need for knowledge, motivation, availability, and social contexts. Conclusion: Dietary changes are crucial in the treatment of type 2 diabetes and adherence to these changes depends heavily on personal factors in an individual’s life. Therefore, it’s important for nurses to provide effective person-centered care and it is necessary to have a holistic perspective in their supportive and health-promoting work.

Bakgrund: Diabetes mellitus typ 2 är en kronisk sjukdom som uppstår när kroppens vävnader blir insulinresistenta. Diabetes typ 2 är den vanligaste typen av diabetes som drabbar vuxna människor. Symtom vid diabetes typ 2 är ökad törst, stora urinmängder samt trötthet. Fysisk aktivitet och kostförändringar kan reglera blodsockret samt minska risken för kardiovaskulära komplikationer. Sjuksköterskans roll är att vårda, ge undervisning men också stödja personer med diabetes så att egenvården kan effektiviseras och förbättras.   Syfte: Att beskriva vuxna personers upplevelser av egenvård vid diabetes typ 2.  Metod: En litteraturöversikt baserad på tio kvalitativa artiklar från databaserna Pubmed och Cinhal Complete. Artiklarna analyserades och teman sammanställdes.      Resultat: Genom dataanalysen hittades tre huvudteman: Förändringar i det dagliga livet, Stöd samt Kulturella aspekter. Resultatet visade hur dessa aspekter upplevs av personer med diabetes typ 2.       Sammanfattning: Kostförändringar är nödvändigt men kan komma i konflikt med tidigare vanor. Sociala situationer, rädsla, psykisk ohälsa, bristande motivation samt kultur kan utgöra ett hinder för egenvård. Egenvården gynnas av stöd men kan även försämras om den är bristande. / Background: Type 2 Diabetes Mellitus is a chronic disease which occurs when the body tissue becomes more insulin resistant. Type 2 Diabetes is the most common type of diabetes which mostly affects adults. Symptoms of Type 2 Diabetes are increased thirst, urination and fatigue. Physical activity and dietary changes can regulate blood sugar and reduce the risk of cardiovascular issues. The nurse’s role is to give care, education but also to support people with diabetes so the self-care can be more effective and improved.      Aim: To describe adult’s experiences of self-care in diabetes type 2      Method: A literature review based on ten qualitative articles acquired from the databases Pubmed and Cinhal Complete. The articles were analysed and themes were compiled.      Results: Through the data analysis three main themes were found: Changes in daily life, Support including Cultural aspects. The result showed how people with diabetes type 2 experienced these aspects.      Summary: Dietary changes are necessary but may conflict with old habits. Social situations, fear, mental illness, lack of motivation and culture can be barriers for self-management. Self-management benefits from support but it can also deteriorate if it is insufficient.

Cehic, A & Meijer, S. Gruppundervisning för individer med diabetes typ 2. En litteraturstudie. Examensarbete i omvårdnad 15 högskolepoäng. Malmö högskola: Hälsa och samhälle, Utbildningsområde omvårdnad, 2009.Syftet med denna litteraturstudie var att undersöka om det finns stöd i vetenskaplig litteratur för att gruppundervisning för individer med typ 2-diabetes stimulerar till livsstilsförändringar. Författarna ville även belysa vilka faktorer i undervisningen som är viktiga. Litteraturstudien är genomförd efter modell av Friberg (2006). Tio kvantitativa artiklar ligger till grund för resultatet. Detta visar på starkt stöd för att gruppundervisning stimulerar typ 2-diabetiker till livsstilsförändringar. Viktiga faktorer i undervisningen var att den som ledde undervisningen hade förtrogenhetskunskap om diabetes, att undervisningen byggde på empowerment och/eller problembaserat lärande och stimulerade till aktiv medverkan av gruppdeltagarna, samt att utbildningen hade långtidsuppföljningar. Ingen skillnad sågs mellan undervisning som leddes av olika yrkeskategorier. Ytterligare forskning med fler studier med långtidsuppföljning samt kvalitativa studier av individernas egna upplevelser är önskvärda. / Cehic, A & Meijer, S. Group education for individuals with type 2 diabetes. A literature review. Degree Project, 15 Credit Points. Malmö University: Health and Society, Department of Nursing, 2009.The aim of this review was to examine if there is support in scientific literature that group education for individuals with type 2 diabetes encourages lifestyle changes. The authors also wished to describe what factors in group education are important. A model of Friberg (2006) was used as method for the review. The result, based on 10 quantitative articles, shows strong support for group education encouraging type 2 diabetics to make lifestyle changes. Important factors in education were familiarity of diabetes in the educators and education based on empowerment and/or problem based learning. Also was long term follow-up of the education groups important. No differences were seen in the results between groups led by different professions. Further research, more long-term studies and qualitative studies of how patients experience group education, is required.

No description available.

Background: To investigate the link between depressive symptoms and physical activity (PA) by examining their association across genders, age, and race/ethnicity. Methods: Data of the cross-sectional study were from the 2011 and 2015 Behavioral Risk Factor Surveillance System. The Patient Health Questionnaire-8, a well-validated instrument to measure depressive symptoms was used. PA was categorized as active, moderately active, and inactive. A generalized linear model specified with a Poisson distribution and log link was performed to investigate the association between depressive symptoms and PA across population characteristics. Results: No significant association between PA and depressive symptoms between genders and across racial/ethnic groups was found. Persons aged 65 years or older showed a significantly lower risk of depressive symptoms than those below 45 years when physically active (Adjusted Prevalence Ratio (APR) 0.36, 95% CI = 0.16–0.82) and moderately active (APR 0.39, 95% CI = 0.16–0.98). Limitations: The study included only leisure-time PA. Well-designed surveys that reflect a wider scope of PA are needed to strengthen the analysis. Conclusions: Compared to younger adults, older adults may gain further health benefits in reducing the risk of depressive symptoms by being physically active. Similar health benefits may be gained from PA between genders and between racial/ethnic groups. The different association between PA and depressive symptoms provides practical implications for the effective management of depressive symptoms in persons with diabetes.

Although higher dietary intake of MUFA has been shown to improve glycaemic control and lipid profiles, whether MUFA consumption from different sources is linked to the development of type 2 diabetes (T2D) remains unclear. We aimed to prospectively assess the associations of plant-derived MUFA (P-MUFA) and animal-derived MUFA (A-MUFA) intakes with T2D risk in a nationwide oriental cohort. Overall, 15 022 Chinese adults, aged andhe;20 years, from the China Health and Nutrition Survey (CHNS 1997-2011) were prospectively followed up for a median of 14 years. Consumption of MUFA from plant and animal sources was assessed using 3-d 24-h recalls in each survey, and the cumulative average of intake was calculated. Multivariable-adjusted Cox models were constructed to estimate the hazard ratios (HR) of T2D according to quartiles of MUFA intake. P-MUFA were mainly consumed from cooked vegetable oils, fried bread sticks and rice, while A-MUFA were mainly consumed from pork, lard and eggs. Intake of P-MUFA was associated with a higher risk of T2D (HRQ4 v. Q1 1-50 (95 % CI 1-18, 1-90); Ptrend = 0-0013), whereas A-MUFA showed no significant association (HRQ4 v. Q1 0-84 (95 % CI 0-59, 1-20); Ptrend = 0-30). When further considering the cooking method of food sources, consumption of P-MUFA from fried foods was positively associated with T2D risk (HRQ4 v. Q1 1-60 (95 % CI 1-26, 2-02); Ptrend = 0-0006), whereas non-fried P-MUFA were not associated. Intake of MUFA from fried plant-based foods may elevate T2D risk among the Chinese population.

Bakgrund: Diabetes mellitus (DM) ses som en av de snabbast växande sjukdomarna globalt där diabetes mellitus typ 2 (DMT2) står för majoriteten av alla insjuknanden av DM. Övervikt i kombination med fysisk inaktivitet är två av faktorerna som bidrar till insjuknandet av DMT2. Förändringar av kost och motion blir därför grunden i behandlingen. Sjuksköterskan behöver kunskap om individuella patienters behov för att möta patienters individuella kunskaper och behov. Syfte: Syftet var att beskriva patienters upplevelser av att förändra kost- och motionsvanor vid diabetes mellitus typ 2. Metod: Litteraturöversikten baserades på kvalitativa artiklar. Urvalsprocessen skedde utifrån Forsberg och Wengströms sex olika steg. I dataanalysen användes Fribergs metod. Databaserna Cinahl och Medline användes och resulterade i 12 artiklar. Resultat: Analysen resulterade i fyra huvudteman vilka var Vikten av tillräcklig kunskap och information för kostförändringar, Känslor och begränsningar vid kostförändringar, Sociala interaktioner och dessas påverkan på kostförändringar och Upplevelser av att förändra motionsvanor. Nio underteman identifierades.Slutsats: Resultatet visar på varierande faktorer som påverkar upplevelsen av kost- och motionsförändringar vid DMT2. En viktig aspekt är att sjuksköterskan tillämpar en personcentrerad vård för att öka patientens compliance. / Background: Diabetes mellitus (DM) is seen as one of the fastest growing diseases globally where type 2 diabetes mellitus (T2DM) accounts for the majority of all illnesses regarding DM. Obesity in combination with physical inactivity are two of the factors that contribute to the onset of T2DM. Changes in diet and exercise therefore become the basis of the treatment. The nurse needs pedagogical competence to meet patients' individual knowledge and needs. Aim: The aim was to describe patients' experiences of changing diet and exercise habits in type 2 diabetes mellitus. Method: The literature review was based on qualitative articles. Based on Forsberg and Wengström, the selection process took place in six different steps. Friberg's method was used in the data analysis. The Cinahl and Medline databases were used and resulted in 12 articles. Results: Four main themes were presented which were: The importance of sufficient knowledge and information for dietary changes, Emotions and limitations in dietary changes, Social interactions and their impact on dietary changes and Experiences of changing exercise habits. Nine sub-themes were identified. Conclusion: The results show varying factors that affect the experience of diet and exercise changes in T2DM. An important aspect is that the nurse applies a person-centered care to increase the patient's compliance.