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BakgrundDiabetes typ 2 är en av de vanligaste kroniska sjukdomarna i Sverige. Det innebär att cellernas respons till insulin har blivit nedsatt. Genom att kontrollera blodsockret minskas risken att drabbas av komplikationer. Målsättningen med insulinbehandling är patientens välmående och ett stabilt blodsocker. När patienterna är inne i en förändring känner de sig sårbara, då de behöver lära sig nya mönster. SyfteAtt beskriva upplevelsen hos personer med diabetes typ 2 vid övergång från tablett till insulinbehandling i Sverige. MetodKvalitativ litteraturöversikt genomfördes utifrån 11 vetenskapliga artiklar. Insamlingen av resultat artiklarna gjordes utifrån databaserna CINAHL, PubMed och MEDLINE. Artiklarna analyserades enligt Fribergs analysmetod. ResultatResultatet presenteras i fem huvudteman: Svårt att förstå vad som hänt, olika rädslor, förändring i vardagen, behov av stöd och bättre kontroll av blodsockret. KonklusionNär patienterna skulle börja med insulinbehandling hade de svårt att förstå vad som hänt. De blev rädda när de fick råd från vårdpersonalen att söka om komplikationer på nätet. Patienterna hade för höga krav som gjorde att de mådde dåligt. Deras självförtroende förbättrades när de visste mer om diabetesen. När de fick träffa vårdpersonalen skapade det ett lugn hos patienterna. Genom att träffa andra som har samma sjukdom förbättrades patienternas egenvård. / BackgroundType 2 diabetes is one of the most common chronic diseases in Sweden. This means that the cells' response to insulin has been impaired. By controlling blood sugar, the risk of complications is reduced. The goal of insulin therapy is the patient's well-being and stable blood sugar. When patients are in the midst of a change, they feel vulnerable, as they need to learn new patterns. AimTo describe the experience in people with type 2 diabetes when switching from tablet to insulin treatment in Sweden. MethodA qualitative literature review was conducted based on 11 scientific articles. The collection of the results was done based on the databases CINAHL, PubMed and MEDLINE. The articles were analyzed according to Friberg's method of analysis. Findings:The results are presented in five main themes: Difficult to understand what has happened, different fears, change in everyday life, need for support and better control of blood sugar. ConclusionWhen the patients were about to start insulin treatment, they had difficulty understanding what had happened. They were frightened when they were advised by the healthcare professional to search for complications online. The patients' demands were too high, which made them feel bad. Their self-confidence improved when they knew more about the diabetes. When they got to meet the healthcare staff, it created a sense of calm among the patients. By meeting others who have the same disease, the patients' self-care improved.

<p>This thesis examined the biochemical role of skeletal muscle mitochondria and metabolic consequences of mitochondrial adaptations to exercise in individuals with poor glycemic control. Mitochondrial dysfunction and/or ectopic lipid accumulation has been implicated in the pathogenesis of metabolic-related diseases such as obesity and type 2 diabetes (T2D). However, whether mitochondrial dysfunction is the cause of insulin resistance and T2D or is a consequence of this disorder remains controversial. Alternatively, pro-inflammatory stress signals initiated through altered secretion of adipocytokines and oxidative stress may be a unifying mechanism underlying insulin resistance and T2D. Furthermore, the impact of exercise on muscle adaptation in insulin-resistant states is not well defined. At rest and prior to exercise training, no evidence of mitochondrial dysfunction or disproportionate intramyocellular lipid (IMCL) accretion was detected in obese, insulin-resistant skeletal muscle biopsy samples <em>vs.</em> healthy, lean age-, and fitness-matched men. In response to exercise training (12 weeks, consisting of 32 sessions of 30-60 min @ 50-70% maximal oxygen uptake [VO₂peak]), there was an increase in mitochondrial oxidative phosphorylation (OXPHOS) capacity, mitochondrial content, and IMCL deposition with sub-cellular specificity. Exercise training also reduced both skeletal muscle and systemic oxidative damage, already elevated in the obese. The improved adipocytokine profile associated with obesity after training also coincided with improvements in glycemic regulation. Patients with genetic mitochondrial mutations, resulting in skeletal muscle mitochondrial dysfunction have an increase prevalence of dysglycemia/T2D. However, when evaluated against age- and activity-matched normoglycemic myopathy controls, no differences in mitochondrial electron transport chain protein subunits, mitochondrial or IMCL density, or level of whole-body insulin resistance was detected. In fact, dysglycemic mitochondrial myopathy patients demonstrated <em>higher </em>skeletal muscle OXPHOS capacity and Akt activation, a key step in insulin-stimulated glucose transport activity as compared with normoglycemic mitochondrial myopathy patients. Interestingly, a significant impairment in β-cell function (defective insulin secretion), in the dysglycemic patients was observed coincident with elevated glucose levels during the oral glucose tolerance test (OGTT). These findings indicate that insulin resistance does not cause skeletal muscle mitochondrial dysfunction/IMCL accumulation or <em>vice versa</em> and provides evidence against a direct link between mitochondrial dysfunction and the development of insulin resistance/T2D. Perhaps, oxidative stress/inflammation and pancreatic β-cell erosion mediate the observed obesity-induced insulin resistance and mitochondrial myopathy-associated T2D, respectively? Twelve weeks of moderate endurance exercise is an effective strategy to improve mitochondrial capacity, oxidative damage, inflammation, and glycemic regulation in insulin-resistant, obese individuals, but an improvement in muscle insulin sensitivity did not appear to be required.</p> / Doctor of Philosophy (Medical Science)

Urinary incontinence (UI) is a common complication of type 2 diabetes mellitus (T2DM) for older adults (≥65 years) that is associated with reduced quality of life and risk of institutionalization. This convergent, mixed methods research study, informed by a model of clinical complexity, explored the complexities for older adults living with UI and T2DM, and home-care nurses providing care to this population in Ontario. In the quantitative strand, the most recently completed Resident Assessment Instruments for Home Care from 2011-2016 for older home-care clients with diabetes were analyzed to determine the prevalence and correlates of UI. The qualitative strand used interpretive description methodology to explore the experiences of 18 older adults living with T2DM and UI receiving home-care services and the experiences of 15 home-care nurses caring for this population. These data sources were converged to describe the factors that contributed to complexity for older adults with UI and T2DM: (a) challenges of living with multiple chronic conditions (MCC), medical instability, and high care needs; (b) financial barriers; (c) lack of understanding of older adults’ values and preferences by health-care providers; (d) caregiver burden; and (e) functional impairments. The health-care system contributed to this complexity through: (a) inadequate and minimal provision of nursing and interprofessional home-care services; (b) task-focused structure of home care; (c) minimal interprofessional collaboration; (d) lack of an integrated communication system; and (e) lack of navigation to community resources. Providing health-promoting care for older adults with UI and T2DM requires a system-wide enactment of integrated care that takes both a person- and family-centred care and social determinants of health approach. Interventions for older adults with MCC should involve standardized and comprehensive assessment, care coordination, enhanced nursing service provision, and interprofessional team collaboration to attend to the dimensions of complexity and ensure the needs of older adults and their caregivers are met. / Thesis / Doctor of Philosophy (PhD) / Many older adults with diabetes have urinary incontinence that is emotionally and physically bothersome. These older adults also receive home-care services. In this study, older adults were asked about how they care for their diabetes and incontinence and how their home-care workers help them with this care. Nurse participants were asked how they help older adults with diabetes and incontinence and the challenges they face. The results of home-care assessments done in Ontario were also analyzed to learn how common incontinence is in older adults with diabetes and factors associated with having incontinence. The study found many factors, such as living with many chronic conditions and lack of finances, as well limited home-care service provision and the task-focus of home care created challenges for these older adults. The findings can help in making changes to home-care service delivery to improve care for older adults and their caregivers.

Bakgrund: Diabetes mellitus typ 2 (DMT2) ökar globalt. Sjukdomstillståndet kan lindras med en sund livsstil och en god egenvård. En stor andel personer med sjukdomen har svårt att följa rekommendationer för egenvård. Sjuksköterskan har därav en viktig roll för att egenvården ska bli optimalt utformad utifrån individuella perspektiv.    Syfte: Att beskriva personers upplevelser av följsamhet till egenvård vid diabetes mellitus typ 2.   Metod: En kvalitativ litteraturöversikt med en induktiv ansats. Vetenskapliga artiklar hämtade från CINAHL och PubMed bearbetades med hjälp av Fribergs analyssteg.    Resultat: Nyckelfynden presenteras i tre kategorier med sex tillhörande subkategorier. Socioekonomiska faktorer presenteras som första kategori, med bostad, ekonomi, familjestöd och sociala aspekter som tillhörande subkategorier. Andra kategorin tar upp psykologiska faktorer, varav förnekelse, attityd och känslomässiga utmaningar benämns som subkategorier. Tredje kategorin är sjukvårdsinsatser, som redogör för relation, bemötande och informationsutbyte.   Slutsats: Egenvård vid DMT2 är utmanande. Socioekonomiska faktorer var förutsättningar för att kunna prioritera egenvård, där en stabil boendesituation och ekonomisk trygghet i kombination med stöd från både familj och samhälle gynnade en god följsamhet till egenvård. Psykologiska faktorer kunde skapa utmaningar kring förmågan att hantera egenvården. Det är av stor vikt att hälso- och sjukvårdspersonal ger adekvat information och skapar individualiserade behandlingsplaner. Ett tillräckligt stöd från hälso- och sjukvården sågs kunna stärka personens motivation till att upprätthålla en god egenvård. Det är betydelsefullt att vårdpersonal och samhälle får en ökad förståelse för faktorer som påverkar följsamhet till egenvård för att kunna ge rätt stöd. / Title: People´s experiences of adherence to self-care in diabetes mellitus type 2. Background: Type 2 Diabetes Mellitus (T2DM) is increasing globally. The condition can be alleviated with a healthy lifestyle and considerable self-care. A large proportion of individuals with the disease struggle to adhere to self-care recommendations. Therefore, nurses play a vital role in optimizing self-care tailored to individual perspectives.  Aim: To describe people´s experiences of adherence to self-care in type 2 diabetes mellitus.  Method: A qualitative litterature review with an inductive approach. Scientific articles were retrieved from CINAHL and PubMed and analyzed using Friberg´s analysis steps.  Results: Key findings are presented in three categories with six associated subcategories. Socioeconomic factors are presented as the first category, with housing, economy, family support and social aspects as its subcategories. The second category addresses psychological factors, including denial, attitude and emotional challenges as subcategories. The third category pertains to healthcare interventions, detailing relationship, treatment and information exchange.  Conclusion: Self-care in T2DM is challenging. Socioeconomic factors are prerequisites for prioritizing self-care, where a stable housing situation and financial security, combined with support from both family and the community promote good adherence to self-care practices. Psychological factors can create challenges in managing self-care. It is crucial for healthcare professionals to provide adequate information and create individualized treatment plans. Adequate support from the healthcare system has been shown to strengthen a person´s motivation to maintain effective self-care. It is important for healthcare personal and the community to gain better understanding of the factors that influence adherence to self-care in order to provide appropriate support.

Type 2 Diabetes Mellitus (T2D) is a major public health issue. Diabetes prevalence is growing and is the 7th leading cause of death in the US. Virginia has a slightly higher prevalence than the national average. Community-based diabetes lifestyle management programs that include a physical activity component are effective at improving glycemic control and influencing lifestyle behavior changes among people with T2D. The Balanced Living with Diabetes (BLD) program uses an active learning approach to improve glycemic control and healthful lifestyles. The Lifelong Improvements through Fitness Together (LIFT) program uses behavioral strategies to improve functional fitness, participant engagement, and program adherence. Participant retention is a challenge for community-based program. Participants may start the program, but then fail to complete the program and/or adhere to program recommendations. Two pilot studies were conducted to evaluate strategies for increasing participant retention and improving outcomes. The first evaluated the implementation and impact of a retention plan implemented in BLD programs conducted from 2015-2017. There were more participants returned to the reunion class session prior the development of the retention plan. There were improvements in some health behavior and self-efficacy indicators in programs that used the retention materials, however, impacts on outcomes were mixed. Preliminary findings showed that the retention plan could be a tool for providing additional support to participants, however strategies for dissemination of the retention plan needs to be reevaluated. The second study evaluated the impact on participant engagement and program outcomes when the LIFT program is incorporated with the BLD program. There was an increase in participant retention, self-efficacy and one health behavior for physical activity and health behaviors related to diet in BLD+LIFT programs. Extension Agents are willing to implement the BLD+LIFT programs, however, clarity of program logistics is needed prior to implementation. Extension Agents indicated that implementation of these programs in locations with older adults that have greater disability may not be the best locations. Having larger studies on the effect of incorporation of LIFT with the BLD with older adult populations that have fewer co-morbidities are needed to determine the impact of addition of the LIFT program with the BLD program on program outcomes. / Doctor of Philosophy / Type 2 Diabetes is a chronic disease in which the body does not use insulin as it should or does not produce enough insulin. The Centers for Disease Control and Prevention (CDC) indicates that the prevalence of diabetes was 23.1 million among US adults in 2015. The prevalence of diabetes in Virginia is slightly higher than the national average. Community-based diabetes lifestyle management programs that include a physical activity component are effective in improving glycemic control and influencing lifestyle behavior changes among people with T2D. The Balanced Living with Diabetes (BLD) program uses an active learning approach to influence better glycemic control and healthful lifestyles. The Lifelong Improvements through Fitness Together (LIFT) program uses behavioral strategies to improve functional fitness, participant engagement, and program adherence. The challenge with implementing community-based programs is retention. Participants may initially agree to participate in a program, but then fail to complete the program and/or follow program recommendations. Two pilot studies were conducted to evaluate strategies for increasing participant retention and program outcomes. The first evaluated the implementation and impact of a retention plan implemented in BLD programs conducted from 2015-2017. There were more participants returned prior to the development of the retention plan. There were improvements in some health behavior and self-efficacy indicators in programs that used the retention materials, however, impacts on outcomes were mixed. Findings showed that the retention plan could be a useful tool for providing additional support to participants, however distribution of the retention plan needs to be reevaluated. The second study evaluated the impact of program outcomes when the LIFT program is combined with the BLD program. There was an increase in participants' self-confidence to perform physical activity and making changes in their diet in BLD+LIFT groups. Extension Agents were enthusiastic about conducting more BLD+LIFT programs, however, program procedures and the time commitment needs to be understood before doing so. Expanding the conduct of BLD programs that incorporate the LIFT program can be effective in improving glycemic control and increasing physical activity, however, working with organizations that service people that have diabetes with fewer health conditions that limit physical activity may be more effective.