Bakgrund   Det spås att 1,3 miljarder människor kommer att lida av diabetes år 2050, där typ 2-diabetes är den främsta orsaken till den snabba ökningen. Ohälsosamma livsstilsvanor kombinerat med ärftlighet och ålder ökar risken för att drabbas av sjukdomen. Behandling av typ 2-diabetes innefattar medicinering samt livsstilsförändringar för att uppnå god egenvård och stabila blodglukosvärden. Vårdpersonal spelar en viktig roll i att involvera och motivera personer med typ 2-diabetes till egenvård. Det finns ett behov av att belysa patientutbildningar som stödjer egenvård och sprida framgångsrika exempel för att främja god hantering av sjukdomen. Syfte  Att belysa patientutbildningar för stöd till egenvård hos vuxna med typ 2-diabetes. Metod  En icke-systematisk litteraturöversikt som baserades på 13 vetenskapliga originalartiklar med kvalitativ och kvantitativ ansats har genomförts. Systematisk datainsamling genomfördes för att inhämta artiklar från databaserna PubMed och CINAHL, med hjälp av identifierade sökord. Artiklarna har genomgått kvalitetsgranskning utifrån Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering och kvalitet. Resultatet sammanställdes och analyserades med en integrerad dataanalys. Resultat Två huvudteman framkom ur sammanställningen av studiens resultat - Utbildningar för ökad kunskap och motivation samt Stärkt egenvårdsförmåga. Kunskap och utbildning har visat sig spela en betydande roll för att möjliggöra för patienter med typ 2-diabetes att genomföra nödvändiga livsstilsanpassningar och utöva god egenvård. En känsla av kontinuerligt stöd har visat sig vara en viktig motivationsfaktor. Resultatet visade att patienter som känner stöd är mer benägna att ta ansvar för sin egenvård och därmed minska risken för komplikationer och uppleva god livskvalitet trots sjukdom.  Slutsats Oavsett utbildningsmetod är deltagarnas engagemang och motivation till förändring avgörande faktorer. Grupputbildningar och individuella interventioner ger positiva resultat av ökad sjukdomskunskap och motivationen för egenvård. Personcentrerad vård är av största vikt för att säkerställa framgången för patientutbildningar för personer med typ 2-diabetes. / Background It is projected that 1.3 billion people will suffer from diabetes by 2050, type 2 diabetes being the primary cause of its rapid increase. Poor lifestyle habits combined with heredity and age increase the risk of type 2 diabetes. Treatment involves medication and lifestyle changes. Healthcare professionals play a crucial role in involving and motivating patients towards self-care. There is a need to highlight education programs that support self-care and spread examples to promote better management of the disease. Aim To highlight patient education that encourages self-care to adults with type 2 diabetes. Method A non-systematic literature review was conducted, analyzing 13 scientific original articles using both qualitative and quantitative approaches. Systematic data collection was carried out to retrieve articles from the databases PubMed and CINAHL, using identified search terms. Articles underwent a quality assessment based on the evaluation criteria for scientific classification and quality from Sophiahemmet University. The results were compiled and analyzed using an integrated data analysis.  Results Two main themes emerged in the compilation of the results - Education for increased knowledge and motivation, and Enhanced self-care ability. Knowledge and education play significant roles in enabling patients with type 2 diabetes to make necessary lifestyle adjustments and practice good self-care. A sense of support has proven to be a motivating factor. Patients who feel supported are more likely to take responsibility for their self-care, reducing the risk of complications and can experience a good quality of life despite their disease. Conclusions Regardless of education method, a participant's commitment and motivation to change are crucial factors. Both group training and individual interventions yield positive results in disease knowledge and motivation for self-care. Person-centered care is essential in ensuring the success of self-care programs for individuals with type 2 diabetes.

Bakgrund Diabetes mellitus typ 2 är en sjukdom vars prevalensen ökar i världen. Behandlingen består av läkemedel och egenvårdsåtgärder, innehållande bland annat hälsosam kost och ökad fysisk aktivitet. Stöttande anhöriga kan öka följsamheten för behandlingen.     Syfte Att undersöka effekter av fysisk träning för personer med DMT2. Metod En kvantitativ litteraturanalys genomfördes. Databassökning i Pubmed och Cinahl. Nio randomiserade kontrollerade studier granskades enligt Olsson och Sörensens mall för kvantitativa studier. Analysen av studierna gjordes i enlighet med Popenoes mall. Resultat Interventionerna bestod av tre olika typer av träning: Aerob fysisk aktivitet, muskelstärkande fysisk aktivitet och högintensiv intervallträning. Studierna varierade i längd mellan 10 veckor och ett år och mätvärdena var bland annat hba1c, olika typer av kroppsfett och plasmaglukos. Minskning av fettmassa var signifikant i alla studier förutom en och hba1c minskade signifikant i tre studier.   Konklusion Resultatet kan tyda på att en minskning av fett kan ske vid träningsinterventioner, att MFA kan öka den fettfri massa och att HIIT och AFA kan öka kondition för personer med DMT2. / Background Type 2 diabetes mellitus is a disease whose prevalence is increasing worldwide. Treatment consists of medication and self-care measures, including a healthy diet and increased physical activity. Supportive family members can increase adherence to treatment. Aim To investigate the effects of physical exercise on people with diabetes mellitus type 2 Methods A quantitative literature analysis was conducted. Database search in PubMed and Cinahl. Nine randomised controlled trials were reviewed according to Olsson and Sörensens template for quantitative studies.  The studies were analysed according to the Popenoe template. Results The interventions consisted of three different types of exercise: Aerobic physical activity, muscle-strengthening physical activity and high-intensity interval training. The studies varied in length from 10 weeks to one year and the measurements included hba1c, fat mass and plasma glucose. Reduction in fat mass was significant in all but one study and hba1c decreased significantly in three studies. Conclusion The results may indicate that a reduction in fat can occur with exercise interventions, that MFA can increase fat-free mass and that HIIT and AFA can increase fitness for people with DMT2.

Bakgrund Typ 2 diabetes är en snabbt växande kronisk sjukdom som förväntas öka kraftigt runt om i världen och leder till svåra komplikationer. Hälsofrämjande arbete är en central dimension vid typ 2 diabetes som ger patienterna möjlighet att aktivt främja sin hälsa och förbygga sjukdom. Syfte Syftet var att beskriva sjuksköterskors uppfattningar av det som påverkar arbetet med hälsofrämjande insatser vid typ 2 diabetes inom primärvården. Metod En strukturerad litteraturöversikt baserad på femton vetenskapliga artiklar publicerade mellan åren 2013 och 2023. Artiklarna var av kvalitativ design och inhämtade från databaserna CINAHL och PubMed. Artiklarna har analyserats med Fribergs fyrstegsmetod där resultaten sammanställdes till en ny helhet. Resultat Resultat presenteras i tre huvudkategorier: patienternas förutsättningar, sjuksköterskors förhållningssätt och organisatoriska förutsättningar följt av sju underkategorier: Behov av kunskap, förmåga till kunskapsinhämtning, eget ansvar, personcentrerat förhållningssätt, stödjande roll, tidsbrist och teamarbete. Slutsats Hälsofrämjande insatser påverkas av tre centrala dimensioner som interagerar med varandra: patient, sjuksköterska och sjukvårdsorganisationen. För att kunna arbeta hälsofrämjande behöver sjuksköterskan organisationens stöd och en arbetsmiljö som möjliggör personcentrerad vård vid hälsofrämjande insatser. / Background Type 2 diabetes is a rapidly growing chronic disease that is expected to increase significantly worldwide and it can lead to severe complications. Health promoting work is central dimension in type 2 diabetes that enables patients to actively promote their health and prevent illness. Aim The aim is to describe nurses' perceptions of factors influencing work with health promotion in type 2 diabetes within primary care. Method A structured literature review based on fifteen scientific articles published between 2013 and 2023. The articles are of qualitative design and were searched in the databases CINAHL and PubMed. Fifteen articles were analysed using Friberg's integrated synthesis method. Results The results are presented in three main categories: patients' conditions, nurses' approaches, and organizational conditions, followed by seven subcategories: Need of knowledge, ability to acquire knowledge, self-responsibility, person-centered approach, supportive role, lack of time and teamwork. Conclusions Health promotion interventions are influenced by three central dimensions that interact with each other: the patient, the nurse, and the healthcare organization. To work with health promotion, the nurse needs the support of the organization and a work environment that enables person-centered care in health promotion interventions.

Bakgrund: Typ 2-diabetes är en kronisk sjukdom som drabbar miljontals människor runt om i världen, och antalet personer som får diagnosen ökar varje år. Förekomsten av sjukdomen är till stor del kopplad till ohälsosamma livsstilsvanor, såsom dålig kost, otillräcklig fysisk aktivitet, hög alkoholkonsumtion och rökning. Sjukdomen kräver förändringar i livsstil och egenvård. I syfte att stödja egenvård är patientutbildning en viktig aspekt i vården av personer med typ 2-diabetes. Syfte: Syftet var att belysa hur patienter med diabetes typ 2 upplever sjuksköterskeledd patientutbildning i egenvård. Metod: En litteraturöversikt där systematisk sökning genomfördes i databaser CINAHL, PubMed och PsycInfo. Det var begränsat till artiklar som publicerats den senaste 10 åren, skrivna på engelska och enbart vuxna. Sexton artiklar inkluderas, varav femton kvalitativa och med blandad metod. En induktiv innehållsanalys genomfördes utifrån Tomas och Hardens tematiska analys i tre steg. Resultat: Resultatet visade varierande upplevelser av patientutbildning som gavs av sjuksköterska, och det framkom olika faktorer som hade betydelse för egenvård. Resultatet presenteras genom två huvudteman: (1) Upplevelser av kunskap och information (2) Betydelse av relationer och stöd för lärande. Slutsats: Sjuksköterskeledd patientutbildning hade positiv effekt på deltagarnas kunskap om sjukdomen, och ökade förståelse för egen roll och ansvar. Sjuksköterskor uppfyller en viktig roll i att utbilda, stödja och skapa förutsättningar för egenvård. Det framkom även vissa kunskapsluckor och barriärer som gör det svårt för patienter att omsätta kunskapen i det dagliga livet. Vidare forskning i området är nödvändigt för att främja egenvården. / Background: Type 2 diabetes is a chronic disease that affects millions of people around the world, and the number of people being diagnosed is increasing every year. The occurrence of the disease is largely linked to unhealthy lifestyle habits, such as poor diet, insufficient physical activity, overweight/obesity, excessive alcohol consumption and smoking. The disease requires changes in lifestyle and self-care. Patient education is therefore an important aspect in the care of people with type 2 diabetes. Aim: A literature review that highlights how patients with type 2 diabetes experience nurse-led patient education in self-care. Methods: A literature review in which a systematic search was carried out in databases CINAHL, PubMed and PsycInfo. It was limited to articles published in the last 10 years, written in English and adults only. Sixteen articles are included, of which fifteen are qualitative and with a mixed method. An inductive content analysis was carried out using Tomas and Harden's three step thematic analysis. Results: The results showed varying experiences of patient education given by nurses, and different factors emerged that were important for self-care. The results are presented through two main themes: (1) Experiences of knowledge and information (2) Importance of relationships and support for learning. Conclusions: Nurse-led patient education had a positive effect on the participants' knowledge of the disease, and increased understanding of their own role and responsibility. Nurses fulfill an important role in educating, supporting, and creating conditions for self-care. There were also certain knowledge gaps and barriers that made it difficult to implement the knowledge in daily life. Further research in the area is necessary to promote self-care.

Bakgrund: Diabetes typ 2 har blivit en av vår tids största folkhälsosjukdomar. Det som är hoppfullt är att sjukdomen går att fördröja och till och med förhindra med sunda levnadsvanor. För de redan drabbade går det att göra mycket för att förbättra hälsan och förhindra följdsjukdomar. Distriktssköterskor har en central roll i diabetesvård inom primärvård, för att genom det hälsofrämjande samtalet motivera patienter till egenvård. Syfte: Syftet med studien var att belysa förutsättningar som distriktssköterskor inom primärvård har för hälsofrämjande samtal med patienter som har diabetes typ 2. Metod: Studien genomfördes med kvalitativ metod där 14 distriktssköterskor svarade på en enkät med öppna frågor. Resultatet bearbetades med hjälp av kvalitativ innehållsanalys. Resultat: Förutsättningar för goda hälsofrämjande samtal påverkas av distriktssköterskans utbildning, avsatt tid för samtalet och möjligheten att inhämta och lämna ut adekvat information. Teamarbetet är av betydelse och den viktigaste teammedlemmen är patienten. Det är viktigt att patienten känner delaktighet i samtalet för att bli motiverad att ta ansvar för sin hälsa. Konklusion: Utbildning, tid och information är viktiga premisser för ett bra patientmöte. Det visade sig också att samarbete med andra professioner och samarbete med patienten är viktigt för ett bra teamarbete. / Background: Type 2 diabetes has become one of the biggest public health diseases of our time. What is hopeful is that the disease can be delayed and even prevented with healthy lifestyle habits. For those already affected, there is much you can do yourself to improve your health and prevent sequelae. The district nurse has a central role in diabetes care in primary care, in order to motivate the patient to self-care through the health-promoting conversation. Aim: The purpose of the study was to highlight the presuppositions that district nurses in primary care have for health-promoting conversations with patients who have type 2 diabetes. Method: The study was conducted using a qualitative method where 14 district nurses answered a questionnaire with open questions. The results were processed using qualitative content analysis. Findings: Presuppositions for good health-promoting conversations are affected by the district nurse's education, the time allocated for the conversation and the ability to obtain and provide adequate information. Teamwork is important and the most important team member is the patient. It is important that the patient feels participation in the conversation in order to be motivated to take responsibility for their health. Conclusion: Education, time and information are important premises for a good patient meeting. It also showed that collaboration with other professions and collaboration with the patient is important for good teamwork.

Master of Public Health / Human Nutrition / Richard R. Rosenkranz / Background: Type 2 diabetes mellitus (T2DM) is a costly and burdensome lifelong disease, and without proper glycemic control, severe life-threatening complications result. In Southeast Asia, the prevalence of T2DM is forecast to increase markedly from 2000 to 2030. Although literature reviews on lifestyle modification for glycemic control are available, these are mainly for the Western context, and there is a dearth of evidence for Southeast Asians who are at greater risk of T2DM and have differing patterns of diet, physical activity and body composition than Western populations. Objective: To systematically review literature on the effectiveness of lifestyle modification interventions for glycemic control in T2DM patients from Southeast Asia. Methods: Randomized controlled trials (RCT) with interventions ≥ 8 weeks that compared HbA1c or blood glucose for intervention (lifestyle modification) versus control groups were identified from searches in Cochrane Library, CINAHL, PubMed, ProQuest, Science Direct, SPORTDiscus, Scopus and Web of Science. Results: Seven RCTs (679 participants) meeting inclusion and exclusion criteria were identified. There was a significant reduction in HbA1c% (MD = -0.56%; 95% CI = -0.95,-0.16%; p = 0.006; n = 5 studies) and in blood glucose mg/dl (MD = -16.76 mg/dl; 95% CI = -31.36, -2.17 mg/dl; p = 0.02; n = 4 studies) over 3 months for lifestyle modification intervention groups. Lifestyle interventions included diet (n = 2), exercise (n = 2), and general lifestyle interventions (n = 3). Duration of interventions ranged from 12 weeks to 6 months. Studies included populations from Thailand (n = 5) and Malaysia (n = 2). Conclusion: Overall, lifestyle modification interventions are effective for the glycemic control of T2DM patients in countries of Southeast Asia.

The aim of the study was to evaluate type 2 diabetes mellitus (DM) medicine management in Government Clinics in Maseru, Lesotho. A two-dimensional research method was employed, consisting of a literature review and an empirical investigation. The objective of the literature review was to provide information on the pathophysiology, signs and symptoms, diagnosis, treatment and clinical management of DM. The empirical investigation consisted of a descriptive pharmacoepidemiological study, in which data for analysis was collected retrospectively from patients‘ medical records (―bukanas‖) at dispensing points, a using data collection tool. The selected study sites were Domiciliary Health Center, Mabote, Likotsi, and Qoaling filter clinics in Maseru district of Lesotho. Data on costs of antidiabetic agents was collected from purchase invoices provided by the pharmacy department of Domiciliary Health Center. Results showed that the overall ratio of males to females was 1.3. There were no statistical difference in DM prevalence between males and females in the different clinics (p = 0.48). The mean age of males and females was 57.5 ± 14.2 years and 58.6 ± 11.3 years, respectively (Cohen‘s d = 0.07). DM was more prevalent in patients 59 to 69 years for both males and females, with the exception of Mabote and Qoaling filter clinics, where DM was more prevalent in patients 49 to 59 years. These differences in prevalence were not statically significant. Overall, 20% (n = 69) of the study sample had DM alone, while 80.0% of patients had DM concurrently with hypertension. The odds ratio implicated that women were 1.7 times more likely to have hypertension concurrently with Type 2 Diabetes Mellitus. The mean blood glucose level at 95% confidence interval for females and males were 10.1 ± 5.9 mmol/L (95% CI: 10.1–11.7) and 10.9 ± 6.2 mmol/L (95% CI: 11.0–14.0) respectively. The difference in the mean blood glucose levels of males vs. females was not statistically significant (p = 0.07). In both males and females there were outliers as high as 33.3 mmol/L. Metformin 850 mg given three times, metformin 500 mg three times a day, glibenclamide 10 mg daily and glibenclamide 5 mg twice daily are oral hypoglycaemic agents that were first, second, third and fourth choice treatment of DM at all four study sites at a frequency of 54.2% (n = 160), 27.7% (n = 82), 4% (n = 12) and 2.7% (n = 27), respectively. Actraphane® 20 units in the morning and 10 units in the evening was prescribed at a frequency of 11.6% (n = 432) in comparison to other Actraphane®-containing regimens. The frequencies of prescribing metformin and Actraphane® as combination therapies represented 10.6% (n = 40), 7.1% (n = 27), and 6.6% (n = 25), respectively, for Actraphane® 20 units in the morning and 10 units in the evening, plus metformin 500 mg three times per day; Actraphane® 20 units in the morning and 10 units in the evening plus metformin 850 mg three times per day; and Actraphane® 30 units in the morning and 15 units in the evening plus metformin 850 mg three times per day. The combination therapy of metformin and glibenclamide were prescribed at frequencies of 24.6% (n = 172), 22.9% (n = 160), and 13.4% (n = 94) respectively for glibenclamide 10 mg daily plus metformin 850 mg three times per day, glibenclamide 5 mg daily plus metformin 850 mg three times per day, and glibenclamide 5 mg once a day plus metformin 500 mg three times per day as first, second and third choice treatments at all study sites. The total cost incurred for all the oral drugs prescribed alone within different regimens was M75.6 with the weighted average cost per patient of M0.81 ± 2.06 per day compared to the cost of Actraphane® which was M40 660.52 per month at a weighted average daily cost of M21.43 ± 6.23 per patient. The overall cost of Actraphane® and metformin combination therapy amounted to M50 676.50, at an average cost per patient of M21.77 ± 6.80 per day. The cost of combination therapy consisting of metformin and glibenclamide amounted to M377.10, at a weighted average cost amounting to M0.49 ± 0.16 per patient, per day. Based on the results of this study some conclusions were reached on the prevalence of DM, prescribing patterns and the cost of antidiabetic agents. Recommendations pertaining to the clinics and further research were made. / MPham (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014

The aim of the study was to evaluate type 2 diabetes mellitus (DM) medicine management in Government Clinics in Maseru, Lesotho. A two-dimensional research method was employed, consisting of a literature review and an empirical investigation. The objective of the literature review was to provide information on the pathophysiology, signs and symptoms, diagnosis, treatment and clinical management of DM. The empirical investigation consisted of a descriptive pharmacoepidemiological study, in which data for analysis was collected retrospectively from patients‘ medical records (―bukanas‖) at dispensing points, a using data collection tool. The selected study sites were Domiciliary Health Center, Mabote, Likotsi, and Qoaling filter clinics in Maseru district of Lesotho. Data on costs of antidiabetic agents was collected from purchase invoices provided by the pharmacy department of Domiciliary Health Center. Results showed that the overall ratio of males to females was 1.3. There were no statistical difference in DM prevalence between males and females in the different clinics (p = 0.48). The mean age of males and females was 57.5 ± 14.2 years and 58.6 ± 11.3 years, respectively (Cohen‘s d = 0.07). DM was more prevalent in patients 59 to 69 years for both males and females, with the exception of Mabote and Qoaling filter clinics, where DM was more prevalent in patients 49 to 59 years. These differences in prevalence were not statically significant. Overall, 20% (n = 69) of the study sample had DM alone, while 80.0% of patients had DM concurrently with hypertension. The odds ratio implicated that women were 1.7 times more likely to have hypertension concurrently with Type 2 Diabetes Mellitus. The mean blood glucose level at 95% confidence interval for females and males were 10.1 ± 5.9 mmol/L (95% CI: 10.1–11.7) and 10.9 ± 6.2 mmol/L (95% CI: 11.0–14.0) respectively. The difference in the mean blood glucose levels of males vs. females was not statistically significant (p = 0.07). In both males and females there were outliers as high as 33.3 mmol/L. Metformin 850 mg given three times, metformin 500 mg three times a day, glibenclamide 10 mg daily and glibenclamide 5 mg twice daily are oral hypoglycaemic agents that were first, second, third and fourth choice treatment of DM at all four study sites at a frequency of 54.2% (n = 160), 27.7% (n = 82), 4% (n = 12) and 2.7% (n = 27), respectively. Actraphane® 20 units in the morning and 10 units in the evening was prescribed at a frequency of 11.6% (n = 432) in comparison to other Actraphane®-containing regimens. The frequencies of prescribing metformin and Actraphane® as combination therapies represented 10.6% (n = 40), 7.1% (n = 27), and 6.6% (n = 25), respectively, for Actraphane® 20 units in the morning and 10 units in the evening, plus metformin 500 mg three times per day; Actraphane® 20 units in the morning and 10 units in the evening plus metformin 850 mg three times per day; and Actraphane® 30 units in the morning and 15 units in the evening plus metformin 850 mg three times per day. The combination therapy of metformin and glibenclamide were prescribed at frequencies of 24.6% (n = 172), 22.9% (n = 160), and 13.4% (n = 94) respectively for glibenclamide 10 mg daily plus metformin 850 mg three times per day, glibenclamide 5 mg daily plus metformin 850 mg three times per day, and glibenclamide 5 mg once a day plus metformin 500 mg three times per day as first, second and third choice treatments at all study sites. The total cost incurred for all the oral drugs prescribed alone within different regimens was M75.6 with the weighted average cost per patient of M0.81 ± 2.06 per day compared to the cost of Actraphane® which was M40 660.52 per month at a weighted average daily cost of M21.43 ± 6.23 per patient. The overall cost of Actraphane® and metformin combination therapy amounted to M50 676.50, at an average cost per patient of M21.77 ± 6.80 per day. The cost of combination therapy consisting of metformin and glibenclamide amounted to M377.10, at a weighted average cost amounting to M0.49 ± 0.16 per patient, per day. Based on the results of this study some conclusions were reached on the prevalence of DM, prescribing patterns and the cost of antidiabetic agents. Recommendations pertaining to the clinics and further research were made. / MPham (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014

Bakgrund: I den systematiska litteratur studien Mat vid diabetes (SBU 2010) framgår det att lågkolhydratkost har likartade metabola effekter hos personer med diabetes i jämförelse med en traditionell lågfettskost. Trotts dessa råd visar en undersökning ifrån samma studie att endast 18 % av de tillfrågade sjuksköterskorna kliniskt tillämpade denna typ av kostintervention. Detta tycks vara problematiskt vilket nyligen uttryckts i en rad olika mediala sammanhang. Utöver denna debatt har vi idag också en epidemiskt stor utbredning av patienter med typ 2 diabetes mellitus vilket ställer krav på de allt mer begränsade resurser som finns inom vård och omsorg.  Syfte: Syftet var att beskriva lågkolhydratkostens metabola påverkan hos patienter med Diabetes Mellitus typ 2. Metod: Den elektroniska sökningen av artiklar utfördes i PubMed, CINAHL, Academic Search Elite, Scopus, Web of Science, PsycINFO (2009-2014) samt PMC (2011-2014). 13 artiklar bedömdes utifrån studiedesign, metabola markörer, intervention/kontrollgrupp, inklusions och exklusionskriterer vara lämpliga för studien. Resultat: En övergripande majoritet studierna visade på att lågkolhydratkosten gav signifikant förbättrade metabola markörer och framförallt gällande HbA1c och HDL-kolesterol. Endast en studie visade på ett negativt icke-signifikant resultat. Konklusion: Lågkolhydratkost förefaller utifrån studiens syfte och resultat som ett fullgott alternativ till den traditionella diabeteskost som utgör stora delar av den kostbehandling som patienter med T2DM får idag. Men kan innebära ett stort ansvar i det arbetsätt som sjuksköterskan tillämpar för att stödja och hjälpa en patient med T2DM att nå en god egenvård, hälsa och metabolkontroll  Nyckelord: Typ 2 diabetes mellitus. Lågkolhydratkost. Traditionell diabeteskost. Chronic Care Model. Egenvård. Empowerment. / Background: The systematic literature review Mat vid diabetes (SBU 2010) indicates that a low carbohydrate diet possesses similar metabolic effects in people with diabetes compared to a traditional low-fat diet. Contrary to this advice, a review from the same study portrayed that only 18% of the surveyed nurses clinically applied this type of diet intervention. This seems to be problematic, as was recently expressed in a variety of media. In addition to this debate, health care now also face a widespread epidemic of patients with type 2 diabetes mellitus which in turn puts the increasingly diminished and limited resources in health care under additional pressure.  Aim: The aim of this study was to describe a low-carbohydrate diet and its metabolic effects in patients with Diabetes Mellitus type 2. Method: Included articles in this review was found by searching PubMed, CINAHL, Academic Search Elite, Scopus, Web of Science, PsycINFO (2009-2014) and PMC (2011-2014). 13 articles were assessed to be eligible for this review by assessing study-design, metabolic markers, intervention / control group, inclusion and exclusions criteria.  Results: An overall majority of studies proved that a low carbohydrate diet could result in significantly improved metabolic markers, and in particular the HbA1c and HDL cholesterol. Only one study showed a negative non-significant result. Conclusion: A low-carbohydrate diet seems based on our findings as a viable alternative to the traditional diabetic diet which constitute a large part of the diet treatment that patients with T2DM receives from current healthcare. But this in turn implies that a greater responsibility is taken by the nurse in order to support and help a patient with T2DM to achieve a good self-care, health and metabolic control. Keywords: Type 2 diabetes mellitus. Low carbohydrate diets. Traditional diabetic diet. Chronic Care Model. Self-care. Empowerment.

Type 2 diabetes (T2D) has a genetic component which is only partially understood. The majority of genetic variance in disease susceptibility is unaccounted for, whilst the precise transcripts and molecular mechanisms through which most risk variants exert their effect is unclear. A complete understanding of T2D susceptibility mechanisms could have benefits in risk prediction, and in drug discovery through the identification of novel therapeutic targets. Work presented in this thesis aims to define relevant transcripts and disease mechanisms at known susceptibility loci, and to identify disease association with classes of genetic variation other than common single nucleotide polymorphisms (SNPs). KCNQ1 contains intronic variants associated with T2D susceptibility and β-cell dysfunction, but only maternally-inherited alleles confer increased disease risk. It maps within an imprinted domain with an established role in congenital and islet-specific growth phenotypes. Using human adult islet and foetal pancreas samples, I refined the transcripts and developmental stage at which T2D susceptibility must be conferred by demonstrating developmentally plastic monoallelic and biallelic expression. I identified a potential risk mechanism through the effect of T2D risk alleles upon DNA methylation. The disease-associated regions identified through genome-wide association (GWA) studies often contain multiple transcripts. I performed mRNA expression profiling of genes within loci associated with raised proinsulin/insulin ratios in human islets and metabolically relevant tissues. Some genes (notably CT62) were not expressed and therefore excluded from consideration for a risk effect, whilst others (for example C2CD4A) were highlighted as good regional candidates due to specific expression in relevant tissues. GWA studies for T2D risk have focused predominantly upon common single nucleotide polymorphisms. As part of a consortium conducing GWA analysis for copy number variation (CNV) and T2D risk, I optimised and compared alternative methods of CNV genotyping, before using this information to validate two signals of disease association. I genotyped three rare single nucleotide variants emerging from an association study with T2D risk based on imputed data, providing an indication of imputation accuracy and more powerful disease association analysis. These data underscore the challenge of translating association signals to causal mechanisms, and of identifying alternative forms of genomic variation which contribute to T2D risk. My work highlights candidates for functional analysis around proinsulin-associated loci, and makes significant progress towards uncovering risk mechanisms at the KCNQ1 locus.