Objective: To describe the design of the Feel4Diabetes-intervention and the baseline characteristics of the study sample. Design: School- and community-based intervention with cluster-randomized design, aiming to promote healthy lifestyle and tackle obesity and obesity-related metabolic risk factors for the prevention of type 2 diabetes among families from vulnerable population groups. The intervention was implemented in 2016–2018 and included: (i) the ‘all-families’ component, provided to all children and their families via a school- and community-based intervention; and (ii) an additional component, the ‘high-risk families’ component, provided to high-risk families for diabetes as identified with a discrete manner by the FINDRISC questionnaire, which comprised seven counselling sessions (2016–2017) and a text-messaging intervention (2017–2018) delivered by trained health professionals in out-of-school settings. Although the intervention was adjusted to local needs and contextual circumstances, standardized protocols and procedures were used across all countries for the process, impact, outcome and cost-effectiveness evaluation of the intervention. Setting: Primary schools and municipalities in six European countries. Subjects: Families (primary-school children, their parents and grandparents) were recruited from the overall population in low/middle-income countries (Bulgaria, Hungary), from low socio-economic areas in high-income countries (Belgium, Finland) and from countries under austerity measures (Greece, Spain). Results: The Feel4Diabetes-intervention reached 30 309 families from 236 primary schools. In total, 20 442 families were screened and 12 193 ‘all families’ and 2230 ‘high-risk families’ were measured at baseline. Conclusions: The Feel4Diabetes-intervention is expected to provide evidencebased results and key learnings that could guide the design and scaling-up of affordable and potentially cost-effective population-based interventions for the prevention of type 2 diabetes.

Background: Puerto Ricans experience high prevalence of type 2 diabetes (diabetes). Stress is a risk factor for diabetes. The allostatic load (AL) model explains how stress influences disease through a chain of physiological changes. Puerto Ricans experience psychological and physiological (obesity and high glycemic load (GL)) stressors linked with diabetes, yet how these stressors impact the AL chain and how their interplay affects glucose metabolism remains unknown. Methods: Using data from the Boston Puerto Rican Health Study, this thesis sought to examine: 1) the relationship between GL and primary AL markers, 2) the interaction between perceived stress and GL on HbA1c, and if primary AL markers mediate this interaction, and 3) the interaction between change in weight and in perceived stress on HbA1c. Results: 1) GL change over 2 years was associated with increases in primary AL markers in women. 2) Women with high perceived stress and high GL had higher HbA1c and primary AL markers did not mediate this interaction. 3) In women, there was an interaction between change in weight and perceived stress on HbA1c over 2 years, with the effect of weight change on HbA1c being greater with increases in perceived stress. None of these associations were observed in men. Conclusion: This study partially confirms the AL model in Puerto Rican women but not in men. It provides data to inform intervention targets to prevent and manage diabetes in Puerto Rican women and identifies women at high risk of diabetes in this minority group.

Bakgrund: Diabetes mellitus typ 2 är en kronisk systemsjukdom och en av de stora folksjukdomarna i världen och i Sverige. Diabetes typ 2 karakteriseras av förhöjd glukoshalt i blodet vilket på sikt kan orsaka komplikationer i blodkärlen. Utvecklingen av diabetes typ 2 påverkas av individens levnadsvanor så som ohälsosam kost, rökning och fysisk inaktivitet. Fysisk aktivitet är en central del i diabetesbehandlingen där effekten både förebygger uppkomsten av diabetes typ 2 och förbättrar metabol kontroll. Processen att gå från att vara fysiskt inaktiv till att vara fysisk aktiv är dock svår. Trots att det länge varit välkänt att fysisk aktivitet har både kortsiktiga och långsiktiga positiva effekter, har det varit svårt att motivera personer med diabetes typ 2 att förändra sitt beteende och öka sin fysiska aktivitetsnivå. Syfte: Syftet var att undersöka effekten av motivationshöjande metoder för att öka den fysiska aktivitetsnivån hos vuxna med diabetes typ 2. Metod: I arbetet användes en beskrivande design med allmän litteraturöversikt som datainsamlingsmetod med kvantitativ ansats. Litteraturöversikten är baserad på vetenskapliga kvantitativa originalartiklar publicerade mellan år 2011–2021. Sökningen utfördes med databaserna PubMed och CINAHL. Resultat: Interventioner med olika motivationshöjande metoder ökar fysisk aktivitet hos personer med diabetes typ 2. Både motiverande samtal och mobilhälsa som intervention visade en statistiskt signifikant skillnad på antal steg per dag, antal minuter total fysisk aktivitet samt olika intensitet av fysisk aktivitet. Slutsats: Motiverande samtal och mobilhälsa som intervention visade en god effekt på fysisk aktivitetsnivå. Mer forskning behövs i framtiden som undersöker effekten av andra motivationshöjande metoder, samt olika interventionsperioder / Background: Type 2 diabetes is a chronic disease and one of the major public diseases in the world as well as in Sweden. Type 2 diabetes is characterized by elevated levels of glucose in the blood, which leads to complications in the blood vessels. Development of type 2 diabetes is affected by the individual’s lifestyle habits such as unhealthy diet, smoking and physical inactivity. Physical activity is a central part in the treatment of diabetes, where the effect prevents the development of type 2 diabetes and improves metabolic control. The process of changing a habit of being physically inactive to physically active is difficult. Although it has been well known that physical activity has both short- and long-term positive effects, it has been difficult to motivate people with type 2 diabetes to change their behavior and be more physically active. Aim: The aim of the study was to examine the effect of motivation enhancing methods on the physical activity level in adults with type 2 diabetes. Method: A descriptive design with a general literature overview as a data collection method was used with a quantitative approach. The general literature overview is based on scientific quantitative original article’s, published between 2011–2021. The search was performed with PubMed and CINAHL databases. Result: Intervention with different motivation enhancing methods increases physical activity in people with type 2 diabetes. Both motivational interviewing and mobile health interventions showed a statistically significant difference regarding the number of steps per day, total minutes of physical activity and intensity of physical activity. Conclusion: Motivational interview and mobile health interventions elicit a good effect on physical activity. Further research is needed in the future which examines the effectiveness of other motivational enhancing methods as well as different intervention periods.

Bakgrund: Diabetes typ 2 är en allvarlig kronisk sjukdom som uppstår antingen via ärftlighet eller osund livsstil och behandlas med livsstilsförändringar. Sjukdomen ger upphov till kroppsliga symtom och komplikationer som kan orsaka påfrestningar, vilket kan orsaka ett lidande för den som drabbas av sjukdomen.   Syfte: Att beskriva hur patienter med diabetes typ 2 upplever livsstilsförändringar.    Metod: En kvalitativ allmän litteraturöversikt baserat på tio originalartiklar, med hjälp av databaserna Cinahl och Pubmed. Inkluderade artiklar kvalitetsgranskades och enbart hög och medelhög kvalité av artiklar valdes. Samtliga artiklar bearbetades och lästes igenom för att få fram kategorier.   Slutsats: Att ha diabetes typ 2 innebär en behandling med främst livsstilsförändringar och en individanpassad vård som ska vara personcentrerat. Hälso- och sjukvårdspersonal bör bli bättre på att informera patienten med diabetes typ 2 om komplikationer som kan uppstå. Dessa komplikationer kan uppstå på grund av att patienten bland annat inte gör sina livsstilsförändringar, såsom kostförändringar. Om patienten har kunskapen om varför det är bra med livsstilsförändringar kan det motivera dem så de kan jobba för att förebygga komplikationer som kan uppstå i samband med sjukdomen.   Nyckelord: Diabetes Mellitus typ 2, patientupplevelse, livsstilsförändringar, omvårdnad, litteraturöversikt

>Magister Scientiae - MSc / The burden of non-communicable diseases (NCDs) in South Africa is predicted to increase substantially in the next decades if the necessary preventative measures are not taken. The two most common NCDs associated with rapid mortality increase are diabetes mellitus (DM) and hypertension (HTN). Both of these diseases, i.e DM and HTN, can be a result of a combination of modifiable risk factors (behavioral) and non-modifiable risk factors (genetic, physiological, and environmental). New strategies implemented to manage these diseases should include addressing both modifiable and non-modifiable risk factors for patients with NCDs. The aim of this study was to contribute to the reduction of incidence of uncontrolled T2DM among patients taking metformin as a first-line anti-diabetic drug, through the development of individualized therapy for this drug. When implemented, this could be one of the healthcare strategies to address non-modifiable risk factors for patients with T2DM as an important NCD. The first objective of the study was to explore the prevalence and risk factors of DM and HTN in South Africa, especially within the economically disadvantaged population.

Background: Diabetes self-management education, including nutrition education (NE) is an essential component of diabetes management. Effective NE can assist individuals with type 2 diabetes mellitus (DM) in resource limited settings to improve their dietary self-care; an area cited among the most difficult with consequent improvement in health outcomes. Aim: To develop a NE programme that is tailored to the needs of adults with type 2 DM in a resource limited setting and to evaluate the programme's effectiveness on health outcomes. Setting: Makapanstad and Mathibestad community health centres in the Moretele sub-district, North West Province (South Africa). Methods: The study was done in three phases employing mixed methods research. Qualitative methods, using focus group discussions with 31 diabetic patients (a convenience purposive sample), and an open ended self-administered questionnaire with ten health professionals serving them, assessed the NE needs and preferences (phase 1). The data were analysed according to the framework approach. The results from the needs assessment were used to plan a tailored NE programme (phase 2). A randomised controlled trial (quantitative) with a sample of 82 patients (with HbA1c ≥ 8), allocated to either intervention or control groups, evaluated the effect of the NE programme (phase 3). Outcomes [HbA1c, dietary behaviours, blood lipids, blood pressure, body mass index (BMI), diabetes knowledge and attitudes towards diabetes and its treatment] were assessed at baseline, six months and 12 months respectively. An analysis of covariance (ANCOVA) compared the groups on measured outcomes using baseline values, age, gender, and clinic as covariates. Rank ANCOVA was used for dietary intake. The level of significance for all tests was set at α < 0.05 for a two-tailed test. Results: Needs assessment Diabetes related knowledge deficits and inappropriate dietary practices, including food portion control problems, inadequate intake of vegetables and fruits and unbalanced diets, were observed. Eight barriers and two facilitators to dietary adherence were identified. Financial constraint was the major barrier while social support was the major facilitator. NE recommendations included content related to the disease and diet, group education at the clinic, a competent educator, provision of education materials and inclusion of family members. The planned NE programme consisted of eight weekly training sessions and six follow-up sessions (monthly and bi-monthly), vegetable gardening demonstrations and education materials. Nutrition education programme effects: Seventy six participants (38 per group) completed the study. The differences in HbA1c (primary outcome) between the intervention and control groups were -0.62% (p=0.15) at six months and -0.67% (p=0.16) at 12 months. Few participants, four from the intervention group and one from the control group, achieved HbA1c target (<7%) at both six and 12 months, [(p=0.20), (p=0.36)] respectively. There were no significant between group differences in BMI, lipid profile and blood pressure at six months and 12 months. Starchy foods intake (median servings) were significantly lower in the intervention group compared to the control group, 9.3 vs. 10.8 (p=0.005) at six months and 9.9 vs. 11.9 (p=0.017) at 12 months. The proportion of participants growing own vegetables significantly increased in the intervention group compared to the control group 17/41 vs. 5/40 (p=0.003) at six months and 16/38 vs. 5/38 at 12 months. No significant group differences in the intake of energy, macronutrients, vegetable and fruits, sodium, cholesterol and fibre were observed at six and 12 months. Diabetes knowledge improved in the intervention group +0.95 (p=0.033) and +2.2 (p=0.000) when compared with the control group at six and 12 months respectively. There were no significant group differences in the attitudes towards diabetes and its treatment. Conclusions: The qualitative needs assessment provided insight for planning a tailored NE programme. The NE improved some dietary behaviours (starchy foods portion control and growing own vegetables) and diabetes knowledge. A non-significant lowering of HbA1c was observed. / Thesis (Phd)--University of Pretoria, 2013. / Human Nutrition / unrestricted

Le diabète est en progression au Bénin et sa prévalence est passée de 2,9% en 2008 à 12,4% en 2015. Or, il existe peu de données sur les facteurs favorisant ou aggravant la gestion de cette maladie. Cette recherche vise à évaluer les pratiques alimentaires des diabétiques et leur prise en charge nutritionnelle au Bénin. Une étude transversale auprès de 252 diabétiques âgés de 18 ans et plus suivis au Centre National Hospitalier Universitaire (CNHU) et à la banque d’insuline de Cotonou a été réalisée. Des rappels de 24h, des questionnaires et des mesures d’hémoglobine glyquée ont été colligés auprès des diabétiques et des entrevues ont été réalisées auprès de 18 professionnels de santé. Des analyse statistiques ont permis de rechercher les associations entre les pratiques alimentaires et la gestion du diabète et une grille d’analyse a permis de qualifier leur prise en charge nutritionnelle. Dans l’ensemble, les individus suivis au CNHU gèrent mieux leur diabète que ceux de la banque d’insuline. Il existe une différence significative dans la gestion du diabète selon l’âge et la profession. Les pratiques alimentaires sont surtout basées sur la cuisine maison mais les plats cuisinés souffrent de diversité. Peu de diabétiques ont une bonne gestion de leur diabète et ceux-ci reçoivent une prise en charge nutritionnelle déficiente variant d’un centre de diabétologie à l’autre. Il est important de mieux étudier les pratiques alimentaires des diabétiques, de standardiser la prise en charge nutritionnelle et de recruter des nutritionnistes dans les services de diabétologie au Bénin. / Diabetes is on the rise in Benin and its prevalence increased from 2.9% in 2008 to 12.4% in 2015. There is little information on the factors promoting or aggravating diabetes management. This research aims to evaluate the dietary practices of diabetics and their nutritional management by health professionals in Benin. We conducted a cross-sectional study of 252 diabetics aged 18 years and older followed at the Centre National Hospitalier Universitaire (CNHU) and the Cotonou insulin bank. Questionnaires, 24-hour recalls and glycated hemoglobin measurements were collected among the diabetics. Semi-directed interviews were also conducted with 18 health professionals. Statistical analyses were used to test for associations between dietary practices and diabetes management, and an analytical grid was used to qualify their nutritional management by health professionals. Overall, individuals monitored at the CNHU managed their diabetes better than those at the insulin bank. There is a significant difference in diabetes management by age and occupation. Dietary practices are mainly based on home-cooking, but dishes suffer from diversity. Few diabetics have good management of their diabetes and they receive poor nutritional management that varies from one diabetes centre to another. This study highlights the need to better study the dietary practices of diabetics, to standardize nutritional care and to recruit nutritionists in the diabetes services in Benin.

La stéatose hépatique non-alcoolique (NAFLD) est une altération hépatique fréquente dans le diabète de type 2 (DT2) et est associée à diverses complications telles que la mortalité. L’établissement d’outils de prédiction non-invasifs de NAFLD est primordial. Mon projet de maîtrise avait pour objectif d’établir des marqueurs génétiques de NAFLD dans le DT2 via deux stratégies : 1) une sélection non-ciblée des marqueurs génétiques (SNPs) via la méthode LASSO et 2) une sélection ciblée de SNPs rapportés comme liés à la maladie ou à des altérations associées. Une population de 4098 patients avec DT2 d’origine caucasienne (ADVANCE) a été utilisée. Des données statistiques sommaires d’études pangénomiques ont été exploitées pour sélectionner, via LASSO, les marqueurs génétiques (SNPs) à inclure dans le score de risque polygénique (PRS). J’ai également développé un modèle de 3210 SNPs ajusté par des covariables capable de prédire les taux élevés de ALT (AUC=0,69) et la mortalité non-cardiovasculaire (AUC=0,66). Le criblage du locus candidat PNPLA3-SAMM50 a mis en avant une diversité des associations génétiques aux différentes altérations métaboliques comme les taux de ALT (substitut du diagnostic de NAFLD) (rs2294915, P = 1,83x10-7), à la mortalité non-cardiovasculaire (rs2294917, P = 3,9x10-4) et à l’efficacité de la thérapie intensive antidiabétique chez certains patients de la population (porteurs GG de rs16991236, P=0,007). Mes travaux ont permis de mieux comprendre le fond génétique de NAFLD dans le DT2 et laissent envisager l’établissement d’outils de diagnostic et de suivi de la maladie plus adéquats. / Non-alcoholic fatty liver disease (NAFLD) is a liver disorder more frequent in type 2 diabetes (T2D) and is associated with complications such as mortality. For this reason, establishing non-invasive tools for predicting NAFLD is crucial. My master’s project aimed to establish genetic markers for NAFLD in T2D using two strategies: 1) a non-targeted selection of genetic markers (SNPs) by the LASSO method and 2) a targeted selection of SNPs reported as associated with the disease or its related abnormalities. A population involving 4098 patients with T2D and Caucasian ancestry was used. Summary statistics data of pangenomic studies were exploited for the selection of SNPs to be involved in the polygenic risk score (PRS). I also designed a model of 3210 SNPs adjusted by covariates and able to predict the high rates of ALT (AUC=0.69) and non-cardiovascular death (AUC=0.66). Mapping of the candidate locus PNPLA3-SAMM50 allowed the observation of diversity in terms of genetic association with the metabolic abnormalities such as ALT (surrogate of NAFLD) (rs2294915, P = 1.83x10-7), non-cardiovascular death (rs2294917, P = 3.9x10-4) and the efficiency of the intensive antidiabetic therapy within a subgroup in the population (individuals with GG of rs16991236, P = 0.007). My studies allowed for a better understanding of the genetic background of NAFLD in T2D and open perspectives for establishing more adequate tools for diagnosis and follow-up of the disease.

Type 2 diabetes mellitus (T2D) is a highly prevalent metabolic disorder linked with the development of specific complications and comorbidities that negatively affect life quality and greatly increase the risk of an early death. The main goal of T2D treatment, which in common clinical practice comprises lifestyle changes and pharmacotherapy, is to delay onset of these complications. Evidence from many recent studies shows the ability of some interventional methods to induce remission of T2D, meaning a major improvement or complete disappearance of T2D symptoms. Besides bariatric surgery procedures, some dietary regimens such as low-energy diet, low-carbohydrate diet and intermittent fasting, can also lead to T2D remission. Attributes of these dietary regimens, especially their effect in T2D treatment, is summarized in the theoretical part of this theses. The aim of the practical part of this thesis was to assess the effect of the dietary regimens mentioned above on morphometric and biochemical parameters associated with T2D by clinical and survey research. In most of the subjects with T2D, the individual dietary regimens, more precisely low-energy diet and low-carbohydrate diet, decreased body weight, where the weight loss induced by low-carbohydrate diet was caused by major decrease in the amount...

Bakgrund: Diabetes typ 2 är en kronisk sjukdom samt ett globalt folkhälsoproblem. Hälso-och sjukvården i många länder strävar efter att minska diabetesrelaterade komplikationer. Patientens egenvård och självhantering av diabetes typ 2 har en betydande roll i behandlingsförloppet. Digital hälsoteknik och m-hälsa är en resurs som kan möjliggöra att patienter känner sig delaktiga och självständiga i hantering av diabetes typ 2. Dessa hälsoinsatser har potential att öka patientens välbefinnande och livskvalité.   Syfte: Syftet är att beskriva erfarenheter från användning av m-hälsa och digital hälsoteknik bland patienter med diabetes typ 2.   Metod: Allmän litteraturöversikt med tematisk analys som baserades på 11 vetenskapliga originalartiklar med kvalitativ ansats. Resultat: Dataanalysen resulterade i fem teman: Förbättrad egenvård och empowerment, Ökad kunskap och patientcoaching, Integritet, säkerhet och trovärdighet, Tillgänglighet till vårdgivare, samt Utmaningar- kostnad och teknisk erfarenhet. Resultatet visade att det finns både möjligheter och utmaningar med användning av m-hälsa och digital hälsoteknik för patienter med diabetes typ 2. Dessa hälsoresurser kunde stärka patienters förmågan till egenvård som bidrog till ökad egenmakt och självständighet hos patienterna. Slutsats: Patienterna hade en positiv upplevelse av tillämpning av digital hälsoteknik och m-hälsa med avseende på egenvårdaktiviteter samt kunskap och kontroll över sjukdomstillståndet. Digitala hälsovårdstjänster på distans möjliggjorde en lätt och bekväm tillgång till sjukvårdspersonal för patienter med diabetes typ 2. Detta ökade deras tillfredsställelse och minskade behovet av fysiska besök av sjukvårdspersonal. Kostnaden för teknikutrustning samt låga nivåer av digital kompetens begränsade patienters upplevelse av de möjligheter som dessa resurser kan bidra med. En god och jämlik hälsa kan uppnås genom att öka medvetenheten kring de möjligheter som erbjuds av m-hälsa och digital hälsoteknik. / Background: Type 2 diabetes is a chronic disease and a global public health problem. Healthcare in many countries are working hard to reduce diabetes-related complications. Patient self-care and self-management of type 2 diabetes play a major roll during the treatment. Digital health technology and mHealth are resources that can enable patients to feel involved and independent in the management of type 2 diabetes. These health initiatives have the potential to increase the patient’s well-being and quality of life.  Aim: The aim was to describe experiences of the use of mHealth and digital health technologies among patients with type 2 diabetes.  Method: General literature review with thematic analysis based on 11 original scientific articles with a qualitative approach.  Results: The data analysis resulted in five themes: Improved self-care and empowerment, Increased knowledge and patient coaching, Integrity, safety and credibility, Accessibility to care providers, Challenges- costs and technical experience. The results showed that there are both opportunities and challenges with the use of m-health and digital health technology for patients with type 2 diabetes. These health resources could strengthen patients' ability to self-care which contributed to increased autonomy and independence in patients. Conclusions: The patients had a positive experience of applying digital heath technologies and mHealth regarding to self-care activities as well as knowledge and control over the disease state. Digital health care services in long distance enabled easy and convenient access to healthcare professionals for patient with type 2 diabetes, increased their satisfaction and reduced the need for physical visits by healthcare professionals. The cost of technology equipment and low levels of digital competence limited patients’ experience of the opportunities that might be used of these resources. Good and equal health can be achieved by increasing awareness of the opportunities offered by mHealth and digital health technologies.