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Problématique. La prévalence du diabète de type 2 (DT2) est plus de trois fois plus élevée chez les Premières Nations que chez la population générale au Canada. La qualité de l'alimentation des Premières Nations vivant sur-réserve est sous-optimale, dans un contexte où de multiples politiques coloniales ont forcé une transition alimentaire et rendu les aliments sains plus difficiles d'accès. Une alimentation de faible qualité s'accompagne généralement d'un risque accru de DT2. Objectifs. 1) Comparer la qualité de l’alimentation selon le statut diabétique autodéclaré chez les Premières Nations vivant sur-réserve au Canada. 2) Évaluer les associations entre la qualité de l’alimentation et le DT2 chez cette population. Méthodologie. Les données transversales ont été collectées entre 2009–2016 lors de l’« Étude sur l’alimentation, la nutrition et l’environnement chez les Premières Nations ». Des données de rappels de 24h ont été examinées pour 5 823 adultes (âgés de 19+ ans) membres de 84 communautés dans sept régions situées au sud du 60e parallèle au Canada. Les apports absolus en nutriments, la contribution énergétique des aliments traditionnels, l’indice canadien de saine alimentation (C-HEI) et la contribution énergétique des aliments ultra-transformés selon la classification NOVA ont été calculés pour chaque participant. Des statistiques descriptives et des modèles de régression logistique multiple ont permis d'évaluer les relations entre les mesures de la qualité de l'alimentation et le statut diabétique. Résultats. La prévalence du DT2 s’élevait à 17,9% chez les adultes des Premières Nations. Les individus diabétiques avaient une alimentation de qualité sous-optimale, mais tout de même légèrement supérieure à celle des non-diabétiques selon les apports en plusieurs nutriments clés et les trois indices globaux. Les personnes diabétiques consommaient également moins de boissons sucrées et de sucreries. Par rapport à ceux du tertile le plus bas, les adultes du tertile le plus élevé de l'indice C-HEI avaient un risque 53% plus élevé de présenter un DT2 (RC = 1,53, IC à 95 % : 1,09–2,15), après ajustement pour une gamme de variables. Conclusion. Chez les adultes des Premières Nations atteints du DT2, nos résultats suggèrent une amélioration des habitudes alimentaires après le diagnostic qui reflète les recommandations nutritionnelles pour les personnes atteintes de diabète. Cette étude est utile pour le co-développement de programmes d'intervention communautaires ciblant la prévention et la gestion du diabète d'une manière culturellement appropriée. / Background. The prevalence of type 2 diabetes (T2D) is more than three times higher among First Nations than in the general population in Canada. The diet quality of First Nations living on-reserve is nutritionally poor, in a context where multiple colonial policies have forced a dietary transition and made healthy foods more difficult to access. Low quality diets are generally associated with an increased risk of T2D. Objectives. 1) To compare diet quality among First Nations living on-reserve in Canada with and without T2D. 2) To measure associations between diet quality and T2D prevalence in this population. Methods. Cross-sectional data were collected between 2009–2016 during the "First Nations Food, Nutrition and Environment Study". Twenty-four-hour recall data were examined for 5,823 adults (aged 19+ years) from 84 communities in seven regions south of the 60th parallel in Canada. Absolute nutrient intakes, proportion of energy from traditional foods, the Canadian Healthy Eating Index (C-HEI) and proportion of energy from ultra-processed foods according to the NOVA classification were calculated for each participant. Descriptive statistics and multivariable logistic regression models assessed the relationships between diet quality measures and self-reported diabetes status. Results. The prevalence of T2D was 17.9% among First Nations adults. Participants with T2D had poor diet quality, but still slightly better than those without T2D based on intakes of several key nutrients and the three overall diet quality indices. Individuals with T2D also consumed fewer sugar-sweetened beverages and sweets. Compared with those in the lowest tertile, adults in the highest tertile of the C-HEI had 53% higher odds of T2D (OR = 1.53, 95% CI: 1.09-2.15), adjusting for sociodemographic and lifestyle covariates. Conclusion. Among First Nations with T2D, our results suggest an improvement in dietary habits after diagnosis that reflects dietary guidelines for people with diabetes. This is useful for the co-development of community-based intervention programs targeting the prevention and management of diabetes in a culturally appropriate way.

Bakgrund: Diabetes ökar i världen. Majoriteten av de som drabbas både i Sverige och internationellt har diabetes typ 2. Egenvård har stor betydelse för att förhindra komplikationer. Forskning visar att distriktssköterskor har uppmärksammat att patienter är i behov av personcentrerad vård för en god egenvård. Därmed är det viktigt att utforska patienters upplevelser av vad som främjar och hindrar rekommenderad egenvård.  Syfte: Syftet var att beskriva patienters upplevelser av vad som främjat respektive hindrat deras genomförande av rekommenderad egenvård vid diabetes typ 2.  Metod: Artiklar söktes i databaserna CINAHL och PubMed. En allmän litteraturöversikt utfördes och 16 vetenskapliga kvalitativa artiklar granskades med bedömningsmall från Statens beredning för medicinsk och social utvärdering samt analyserades med hjälp av Fribergs metod.   Resultat: Vad som främjat patienters genomförande av rekommenderad egenvård var: patienters upplevelse av att ha eget ansvar; patienters upplevelse av att ha goda sociala relationer; patienters upplevelse av att ha en god relation med vårdpersonal och patienters upplevelse av att erhålla optimalt med information och kunskap. Vad som hindrat patienters genomförande av rekommenderad egenvård var: patienters upplevelse av att känna svårigheter att upprätthålla motivation; patienters upplevelse av att sakna socialt stöd; patienters upplevelse av att sakna en god relation med vårdpersonal och patienters upplevelse av otillräcklig information och brist på kunskap. Slutsats: Resultatet ökar distriktssköterskors förståelse av patienters upplevelser av vad som främjar respektive hindrar rekommenderad egenvård vid diabetes typ 2, för att därmed kunna stödja samt öka patienters förutsättningar i genomförandet av rekommenderad egenvård. / Background: Cases of diabetes are increasing globally. The majority of those affected have type 2 diabetes. Self-care is of great importance in preventing complications related to type 2 diabetes. District nurses have expressed the need for a person-centered approach for patients to achieve good self-care according to previous research. Therefore, it is important to explore patients’ experiences of what promotes and hinders self-care.   Aim: The purpose was to describe patients experiences of what promotes and hinders the implementation of recommended self-care in type 2 diabetes.   Method: Articles were searched in the databases CINAHL and PubMed. A general literature review was performed, and 16 scientific qualitative articles were reviewed using an assessment template from the Swedish Agency for Health Technology Assessment and Assessment of Social Services and analyzed using Friberg's method.  Result: What promoted patients implementation of recommended self-care was: patient experience of having personal responsibility; patient experience of having good social relationships; patient experience of having a good relationship with the healthcare providers and patient experience of obtaining optimal information and knowledge. What hindered patients from implementing recommended self-care was: patient experience of feeling difficulties in maintaining motivation; patient experience of lacking social support; patient experience of lacking a good relationship with the healthcare providers and patient experience of insufficient information and lack of knowledge. Conclusion: The result increases the district nurses' understanding of patients' experiences of what promotes or hinders recommended self-care in type 2 diabetes, thus supporting and increasing patients' prerequisites in the implementation of recommended self-care.

Type 2 diabetes mellitus (T2DM) is a global health concern affecting six to ten percent of adults worldwide, with the number of diagnosed individuals projected to double in the next 25 years. However, effective public health strategies can help mitigate its impact on quality of life, morbidity, mortality and the associated social and economic burden. In Sweden, screening programs classify individuals with Impaired fasting glucose (IFG) as high-risk individuals, however scholars argue that preventative measures should also include those at lower fasting plasma glucose (FPG) concentrations as some evidence suggests that the disease begins developing several years before the current threshold. A systematic review and meta-analysis of cohort and case-control studies was conducted with the purpose of exploring the IFG threshold from a longitudinal perspective. Eleven studies on the incidence rates of T2DM in normoglycemic individuals and seven studies on pre-diagnostic trajectories of FPG concentrations were analyzed. Incidence rates increased progressively across the normoglycemic range, with a twelve-fold difference between the low and high end. FPG concentrations in eventual progressors and non-diabetic controls were significantly different twelve years prior to diagnosis. Mildly increasing FPG concentrations were observed in eventual progressors until three years before diagnosis, at which a larger increase followed. In the last year before diagnosis, FPG concentrations rose dramatically in this group. The findings imply that a lowering of the threshold would extend the time spent in the IFG state, allowing for earlier identification of at-risk individuals. In addition, further stratification of normoglycemic range may enhance the accuracy of T2DM risk assessment.

Indiana University-Purdue University Indianapolis (IUPUI) / Talks about health literacy, beliefs about health of immigrants from the French speaking countries of West Africa in the USA. How they handle diabetes, navigate the health care system and how they get their information.

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Es gibt widersprüchliche Befunde darüber, ob depressive Symptome Risikofaktoren für die Neumanifestation eines Diabetes sind oder ob umgekehrt auch Diabetes ein Risikofaktor für depressive Zustände ist. Daher untersuchen wir die längsschnittlichen wechselseitigen Assoziationen zwischen depressiven Symptomen und Typ-2-Diabetes (T2D) sowie die Auswirkungen des gemeinsamen Auftretens beider Erkrankungen auf die Mortalität anhand einer Stichprobe von Hausarztpatienten im Verlauf eines im Mittel 3,5-jährigen Beobachtungszeitraums. Die depressive Symptomatik wurde anhand des Depression Screening Questionnaire (DSQ) kategorial sowie dimensional betrachtet. Die Einteilung in Patienten mit normalem Nüchternblutzucker (NBZ), erhöhtem NBZ sowie T2D (unbehandelt, medikamentös, mit Insulin/kombiniert behandelt) erfolgte nach Arztangaben beziehungsweise nach Laborbefunden zur Baseline-Untersuchung. Die Inzidenz des T2D bei Patienten mit beziehungsweise ohne depressive Symptome betrug 25,6 und 20,9 pro 1000 Personenjahre. Bei dimensionaler Betrachtung des DSQ erhöhte sich das T2D-Risiko (unadjustiert) um das 1,03-Fache [KI (95%): 1,01–1,06] bei punktweisem Anstieg des DSQ. Die Inzidenz depressiver Symptome per 1000 Personenjahre betrug 30,5 für Patienten mit normalem, 34,2 für Patienten mit erhöhtem NBZ, 36,4 für unbehandelte, 32,3 für oral behandelte und 47,8 für insulinbehandelte T2D-Patienten. Verglichen mit Patienten mit einem normalen NBZ hatten insulinbehandelte Patienten ein höheres Risiko für depressive Symptome [HR: 1,71; KI (95%): 1,03–2,83] und oral behandelte T2D-Patienten ein niedrigeres Risiko [HR: 0,58; KI (95%): 0,36–0,96]. Verglichen mit Patienten ohne T2D und depressiver Symptomatik ist das Vorliegen beider Erkrankungen mit einer erhöhten Mortalität assoziiert [HR: 2,49; KI (95%):1,45–4,28]. Die Ergebnisse deuten an, dass vor allem eine Insulinbehandlung bei T2D-Patienten mit inzidenten depressiven Symptomen assoziiert ist. / It is unclear whether depressive symptoms are a risk factor for incident diabetes or diabetes is a risk factor for depressive conditions. Therefore, we examined the longitudinal bidirectional associations between depressive symptoms and type 2 diabetes (T2D) as well as the impact of both diseases on (all cause) mortality in a sample of primary care patients over a 3.5-years follow-up period on average. Depressive symptomatology, defined by the Depression Screening Questionnaire (DSQ), was examined both categorically and dimensionally. Patients were categorized as normal fasting glucose (NFG), impaired fasting glucose (IFG), and T2D (untreated, oral antidiabetics, insulin/combined treatment) according to physician ratings and baseline lab values. Incidence rates of T2D were 25.6 and 20.9 per 1000 person–years for those with and without depressive symptoms, respectively. The unadjusted risk of incident type 2 diabetes was 1.03 times higher (CI(95%): 1.01–1.06) for each 1-point increment in DSQ score. The incidence rates of elevated depressive symptoms per 1000 person–years were 30.5 for NFG, 34.2 for IFG, 36.4 for untreated T2D, 32.3 for oral treated T2D, and 47.8 for insulin/combined-treated T2D patients. Compared to NFG patients, insulin-treated patients had a higher risk of incident depressive symptoms (HR: 1.71; CI(95%): 1.03–2.83) and oral-treated patients had a lower risk (HR: 0.58; CI(95%): 0.36–0.96). Higher mortality rates were associated with both diseases compared to patients without T2D or depressive symptoms at baseline (HR: 2.49; CI(95%):1.45–4.28). Results indicate that especially insulin treatment in T2D patients is associated with incident depressive symptoms.