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Bakgrund: Typ 2 diabetes är en folksjukdom som ökar både globalt och i Sverige. Bidragande faktorer för att utveckla sjukdomen är bland annat ohälsosamma kostvanor och stillasittande livsstil. Vid noggrann egenvårdsbehandling kring framför allt kost och motion kan blodsockernivåerna hållas jämna, vilket minskar risken för diabeteskomplikationer. Genom utbildning, stöd och motivation av vårdpersonal kan personer med typ 2 diabetes få hjälp att förändra ohälsosamma levnadsvanor. Syfte: Beskriva vårdpersonals upplevelser av att arbeta med förändring av levnadsvanor hos personer med typ 2 diabetes. Metod: Examensarbetet genomfördes som en litteraturstudie baserad på artiklar med kvalitativ ansats. Genom databaserna Cinahl och PubMed utvanns 10 artiklar vilka kvalitetsgranskades enligt SBU:s Granskningsmall för kvalitativ forskning och analyserades utifrån Fribergs analysmetod. Resultat: Efter analys av samtliga artiklar identifierades tre huvudkategorier; organisationens betydelse, kompetens hos vårdpersonalen och utmaningar i patientmötet där resultatet presenteras i 8 underkategorier. Slutsats: Vårdpersonalen upplevde flera faktorer, både positiva och negativa som påverkade arbete med livsstilsförändring hos personer med typ 2 diabetes. Samverkan i multiprofessionellt team, god relation till patienter och patienters stöd av närstående upplevdes främja följsamhet hos patienter. Negativa faktorer som kan ses som hinder vid förändring av levnadsvanor var tidsbrist i arbetet, otillräckliga organisatoriska verktyg i form av vårdprogram och riktlinjer samt kunskapsluckor hos såväl vårdpersonal som hos patienter. / Background: Type 2 diabetes is a public health disease that increases both globally and in Sweden. Contributing factors to the development of the disease include unhealthy eating habits and sedentary lifestyle. With accurate self-care, especially regarding diet and exercise, blood sugar levels can be kept even, which reduces the risk of diabetic complications. Through education, support and motivation from health care professionals people with type 2 diabetes can get help to change unhealthy lifestyle habits. Purpose: Describe healthcare professionals’ experiences of working with lifestyle change in people withtype 2 diabetes. Method: This degree project was conducted as a literature review based on articles with a qualitative approach. The literature study was based on ten scientific articles found in the databases Cinahl and PubMed. Quality review of the articles according to SBU’s Review template for qualitative research and data analysis based on Friberg’s analysis method was conducted. Findings: After analysis of all articles, three main categories were identified; the importance of the organization, competence of the healthcare professionals and challenges in the patient meeting. The results were categorized into a total of 8 subcategories. Conclusion: The healthcare professionals experienced several factors, both positive and negative that influenced the work with lifestyle changes in people with type 2 diabetes. Collaboration in a multi-professional team, good relationship with the patients and patient support from relatives were experienced to promote patient compliance. Negative factors that can be seen as obstacles to lifestyle change were lack of time, insufficient organizational tools such as health care programs and guidelines and knowledge gaps in both health care staff and patients.

<p>  To improve cardiometabolic health, omnivores are often recommended to simultaneously adopt a healthy dietary pattern with an emphasis on increasing intakes of plant-based proteins and decreasing intakes of red and processed meats. However, the totality of observational and experimental results inconsistently supports relations between red meat intake and risks of cardiometabolic diseases such as cardiovascular disease and type 2 diabetes mellitus. Red meat is often not clearly or consistently defined within nutrition and health research and is consumed within healthy and unhealthy dietary patterns. These issues contribute to the conflicting findings. Observational data, which assess red meat (both unprocessed and processed) within an unrestricted Western-style dietary pattern, typically support positive associations with cardiometabolic disease incidence and mortality outcomes. Whereas experimental randomized controlled trial data consistently show that consuming healthy dietary patterns with or without the inclusion of lean unprocessed red meat, improve cardiometabolic disease risk factors. These discordant findings have left laymen, researchers,and policymakers alike to question whether a high intake of red meat is causally related to cardiometabolic disease outcomes. The results of the single blinded crossover randomized controlled feeding trial (Study 1, Chapter 3) support that consuming a U.S.-style healthy dietary pattern that included two 3oz servings/day of lean unprocessed beef did not adversely affect cardiometabolic disease risk factors. Based on observational and experimental research, the umbrella systematic review described in Chapter4, led to the inference that red and processed meats are not causally related with cardiovascular disease. However, relations between processed meat and mixed unprocessed and processed meat and type 2 diabetes were inferred to be potentially causal. Overall, the results described in this dissertation support that lean and unprocessed red meats consumed within healthy dietary patterns do not adversely affect cardiometabolic health</p>

<p>  </p> <p>The role of the endoplasmic reticulum (ER) Ca2+ release channels ryanodine receptor 2 (RyR2) and inositol 1,4,5-triphosphate receptor (IP3R) in pancreatic b-cell function are emerging, but are not well defined. It has been demonstrated that ER stress brought about by RyR2 dysfunction leads to impaired insulin secretion and contributes to the etiology of type 2 diabetes (T2D). Our work contributes to the understanding of the role of RyR2 in physiological pancreatic b-cell function and how loss of RyR2 contributes to the pathophysiology of T2D.</p> <p>To investigate the role of RyR2 in pancreatic b-cell function, we utilized CRISPR-Cas9 to delete RyR2 from the rat insulinoma INS-1 cell line (RyR2KO). We found that RyR2KO cells displayed an enhanced glucose-stimulated Ca2+ integral (area under the curve; AUC) and were sensitive to inhibition by the IP3R antagonist, xestospongin C. Loss of RyR2 also resulted in a reduction in IRBIT protein levels. Therefore, we deleted IRBIT from INS-1 cells (IRBITKO) and found that IRBITKO cells also displayed an increased Ca2+ AUC in response to glucose stimulation. We discovered that total cellular insulin content and secretion were reduced in RyR2KO cells, but more modestly reduced in IRBITKO cells. We found that <em>INS2</em> mRNA levels were reduced in both RyR2KO and IRBITKO cells, but <em>INS1</em> mRNA levels were specifically decreased in RyR2KO cells. Additionally, nuclear localization of S-adenosylhomocysteinase (AHCY) was increased in both RyR2KO and IRBITKO cells. DNA methylation of exon 2 of the <em>INS1</em> and <em>INS2</em> genes was more extensively methylated in RyR2KO and IRBITKO cells compared to controls. Proteomics analysis revealed that deletion of RyR2 or IRBIT resulted in differential regulation of 314 and 137 proteins, respectively, with 41 in common. Our results suggest that RyR2 regulates IRBIT levels and activity, and together maintain insulin content and secretion, and regulate the INS-1 cell proteome, perhaps via DNA methylation.</p> <p>The role of interplay between RyR2 and IP3R in Ca2+ signaling and homeostasis in pancreatic b-cell function remains understudied. Stimulation with the sulfonylurea tolbutamide resulted in markedly delayed Ca2+ transients in both RyR2KO and IRBITKO cells. Xestospongin C significantly reduced the AUC of Ca2+ in RyR2KO and IRBITKO cells. Muscarinic receptor stimulation revealed a markedly increased AUC of Ca2+ in IRBITKO cells compared to both RyR2KO and control INS-1 cells. Assessment of PLC activity revealed that basal and stimulated PLC activity were reduced in the absence of RyR2 or IRBIT. Store-operated Ca2+ entry (SOCE) following ER Ca2+ depletion revealed a decreased SOCE amplitude only in RyR2KO cells. Given evidence that phosphatidylinositol-4,5-bisphosphate (PIP2) depletion from the plasma membrane can regulate voltage-gated Ca2+ channel inhibition, we explored electrophysiological properties of all three cell lines. The frequency of glucose-stimulated action potentials was doubled in RyR2KO cells. Additionally, whole-cell voltage-gated Ca2+ current density was doubled in RyR2KO cells, and this current was more sensitive to hydrolysis of PIP2. These results evidence crosstalk between RyR2 and IP3R, and that RyR2 plays a critical role in maintaining proper Ca2+ homeostasis, PLC activity, and electrophysiological properties in pancreatic b-cells.</p>

It is estimated that 61% of people with Type 2 Diabetes (T2D) don't engage in any form of leisure time physical activity (LTPA) (Morrato, Hill, Wyatt, Ghushchyan, & Sullivan, 2007). One of the primary interventions to manage T2D is regular engagement in Leisure Time Physical Activity (LTPA) (Sigal, Kenny, Wasserman, Castaneda-Sceppa, & White, 2006). Many studies have tried to increase the frequency of LTPA in this population with little success (e.g., Williams, Bezner, Chesbro, & Leavitt, 2005). A new innovative approach to increasing engagement in LTPA is needed. Feelings of enjoyment have been found to correlate with adherence to LTPA (e.g., Williams, Papandonatos, Napolitano, Lewis, Whiteley, & Marcus, 2006) and theorized to be an outcome of experiencing something that is personally meaningful (Snyder & Lopez, 2002). It has also been found that "participation in leisure...continues when the experiences and/or the activity are meaningful to the individual" (Ragheb, 1996, p. 247). Thus, exploration of personal meanings that are valued and experienced within LTPA may be a key approach to effectively increasing LTPA. A content-analysis of the literature yielded the identification of five leisure meanings and three outcomes that are derived within and/or from leisure activity engagement. A new scale, the Leisure Meanings Gained and Outcomes Scale (LMGOS), was developed to reflect the findings. It was confirmed by an expert panel for face and content validity and then administered to Temple University students (n = 163). Exploratory factor analyses provided evidence for construct validity and reliability and led to further refinement. The refined LMGOS was given to adults with T2D (n = 26). The results showed significant correlations between specific leisure meanings gained and LTPA engagement, as well as between outcomes of meanings gained and LTPA engagement. The implications of the study include demonstrating: (a) the utility of a theoretically and psychometrically sound measure of the meanings gained and its outcomes via leisure (i.e., LMGOS), (b) the need for acknowledging meaning-oriented experiential and emotional properties of LTPA from a more holistic and humanistic perspective, and (c) the importance of meaning-seeking or meaning-making through leisure as a key facilitator to active living and health promotion for people including individuals with T2D. / Therapeutic Recreation

Bakgrund  Förekomsten av typ 2-diabetes ökar globalt. Att ha ohälsosamma levnadsvanor ökar risken för komplikationer och följdsjukdomar av diabetes samt bidrar till höga samhällskostnader och sjukdomsbördan i Sverige. Till levnadsvanor hör kostvanor, fysisk aktivitet, rökning och alkoholbruk. Sjuksköterskor har en viktig roll att främja hälsosamma levnadsvanor och hälsa hos personer med typ 2-diabetes. Stigmatisering och bristande kommunikation kan försvåra och utgöra ett hinder i sjuksköterskans arbete och bemötande. Motiverande samtal är en personcentrerad rådgivningsstil som kan användas för att stärka personens motivation till förändring. Det finns ett behov av att sammanställa aktuell forskning för att se hur motiverande samtal fungerar i detta sammanhang.  Syfte  Syftet var att beskriva motiverande samtal för att främja hälsosamma levnadsvanor och hälsa hos personer med typ 2-diabetes.  Metod  För att besvara syftet genomfördes en icke-systematisk litteraturöversikt där 11 vetenskapliga artiklar inkluderades. Litteratursökningen genomfördes i databaserna PubMed, CINAHL och PsycInfo. De inkluderade artiklarna genomgick en kvalitetsgranskning i enlighet med Sophiahemmet Högskolas bedömningsunderlag. Resultatet analyserades utifrån en integrerad dataanalys.  Resultat  I resultatet har det framkommit att motiverande samtal kan fungera för att främja hälsosamma kostvanor och fysisk aktivitet hos personer med typ 2-diabetes. Vidare visades att kommunikationen samt relationen förbättrades mellan sjuksköterskor och personer med typ 2-diabetes där även förbättrad fysisk, psykisk och social hälsa kunde ses. Resultatet diskuterades utifrån Travelbees omvårdnadsteori om mellanmänskliga aspekter av omvårdnad som handlar om att se personen bakom sjukdomen.  Slutsats  Denna litteraturöversikt belyser hur motiverande samtal kan fungera för att främja hälsosamma levnadsvanor och hälsa hos personer med typ 2-diabetes. Sammanställningen av aktuell forskning visar att det finns positiva samband mellan motiverande samtal och förbättrade kostvanor och fysisk aktivitet. Detta kan appliceras i sjuksköterskans profession för att stödja personer till förändrade levnadsvanor och hälsa. / Background  The prevalance of type 2 diabetes is increasing globally. Having unhealthy lifestyle habits increases the risk of complications and sequelae of diabetes and contributes to high social costs and the burden of disease in Sweden. Lifestyle habits include diet, physical activity, smoking and alcohol use. Nurses have an important role in promoting healthy lifestyles and health in people with type 2 diabetes. Stigmatization and lack of communication can make it difficult and constitute a barrier in the nurse's work and approach. Motivational interviewing is a person-centered counselling style that can be used to strengthen the person's motivation to change. There is a need to compile current research to see how motivational interviewing function in this context.  Aim  The aim was to describe motivational interviewing to promote healthy lifestyle habits and health in people with type 2 diabetes.  Method  In order to answer the purpose, a non-systematic literature review was made in which 11 scientific articles were included. The scientific articles were obtained from the databases PubMed, CINAHL and PsycInfo. The included articles have undergone a quality review in accordance with Sophiahemmet University's assessment documents. The result was analyzed based on an integrated data analysis.  Results  In the result, it has emerged that motivational interviewing can work to promote healthy dietary habits and physical activity in people with type 2 diabetes. Furthermore, it was shown that communication and the relationship improved between nurses and people with type 2 diabetes, where improved physical, mental and social health could also be seen. The result was discussed based on Travelbee's nursing theory about interpersonal aspects of nursing which is about seeing the person behind the illness.  Conclusions  This literature review highlights how motivational interviewing works to promote healthy lifestyle habits and health in people with type 2 diabetes. The compilation of current research shows that there are positive connections between motivational interviewing and improved dietary habits and physical activity. This can be applied in the nursing profession to support people to change lifestyles and health.

Introduction The prevalence of prediabetes in adults aged 18 or older was as high as 38% between 2017-2020. Youth-onset T2DM is a more aggressive phenotype than T2DM that occurs later in life. Young adults with T2DM have poorer health outcomes, lose an average of 15 years of life, all resulting in significant economic burden impacting the person. Current self-management interventions do not improve health outcomes in young adults with T2DM. Purpose The purpose of this research was to explore the self-care experiences of young adults living with T2DM. Methods Existential hermeneutic phenomenology informed the research. Inclusion criteria as follows: adults aged 18 to 30 with a self-reported diagnosis of T2DM, physical presence in the United States, English proficiency. Purposive and snowball sampling were used. Nineteen participants were interviewed: 16 self-identified as Black, 2 as White, and 1 as Latino. Interviews were transcribed verbatim. Transcripts were analyzed using an iterative approach for meaning units and themes. Thematic meanings were identified from the data. Results The grand theme my journey and two themes: finding out and navigating, three subthemes include distress, around me, and my duties. The second subtheme, around me, included two micro themes: support and juggling. The third subtheme, my duties, included three micro themes: exercise, education, and trigger surveillance. Several factors were unique to young adults' perception of self-care. Perceptions of time, support networks, novel coping strategies, and search for disease literacy impacted self-care perceptions and understanding. Results suggest the need for future person-centered, self-care intervention research with young adults that could result in improved health outcomes.

We have previously demonstrated that long-term dietary Se deficiency in old Terc-/- mice with humanized telomeres induces type-2 diabetes and exacerbates age-dependent increases in the abundance of A. muciniphila and Lachnospiraceae, which are related to obesity and metabolic syndromes. The objectives of this dissertation are: 1) to determine the minimum intake of Se required for type 2 diabetes prevention in middle-aged mice; 2) to evaluate the efficacy of A. muciniphila and R. torques (a Lachnospiraceae family member) to intervene dietary Se deficiency-induced type 2 diabetes and the underlying mechanisms; 3) to assess sex differences in the responses to dietary Se deficiency and oral gavage of such bacteria. Our results demonstrated that mice fed diets containing ≤0.10 mg Se/kg developed glucose intolerance and insulin resistance at middle-aged stage. To address objectives 2 and 3, we showed that dietary Se deficiency exacerbated type-2 diabetes-like phenotypes in males but the extent was less in females aged 7 and 13 months. Oral gavage of A. muciniphila into either antibiotics-treated or conventional mice ameliorated these phenotypes and elevated beneficial bacteria (Lactobacillus, F. prausnitzii, and Roseburia spp./E. rectale) abundance, but reduced E. coli abundance. Dietary Se deficiency decreased intestinal barrier functions and induced intestinal inflammation. In conventional mice, A. muciniphila oral gavage reversed such intestinal defects but did not affect the expression of selenoproteins. By contrast, oral gavage of R. torques did not restore dietary Se deficiency-induced type 2 diabetes-like phenotypes in female mature mice and showed opposite impacts on the change of the 4 specific genera in comparison with A. muciniphila oral gavage. Taken together, our findings demonstrate that suboptimal body Se status induces type 2 diabetes and reshapes gut microbiota in an age- and sex-dependent manner. Such metabolic defects in conventional Se-deficient mice can be alleviated by A. muciniphila but not R. torques supplement, which may counteract common intestinal defects in metabolic syndrome. In conclusion, optimal Se at nutritional level of intake is necessary to prevent type 2 diabetes. A. muciniphila is a promising supplement for alleviation of type 2 diabetes and possibly other metabolic diseases in relation to intestinal inflammation and glucose dysregulation.

Most research on human pancreatic islets is conducted on samples obtained from normoglycaemic or diseased brain-dead donors and thus cannot accurately describe the molecular changes of pancreatic islet beta cells as they progress towards a state of deficient insulin secretion in type 2 diabetes (T2D). Here, we conduct a comprehensive multi-omics analysis of pancreatic islets obtained from metabolically profiled pancreatectomized living human donors stratified along the glycemic continuum, from normoglycemia to T2D. We find that islet pools isolated from surgical samples by laser-capture microdissection display remarkably more heterogeneous transcriptomic and proteomic profiles in patients with diabetes than in non-diabetic controls. The differential regulation of islet gene expression is already observed in prediabetic individuals with impaired glucose tolerance. Our findings demonstrate a progressive, but disharmonic, remodelling of mature beta cells, challenging current hypotheses of linear trajectories toward precursor or transdifferentiation stages in T2D. Furthermore, through integration of islet transcriptomics with preoperative blood plasma lipidomics, we define the relative importance of gene coexpression modules and lipids that are positively or negatively associated with HbA1c levels, pointing to potential prognostic markers.

Bakgrund: Diabetes är en folksjukdom som ökar i världen. För en framgångsrik behandling behöver personer med diagnosen diabetes typ 2 förutom medicinsk vård även ändra sin livsstil vilket främst innefattar förändrade vanor kring kost och fysisk aktivitet.  Syfte: Syftet med denna studie var att beskriva personers upplevelser av livsstilsförändringar vid diabetes typ 2. Metod: Allmän litteraturöversikt. Systematiska sökningar gjordes i databaserna CINAHL och PubMed. Kvalitativ innehållsanalys genomfördes för analys. En tematisk analys gjordes av nio forskningsartiklar och dess resultat. Resultat: Resultatet genererade två teman med respektive två subteman, Motivation - Motiverade till livsstilsförändringar och Omotiverade till livsstilsförändringar, Ändra och bibehålla vanor - Beteendeförändringar och Praktiska utmaningar  Slutsats: Resultaten pekade på att motivation, bibehållandet av livsstilsförändringar över tid, känslor relaterade till diagnosen och socialt sammanhang var avgörande för livsstilsförändring. Sjuksköterskor har en viktig funktion att förstå patienters unika livssituationer och levnadsvillkor för att effektivt kunna stödja dem i att göra nödvändiga livsstilsförändring. Fortsatt forskning: Studien understryker även behovet av fortsatt forskning för personer med diabetes typ 2 med fokus på den yngre befolkningens omvårdnadsbehov och livsstilsförändringar. Nyckelord: Diabetes mellitus typ 2, livsstilsförändring, omvårdnad, personer, personcentrerad vård, upplevelser / Background: Diabetes is a common disease that is increasing worldwide. For successful treatment, individuals diagnosed with type 2 diabetes need not only medical care but also to change their lifestyle, which mainly involves changing habits related to diet and physical activity. Purpose: The purpose of this study was to describe individuals' experiences with lifestyle changes in type 2 diabetes. Method: General literature review. Systematic searches were conducted in the CINAHL and PubMed databases. Qualitative content analysis was performed for analysis. A thematic analysis was done of nine research articles and their results. Results: The results generated four themes two subthemes each, Motivation - Motivated for Lifestyle Changes and Unmotivated for Lifestyle Changes, Changing and Maintaining Habits - Behavioral Changes and Practical Challenges.  Conclusion: The results indicated that motivation, maintaining lifestyle changes over time, emotions related to the diagnosis, and social context was crucial for succeeding with lifestyle changes. Nurses play a significant role in understanding patients' unique life situations and living conditions to effectively support them in making necessary lifestyle changes. Continued Research: The study also emphasizes the need for further research on individuals with type 2 diabetes, focusing on the care needs and lifestyle changes of the younger population. Keywords: Experiences, lifestyle changes, nursing, person-centered care, persons, type 2 diabetes mellitus.