Background: Obesity has a strong correlation with the development of type two diabetes. As adipocytes accrue in obesity, adipose tissue may induce peripheral insulin resistance through production of pro-inflammatory cytokines and unregulated lipolysis after stimulation by endotoxin or environmental cues. In addition, obesity poses high risks of Staphylococcal aureus colonization and infection. S. aureus can cause a myriad of serious illnesses in both immunocompromised and healthy individuals. Among the S. aureus virulence factors, superantigens are essential for the organism's pathogenesis. Considering the importance of the microbiome in human illnesses, we've examined whether a staphylococcal superantigen has an impact on the development of type two diabetes via affecting adipocytes. Methodology/Principal Findings: Immortalized human adipocytes and primary rabbit adipocytes that were exposed to staphylococcal superantigen toxic shock syndrome toxin-1 (TSST-1), stimulated proinflammatory cytokine and chemokine production, and such effect could be significantly enhanced by endotoxin and other proinflammatory signals. TSST-1 also induced lipolysis in both human and rabbit adipocytes. Prolonged treatment of rabbits with subclinical doses of TSST-1 induced chronic systemic inflammation and an increase in circulating endotoxin levels, which ultimately resulted in adipocyte insulin resistance and systemic impaired glucose intolerance. Conclusions/Significance: Endotoxin has been proposed to contribute to type two diabetes through enhanced insulin resistance after chronic exposure and stimulation of adipocytes to produce cytokines. Our data indicate that staphylococcal superantigen(s) can also induce proinflammatory cytokine production and lipolysis in adipocytes. In addition, rabbits, which are chronically exposed to superantigens, experience asymptomatic systemic inflammation, high circulating endotoxin levels, and glucose metabolism deficiency that are common symptoms observed in type two diabetic patients. This is the first study that has shown that bacterial exotoxins, like S. aureus superantigen, may directly contribute to the development of type two diabetes.

Objective: Diabetes mellitus is a known epidemic that is increasing throughout the United States and if current trends continue, it is estimated that as many as one in three U.S. adults could have diabetes by 2050. Considerable evidence has been found to link the presence of depression and or Diabetes Distress Syndrome with type two diabetes mellitus. Current studies demonstrate that lack of treatment of Diabetes Distress Syndrome may result in a decrease in medication adherence, participation in diabetic group meetings, and quality of life. The purpose of this study was to examine nurse practitioners (NPs') knowledge, perceptions and attitudes in utilizing behavioral therapy in TTDM management. Research Design and Methods: A total of 20 NPs completed the survey using Qualtrics. Results: suggest that there is a lack of knowledge in regards to Diabetes Distress Syndrome. Current practice for behavioral services in TTDM treatment is also deficient, however, NPs' are willing to learn more and use it as a treatment modality in their practice.

Minority populations such as American Indians (AIs) in the United States experience large-scale healthcare related disparities when compared with non-minority citizens. Diabetes can affect all races and ethnicities across the globe, regardless of age, sex, or location on the map, and affects AIs at disproportionately high rates. While type 1 diabetes mellitus (T1DM) is not preventable, type 2 diabetes mellitus (T2DM) can be prevented and avoided in some instances. The implementation of an evidence-based diabetes program in a school-based setting has the potential to positively improve the health of school-aged children. Based on the need for high-quality diabetes prevention education, an evidence-based educational curriculum was piloted in order to ascertain the feasibility of using such a program to increase diabetes and obesity prevention knowledge in the school setting. The implementation of the Diabetes Education in Tribal Schools (DETS) curriculum in community and school-based settings has been reported in literature. The program is intended to lower the prevalence of T2DM by incorporating lifestyle management options that specifically targets American Indian/Alaska Native (AI/AN) minority communities. Three lessons from the DETS curriculum were presented to the Boys and Girls Club of Three Affiliated Tribes (TAT) in Mandaree, North Dakota. Throughout the curriculum, students were educated regarding T2DM and obesity prevention by engaging in interactive learning activities. The results of the project revealed that community-based interventions for preventing T2DM and obesity can be a helpful way to reach children in the community setting. Overall, this curriculum was effective and successfully taught to voluntary participants. The measures used included qualitative interviewing and learning activities with answers/responses from the participants. Active community involvement by healthcare providers can promote primary prevention through educational activities.

This thesis reports on a qualitative exploration of the experiences of 30 women designated as ‘high risk’ due to the co-existence of ‘maternal obesity’ (BMI ≥ 30) and Gestational Diabetes Mellitus (GDM)/Type Two Diabetes Mellitus (T2DM) in pregnancy. This is examined in the context of medico-scientific/public health/ popular media discourses pertaining to ‘maternal obesity’/GDM/T2DM in pregnancy. ‘Maternal obesity’/GDM/T2DM in pregnancy are increasingly prevalent and clinically associated in manifold ways. Increasing prevalence is linked to the ‘global epidemic’ of ‘obesity’/diabetes: now commonly referred to as ‘diabesity’. Current biomedical knowledge asserts ‘maternal obesity’ and diabetes (‘maternal diabesity’) synergise in causing adverse pregnancy outcomes, have long term health implications for the offspring and contribute to an ‘intergenerational cycle’ of ‘obesity’/diabetes. This is the first qualitative study to consider pregnancy/post-birth experiences of women with co-existing ‘maternal obesity’ and GDM/T2DM in pregnancy from a sociological perspective. Participants undertook a series of auto/biographical narrative interviews. Longitudinal engagement provided nuanced psycho-social insight into women’s perceptions/experiences and the socio-cultural context of their lives. Analysis of pertinent ‘pregnancy’ Internet fora postings augmented interview data and was utilised for comparative/corroborative purposes. Participants were predominantly of low socio-economic status, congruent with epidemiological data. The concept of pregnancy ‘planning’ was not resonant and few women accessed/felt predisposed to access preconception care. Women did not identify as ‘obese’, and knowledge/perception of risks associated with the medical ‘conditions’ was low. Women perceived themselves to be stigmatised due to their weight in society and specifically within healthcare. Many participants were experiencing acute/chronic stress which appeared to have mediated risk perceptions/compromised diabetic regimen adherence. Expense of ‘healthy’ eating/diabetic diet was considered prohibitive. Women’s material circumstances/socio-cultural milieux may militate against ability to minimise risk and effect lifestyle change. Policy and practice, for the most part, fails to take this into account.

In the United States alone, there were 25.8 million people suffering from diabetes in 2010. The prevalence of diabetes is expected to markedly increase worldwide over the next 30 years, an estimated 2.8% in 2000 and 4.4% in 2030. For individuals diagnosed with type 2 diabetes mellitus (T2DM), treatment is essential to control adverse effects such as hypertension and diabetic neuropathy. The focus of this study is to examine various approaches to maintain and improve the lifestyle of individuals suffering from T2DM. A comparative approach has been used to evaluate the differences in the treatment of T2DM with the use of traditional Chinese medicine (TCM) and Western medicine. In Western society, pharmaceuticals are commonly used as a treatment method to manage hyperglycemia, along with life-style modifications. Furthermore, TCM views the human body and its functioning in a holistic way, stating that no single body part or symptom can be understood apart from its relation to a whole. Herbal medications and other treatments in TCM are targeted to treat underlying medical complaints that resulted in symptoms, instead of treating one specific manifestation. Data collection has been gathered through Qualitative over the phone interviews with patients suffering from T2DM, as well as TCM physicians. Interviews were conducted on patients that were diagnosed with T2DM (fasting plasma glucose levels of 126 or greater and HbAlc levels [greater than] 8%), and had continued treatment longer than three months prior to interviews. Collection of chart notes containing glucose levels, levels of pain, lifestyle changes, and vital signs were also used. A total of 21 patients from a family practice were interviewed, answering 23 constructed questions based on treatment of choice (TCM or western) and their personal input on treatment satisfaction. Patients varied in age, ethnicities, and gender, ranging from 39-70 years of age. Two traditional Chinese medicine physicians were also interviewed. Interviews with TCM physicians elaborated on course of treatment and steps taken to diagnose T2DM. Furthermore, prescription medications were also charted and documented to further analyze with secondary data. Upon completing the interviews, the data stated 21 patients (total population questioned) had not experienced alternative medicine and were exposed only to western medicine as treatment. A major concern for most patients were the pharmaceutical side effects, and 85.1% of patients stated they would be interested in an alternative treatment. Due to insufficient sources and knowledge on TCM treatment, 14.2% of patients stated they were satisfied with their western medicine treatment of choice and would not change treatment. The research's objective was to evaluate the differences in treatment of T2DM. Data collected supported the objective and showed the lack of sources to alternative treatments aside from western medicine. The researcher informed and educated interviewees about literature review on traditional Chinese medicine about alternative treatments available to treat T2DM.