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.

<p><strong>Syfte: </strong>Syftet<strong> </strong>var att beskriva hur personer med diabetes mellitus typ två upplever socialt stöd. <strong>Bakgrund:</strong> Forskning har visat att socialt stöd är betydelsefullt för personer med diabetes mellitus typ två. Personerna behöver ofta genomföra livsstilsförändringar som kan påverka den sociala miljön och vardagen. Socialt stöd är centralt för personens förmåga till livsstilsförändringar och en god egenvård. För att hjälpa personen att förbättra egenvården kan sjuksköterskan arbeta för att förbättra det sociala stödet för personen med diabetes mellitus typ två. <strong>Metod: </strong>Studien utformades som en allmän litteraturstudie med ett systematiskt arbetssätt. Resultatet utgjordes av vetenskapliga artiklar baserade på kvalitativa empiriska studier. Under analysen togs meningsenheter ut och sammanfogades till kategorier <strong>Resultat: </strong>Genom analysen utarbetades åtta kategorier: att ha någon att tala med, att uppleva förståelse, att bli accepterad, att få information och råd, att få uppmuntran, att få utvärderande kommentarer, att få assistans och att förändras tillsammans. <strong>Slutsats: </strong>För att hjälpa personen att genomföra bestående livsstilsförändringar kan sjuksköterskan inkludera omgivningen och diskutera frågor angående det sociala stödet. För att kunna hjälpa personen att hantera det sociala stödet kan sjuksköterskan uppmärksamma att socialt stöd kan upplevas både som positivt och negativ och hjälpa personen att utvärdera sina sociala influenser.</p> / <p><strong>Aim: </strong>The aim was to describe social support as experienced by people with diabetes mellitus type two. <strong>Background:</strong> Research has shown that social support is significant for persons with diabetes mellitus type two. The person often has to make life-style changes that can affect the social environment and daily life. Social support is central to the person’s ability of making life-style changes and to self-management. To help the person improve self-management nurses should try to improve the social support for the person<strong>. Methods: </strong>The study was designed as a literature review with a systematic work procedure. The findings were based on qualitative empirical studies, published in peer reviewed periodicals. Meaning units were identified and arranged into categories. <strong>Findings: </strong>Through the analysis eight categories were discovered: having someone to talk to, experiencing understanding, experiencing acceptance, receiving information and advice, receiving encouragement, receiving appraising comments, receiving assistance and changing together. <strong>Conclusions: </strong>To help the person make lasting life-style changes, nurses can include the social environment and discuss matters of social support. To help the person manage their social support, nurses can inform that social support can be experienced as positive as well as negative and help the person evaluate their social influences.</p>

The type II secretion system is used by many pathogenic and non-pathogenic bacteria for the extracellular secretion of enzymes and toxins. <i>Aeromonas hydrophila</i> is a Gram-negative pathogen that secretes proteins via the type II secretion system.<p> In the studies described here, a series of yeast two-hybrid assays was performed to identify protein-protein interactions in the type II secretion system of <i>A. hydrophila</i>. The periplasmic domains of ExeA and ExeB were assayed for interactions with the periplasmic domains of Exe A, B, C, D, K, L, M, and N. Interactions were observed for both ExeA and ExeB with the secretin ExeD in one orientation. In addition, a previously identified interaction between ExeC and ExeD was observed. In order to further examine and map these interactions, a series of eight two-codon insertion mutations in the amino terminal domain of ExeD was screened against the periplasmic domains of ExeA and ExeB. As a result, the interactions were verified and mapped to subdomains of the ExeD periplasmic domain. To positively identify the region of ExeD involved in the interactions with ExeA, B, C and D, deletion mutants of ExeD were constructed based on the two-codon insertion mutation mapping of subdomains of the ExeD periplasmic domain, and yeast two-hybrid assays were carried out. The results showed that a fragment of the periplasmic domain of ExeD, from amino acid residue 26 to 200 of ExeD, was involved in the interactions with ExeA, B and C. As an independent assay for interactions between ExeAB and the secretin, His-tagged derivatives of the periplasmic domains of ExeA and ExeB were constructed and co-purification on Ni-NTA agarose columns was used to test for interactions with untagged ExeD. These experiments confirmed the interaction between ExeA and ExeD, although there was background in the co-purification test.<p> These results provide support for the hypothesis that the ExeAB complex functions to organize the assembly of the secretin through interactions between both peptidoglycan and the secretin that result in its multimerization into the peptidoglycan and outer membrane layers of the envelope.

The type II secretion system is used by many pathogenic and non-pathogenic bacteria for the extracellular secretion of enzymes and toxins. <i>Aeromonas hydrophila</i> is a Gram-negative pathogen that secretes proteins via the type II secretion system.<p> In the studies described here, a series of yeast two-hybrid assays was performed to identify protein-protein interactions in the type II secretion system of <i>A. hydrophila</i>. The periplasmic domains of ExeA and ExeB were assayed for interactions with the periplasmic domains of Exe A, B, C, D, K, L, M, and N. Interactions were observed for both ExeA and ExeB with the secretin ExeD in one orientation. In addition, a previously identified interaction between ExeC and ExeD was observed. In order to further examine and map these interactions, a series of eight two-codon insertion mutations in the amino terminal domain of ExeD was screened against the periplasmic domains of ExeA and ExeB. As a result, the interactions were verified and mapped to subdomains of the ExeD periplasmic domain. To positively identify the region of ExeD involved in the interactions with ExeA, B, C and D, deletion mutants of ExeD were constructed based on the two-codon insertion mutation mapping of subdomains of the ExeD periplasmic domain, and yeast two-hybrid assays were carried out. The results showed that a fragment of the periplasmic domain of ExeD, from amino acid residue 26 to 200 of ExeD, was involved in the interactions with ExeA, B and C. As an independent assay for interactions between ExeAB and the secretin, His-tagged derivatives of the periplasmic domains of ExeA and ExeB were constructed and co-purification on Ni-NTA agarose columns was used to test for interactions with untagged ExeD. These experiments confirmed the interaction between ExeA and ExeD, although there was background in the co-purification test.<p> These results provide support for the hypothesis that the ExeAB complex functions to organize the assembly of the secretin through interactions between both peptidoglycan and the secretin that result in its multimerization into the peptidoglycan and outer membrane layers of the envelope.

Syfte: Syftet var att beskriva hur personer med diabetes mellitus typ två upplever socialt stöd. Bakgrund: Forskning har visat att socialt stöd är betydelsefullt för personer med diabetes mellitus typ två. Personerna behöver ofta genomföra livsstilsförändringar som kan påverka den sociala miljön och vardagen. Socialt stöd är centralt för personens förmåga till livsstilsförändringar och en god egenvård. För att hjälpa personen att förbättra egenvården kan sjuksköterskan arbeta för att förbättra det sociala stödet för personen med diabetes mellitus typ två. Metod: Studien utformades som en allmän litteraturstudie med ett systematiskt arbetssätt. Resultatet utgjordes av vetenskapliga artiklar baserade på kvalitativa empiriska studier. Under analysen togs meningsenheter ut och sammanfogades till kategorier Resultat: Genom analysen utarbetades åtta kategorier: att ha någon att tala med, att uppleva förståelse, att bli accepterad, att få information och råd, att få uppmuntran, att få utvärderande kommentarer, att få assistans och att förändras tillsammans. Slutsats: För att hjälpa personen att genomföra bestående livsstilsförändringar kan sjuksköterskan inkludera omgivningen och diskutera frågor angående det sociala stödet. För att kunna hjälpa personen att hantera det sociala stödet kan sjuksköterskan uppmärksamma att socialt stöd kan upplevas både som positivt och negativ och hjälpa personen att utvärdera sina sociala influenser. / Aim: The aim was to describe social support as experienced by people with diabetes mellitus type two. Background: Research has shown that social support is significant for persons with diabetes mellitus type two. The person often has to make life-style changes that can affect the social environment and daily life. Social support is central to the person’s ability of making life-style changes and to self-management. To help the person improve self-management nurses should try to improve the social support for the person. Methods: The study was designed as a literature review with a systematic work procedure. The findings were based on qualitative empirical studies, published in peer reviewed periodicals. Meaning units were identified and arranged into categories. Findings: Through the analysis eight categories were discovered: having someone to talk to, experiencing understanding, experiencing acceptance, receiving information and advice, receiving encouragement, receiving appraising comments, receiving assistance and changing together. Conclusions: To help the person make lasting life-style changes, nurses can include the social environment and discuss matters of social support. To help the person manage their social support, nurses can inform that social support can be experienced as positive as well as negative and help the person evaluate their social influences.

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.

Bakgrund: Diabetes mellitus typ två är en sjukdom som ökar världen över till följdav alltmer stillasittande. Komplikationerna är många och varierande isvårighetsgrad, flertalet kan dock förhindras eller fördröjas med rätt vård.Behandlingen består till stor del av egenvård, men även av läkemedel. Bristen påföljsamhet hos patienterna till rekommendationerna från hälso- och sjukvården ledertill ökat lidande för patienten samt stora kostnader för samhället.Syfte: Att undersöka vilka faktorer som motiverar till egenvård för patienter meddiabetes mellitus typ två.Metod: En litteraturöversikt baserad på sexton vetenskapliga, kvalitativa ochkvantitativa artiklar. Artiklarna hämtades i databaserna CINAHL, PubMed ochPsykInfo.Resultat: I litteraturöversiktens resultat fann vi tre huvudkategorier som vi valt attbenämna som Individuella faktorer, Psykosocialt stöd och Uppnå resultat. Vidarekunde sju underkategorier identifieras med koppling till huvudkategorierna.Slutsats: För patienter med diabetes mellitus typ två är egenvården ettmångfacetterat problem där det psykosociala stödet spelar en viktig roll.Psykosocialt stöd verkar vara en av de viktigaste faktorerna, oavsett om detta stödkommer från familj och vänner, hälso- och sjukvårdspersonal eller från andradiabetiker. Vi fann att grupputbildningar uppfyller många av de behov sompatienterna har, då de får stöd av varandra samt lär sig av varandra. Detta ökarpatienternas motivation till förbättrad egenvård. / Background: Type two diabetes mellitus is a disease that is increasing worldwideas a result of increasingly sedentary lifestyle. The complications are many and varyin severity, but most can be prevented or delayed with the right care. The treatmentlargely consist of self-care, but also of medicines. The lack of compliance amongpatients to the recommendations from the health care system leads to increasedsuffering for the patient and large costs for society.Aim: To investigate the factors that motivate self-care for patients with type 2diabetes mellitus.Method: A literature review based on sixteen scientific, qualitative and quantitativearticles. The articles were retrieved from the databases CINAHL, PubMed andPsykInfo.Results: In the results of the literature review, we found three main categories thatwe have chosen to name as Individual factors, Psychlogical support and Achieveresults. Furthermore, seven subcategories could be identified in connection with themain categories.Conclusion: For patients with type two diabetes mellitus, self-care is amultifaceted problem where psychosocial support plays an important role.Psychsocial support seems to be one of the most important factors, whether thissupport comes from family and friends, healthcare professionals or from otherdiabetics. We found that group educations meet many of the needs of patients, asthey recieve support from each other and learn from each other. This increasespatients´ motivation for improved self-care.

"Diabetes mellitus" refers to a spectrum of conditions, which all present with hyperglycaemia as a common medical finding. Diabetes was once thought of as a single disease, but according to Setter et a/. (2000:378), it includes a heterogeneous group of disorders that are secondary to various genetic predispositions and precipitating factors. Type 1 diabetes mellitus (DM) accounts for 10 to 15% of all cases of diabetes mellitus and is clinically characterised by hyperglycaemia and a propensity to diabetic keto-acidosis. Its control requires chronic insulin treatment. Although it may occur at any age, it most commonly develops in childhood or adolescence and is the predominant type of diabetes mellitus diagnosed before age 30 (Beers & Berkow, 2004). Type 2 DM is usually the type diagnosed in patients older than 30 years of age. It is also commonly associated with obesity (Berkow, 1992:1108). The objective of this study was to review the usage and cost of antidiabetic drugs and to determine the influence of the pricing regulations on the cost of these drugs. This research can be classified as retrospective and quantitative. Data were obtained from a prescription claims database, and the study population consisted of all the antidiabetic prescriptions for the year 1 January 2004 to 31 December 2004. The one-year period was divided into three study periods, namely January to April, May to August and September to December. Firstly diabetes mellitus was investigated in order to understand the disease and to determine the prevalence and treatment thereof. It was found that diabetes mellitus is a heterogeneous disorder acquired from both genetic and environmental factors and that education for the general population, and in particular for the patients, is the key to preventing and controlling diabetes and reducing the complications arising from it. Secondly managed health care, pharmaco-economics and a drug utilisation review were investigated in order to understand these concepts. The influence of the South African Government on health care was discussed, including the new pricing regulations of medicine in South Africa. Thirdly, the utilisation patterns of antidiabetic drugs were reviewed, analysed and interpreted. It was determined that the oral antidiabetic agents are relatively less expensive than the insulins and that they are prescribed more frequently, and secondly that the biguanides presented almost half (49.4%, n = 116 138) of all the oral antidiabetic agents. It was also determined that the average cost of the oral antidiabetic drugs was between 21 .O% and 28.0% lower in 2004 than in 1996 - an indication that, despite inflation, the antidiabetic drugs were less expensive in 2004 than eight years ago in 1996. It was also calculated that the total cost savings in antidiabetic medication could have been R1 448 682.26 if the lower price of antidiabetic agents had been implemented during the period January to April. And finally it was also determined that further substantial "cost savings" could have been possible if all the innovator antidiabetic products had been substituted for less expensive generic antidiabetic products. Abstract / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2006.