Includes bibliographical references and index.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / O diabetes mellitus tipo 2 à uma doenÃa de importÃncia crescente na saÃde pÃblica, jà que sua incidÃncia e prevalÃncia tÃm avanÃado de forma assustadora, sendo causada por uma combinaÃÃo de fatores genÃticos e estilo de vida. Em face disso, a saÃde pÃblica indica a prevenÃÃo primÃria para identificar os fatores de risco para DM2 e traÃar estratÃgias com vistas a evitar a exposiÃÃo ao risco, retardando ou impedindo o aparecimento da doenÃa. Objetivou-se avaliar o risco para o desenvolvimento do DM2 entre adultos de Itapipoca-CE. Trata-se de pesquisa quantitativa, com delineamento transversal e observacional, realizada no perÃodo de janeiro a marÃo de 2010, com 419 usuÃrios da EstratÃgia SaÃde da FamÃlia do municÃpio de Itapipoca-CE, com idades entre 20 e 59 anos. Para a coleta de dados aplicou-se um formulÃrio no qual se registraram dados sociodemogrÃficos e clÃnicos e o Finnish Diabetes Risk Score. Os dados foram armazenados no Excel, sendo processados no Statistical Package for Science Social versÃo 18.0. O estudo foi aprovado pelo Comità de Ãtica em Pesquisa da Universidade Federal do Cearà sob protocolo 346/09. Dos 419 usuÃrios participantes, 88,1% eram do sexo feminino; a mÃdia de idade foi de 37 anos; 60,4% eram casados ou mantinham uniÃo estÃvel; 39,4% cursaram atà o ensino fundamental incompleto e 58,2% pertenciam Ãs classes econÃmicas D/E. Em relaÃÃo aos fatores de risco para DM2, 25,3% tinham idade ≥ 45 anos; 59,7% estavam com excesso de peso; 84% foram classificados em risco cardiovascular; 83,3% eram sedentÃrios; 53,7% relataram nÃo comer frutas e/ou verduras diariamente; 12,9% tomavam anti-hipertensivos; 5,3% mencionaram histÃria prÃvia de glicose alta e 47% histÃria familiar de DM2. Segundo observou-se, 5,2% da amostra foram classificados com hipertensÃo e apenas 0,7% com provÃvel diabetes. Quanto ao grau de risco para DM2, 24,6% estavam em baixo risco; 63% em risco moderado e 11,7% em alto risco. Entre os participantes com alto risco, 12,0% eram homens; 30,2% tinham idades ≥ 45 anos; 37,4 estavam com excesso de peso; 21,1% estavam em risco cardiovascular aumentado; 12,9% eram sedentÃrios; 14,7% nÃo comiam frutas/verduras diariamente; 31,5% tomavam anti-hipertensivos; 81,8% relataram histÃria de glicose alta e 23,9% histÃria familiar de DM2. Esse estudo abre portas para uma posterior pesquisa de intervenÃÃo no municÃpio, na qual os indivÃduos com alto risco para DM2 seriam acompanhados pelos profissionais de saÃde da ESF e dos NÃcleos de Apoio à SaÃde da FamÃlia, com orientaÃÃes quanto Ãs mudanÃas no estilo de vida, e com intervenÃÃes nos fatores de risco potenciais encontrados, objetivando reduzir ou retardar o aparecimento da doenÃa. / The type 2 diabetes mellitus is a disease of increasing importance in public health, since its incidence and prevalence have dauntingly advanced, and has been caused by a combination of genetic factors and lifestyle. In this view, public health indicates primary prevention to identify risk factors for T2DM and strategize in order to avoid exposure to risk by delaying or preventing the onset of the disease. The objective was to evaluate the risk for the development of T2DM among adults in Itapipoca town-CearÃ. It is a quantitative research with cross-sectional observational study conducted from January to March 2010, with 419 users of EstratÃgia SaÃde da FamÃlia (ESF) in Itapipoca town-CearÃ, the participants aged between 20 and 59 years. To collect data we applied a form in which demographic and clinical data and Finnish Diabetes Risk Score were registered. The data were stored in Excel, and processed in the Statistical Package for Social Science 18.0. The study was approved by the Ethics Committee of the Federal University of CearÃ, under protocol 346/09. Out of the 419 participating users, 88.1% were female and the average age was 37 years, 60.4% were married or had common law-marriage, 39.4% attended to part of primary school and 58.2% belonged to lower social classes. Regarding risk factors for T2DM, 25.3% were aged ≥ 45 years, 59.7% were overweight, 84% were classified as cardiovascular risk, 83.3% were sedentary, 53.7% reported not eating fruit and / or vegetables daily, 12.9% were taking anti-hypertensive, 5.3% reported a previous history of high glucose and 47% had family history of T2DM. As observed, 5.2% of the sample were classified as having hypertension, and only 0.7% with probable diabetes. As for the risk levels for T2DM, 24.6% were at low risk, 63% in moderate risk and 11.7% at high risk. Amongst participants with high risk, 12.0% were men, 30.2% were aged ≥ 45 years, 37.4% were overweight, 21.1% were at increased cardiovascular risk, 12.9% were sedentary; 14.7% did not eat fruit / vegetables daily, 31.5% took antihypertensive drugs, 81.8% reported a history of high glucose and 23.9% had family history of T2DM. This study opens doors for further intervention research in the town, in which individuals at high risk for T2DM would be accompanied by health professionals from the ESF and the NÃcleos de Apoio à SaÃde da FamÃlia. With the aim to reduce or delay the onset of the disease, the individuals would be given guidance as to changes in lifestyle and interventions on potential risk factors found.

archives@tulane.edu / Gestational diabetes mellitus (GDM) increases the lifetime risk of developing type 2 diabetes mellitus (T2DM) in the mother; however, biological mechanisms remain relatively unknown, and known risk factors have shown to be incomplete. Both epidemiological and experimental research suggest that environmental exposure to particulate matter (PM2.5) may initiate and further progress chronic diseases such as T2DM. This study investigates the association between PM2.5 exposure and the risk of T2DM among women with a history of GDM. Associations between prevalent and incident T2DM with PM2.5 utilized two PM2.5 metrics: 1) annual average PM2.5 concentration and 2) annual average modeled PM2.5 exposure, calculated from daily PM2.5 concentration levels provided by the USRA/NASA Marshal Space Flight Center. Data from the Southern Community Cohort Study, who at recruitment reported a previous diagnosis of GDM, for whom T2DM, risk factor, and follow-up information were available, was provided. In total, 2403 participants were included in the analysis of prevalent T2DM, and 1036 participants were included in the analysis of incident T2DM. Associations between proximity to roadways and race with PM2.5 metrics were also conducted. Participants that live close to roadways were exposed to higher annual average PM2.5 concentrations and annual average modeled PM2.5 exposures. When stratified by race, non-Black participants were exposed to higher averages. After adjustment, a significant association was observed between annual average PM2.5 concentration and incident T2DM (hazards ratio (HR)= 1.022, 95% confidence interval (CI): 1.003, 1.040). No association was observed between annual average PM2.5 concentrations and prevalent T2DM. Annual average modeled PM2.5 exposure was not associated with either prevalent or incident T2DM. Results were partly consistent with previous literature. Additional studies with a greater range of air pollution exposures, including higher levels, additional pollutants, and more tailored exposure models, are warranted to investigate hypothesized associations. / 0 / Ashley Bell

No abstract available. / Thesis (DPhil)--University of Pretoria, 2010. / Biokinetics, Sport and Leisure Sciences / unrestricted

Background: Self-monitoring of blood glucose (SMBG) can inform on the timing of hyperglycaemia; however there is currently no standardised approach to utilise these data to improve glycaemic control in type 2 diabetes patients. Aims: To assess the efficacy of structured blood glucose testing in guiding an insulin titration algorithm in poorly controlled, insulin-treated type 2 diabetes patients. The secondary aim was to compare change in HbA1c between the study subjects and matched controls receiving standard treatment. Methods: This six-month prospective intervention recruited 39 poorly controlled (HbA1C ≥ 8.5% or 69.4 mmol/mol), type 2 diabetes subjects using twice-daily biphasic insulin from two public hospitals in Tshwane, South Africa. Patients were asked to perform structured SMBG over 4 weeks and return monthly for consultations where physicians titrated insulin doses using a standardised algorithm guided by the data collected. Post-hoc analysis was performed to assess glycaemic control of study participants compared to those receiving standard treatment. Results: It was found that mean HbA1c decreased over the study period by 1.89% (95% CI: -2.46 to -1.33, p-value<0.001). Mean SMBG and mean fasting plasma glucose (FPG) decreased by 1.6 mmol/L (95% CI: -2.5 to -0.6 mmol/L, p-value: 0.002) and 1.5 mmol/L (95% CI: -2.2 to -0.2 mmol/L, p-value: 0.024), respectively. Hypoglycaemic event rate (≤3.9 mmol/L) was 33.08 events per patient-year. Total daily insulin use increased by a mean 40.12 units.day-1 (SE: 7.7, p-value<0.001); weight increased by an average 3.98 kg (95% CI: 2.56 to 5.41, p-value <0.001) over the study period. Study participants were found to have a greater mean (SE) reduction of 0.777% (0.404) in HbA1c compared to patients receiving standard care, which fell short of statistical significance (95% CI: -1.569 to 0.015%, p-value: 0.054) due to lack of power (56.5%) in the post-hoc comparison. Conclusion: A structured SMBG programme that advises monthly algorithmic insulin titration can improve glucose control in type 2 diabetes patients using insulin, with moderate hypoglycaemic events and weight gain. / Dissertation (MSc)--University of Pretoria, 2016. / National Research Foundation (NRF) / Roche Products (South Africa) / School of Health Systems and Public Health, University of Pretoria / School of Medicine, University of Pretoria / School of Health Systems and Public Health (SHSPH) / MSc / Unrestricted

Background: A cross-sectional design was employed to ascertain the relationship between dairy consumption and insulin resistance (IR) in 272 middle-aged, nondiabetic women. Methods: Participants kept a seven-day weighed food record to report their diets, including consumption of dairy foods. IR was assessed using the homeostatic model assessment (HOMA), using the following formula: fasting plasma insulin (µU/ml) x fasting plasma glucose (mg/dL)/405. The Bod Pod was used to examine body fat percentage, and accelerometry over a seven-day period was used to assess physical activity. HOMA values were log-transformed and regression analysis and the General Linear Model procedure were used to determine how mean HOMA differed across low, moderate, and high dairy intake groups. Results: (Mean ± SD) age: 40.1 ± 3.0 years, physical activity (average activity counts for one week, divided by 1,000): 2700.1 ± 781.9, body fat percentage: 31.7 ± 6.9, weight (kg): 66.1 ± 10.0, fasting glucose (mg/dL): 86.7 ± 5.9, fasting insulin (µU/mL): 7.0 ± 4.2, energy intake (kcal/day): 2051.9 ± 319.1, kcal from carbohydrate (%): 55.7 ± 6.2, kcal from protein (%): 13.8 ± 2.5, kcal from fat (%): 30.5 ± 5.8, soluble fiber (g per 1,000 kcal): 1.7 ± 0.9, insoluble fiber (g per 1,000 kcal): 3.8 ± 1.9, dairy intake (servings/day): 1.1 ± 1.0, HOMA: 1.5 ± 1.0, log-transformed HOMA: 0.3 ± 0.6. Those in the highest quartile for dairy consumption had significantly higher log-transformed HOMA (0.41 ± 0.53) than those in the moderate (0.22 ± 0.55) or low (0.19 ± 0.58) consumption categories (F = 6.90, p = 0.0091). This relationship remained significant after controlling for all covariates (F = 4.71, p = 0.030). Controlling for physical activity strengthened the relationship between dairy consumption and IR by 7%. Adjusting for body weight, percent of kcal from fat, and insoluble and soluble fiber intake also strengthened the relationship. Controlling for energy intake and body fat percentage weakened the relationship by 32% and 13%, respectively, though it remained significant. Conclusion: High dairy consumption is significantly associated with IR in middle-aged, nondiabetic women.

The purpose of this thesis was to determine the perceived risk of falling and its relationship to balance and falls in older community-dwelling adults with type 2 diabetes mellitus (DM2). Study One was a systematic review of published literature on risk factors for falling in older adults with DM2. Study Two was a prospective cohort study for parameter estimation, the goal was to determine the test-retest reliability, internal consistency, construct validity and factor structure of a falls Risk Perception Questionnaire in older community-dwelling adults with DM2. Study Three was also a prospective cohort study; the goals of this study were to determine the association between perceived of falling and balance in older adults with DM2 and to determine whether older adults alter their perceived risk of falling after receiving feedback about their balance. The information gained from these studies will be used to guide subsequent research as well as falls risk assessment and prevention in older adults with DM2. / Thesis / Master of Science (MSc)

Yes / Type 2 diabetes mellitus (T2DM) is increasing worldwide, and it is associated with increased risk of coronary artery disease (CAD). For T2DM patients, the main surgical intervention for CAD is autologous saphenous vein grafting. However, T2DM patients have increased risk of saphenous vein graft failure (SVGF). While the mechanisms underlying increased risk of vascular disease in T2DM are not fully understood, hyperglycaemia, insulin resistance, and hyperinsulinaemia have been shown to contribute to microvascular damage, whereas clinical trials have reported limited effects of intensive glycaemic control in the management of macrovascular complications. This suggests that factors other than glucose exposure may be responsible for the macrovascular complications observed in T2DM. SVGF is characterised by neointimal hyperplasia (NIH) arising from endothelial cell (EC) dysfunction and uncontrolled migration and proliferation of vascular smooth muscle cells (SMCs). This is driven in part by proinflammatory cytokines released from the activated ECs and SMCs, particularly interleukin 6 (IL-6). IL-6 stimulation of the Janus kinase (JAK)/signal transducer and activator of transcription 3 (STAT) pathway is a key mechanism through which EC inflammation, SMC migration, and proliferation are controlled and whose activation might therefore be enhanced in patients with T2DM. In this review, we investigate how proinflammatory cytokines, particularly IL-6, contribute to vascular damage resulting in SVGF and how suppression of proinflammatory cytokine responses via targeting the JAK/STAT pathway could be exploited as a potential therapeutic strategy. These include the targeting of suppressor of cytokine signalling (SOCS3), which appears to play a key role in suppressing unwanted vascular inflammation, SMC migration, and proliferation. / FTM is supported by a University of Botswana PhD scholarship.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Bakgrund: Diabetes mellitus typ 2 är ett globalt problem som blir allt vanligare. Den nödvändiga egenvården kräver mycket av diabetes typ 2-patienten, och vårdpersonalen behöver adekvat kompetens för att kunna stötta dessa individer på bästa sätt. Syfte: Att undersöka patienters upplevelse av egenvård vid diabetes mellitus typ 2. Metod: En litteraturöversikt har gjorts baserat på elva originalartiklar tillgängliga på databaserna CINAHL Complete och PubMed. Artiklarna analyserades enligt Friberg, och teman och subteman skapades. Resultat: Resultatet presenteras i fyra teman. Det första temat är Patienters upplevelse av kostförändringar och har tre subteman: Kunskap och motivation, Kostförändringars inverkan på livskvalitet samt Egenvårdskontroll. Två andra teman som presenteras är Upplevelsen av läkemedelsbehandling och Upplevelsen av egenvård genom motion. Det fjärde och sista temat är Sjukvårdens roll i egenvården och presenteras genom tre subteman: Upplevelsen av gruppbaserad utbildning, Behov av stöd i egenvården samt Upplevelsen av mötet med sjukvården. Diskussion: Huvudfynden i resultatet analyserades för att se likheter och olikheter i de upplevelser som patienterna beskrivit. Dessa upplevelser diskuteras under två rubriker; Stödjande faktorer för egenvård och Försvårande faktorer för egenvård. Resultatet diskuterades utifrån Dorothea Orems egenvårdsteori samt konsensusbegreppet hälsa. / Background: Type 2 diabetes mellitus is a global problem that is increasing worldwide. The necessary self-management is demanding a lot of the type 2 diabetes-patient, and the health professionals needs adequate competence to be able to support these individuals in the best way. Aim: To examine patients' experience of self-management in type 2 diabetes mellitus. Method: A literature review has been made based on eleven original articles available on the databases CINAHL Complete and PubMed. The articles were analysed according to Friberg, and themes and subthemes were created. Results: The result is presented in four themes. The first theme is Patients´ experience of dietary changes and has three subthemes: Knowledge and motivation, Dietary changes and its impact on the quality of life and Self-management control. Two other themes are presented as The experience of drug treatment and The experience of self-management through physical activity. The fourth and last theme is The role of healthcare in self-management and is presented through three subthemes: The experience of group based education, The need of support in self-management and The experience of the meeting with the healthcare. Discussion: The main findings in the result were analysed to discover similarities and differences within the experiences as described by patients. These experiences were then discussed under two subtitles; Supporting factors for self-management and Aggravating factors for self-management. The result was discussed from the theory of self-care by Dorothea Orem and the consensus concept of health.