Background Type 2 diabetes is a common disease and the prevalence has increased in large parts of the world. In treatment of diabetes the type of diet is of great importance considering metabolic factors such as glucose level and blood lipids. Which diet that is most beneficial to avoid diabetic complications has been heavily debated in recent decades. This thesis is based on two clinical studies designed to compare the effects of different macronutrients. Methods A clinical trial was designed to compare a low-carbohydrate diet (LCD) to a low-fat diet (LFD) in treatment of patients with type 2 diabetes. Sixty-one patients at two health care centres were included and randomized to get advice to eat a LCD or a LFD. The LCD had an energy content where 50 energy percent (E%) where from fat, 20 E% from carbohydrates and 30 E% from protein. For the LFD the nutrient composition was similar to what is traditionally recommended for treatment of type 2 diabetes in Sweden. Metabolic factors, anthropometrics and questionnaires were analysed. To study postprandial effects a trial was designed to compare three different diets. Twentyone patients with type 2 diabetes were included to in randomized order test the three types of diets on separate test days. On each test day the patients were served breakfast and lunch and blood samples were taken at six times these days. Glucose, lipids and hormones were analysed. Results There were equal weight reduction in the two groups in the first trial during the two-year study period. At six month when compliance was good according to diet-records, the glucose level (HbA1c) was lowered and the HDL-cholesterol was increased in the LCD group. The inflammatory markers IL-6 and IL-1Ra were significantly lower in the LCD group than in the LFD group. At 12 months the physical function, bodily pain and general health  scores improved within the LCD group only. In the second trial the postprandial glucose and insulin levels were lower on the LCD compared to the LFD. However, the LCD resulted in a tendency to higher postprandial triglyceride levels. The Mediterranean type of diet with all energy intake at lunch resulted in a more pronounced insulin response and a glucose level at lunch similar to that of the low-fat diet. The increase-ratio of insulin correlated to the elevation of the incretin glucose-dependent insulinotropic peptide (GIP). Conclusions In the two-year study we found benefits for the LCD group regarding glucose control and insulin doses. Furthermore, only the LCD was found to improve the subclinical inflammatory state and there were some aspects of improved well-being in this group. Aiming for 20% of energy intake from carbohydrates is safe with respect to cardiovascular risk factors  compared with the traditional LFD and this approach could constitute a treatment alternative. In the postprandial state, the LCD induced lower insulin and glucose excursions than the LFD but at the same time a tendency of higher triglycerides. The long-term significance needs to be further examined. The accumulation of caloric intake from breakfast to lunch to a single large Mediterranean-style lunch-meal in type 2 diabetes might be advantageous from a metabolic perspective.

This study examined the energy dependence of cancer cells. Glucose was found to be their main energy source. It seems possible to use this dependence to advantage in the fight against cancer. A novel experiment to reduce the blood glucose supply and utilisation was proposed. It entailed caloric restriction, suppression of glucose secretion by the liver as well as suppression of stress hormones (which elevates glucose levels). This minimises the blood glucose value. As a last step, anti-insulin is provided to inhibit cancer cells to utilise the glucose. The cancer cells are thus deprived of their main energy source. This should lead to a reduction or elimination of tumours and will aid in preventing their development. Although feasible, this method turned out to be too expensive to perform the necessary clinical trials to prove the hypothesis. Next, the focus shifted to cancer prevention. The human energy system was analysed with the goal to reduce the circulating glucose level. The main focus here was metabolised CHO energy consumption. A previously proposed unit – the Equivalent Teaspoon Sugar, or ets , was used to quantify energy with. It was shown that cancer risk increases significantly when the recommended ets consumption per day is exceeded. Furthermore, it was shown that including fibre in a meal reduces the ets value of the meal. One gram of fibre leads to a reduction of around 0.6 ets . The link between exercise, stress, fibre, their resulting blood glucose levels and cancer were quantified in terms of ets . Exercise expends ets , while stress causes the liver to secrete more ets . Experimental data was analysed to confirm the relationships. In conclusion an equation was formulated to describe the combined effect of all these elements on the energy system. One’s total daily ets consumption can be obtained from the equation, and it was linked to one’s cancer risk. Adapting a lifestyle that ensures the correct daily ets intake will lead to a significant reduction in cancer risk. This study proved that cancer cells are very dependent on sugar and a restriction of this energy source forces them into regression. Using this knowledge to advantage may help in the combat one of the biggest killers of our time – cancer. / Thesis (Ph.D. (Electrical and Electronic Engineering))--North-West University, Potchefstroom Campus, 2012

This study examined the energy dependence of cancer cells. Glucose was found to be their main energy source. It seems possible to use this dependence to advantage in the fight against cancer. A novel experiment to reduce the blood glucose supply and utilisation was proposed. It entailed caloric restriction, suppression of glucose secretion by the liver as well as suppression of stress hormones (which elevates glucose levels). This minimises the blood glucose value. As a last step, anti-insulin is provided to inhibit cancer cells to utilise the glucose. The cancer cells are thus deprived of their main energy source. This should lead to a reduction or elimination of tumours and will aid in preventing their development. Although feasible, this method turned out to be too expensive to perform the necessary clinical trials to prove the hypothesis. Next, the focus shifted to cancer prevention. The human energy system was analysed with the goal to reduce the circulating glucose level. The main focus here was metabolised CHO energy consumption. A previously proposed unit – the Equivalent Teaspoon Sugar, or ets , was used to quantify energy with. It was shown that cancer risk increases significantly when the recommended ets consumption per day is exceeded. Furthermore, it was shown that including fibre in a meal reduces the ets value of the meal. One gram of fibre leads to a reduction of around 0.6 ets . The link between exercise, stress, fibre, their resulting blood glucose levels and cancer were quantified in terms of ets . Exercise expends ets , while stress causes the liver to secrete more ets . Experimental data was analysed to confirm the relationships. In conclusion an equation was formulated to describe the combined effect of all these elements on the energy system. One’s total daily ets consumption can be obtained from the equation, and it was linked to one’s cancer risk. Adapting a lifestyle that ensures the correct daily ets intake will lead to a significant reduction in cancer risk. This study proved that cancer cells are very dependent on sugar and a restriction of this energy source forces them into regression. Using this knowledge to advantage may help in the combat one of the biggest killers of our time – cancer. / Thesis (Ph.D. (Electrical and Electronic Engineering))--North-West University, Potchefstroom Campus, 2012

Type 1 Diabetes is a dangerous and life-long disease for which its prevalence is global. Research has shown that tight glycaemic control of this disease significantly reduces the risks of developing several life threatening diabetic complications. The Ets-Insulin-Bolus Calculator (EIBC), inspired by the Ets concept (Equivalent Teaspoon Sugar), was primarily designed to assist type I diabetics in improving their blood glucose control. The EIBC has shown to improve the average blood glucose level of type 1 diabetics. The need for this study however is to determine whether the ET!3C promotes tighter glycaemic control for type 1 diabetics based on a more-in-depth numerical analysis. With the use of the latest technology in blood glucose monitoring, the CGMS from Medtronic, mathematical models expressing and rating blood glucose control have been proposed and derived in this study. A clinical trial with type 1 diabetics has also been conducted. The use of the models together with the clinical trial results have shown that the EIBC does in fact promote tighter glycaemic control for type 1 diabetics. / Thesis (M.Ing. (Mechanical Engineering))--North-West University, Potchefstroom Campus, 2007.

Type 1 Diabetes is a dangerous and life-long disease for which its prevalence is global. Research has shown that tight glycaemic control of this disease significantly reduces the risks of developing several life threatening diabetic complications. The Ets-Insulin-Bolus Calculator (EIBC), inspired by the Ets concept (Equivalent Teaspoon Sugar), was primarily designed to assist type I diabetics in improving their blood glucose control. The EIBC has shown to improve the average blood glucose level of type 1 diabetics. The need for this study however is to determine whether the ET!3C promotes tighter glycaemic control for type 1 diabetics based on a more-in-depth numerical analysis. With the use of the latest technology in blood glucose monitoring, the CGMS from Medtronic, mathematical models expressing and rating blood glucose control have been proposed and derived in this study. A clinical trial with type 1 diabetics has also been conducted. The use of the models together with the clinical trial results have shown that the EIBC does in fact promote tighter glycaemic control for type 1 diabetics. / Thesis (M.Ing. (Mechanical Engineering))--North-West University, Potchefstroom Campus, 2007.

Background: International research has shown that socioeconomically disadvantaged groups experience significantly higher mortality and morbidity rates than other groups. Both cardiovascular disease (CVD) and diabetes are major contributors to Australia's burden of disease, and individuals from lower socioeconomic groups are more likely to be affected by both, and to have worse prognoses and outcomes. There is substantial research evidence that a range of preventive activities can reduce the morbidity and mortality associated with these conditions. Research in countries with good access to primary health care services has demonstrated that socioeconomically disadvantaged groups tend to have higher levels of medical consultations, but make less use of preventive care and screening services. This fact contributes to their poorer health outcomes, as diagnosis will typically occur later than for more advantaged individuals, thus leading to a poorer prognosis. However, to date, there has been little research on the differential utilisation of preventive health services for CVD and diabetes by different socioeconomic groups in Australia. To understand socioeconomic influences on the use of preventive health services, a comprehensive review of the literature of determinants of health service utilisation was conducted and a number of explanations for this relationship considered. It was proposed that the following factors are likely to be important in this relationship: differences in the perception of the availability of, and accessibility to health care, attitudes and beliefs toward preventive health care, having a regular source of care, perception of interpersonal care from general practitioners, and social support. A number of theoretical models were also reviewed; in particular, the Andersen Behavioural Model of Health Service Research Utilisation. Aims: This doctoral research program has described the relationship between socioeconomic position (SEP) and utilisation of preventive health services in relation to CVD and diabetes. It aims to improve the understanding of the determinants of uptake and utilisation of preventive health services in general practice by different socioeconomic groups in Australia. Methods: The study was conducted in Brisbane Australia, in 2004, using a cross-sectional design and a self-administered mailed survey for data collection. A sample of adults aged 25-64 years was selected randomly from the Brisbane Electoral Roll. A conceptual model incorporating a range of relevant socio-demographic, risk-factor and behavioural variables in the relationship between SEP and GP-based use of preventive health services was used to develop a self-administered questionnaire. The questionnaire was pilot-tested and then reviewed by a panel of international experts. A new self-administered questionnaire, the Health Service Utilisation Questionnaire (HSUQ), was developed. It included 79 items: 12 socio-demographic items; 10 items assessing health status, disease conditions and smoking status; 20 items assessing use of health services; and 37 items assessing the factors that might affect use of health services utilisation. The HSUQ was then mailed to 800 randomly selected survey participants. The survey response rate was 65.6 per cent. After exclusion of those patients with cardiovascular diseases and diabetes, the final sample size was 381, consisting of 155 males and 226 females. Socioeconomic indicators were individual education level and family income. Blood pressure, blood cholesterol and blood glucose check-ups by general practitioners (GPs) were used as the major outcome variables. Nine scales and two dichotomous variables that measure those potential factors were derived following Principal Component Analysis and reliability testing. The data were analysed separately by gender, and adjusted for age and each of the socioeconomic indicators. Statistical description, bivariate analysis and multivariable modelling in SPSS were applied for the data analysis. Results: The survey results were suggestive of socioeconomically disadvantaged people being less likely than more advantaged people to utilise preventive health services for CVD and diabetes. For males, the low socioeconomic groups recorded the least use of preventive health services among the three education and income groups, including blood cholesterol and blood glucose check-ups, while the high socioeconomic group recorded the greatest use of preventive health services. There was no apparent relationship between education level and blood pressure check-up, while individuals from low-income families were less likely to go for a blood pressure check-up. For females, most of the results suggested that the low socioeconomic groups were less likely than the high socioeconomic groups to have blood cholesterol and blood glucose check-ups. However, this was not the case for blood pressure check-ups. The results showed that the low and middle socioeconomic groups were more likely than the high socioeconomic groups to have BP check-ups. However, the low socioeconomic groups were still less likely than the middle socioeconomic groups to have a blood pressure check-up. Overall, there was a similar pattern between education and income and the use of GP-based preventive health services among both males and females. The findings from the examination of the mediating factors between SEP and the GP-based use of preventive health services suggested that socioeconomically disadvantaged adults (both low level of education and low income) are more concerned about transport and travel time to health care, and accessibility to health care in terms of finding a GP who bulk bills, the cost of seeing a GP and having a choice of GP. They are also less likely to have a regular place of care and social support. These potential factors are likely to result in a lesser use of preventive health services than their high-SEP counterparts. In addition, the findings also suggested that respondents with a low level of education have less-positive attitudes towards health care, and that those from low-income families do not have a regular care provider and are less likely to visit their GP for a preventive check-up in relation to CVD and diabetes in Australia. Conclusions: Strategies for reducing socioeconomic health inequalities are partly associated with changing social and economic policies, empowering individuals, strengthening social and family networks, and improving the equity of the health care system. Strategies have been recommended for implementation in general practice that are directed at targeting the needs of disadvantaged groups; for example, providing longer consultation time and actively offering information on preventive care. Implementation of health promotion programs is needed in disadvantaged areas to keep the community informed about the availability of health services and to make health services more accessible. The health care system needs to be geographically accessible through improvements to the transport system. In addition, improving access to a regular source of primary health care is likely to be an important step in encouraging low-SEP individuals to use preventive health services.

Background: The number of adults affected by diabetes mellitus in developing countries, such as South Africa, is projected to grow by 170%, from 84 to 228 million people between 1995 and 2025 .This high and increasing prevalence of diabetes worldwide, and the economic burden of diabetes on developing countries like South Africa emphasizes the importance of ensuring good glycemic control so as to slow down the rate of disease progression and prevent complications. The district health care facilities are the foundation of the health care system of South Africa. The current practice is that diabetics have a point of care random blood glucose (RBG) done on the morning of their clinic appointment and this is used as a form of assessment of glycemic control during the consultation. For further clinical decision making a HbA1c is done once a year as a benchmark of glycemic control. The practical clinical question that arises is whether the assumptions underlying local clinical decision making using the RBG are valid and to what extent RBG can be used to guide clinical management. Aim and Objectives: The aim of this study was to assess the strength of the correlation between RBG and HbA1c and to make recommendations for the interpretation of RBG results in adult patients with Type 2 Diabetes taken at Karl Bremer District Hospital out-patient department. The objectives were: To determine glycaemic control in the study population and compare differences between age, sex and racial groups , and determine the RBG cut-off with the best sensitivity and specificity for predicting poor glycaemic control (HbA1c>7.0% ) as well as the predictive value, likelihood ratio and pre/post-test odds and probability at this cut off. Methods: A retrospective analysis of existing hospital data and the HbA1c tests requested from the NHLS by Karl Bremer Hospital over the 2011 year period. The data was analysed by means of a receiver operating characteristic (ROC) curve analysis to determine the value of RBG with the best combination of sensitivity and specificity to predict poor control of diabetes. A p-value of < 0.05 was assumed to represent statistical significance and 95% confidence intervals were used to describe the estimation of unknown parameters. HbA1c level of < = 7% was taken as representing good control and > 7% poor control. Results: Data was obtained on 349 diabetic patients of whom 203 (58.2%) were female and 146 (41.8%) male. This study population had a mean age of 54.7 years, mean RBG of 13.0mmol/l and mean HBA1c of 9.4%. The total number of black patients was 79 (23%), coloured patients 147 (42%) and white patients 122 (35) % and their mean RBG were 15.4 mmol/l, 12.8 mmol/l and 11.9 mol/l respectively. There was a statistically significant correlation between increasing RBG and increasing HbA1c (p< 0.01). The best value obtained on the ROC curve was an RBG of 9.8 mmol/l, which had a sensitivity of 77% and a specificity of 75%, positive predictive value of 0.88, positive likelihood ratio 3.08 and post-test probability of 88.2% for predicting an HbA1c above 7%. Conclusion: It was concluded that a moderate correlation exists between RBG and HbA1c in this population of diabetic patients. .The best RBG for determining poor control, defined as a HbA1c>7.0%, was found to be 9.8mmol/l and this RBG had a sensitivity of 77% , specificity of 75% and positive predictive value of 88%. Significant differences were found in pre- and post -test probability for different racial groups. Point of care testing using this level of RBG for clinical decision making will inappropriately categorise 23% of patients in this population and therefore introducing point of care testing for HbA1c is recommended.

Objetivo: Analisar os efeitos crônicos de dois modelos de treinamento aeróbico realizados em ambiente aquático e terrestre sobre parâmetros cardiorrespiratórios, funcionais, metabólicos, hormonais e de qualidade de vida em pacientes com diabetes mellitus tipo 2 (DMT2). Materiais e métodos: Pacientes com DMT2 foram randomizados em um grupo de treinamento aeróbico aquático (n = 11) ou um grupo de treinamento aeróbico terrestre (n = 10). Ambos os programas apresentaram uma periodização de treinamento similar, diferindo basicamente no meio em que foram realizados. Estes programas tiveram duração de 12 semanas, sendo adotado o método intervalado, com intensidades variando entre 85 e 100% do segundo limiar ventilatório (LV2) e duração total das sessões de 45 minutos. Foram avaliados parâmetros cardiorrespiratórios, funcionais, bioquímicos e de qualidade de vida, todos nos momentos pré e pós-treinamento. Os dados foram descritos pelos valores de média e desvio-padrão. A comparação das variáveis dependentes entre grupos no momento pré-intervenção foi realizada através do teste t de Student para amostras independentes ou através do teste de qui-quadrado. A análise de variância de medidas repetidas com fator grupo foi usada para comparações entre os diferentes momentos em ambos os grupos, adotando-se um nível de significância (α) de 0,05. Resultados: As intervenções propostas resultaram em um aumento do percentual do consumo de oxigênio no segundo limiar ventilatório - %VO2LV2 (p = 0,032) e uma redução da frequência cardíaca de repouso - FCrep (p = 0,011) em ambos os grupos, não alterando significativamente as variáveis cardiorrespiratórias consumo de oxigênio de pico (VO2pico), consumo de oxigênio no segundo limiar ventilatório (VO2LV2), pressão arterial sistólica (PAS) e pressão arterial diastólica (PAD). A mobilidade funcional também melhorou em ambos os grupos, pois estes diminuiram seus tempos médios de realização do Timed Up and Go test em velocidade habitual (p = 0,019) e máxima (p = 0,014). Analisando os desfechos glicêmicos, ambos os grupos apresentaram uma redução significativa nos níveis de hemoglobina glicada – HbA1c (p = 0,035) e não sofreram alterações significativas nos níveis de glicemia de jejum (GJ) e glicemia pós-prandial (GPP) após as intervenções propostas. Este comportamento foi encontrado também na análise dos valores de insulina de jejum (IJ) e resistência a insulina (HOMA-IR), que apresentaram apenas diferença entre os grupos (IJ, p = 0,039 e HOMA-IR, p = 0,032). No perfil lipídico, apenas os valores de triglicerídeos (TG) não demonstraram alterações após o treinamento, tendo ocorrido redução significativa nos níveis de colesterol total - CT (p = 0,054), lipoproteína de alta densidade - HDL (p < 0,001) e lipoproteína de baixa densidade - LDL (p = 0,034). O mesmo comportamento ocorreu na atividade da renina plasmática - ARP (p = 0,035) e nos níveis de proteína C-reativa ultra-sensível - PCRus (p = 0,001). Ambos os grupos também apresentaram melhora significativa após o período de treinamento na qualidade de vida relacionada aos domínios físico (p = 0,019) e psicológico (p = 0,027), sem alterações significativas na qualidade de vida geral e nos demais domínios analisados. Conclusões: O treinamento aeróbico proposto ocasionou benéficos efeitos no %VO2LV2, na FCrep, em parâmetros funcionais, no controle glicêmico, nos níveis de CT e LDL, na inflamação sistêmica, na ARP e na qualidade de vida relacionada aos domínios físico e psicológico, independente do meio em que foi realizado. No entanto, mostrou-se inespecífico para melhorar os níveis de HDL e não impactou significativamente a maioria dos parâmetros cardiorrespiratórios, assim como os níveis insulinêmicos e a qualidade de vida geral e nos domínios ambiental e relações sociais. / Aim: To analyse the chronic effects of two aerobic-training models performed in water and on dry land on cardiorespiratory, functional, metabolic, hormonal and quality-of-life parameters in patients with type 2 diabetes mellitus (T2DM). Materials and methods: Patients with T2DM were randomized to a group of aquatic aerobic training (n = 11) or a group of aerobic training on land (n = 10). Both programs had similar training periodization, with training environment being the main difference between them. The training programs had a duration of 12 weeks and adopted the interval-training method, with intensities ranging between 85 and 100% of second ventilatory threshold (VT2) and total duration of 45 minute per session. We assessed cardiorespiratory, functional, biochemical and quality-of-life parameters before and after the intervention. Data were described by mean and standard deviation. Comparisons between groups in the pre-intervention were performed using the Student t test for independent samples variables and the chi-square test. The repeated-measures analysis of variance with group as a factor was used for comparisons between pre- and post-training values. A significance level (α) of 0.05 was adopted for all analyses. Results: The proposed interventions caused an increase in percentage of oxygen consumption at second ventilatory threshold - %VO2VT2 (p = 0.032) and a reduction in rest heart rate - HR (p = 0.011) in both groups, while no significant alterations were found in the cardiorespiratory variables peak oxygen consumption (VO2peak), oxygen consumption at second ventilatory threshold (VO2VT2), systolic blood pressure (SBP) and diastolic blood pressure (DBP). Functional mobility was also improved in both groups, since average time for completing the Timed up and Go test in usual (p = 0.019) and maximal (p = 0.014) speed was decreased. Regarding the glycemic outcomes, both groups showed a significant reduction in glycated hemoglobin levels – HbA1c (p = 0.035) and no significant changes in the levels of fasting glucose (FG) and postprandial glucose (PPG) after the interventions. The values of fasting insulin (FI) and insulin resistance (HOMA-IR) showed differences only between the groups (FI, p = 0.039 and HOMA-IR, p = 0.032). Considering lipid profile variables, only triglycerides (TG) showed no change after training, with total cholesterol level – TC (p = 0.054), high density lipoprotein – HDL (p <0.001) and low density lipoprotein – LDL (p = 0.034) being significantly reduced. The same pattern was observed for the plasmatic rennin activity - PRA (p = 0.035) and high-sensitivity C-reactive protein - CRP levels (p = 0.001). Both groups also showed a significant improvement in quality of life related to the physical (p = 0.019) and psychological (p = 0.027) domains in response to the intervention, although there were no significant changes in overall quality of life and in the other domains analyzed. Conclusions: The proposed aerobic training programs elicited beneficial effects in %VO2VT2, rest HR, functional parameters, glycemic control, levels of TC and LDL, systemic inflammation, PRA and quality of life related to physical and psychological domains. These benefits did not depend on training environment. Nevertheless, this training method appears to be nonspecific for improvements in HDL levels and did not affect significantly the majority of cardiorespiratory parameters, as well as insulin levels, overall quality of life and quality of life in environmental and social relations.

Self-monitoring of blood glucose (SMBG) can be effective in preventing poor outcomes associated with diabetes mellitus but previous research has identified that SMBG is not being undertaken in line with current recommendations. Guidance informs health professionals to educate patients on how they should self-monitor but very little is know about how patients self-monitor in the real world. In this thesis, a quantitative scoping study is first presented. This study used routine data sources to examine the levels and patterns of self-montoring in different population groups and then proceeded to a larger qualitative study to explore and question what patients are doing in practice in relation to self-monitoring, and why. This involved a qualitative multi-case study of patients, their support people, health care practitioners (HCPs) and patient diaries. Ten individuals and their nominated support people and HCPs formed ten cases among whom 21 in-depth semi-structured interviews were carried out and six patient diaries analysed. The exploratory work was framed around Stones’ version of structuration theory and uncovered a complex linkage of individual motives for monitoring, associated responses and behaviours in relation to the motive, and the underpinning attitudes and beliefs behind the motive. The following key points emerged from the analysis. People have differing relationships with their diabetes and this links with the level of engagement they have with their condition. Resistance to support people and health services was commonly observed. Experiences of diabetes reviews were important, with an identified need for them to feel more like collaboration and less like surveillance. A significant factor was the gaps and limitations in knowledge and understanding around diabetes for patients, relatives, support people and HCPs; and, finally, there was a noted maintenance of blood glucose levels higher than recommended through SMBG in several participants, which stemmed from a fear of hypoglycemic episode. The analysis concluded that although self-monitoring of blood glucose, in theory, and when considered in isolation, is a simple process to undertake, its application in the wider context of self-management and the individual is much more complicated. The process is influenced by many complex factors and generates a variety of responses and behaviours, some not in keeping with good diabetes self-management. There was a significant lack of person-centered approaches to managing diabetes which was, in part, due to existing health systems and processes. Therefore, there is a need to raise awareness of the gaps that exist in terms of such approaches as well as the gaps in knowledge and understanding of individuals with diabetes and those caring for and supporting them. In more specific terms, it is essential to develop and evaluate individual approaches to patients in relation to their self-monitoring and associated self-management in the context of their own lives, which involves the assessment of engagement and understanding around self-monitoring.

Objetivo: Analisar os efeitos crônicos de dois modelos de treinamento aeróbico realizados em ambiente aquático e terrestre sobre parâmetros cardiorrespiratórios, funcionais, metabólicos, hormonais e de qualidade de vida em pacientes com diabetes mellitus tipo 2 (DMT2). Materiais e métodos: Pacientes com DMT2 foram randomizados em um grupo de treinamento aeróbico aquático (n = 11) ou um grupo de treinamento aeróbico terrestre (n = 10). Ambos os programas apresentaram uma periodização de treinamento similar, diferindo basicamente no meio em que foram realizados. Estes programas tiveram duração de 12 semanas, sendo adotado o método intervalado, com intensidades variando entre 85 e 100% do segundo limiar ventilatório (LV2) e duração total das sessões de 45 minutos. Foram avaliados parâmetros cardiorrespiratórios, funcionais, bioquímicos e de qualidade de vida, todos nos momentos pré e pós-treinamento. Os dados foram descritos pelos valores de média e desvio-padrão. A comparação das variáveis dependentes entre grupos no momento pré-intervenção foi realizada através do teste t de Student para amostras independentes ou através do teste de qui-quadrado. A análise de variância de medidas repetidas com fator grupo foi usada para comparações entre os diferentes momentos em ambos os grupos, adotando-se um nível de significância (α) de 0,05. Resultados: As intervenções propostas resultaram em um aumento do percentual do consumo de oxigênio no segundo limiar ventilatório - %VO2LV2 (p = 0,032) e uma redução da frequência cardíaca de repouso - FCrep (p = 0,011) em ambos os grupos, não alterando significativamente as variáveis cardiorrespiratórias consumo de oxigênio de pico (VO2pico), consumo de oxigênio no segundo limiar ventilatório (VO2LV2), pressão arterial sistólica (PAS) e pressão arterial diastólica (PAD). A mobilidade funcional também melhorou em ambos os grupos, pois estes diminuiram seus tempos médios de realização do Timed Up and Go test em velocidade habitual (p = 0,019) e máxima (p = 0,014). Analisando os desfechos glicêmicos, ambos os grupos apresentaram uma redução significativa nos níveis de hemoglobina glicada – HbA1c (p = 0,035) e não sofreram alterações significativas nos níveis de glicemia de jejum (GJ) e glicemia pós-prandial (GPP) após as intervenções propostas. Este comportamento foi encontrado também na análise dos valores de insulina de jejum (IJ) e resistência a insulina (HOMA-IR), que apresentaram apenas diferença entre os grupos (IJ, p = 0,039 e HOMA-IR, p = 0,032). No perfil lipídico, apenas os valores de triglicerídeos (TG) não demonstraram alterações após o treinamento, tendo ocorrido redução significativa nos níveis de colesterol total - CT (p = 0,054), lipoproteína de alta densidade - HDL (p < 0,001) e lipoproteína de baixa densidade - LDL (p = 0,034). O mesmo comportamento ocorreu na atividade da renina plasmática - ARP (p = 0,035) e nos níveis de proteína C-reativa ultra-sensível - PCRus (p = 0,001). Ambos os grupos também apresentaram melhora significativa após o período de treinamento na qualidade de vida relacionada aos domínios físico (p = 0,019) e psicológico (p = 0,027), sem alterações significativas na qualidade de vida geral e nos demais domínios analisados. Conclusões: O treinamento aeróbico proposto ocasionou benéficos efeitos no %VO2LV2, na FCrep, em parâmetros funcionais, no controle glicêmico, nos níveis de CT e LDL, na inflamação sistêmica, na ARP e na qualidade de vida relacionada aos domínios físico e psicológico, independente do meio em que foi realizado. No entanto, mostrou-se inespecífico para melhorar os níveis de HDL e não impactou significativamente a maioria dos parâmetros cardiorrespiratórios, assim como os níveis insulinêmicos e a qualidade de vida geral e nos domínios ambiental e relações sociais. / Aim: To analyse the chronic effects of two aerobic-training models performed in water and on dry land on cardiorespiratory, functional, metabolic, hormonal and quality-of-life parameters in patients with type 2 diabetes mellitus (T2DM). Materials and methods: Patients with T2DM were randomized to a group of aquatic aerobic training (n = 11) or a group of aerobic training on land (n = 10). Both programs had similar training periodization, with training environment being the main difference between them. The training programs had a duration of 12 weeks and adopted the interval-training method, with intensities ranging between 85 and 100% of second ventilatory threshold (VT2) and total duration of 45 minute per session. We assessed cardiorespiratory, functional, biochemical and quality-of-life parameters before and after the intervention. Data were described by mean and standard deviation. Comparisons between groups in the pre-intervention were performed using the Student t test for independent samples variables and the chi-square test. The repeated-measures analysis of variance with group as a factor was used for comparisons between pre- and post-training values. A significance level (α) of 0.05 was adopted for all analyses. Results: The proposed interventions caused an increase in percentage of oxygen consumption at second ventilatory threshold - %VO2VT2 (p = 0.032) and a reduction in rest heart rate - HR (p = 0.011) in both groups, while no significant alterations were found in the cardiorespiratory variables peak oxygen consumption (VO2peak), oxygen consumption at second ventilatory threshold (VO2VT2), systolic blood pressure (SBP) and diastolic blood pressure (DBP). Functional mobility was also improved in both groups, since average time for completing the Timed up and Go test in usual (p = 0.019) and maximal (p = 0.014) speed was decreased. Regarding the glycemic outcomes, both groups showed a significant reduction in glycated hemoglobin levels – HbA1c (p = 0.035) and no significant changes in the levels of fasting glucose (FG) and postprandial glucose (PPG) after the interventions. The values of fasting insulin (FI) and insulin resistance (HOMA-IR) showed differences only between the groups (FI, p = 0.039 and HOMA-IR, p = 0.032). Considering lipid profile variables, only triglycerides (TG) showed no change after training, with total cholesterol level – TC (p = 0.054), high density lipoprotein – HDL (p <0.001) and low density lipoprotein – LDL (p = 0.034) being significantly reduced. The same pattern was observed for the plasmatic rennin activity - PRA (p = 0.035) and high-sensitivity C-reactive protein - CRP levels (p = 0.001). Both groups also showed a significant improvement in quality of life related to the physical (p = 0.019) and psychological (p = 0.027) domains in response to the intervention, although there were no significant changes in overall quality of life and in the other domains analyzed. Conclusions: The proposed aerobic training programs elicited beneficial effects in %VO2VT2, rest HR, functional parameters, glycemic control, levels of TC and LDL, systemic inflammation, PRA and quality of life related to physical and psychological domains. These benefits did not depend on training environment. Nevertheless, this training method appears to be nonspecific for improvements in HDL levels and did not affect significantly the majority of cardiorespiratory parameters, as well as insulin levels, overall quality of life and quality of life in environmental and social relations.