Background: Diabetes Mellitus and its complications have become a major public health problem around the world, with the number of patients diagnosed rising each year. Swellendam is no exception. Many of the patients, who receive their chronic medication from our clinics, have poorly controlled diabetes. Clinical audit can eliminate the gap between current and optimal clinical performance in Swellendam. The aim of this study was to improve the quality of care of diabetic patients at the chronic care clinics of the Swellendam sub district through a quality improvement process. Methods: An audit was done on the treatment and follow up of diabetic patients at Railton, Suurbraak and Buffeljagsrivier clinics in Swellendam. Standards and targets were set and data was collected retrospectively from a sample size of 95 patients. The results of the first audit were compared with the criteria and target standards. The audit team identified the standards we failed to meet and changes were made, as a result of the initial audit. To improve the quality of care of the patients and thus limiting the complications, it was set out to implement practical diabetes guidelines at our clinics to achieve this. After the changes were implemented and twelve months had past, another sample of the same 95 patients were taken and the audit was repeated. Results: The standards set were poorly achieved in the first audit. Significant improvements were noted when the secondary audit was done 12 months later. Patients who attended the clinic at least 6 times a year, improved from 40% during the first audit to 62% during the second audit. This increased the rate well above the target level of 50%. Recording of the patient’s weight at each visit remained fairly constant at 40% during the first audit and 41% during the second audit. This is still lower than the expected target level of 50%. The BMI was measured poorly. Although it improved from 6% in the first audit to 20% in the second audit, it was still far below the target level of 50%. Measuring of the Hgt levels improved well above the target level of 80%, from 78% in the first audit to 94% in the second audit. The same applies to the measuring of the blood pressure, where the first audit measured 78% and the second audit 95%. Testing of the patient’s urine was poorly adhered to, with 28% in the first and 35% in the second audit – much lower than the target level of 70%. A diet sheet was given to 93% of patients in the second audit, 21% more that in the first audit and 13% higher than the target of 80%. There was a huge improvement in the documenting of the patients’ foot exam, with 17% against 67%. In the first audit 61% of patients yearly visited the dietician, against 88% in the second audit. Again it is higher than the target of 80%. The vision test and fundoscopy were not well done, but nevertheless improved from the first audit. Vision test was done in 14% of patients in the first audit against 47% in the second audit, and the fundoscopy was done in 1% of patients against 38% in the second audit. The testing of the creatinine, lipid and HbA1c levels improved significantly in the second audit, respectively measuring 10%, 2% and 7% in the first audit, against 96%, 87% and 95% in the second, all well above the target levels of 70%. Only 24% of the patients’ random blood glucose levels were below 10 in the first audit against 44% in the second audit. This is lower than the target of 50%. The HbA1c levels were lower than 8 in only 13% of patients in the first audit, against 46% of patients in the second audit. Also it is lower than the target of 50%, but increased significantly. Conclusion: The results of the study showed how criteria-based audit can produce significant improvements in the quality of care of diabetic patients in a rural town in South Africa.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--Stellenbosch University, 2008. / OBJECTIVES: To determine perceived Quality of Life (QOL) of the diabetic patient and to assess whether QOL is associated with diabetes-related markers. DESIGN: This was a descriptive cross sectional study. SETTING: A multiethnic group of type 1 and 2 diabetic patients (n= 68) attending a diabetic clinic in Alberton, South Africa, were evaluated. SUBJECTS OUTCOME MEASURES: QOL was assessed by means of the Audit of Diabetes-Dependant Quality of Life (ADDQoL) questionnaire. Glycaemic control, duration of Diabetes Mellitus (DM), type of DM, diabetic complications, level of education and nutritional status were evaluated. RESULTS: Ninety eight percent of diabetic patients perceived their DM to impact negatively on their QOL (p=0.03). QOL and glycaemic control were significantly (p=0.03) related. QOL and the duration (p=0.80) or type (p=0.77) of DM were not significantly related. QOL ratings were lower in participants who had hypertension and hyperlipidaemia, whereas this trend was not present in those with microvascular complications. There was a trend towards a negative relationship between QOL and weight (p=0.10), BMI (p=0.10) and WC (p=0.41). All 13 individual life domains were significantly related (p < 0.05) to QOL for the group as a whole. Rankings of individual life domains differed between type 1 and type 2 diabetics (p<0.05) as well as between black and white subjects (p<0.05). CONCLUSIONS: These results show that DM impacts on various aspects of QOL and that various population sub-groups perceive their DM to impact differently on their QOL. QOL assessments should therefore form part of DM management and should be culturally sensitive.

Made available in DSpace on 2014-06-11T19:23:32Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-06-22Bitstream added on 2014-06-13T18:09:46Z : No. of bitstreams: 1 roselino_mn_me_arafcf.pdf: 540685 bytes, checksum: 986926f9460c0c09aaf8db6dd51572ca (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Universidade Estadual Paulista (UNESP) / O presente trabalho avaliou os efeitos do simbiótico fermentado com Enterococcus faecium CRL 183 e Lactobacillus helveticus ssp jugurti 416, à base de extratos de soja e de yacon produzidos em ratos com Diabetes mellitus, cuja indução foi feita quimicamente pela administração intraperitoneal de estreptozotocina (50mg/kg de peso corporal). Os animais foram divididos em quatro grupos experimentais (n=10): I - animais não diabéticos que receberam somente ração (controle negativo); II - animais diabéticos que receberam somente ração (controle positivo); III – animais diabéticos que receberam ração + dose de 1 mL/Kg de peso corpóreo/dia do produto não fermentado a base de soja e yacon; IV – animais diabéticos que receberam ração + dose de 1 mL/Kg de peso corpóreo/dia do produto fermentado a base de soja e yacon. No produto em estudo foram quantificadas a viabilidade dos microrganismos probióticos e a concentração dos frutanos (FOS e inulina). O período experimental foi de 59 dias e os parâmetros avaliados foram: peso corpóreo dos animais, ingestão hídrica e alimentar, Coeficiente de Eficácia Alimentar (CEA), glicemia, enzimas aspartato aminotransferase (AST) e alanina aminotransferase (ALT), triglicerídeos, colesterol, HDL, nHDL-C, gorduras epididimal e retoperitonial, músculos sóleo e extensor longo dos dedos, cortes histológicos de fígado, pâncreas e rim e, análise de biomarcadores de estresse oxidativo, TBARS (substâncias reativas ao ácido tiobarbitúrico) e DPPH (2,2 - difenil-1-picril de hidrazila). Não foi observada diferença entre os grupos que receberam os produtos não fermentado e fermentado quando comparado com o grupo de diabéticos que não recebeu tratamento, para consumo de água, ração e peso corporal. O mesmo foi observado para os parâmetros bioquímicos, exceto... / This study evaluated the hypoglycemic effects of synbiotic fermented with Enterococcus faecium CRL 183 and Lactobacillus helveticus ssp jugurti 416, based on soymilk and yacon produced in rats with Diabetes mellitus, whose induction was done chemically by intraperitoneal administration of streptozotocin (50 mg/kg body weight). The rats were divided into four groups (n=10): I – non diabetic animals that received only chow diet (negative control), II – diabetic animals that received only chow diet (positive control), III – diabetic animals that received chow diet + 1mL/kg body weight/day of unfermented product of soybean and yacon, IV – diabetic rats that received chow diet + 1mL/kg body weight/day of fermented product of soybean and yacon extracts. In the product under study were quantification viability of microorganisms of the probiotic and the concentration of fructans (inulin and FOS). The experiment was carried out for 59 days and the parameters were evaluated: body weight of animals, feed and water intake, Food Efficiency Ratio (FER), glucose, enzymes aspartate aminotransferase (AST) and alanine aminotransferase (ALT), levels of triglyceride, cholesterol, HDL-C nHDL, epididymal and retoperitonial white adipose tissue, soleus and extensor digitorum longus and tissues liver, kidney and pancreas, and analysis of biomarkers of oxidative stress, TBARS (thiobarbituric acid reactive substances) and DPPH (2,2 - diphenyl-1-picryl of hidrazila). No difference was observed between the groups that received unfermented and fermented products when compared to the diabetic group that not received treatment, for drinking water, feed intake and body weight. The same was observed for the biochemical parameters, except for fractions HDL-cholesterol and triglycerides. With respect to biomarkers there was... (Complete abstract click electronic access below)

Made available in DSpace on 2013-08-07T18:41:34Z (GMT). No. of bitstreams: 1 000386733-Texto+Completo-0.pdf: 743672 bytes, checksum: c329d7b51647dead043fdc30dd374c25 (MD5) Previous issue date: 2005 / A clorpropamida é uma droga hipoglicemiante que atua bloqueando os canais de K+ ATP-dependentes, provocando com isto um aumento na liberação de insulina. Seguindo-se uma série de experimentos a cerca da frutose-1,6-bisfosfato, avaliando seus efeitos antiinflamatório e hipoglicemiante, foi proposto, para esta droga, um mecanismo de ação associado ao bloqueio de canais de K+ ATP-dependentes. Em um estudo comparativo entre a clorpropamida e a frutose-1,6-bisfosfato foi observado um efeito imunomodulador do agente hipoglicemainte em cultura de linfócitos. Este trabalho tem por objetivo avaliar os efeitos imunomoduladores das drogas hipoglicemiantes orais em cultura de linfócitos de voluntários sadios e pacientes diabéticos do tipo 2. Para isso foram realizados experimentos in vitro e ex vivo utilizando as seguintes drogas hipoglicemiantes: sulfoniluréias, metformina e a terapia combinada de ambas. No estudo ex vivo foi acrescentado um grupo de pacientes diabéticos que controlavam a glicemia através de dieta apropriada. Os resultados obtidos demonstraram que existe um efeito inibidor da proliferação celular por parte dos anti diabéticos orais, tanto das sulfoniluréias quanto da metformina, e que esse efeito apresenta correspondência em ambos experimentos. Os pacientes diabéticos do tipo 2 que fazem uso exclusivo da dieta também tiveram uma redução significativa da proliferação celular quando submetidos ao agente imunoestimulador. A partir disto podemos sugerir que as manifestações inflamatórias relacionadas ao diabetes mellitus do tipo 2 podem estar sofrendo influência da terapêutica.

Dissertação (mestrado)—Universidade de Brasília, Faculdade em Ciências da Saúde, Programa de Pós-Graduação em Ciências da Saúde, 2016. / Submitted by Albânia Cézar de Melo (albania@bce.unb.br) on 2016-06-09T15:51:33Z No. of bitstreams: 1 2016_CamilaGreiceChrist.pdf: 2550701 bytes, checksum: 5650ad88b979d9f6192a93b25609fbd3 (MD5) / Approved for entry into archive by Marília Freitas(marilia@bce.unb.br) on 2016-07-30T11:20:02Z (GMT) No. of bitstreams: 1 2016_CamilaGreiceChrist.pdf: 2550701 bytes, checksum: 5650ad88b979d9f6192a93b25609fbd3 (MD5) / Made available in DSpace on 2016-07-30T11:20:02Z (GMT). No. of bitstreams: 1 2016_CamilaGreiceChrist.pdf: 2550701 bytes, checksum: 5650ad88b979d9f6192a93b25609fbd3 (MD5) / A prevalência da obesidade está em ascensão mundial e associa-se ao desenvolvimento de resistência insulínica e diabetes mellitus tipo 2 (DM2). Tiazolidinadionas (TZD) melhoram a sensibilidade à insulina e a homeostase da glicose em humanos e modelos animais. Os efeitos benéficos são, em grande parte, devidos à ativação do receptor gama ativado por proliferadores peroxissomais (PPAR). A utilização clínica das TZD, no entanto, é limitada devido a efeitos adversos de ganho ponderal e adipogênese, retenção hídrica, perda de massa óssea e aumento do risco cardiovascular. A ativação parcial e específica do PPAR, assim como a modulação seletiva de sua atividade em determinados tecidos, apresenta capacidade de sensibilização insulínica sem indução de ganho ponderal associado à ativação completa e não seletiva pelas TZD. Ativação total de PPARpelas TZD está associada também à indução de perfil de expressão gênica relacionado à termogênese no tecido adiposo branco (TAB), aumento da expressão da proteína desacopladora 1 (UCP1) na membrana mitocondrial interna e aumento da biogênese mitocondrial. Estas ações, contudo, não resultam em aumento do gasto energético e redução ponderal. O desenvolvimento de ligantes com atividade agonista parcial/moduladora seletiva e capazes de induzir a termogênese no TAB poderia representar estratégia para tratamento simultâneo da obesidade e resistência insulínica. Com objetivo de investigar o composto derivado de TZD, GQ-02, sobre variáveis metabólicas e a expressão de Ucp1 no adipócito branco, foram realizados ensaios em cultura de células e in vivo, com camundongos C57Bl/6 alimentados com dieta hiperlipídica (DHL). O GQ-02 apresentou efeito adipogênico fraco em pré-adipócitos 3T3-L1 induzidos a se diferenciar em cultura de células com meio contendo inibidor de fosfodiesterase, dexametasona e insulina. In vivo, o tratamento com GQ-02 (20 mg/kg/dia), durante 21 dias, apresentou efeito antidiabético semelhante ao da TZD clássica rosiglitazona e, ainda, perda de peso e redução da eficiência metabólica nos camundongos alimentados com DHL. Foi observado, ainda, em resposta ao tratamento com GQ-02, redução da massa do tecido adiposo branco visceral e do tamanho dos adipócitos, acompanhado de tendência ao aumento do consumo de oxigênio e aumento significativo da expressão do gene que codifica Ucp1 neste depósito de TAB. No tecido adiposo marrom, foi observado redução do conteúdo lipídico intracelular e tendência ao aumento da expressão de Ucp1 nos camundongos tratados com GQ-02. Não foram observadas diferenças nas características histológicas do TAB subcutâneo e, no fígado, foi observado melhora da esteatose hepática em resposta ao tratamento com o GQ-02. Estes resultados sugerem efeitos metabólicos favoráveis do GQ-02 em modelo de obesidade e DM2, que incluem seu possível potencial termogênico. _____________________________________________________________________________________________________________ ABSTRACT / The prevalence of obesity is on the rise worldwide and is associated with the development of insulin resistance and type 2 diabetes mellitus (T2D). Thiazolidinediones (TZD) enhance insulin sensitivity and glucose homeostasis in humans and animal models. The beneficial effects are largely due to the activation of peroxisome proliferator-activated receptor gamma (PPAR). The clinical use of TZDs, however, is limited due to side effects of weight gain and adipogenesis, fluid retention, loss of bone mass and increased cardiovascular risk. The partial and specific activation of PPAR, as well as the selective modulation of its activity in certain tissues, results in improved insulin sensitivity without inducing weight gain associated with the full and non-selective activation by TZDs. Full activation of PPAR by TZDs is also associated with induction of gene expression profile related to thermogenesis in white adipose tissue (WAT), increased expression of uncoupling protein 1 (UCP1) in the inner mitochondrial membrane and increased mitochondrial biogenesis. These actions, however, do not result in increased energy expenditure and weight loss. The development of PPAR ligands with partial agonist / selective modulator activity capable of inducing thermogenesis in WAT could represent a strategy for the simultaneous treatment of obesity and insulin resistance. In order to investigate the TZD-derivative compound GQ-02 on metabolic variables and UCP1 expression in white adipocytes, assays were performed in cell culture and in vivo with C57BL/6 mice fed with high fat diet (HFD). GQ-02 showed a weak adipogenic effect on preadipocytes 3T3-L1 induced to differentiate in cell culture medium containing phosphodiesterase inhibitor, dexamethasone, and insulin. In vivo, treatment with GQ-02 (20 mg/kg/day) for 21 days showed an antidiabetic effect similar to that of the classical TZD rosiglitazone, in addition to weight loss and decreased metabolic efficiency. GQ-02 treatment also reduced visceral WAT mass and the size of adipocytes, accompanied by a trend torwards increased oxygen consumption and an increased expression of Ucp1 in this fat depot. In brown adipose tissue, there was a decrease in intracellular lipid content and a trend towards increases Ucp1 expression in mice treated with GQ-02. No differences were observed in the histological characteristics of subcutaneous WAT. There was an improvement of hepatic steatosis in response to treatment with GQ-02. These results suggest the favorable metabolic effects of GQ-02 in an obesity and T2D model, including its possible potential thermogenic effect.

Tese (doutorado)—Universidade de Brasília, Instituto de Ciências Biológicas, Departamento de Biologia Celular, 2008. / Submitted by Fernanda Weschenfelder (nandaweschenfelder@gmail.com) on 2009-09-23T20:54:12Z No. of bitstreams: 1 2008_ValiaBravoEgana.pdf: 2065608 bytes, checksum: 94fcce433a53fcc9451190300b2bdd0b (MD5) / Approved for entry into archive by Guimaraes Jacqueline(jacqueline.guimaraes@bce.unb.br) on 2009-12-12T12:48:19Z (GMT) No. of bitstreams: 1 2008_ValiaBravoEgana.pdf: 2065608 bytes, checksum: 94fcce433a53fcc9451190300b2bdd0b (MD5) / Made available in DSpace on 2009-12-12T12:48:19Z (GMT). No. of bitstreams: 1 2008_ValiaBravoEgana.pdf: 2065608 bytes, checksum: 94fcce433a53fcc9451190300b2bdd0b (MD5) Previous issue date: 2008 / MicroRNAs (miRNAs) são os produtos gênicos não-codantes (~19-22 nucleotídeos) com um papel chave no regulamento pós-transcricional inibindo a expressão gênica através da união seletiva a seqüências complementares de RNA mensageiro. Nossos resultados indicam que os miRNAs isolados com métodos atualmente usados para preparação de RNA são instáveis assim como também seus cDNAs correspondentes. Estas observações têm grande importância em estudos de análise de expressão de miRNAs. Além, nosso laboratório é pioneiro em determinar perfis específicos de miRNA em ilhotas pancreáticas humanas e de roedores normais assim como em ilhotas expostas à ação de citocinas diabetogênicas pró-inflamatórias. O miR-7 resultou ser o miRNA mais abundante da porção endócrina das ilhota e o miR-375 o mais abundante no pâncreas. Ambos os miRNAs aumentaram sua expressão durante o desenvolvimento pancreático, assim como também, em ilhotas tratadas com citocinas pró-inflamatórias por 6 horas. Estas observações sugerem que o miR-7 e o miR-375 desempenham um papel importante não apenas durante o processo de desenvolvimento e de manutenção do fenótipo das ilhotas mas também nos sinais de sobrevivência nos primeiros estágios da resposta inflamatória. A pesquisa dos miRNAs e de seus mRNAs alvos pode tornar-se uma ferramenta valiosa para o diagnóstico e tratamento de doenças tais como o diabetes. ___________________________________________________________________________________ ABSTRACT / MicroRNAs (miRNAs) are non-coding gene products (~19–22 nucleotides) that play a key role in post-transcriptional regulation by inhibiting gene expression through selective binding to complementary messenger RNA sequences. Our early results indicated that miRNAs isolated with currently used methods for RNA preparation are unstable and so are their corresponding cDNAs. These observations should be of great interest to all researches that outsource RNA samples for miRNA gene array analysis. We are first to determine specific miRNA signatures in normal pancreatic islets as well as in islets exposed to pro-inflammatory (diabetogenic) cytokines. MiR-7 emerged as the most abundant endocrine islet miRNA and miR-375 as the most abundant intra-islet miRNA. Both miRNAs increased their expression during pancreatic development as well as in islets treated with pro-inflammatory cytokines for 6 hours. This suggests that miR-7 and miR-375 play an important role not only in development and islet phenotype maintenance but also in the survival signaling at the early inflammatory response. The research of miRNAs and their target mRNAs could be a valuable tool in diagnostics by indicating the early onset of diseases such as diabetes and by finding new therapeutic targets to treat them.

Thesis (M.Sc.D.)--Boston University School of Graduate Dentistry, 1975. Pedodontics. / Bibliography included.

No description available.

No description available.

La presente investigación tiene como objetivo principal realizar la comparación entre el soporte social en un grupo de adultos diabéticos no insulino dependientes que pertenecen a un club de apoyo y uno que no pertenece. Para cumplir tal objetivo, se aplicó el Inventario de entrevista de soporte social de Arizona, así como una ficha de datos sociodemográficos y asociados a la enfermedad a una muestra de 30 diabéticos no insulino dependientes que pertenecen a un club de apoyo y 26 que no pertenecen. Se encontraron diferencias significativas entre grupos para las funciones de consejo e información, asistencia e interacción negativa efectiva, siendo mayor para el grupo que no pertenece al club de apoyo. Se evidenciaron además, relaciones positivas entre el número de redes sociales y el soporte social percibido y efectivo. Asimismo, las redes familiares presentaron relaciones positivas con las funciones de ayuda material y participación social recibida, tanto como relaciones negativas con la satisfacción con el apoyo material. A nivel de variables asociadas a la enfermedad, se encontraron diferencias significativas entre el último nivel de glucosa y la pertenencia o no al club de apoyo. A nivel de otras variables se evidenciaron diferencias significativas respecto al sexo así como a la situación sentimental. / The aim of this study is to compare the levels of social support between two groups: one group is composed by non-insulin diabetic patients who belong to a support group and the other was non- insulin diabetic group with no support. This was done by using the Arizona Social Support Interview and a data sheet to a group of 30 non – insulin diabetic patients who belong to a support group and 26 non- insulin diabetic group with no support. The results showed statistically meaningful differences between both groups in support functions like advice and information, assistance and negative interaction received support. The support is higher in the group that does not belong to the support group. It was also found a positive correlation between socially network size and the received and perceived support. In the case of family network size, it appears direct correlations with support functions like material and social participation received support, and negative correlation with material support satisfaction. It also appears statistically meaningful differences in the last level of glucose and membership or not to the support group. Finally it appears statistically differences between social support and variables like sex and pairing. / Tesis