Thesis (M Med (Family Medicine) -- University of Limpopo, 2011. / Introduction The burden of type 2 diabetes mellitus continues to rise and constitutes a real threat especially in the developing world. As for most non-communicable diseases, change of behavior and adoption of healthy lifestyle habits help to prevent and slow down the increase of type 2 diabetes mellitus. Aim of the Study To establish the knowledge, attitudes and practices regarding lifestyle modifications among type 2 diabetic patients attending the diabetic clinic at Mamelodi hospital. Methods: This cross sectional study describes the knowledge, attitudes and practices regarding lifestyle modifications (KAP) among 217 type 2 diabetes mellitus patients attending Mamelodi Hospital, Pretoria, Republic of South Africa. A face-to-face interview using a structured questionnaire was carried out for data collection. Socio-demographic characteristics of the participants and anthropometric measurements were obtained and the body mass index (8MI) of participants were determined. The Knowledge, attitude and practice of participants were assessed. 2 Results: Majority of participants were female 176(81.1 %), while male were 41 (18.9%). This amounted to a female to male ratio of 4:1. Most participants were in the age group 51-60 years 93(42.9%). Majority of them had low level of education 108(49.5%) and low income 206(94.9%). Majority of participants were obese 153(71 %) with more female diabetic patients being obese 120 (78.4%) than male 33 (21.6%). 15 participants (14 females and 1 male) were morbidly obese (BMI~40kg/m2). 108 participants (49.5%) did not have a formal education. No respondent had good knowledge and 92.6% of respondents had poor knowledge of the benefits of exercise, weight loss and healthy diet. Majority of respondents (97.7%) had bad practices in relation to lifestyle modifications. Nevertheless, majority of them (84.3%) had positive attitudes toward lifestyle modifications. Significant positive correlation (r= 0.170, p=0.012) was found between the global knowledge level and attitude level alone, whereas there was no significant correlation found between the global knowledge level and practice level as well as the attitude level and practice level. Conclusion: In conclusion, despite positive attitudes of participants toward healthy lifestyle habits, the knowledge and practices regarding lifestyle modifications among type 2 diabetes mellitus patients attending Mamelodi Hospital were generally low. Nevertheless the positive attitudes of participants should be encouraged and the implementation of a lifestyle intervention program will help improve the knowledge and practices of type 2 diabetes mellitus patients attending Mamelodi Hospital for the better management and control of this current pandemic of type 2 diabetes mellitus.

Class of 2009 Abstract / OBJECTIVES: To evaluate an educational booklet written in Chinese designed for Chinese-Americans with Type 2 diabetes mellitus. METHODS: Healthcare professionals who work with Chinese-American patients with Type 2 diabetes mellitus and proficiency in writing Chinese developed an educational booklet on Type 2 diabetes. An expert panel of Chinese American pharmacists and dietitians evaluated the booklet by rating language appropriateness, ease of reading, ease of locating information, overall presentation of the booklet, and usefulness of the booklet in a practice setting. Topics of the booklet were assessed for accuracy, relevance, and irrelevance. RESULTS: Questionnaires were completed by 8 healthcare professionals. In the expert panel, there were five pharmacists and three dietitians. Of the three dietitians, two were certified diabetes educator. The panel rated the booklet very highly; the mean overall rating was 22.4(±1.2) with 25 being the highest possible score. Overall, 100% of the evaluators would recommend this booklet for patients in their setting. CONCLUSIONS: Healthcare professionals found the booklet to be accurate, culturally relevant, and useful for their Chinese- American patients with type 2 diabetes mellitus.

Aims: to test the hypothesis that peripheral blood neutrophils (PMN) exhibit delayed spontaneous apoptosis in individuals with type 2 Diabetes, and that the delay is further exacerbated in individuals who co-express chronic periodontitis. Materials and methods: 73 individuals were enrolled, including those with type 2 diabetes (T2DM) (n=16), chronic periodontitis (CP) (n=15), diabetics with chronic periodontitis (T2DM+CP) (n=21) and healthy volunteers (n=21). PMN apoptosis was determined by flow cytometry using TUNEL and Annexin V assays. Caspase 3, 8 and 9 activity was measured by colorimetric assay. PMN surface death receptor quantification was performed by flow cytometry staining with fluorescence conjugated anti-CD120a (TNFR1) and anti- CD95 (FasR) antibody. Inflammatory biomarker analyses of serum samples were performed using multiplexed sandwich immunoassays. Results: In healthy volunteers, individuals with T2DM, CP and T2DM+CP, spontaneous PMN apoptosis observed at 12 hours reached 85.3% ± 3.1, 67.3% ± 3.9, 62.9% ± 3.5 and 62.5% ± 5.4, respectively (p<0.05 ). Caspase-3 activity was significantly reduced in individuals with T2DM and T2DM+CP (p<0.05), when compared to healthy volunteers. Caspase-8 activity was also significantly decreased in CP and T2DM+CP (p<0.05), associated with reduced cell surface Fas receptor, TNF receptors and Fas ligand serum levels. Glucose alone was not observed to effect PMN apoptosis; concurrent incubation with the RAGE agonist S-100B induced a significant PMN apoptosis (p<0.05). Conclusion: These data support the premise that the inhibition of PMN apoptosis in individuals with T2DM occurs through an AGE/RAGE ligand/receptor mediated interaction.

Bakgrund: Diabetes typ 2, en globalt ökande folksjukdom, kräver aktiv egenvård och livsstilsförändringar för att minimera komplikationer. Egenvård blir därmed en central aspekt i behandlingen av denna sjukdom. Metod: En Litteraturöversikt av 10 vetenskapliga artiklar med kvalitativ design har genomförts. Dataanalysen har skett i fem steg enligt Friberg. Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av patienter med diabetes typ 2 och egenvård. Resultat: Resultatet redogörs med två teman som är uppdelade i sex subteman: betydelsen av relationen till patienten (Kommunikation, Att skapa relation) samt sjuksköterskans roll i förändringsprocessen (Attityders betydelse, Att överbrygga hinder, Att utbilda patienter). Slutsats: Denna litteraturöversikt belyser viktiga aspekter av sjuksköterskors roll med patienter som har diabetes typ 2 och egenvård. Kommunikation, ehälsa och kontinuerlig kompetensutveckling är centrala faktorer. Utmaningar och hinder för patienters följsamhet, inklusive kulturella och ekonomiska faktorer identifieras. / Background: Type 2 diabetes, a globally increasing health challenge with a rising prevalence, requires active self-care and lifestyle changes to minimize complications. Self-care thus becomes a central aspect in the treatment of this disease. Method: Literature review with a qualitative design and inductive approach analyzed using Friberg's five-step analysis method. Purpose: The purpose was to describe nurses' experiences with type 2 diabetes patients and self-care. Results: The result is presented with two themes divided into six subthemes: the significance of the relationship with the patient (Communication, establishing a relationship) and the nurse's role in the process of change (The importance of attitudes, Overcoming barriers, To educate patients). Conclusion: This literature review highlights important aspects of nurses' roles with patients with type 2 diabetes and self-care. Communication, eHealth, and continuous competence development are central factors. Challenges and barriers to patient adherence, including cultural and economic factors, are identified.

Background Type 2 diabetes mellitus (T2DM) and serious mental illness involves major public health problems in the world. People with severe mental illness have an increased risk of metabolic abnormalities and obesity, leading to an increased incidence for T2DM. District nurses with advanced training in diabetes care will in their profession give support to lifestyle changes and healthy living habits. Aim The purpose of this study was to illuminate district nurses´ experience of how they can support people with T2DM and serious mental illness.Method A qualitative methodology based on individual interviews analyzed with qualitative content analysis was used. Twelve informants were part of the study. Results The individual meeting with mutual relations and respect for individuals was important. During periods of worsening mental health of the patient, the district nurses provide support and monitoring, adjusted to the patients' ability. The district nurses felt inadequacy and frustration when the patients' physical and mental health were deteriorating. The strategy was to acknowledge progress when small improvements were made and extended contacts with nurses in out-patient psychiatry were requested. Conclusion Support was designed as respectful treatments and individual meetings were prioritized. District nurses' strategies were to guide the patient by positive attitudes according to the individual, and by giving support adapted to the needs of the patient. Despite feelings of insufficiency the district nurses never gave up and conveyed the message to never let go. Cooperation and extended contact with open psychiatry were desirable to exchange knowledge, giving accordance in decisions and messages.

Class of 2009 Abstract / OBJECTIVES: An estimated 26.3 million Americans have Diabetes Mellitus (DM). Currently six classes of agents are approved for the treatments of Type 2 DM. Problems with current options have led to searches for new medications and adjunctive therapy. Prickly pear (Opuntia species) has been traditionally used by Mexicans and Pima Indians for the treatment of DM. This is a retrospective analysis of data obtained from a randomized placebo-controlled prospective experiment in 28 Type 2 DM rodents (ZDF). There were 2 negative control groups which consisted of non-DM rodents and ZDFs; each receiving water. The positive control group consisted of ZDFs who received rosiglitazone 4.75 mg/kg/day. The treatment group consisted of ZDFs who received 5-10 mL/kg/dose of Opuntia ficus indica (Jugo De Nopal) liquid, given twice daily. Weight, blood glucose and platelet aggregation were recorded and analyzed. At baseline, there were no significant differences in weight or blood glucose among ZDF groups. The lean control rodents had significantly lower blood glucose compared to the ZDF rodents (p<0.001). Treatment with Jugo de Nopal resulted in a statistically significant reduction in blood glucose (p<0.001), with a mean decrease in blood glucose of 7%. All treatment groups demonstrated a significant weight gain, however, the prickly pear group had significantly less weight gain than the rosiglitazone group (p=0.028). CONCLUSIONS: There was not a significant difference among the treatment groups with regard to platelet responsiveness. Further studies are necessary to determine the efficacy of prickly pear as a blood glucose lowering agent.

ABSTRACT Objective: The objective of this review was to describe the effects of low carbohydrate diets in people with diabetes type 2. Methods: Review. An article search was made in the databases PubMed and Medline. The search resulted in 17 studies. After review and analysis of the studies main results five categories were highlighted; bloodsugar levels, HbA1c, weight, lipid levels and antidiabetic medications. Results: The results revealed that diets low in carbohydrates may reduce blood sugar levels, fasting blood glucose and HbA1c-levels in people with type 2 diabetes. A low carbohydrate diet may reduce body weight for people with type 2 diabetes, this was shown in 12 of 17 studies. Total cholesterol was reduced in six of 17 studies. A reduction of triglycerides was found in eight of 17 studies. LDL-cholesterol was reduced in four of the studies. HDL- cholesterol was increased in eight of 17 studies. Conclusion: Some of the studies showed positive effects of a low carbohydrate diet for people with type 2 diabetes, for instance improvements in blood sugar levels, bodyweight, total cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol. The study implies that a low carbohydrate diet may be an alternative for people with type 2 diabetes in short terms.Keywords: Diabetes type 2, diet, low-carbohydrate, ketogenic, HbA1c

Diabetes type 2 is a fast growing illness and a global health problem, often a result from less appropriate standard of living. Lifestyle changes related to diet and physical activity are important lifestyle changes regarding to get control of the self-management and to avoid vascular complications. Aim The aim of this study was to describe patient's experiences of lifestyle changes in diabetes type 2. Method A literature study was carried through based on 12 qualitative scientific articles. Results The analysis result into two main themes and eight subthemes. Main themes where barriers and motivators for lifestyle changes and the subthemes where struggle, denial, lack of knowledge, alienation, support, motivation, acceptance and knowledge. Conclusion This study shows that lifestyle changes are experienced different by patient with diabetes and nurses should therefore be aware of the unique and specific demands these patients require. This is important for providing a good diabetic healthcare and to help patients with their self-management

Genome wide association studies (GWAS) have transformed the study of the heritability of complex diseases such as type 2 diabetes (T2D), with the current tally of established risk loci close to ninety. Each of these loci has the potential to offer novel insights into the biology of this disease, and opportunities for clinical exploitation. However, the complexity of T2D has often frustrated efforts to achieve these functional and translational advances. This thesis aims to delve into the functional characterisation of two known susceptibility loci, KLF14 and ADCY5, and describe findings relevant to disease pathology. KLF14 and ADCY5 are two loci associated with T2D predisposition working through disparate mechanisms. Variants at the maternally imprinted KLF14 locus are associated with measures of insulin resistance and expression data has implicated KLF14 as a master regulator of genes in adipose tissue. In contrast, variation at the ADCY5 locus is associated with impaired beta cell function, high fasting glucose, and low birth weight suggesting ADCY5 is having an effect on insulin secretion. In this thesis, ENU mouse models of these two genes are investigated functionally to elucidate more about the pathology of common human variation at these loci. A mouse model was derived with an ENU point mutation at Adcy5 Y1064C. Phenotyping of this model revealed improved oral glucose tolerance, and secretion studies from isolated islet cells demonstrated impaired glucagon secretion from mice homozygous for the Y1064C mutation in the presence of adrenaline. These results suggest that Adcy5 is involved in glucagon regulation in the alpha cell. The Adcy5 Y1064C confers a protective effect against hyperglycaemia in mouse indicating that the T2D risk allele at the ADCY5 locus in humans may have the opposite direction of effect. A mouse model containing the ENU point mutation Klf14 R238L predicted to be disruptive to KLF14 protein function showed no significant difference in body weight, measures of insulin resistance, or blood cholesterol. However, expression of several genes associated in trans with variation near KLF14 in humans was changed in adipose tissue and skeletal muscle when the R238L mutation was inherited maternally compared to mice which had inherited the mutation paternally or carried two wild type alleles. This result suggests a mechanism by which Klf14 is regulating genes across metabolic tissues.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / IntroduÃÃo: a diabetes à um dos principais fatores de risco relacionados à progressÃo da periodontite. Por outro lado, o tratamento periodontal ou a remoÃÃo de dentes comprometidos pode melhorar o controle glicÃmico dos diabÃticos. Objetivo: comparar por meio de dados de prontuÃrios os nÃveis de glicemia de jejum (GJ) de idosos diabÃticos do tipo 2, desdentados totais e dentados e, especificamente nestes, avaliar o efeito da doenÃa periodontal sobre o seu controle glicÃmico. Material e mÃtodo: idosos diabÃticos do tipo 2 totalmente desdentados (DESD - n=124), assim como dentados (DENT - n=65), foram selecionados segundo as seguintes caracterÃsticas: idade igual ou superior a 60 anos, nÃo fumantes e utilizaÃÃo de algum hipoglicemiante. Resultado: observou-se diferenÃa (p<0,05) para mÃdia de GJ entre os grupos DESD (144,9  66,9 mg/dL) e DENT (120,4  38,0 mg/dL). Quando o grupo DENT foi subdividido dentre os que apresentavam periodontite (DENT-P; GJ=126,7  44,6 mg/dL) ou nÃo (DENT-A; GJ= 117,4  34,2 mg/dL), foi observada diferenÃa apenas entre os grupos DESD e DENT-A. TambÃm foi observado que o grupo DESD demonstrou maior risco para hiperglicemia do que o grupo DENT. Para o corte de GJ &#8805; 126 mg/dL foi observado Odds ratio - OR = 2,01 (IC 95%=1,08 - 3,73). Para o corte de GJ &#8805; 170 mg/dL, OR = 2,47 (IC 95%=1,07 - 5,76). ConclusÃo: idosos desdentados diabÃticos do tipo 2 possuem um risco maior para expressar hiperglicemia do que indivÃduos dentados. Nestes, entretanto, a presenÃa de doenÃa periodontal parece influenciar o seu controle glicÃmico. / Introduction: Some studies had shown that the periodontal treatment can interfere with the glycemic control of diabetes patients. Thus, it can be hypothesized that in the absence of a periodontal infection, as in an edentulous or healthy periodontal patient, the glycemic control of type 2 diabetes patients can be improved. Objectives: The aim of this cross-sectional study was to compare the glycemic control of type 2 diabetes edentulous and dentate patients presenting or not periodontal diseases. Methods: There were selected type 2 diabetics according to the following criteria: they must be non-smokers, aging 60 years or more and being under therapy with hypoglycemics. Subjects were assigned to two groups based on their respective dental condition: edentulous (DESD, n=124) and dentate (DENT, n=65) The glycemic control was analyzed by fasting serum glucose (FSG). Results: It was found significant differences (p<0.05*) for mean GJ between groups DESD (144,9  66,9 mg/dL) and DENT (120,4  38,0 mg/dL). But when the DENT group was divided according to the presence of periodontitis (DENT-P; GJ=126,7  44,6 mg/dL) or not (DENT-A; GJ= 117,4  34,2 mg/dL), this difference was observed only between DESD and DENT-A. It was also observed that DESD group showed higher risk to present hyperglycemia when analyzed through two GJ cutoffs: GJ &#8805; 126 mg/dL, Odds ratio (OR) = 2,01 (CI 95%=1,08 - 3,73) and GJ &#8805; 170 mg/dL, OR = 2,47 (CI 95%=1,07 - 5,76). Conclusions: Edentulous type 2 diabetes patients presented higher glycemic levels than dentate ones. But, in these patients, the presence of periodontal diseases, along with other non-investigated factors could interfere with their glycemic control.