Bakgrund: Diabetes är en kronisk sjukdom som drabbar cirka 425 miljoner människor världen över och kan orsaka förtida död. Diabetes Federation rapporterar en ökning av diabetes runtom i världen, främst i låg- och medelinkomstländer. I Sverige drabbas cirka 5% av befolkningen av typ 2-diabetes och siffran fortsätter att öka. Samhället behöver ta ett större ansvar genom att ta på sig en gedigen ledarroll för att bevara människors hälsa och därigenom hjälpa landets invånare att förändra sin livsstil. Behandlingen av diabetes ska inte enbart fokusera på medicinering utan även på andra omvårdnadsinsatser som kan hjälpa patienter med typ 2-diabetes att leva ett så sunt och normalt liv som möjligt. Syfte: Syftet med denna litteraturöversikt är att beskriva stödet i samband med livsstilsförändringar vid typ 2-diabetes. Metod: Metoden utgjordes av en litteraturöversikt som bygger på 12 vetenskapliga artiklar med både kvalitativa och kvantitativa ansatser. Resultat: Resultatet efter dataanalysen visade på två huvudteman varav den ena var Stöd till ändrad livsstil och den andra var Stöd för ökad kunskap och motivation samt sex subteman vilka innefattade nutritionsstöd, stöd för viktnedgång, stöd för ökad aktivitet, stöd från sjukvårdspersonal, kunskapsstöd och socialt stöd. Det som framkom var att individer med diabetes typ 2 påverkades positivt av olika typ av stöd, vilket kan komma att hjälpa individerna att förändra sin livsstil, hindra komplikationer och uppnå en värdig hälsa. Slutsats: Olika former av stöd främjar hälsa och välmående samt ger patienter med typ 2 diabetes en bättre livskvalitet och möjliggör för patienten att leva ett hälsosamt liv. / Background: Diabetes is a chronic disease that affects approximately 425 million people worldwide and can cause premature death. The Diabetes Federation reports an increase in diabetes around the world, mainly in low- and middle-income countries. In Sweden, about 5% of the population suffers from type 2 diabetes and the number continues to increase. Society needs to take on a greater responsibility by assuming a solid leadership role to preserve human health and thereby help the country's inhabitants to change their lifestyle. The treatment of diabetes should not only focus on medication but also on other nursing efforts that can help patients with type 2 diabetes to live as healthy and normal life as possible. Aim: The purpose of this literature review is to describe the support associated with lifestyle changes in type 2 diabetes. Method: The method consisted of a literature review based on 12 scientific articles with both qualitative and quantitative approaches. Results: The results after the data analysis showed two main themes whereas one was related to support for changing one’s lifestyle and the other one was support for increased knowledge and motivation as well as six subthemes which included nutrition support, weight loss support, increased activity support, support from healthcare professionals, knowledge support and social support. What emerged was that individuals with type 2 diabetes were positively affected by different types of support, which may help individuals to change their lifestyle, prevent complications and help them achieve dignified health. Conclusion: Various forms of support promote health and well-being and give patients with type 2 diabetes a better quality of life and enable the patient to live a healthy life.

Bakgrund: Diabetes typ 2 är en ökande folkhälsosjukdom som till stor del orsakas av ohälsosammalevnadsvanor. Det är viktigt att sjuksköterskan utöver sin specialistkompetens, omvårdnad, har denkunskap som krävs för att kunna hjälpa patienter att motiveras till egenvård och livsstilsförändringargenom motiverande samtal. Syfte: Syftet med studien var att beskriva sjuksköterskors erfarenheter avatt motivera vuxna patienter med diabetes typ 2 till egenvård och livsstilsförändringar. Metod: Studienär en allmän litteraturstudie med kvalitativ ansats. Resultat: Studien resulterade i 3 kategorier och 6underkategorier; Vikten av kunskap (otillräcklig utbildning & utbildning ökar sjuksköterskanssjälvförtroende), Sjuksköterskans hinder (maktlöshet och hopplöshet & Sjuksköterskans upplevelser avpatienternas beteenden och attityder), Stöd från organisationen (ekonomiska brister & behovet av tid)som besvarade studiens syfte och problemformulering. Diskussion: Sjuksköterskorna upplevdekunskapsbrist gällande att motivera patienter till att utföra egenvård och livsstilsförändringar. Ekonomi,resurser och tidsbrist hade en påverkan på sjuksköterskans arbete. Sjuksköterskor som fått utbildninginom hantering av patienter med diabetes typ 2 upplevde vården mer lättsam med förbättradevårdresultat. Slutsats: Vården av patienter med diabetes typ 2 kan förbättras om sjuksköterskor harkunskap, tid och stöd för att kunna utöva personcentrerad vård och för att motivera patienter tillegenvård och livsstilsförändring / Background: Type 2 diabetes is an increasing public-health disease largely caused by unhealthylifestyle habits. It is important that nurses, in addition to their specialized competence, have theknowledge required to help patients to be motivated to self-care and lifestyle changes throughmotivational interviewing. Aim: Describe nurses' experiences of motivating adult patients with type 2diabetes to self-care and lifestyle changes. Method: General literature review with a qualitativeapproach. Results: The study resulted in 3 categories and 6 subcategories; Importance of knowledge(insufficient education & education increases the nurse's self-confidence), nurse's obstacles(powerlessness & hopelessness & nurse's experiences of patients' behaviors and attitudes), Support fromthe organization (financial shortages & the need for time) that answered the study's purpose andproblem formulation. Discussion: The nurses experienced lack of knowledge regarding motivatingpatients to perform self-care and lifestyle changes. Finances, resources and lack of time had an impacton the nurses' work. Nurses who received training in management of type 2 diabetes perceived thecare to be more straightforward with improved outcomes. Conclusion: The care of patients with type 2diabetes can be improved if nurses have the knowledge, time and support to practice person-centeredcare to motivate patients to self-care and lifestyle changes.

Bakgrund: Diabetes typ 2 är en kronisk sjukdom som påverkas av faktorer som övervikt, inaktivitet och genetik. Symtom inkluderar ökad törst och trötthet. Diagnos kräver mätning av blodglukos över tid och behandling fokuserar på livsstilsförändringar och medicinering. Komplikationer kan vara allvarliga, inklusive hjärt- och kärlsjukdomar samt synnedsättning. Egenvård är avgörande i behandlingen. Genom personcentrerad vård kan sjuksköterskan främja patientens välbefinnande och stödja denne att hantera sjukdomen. Syfte: Syftet med studien är att undersöka patienters erfarenhet av egenvård vid diabetes typ 2. Metod: En kvalitativ litteraturstudie, att göra en integrerad sammanställning av kvalitativa forskningsartiklar där nio artiklar har granskats, analyserats för att identifiera nya teman. Resultat: Visar fem teman: Livsstilsförändring är en utmaning, ändrad livsstil ger välbefinnande, kommunikation med sjuksköterskan påverkar, egenvård som ett sätt för att förebygga komplikationer och patienternas kunskap om sjukdomen påverkar. Konklusion: Egenvård är avgörande för att hantera sjukdomen diabetes typ 2. En positiv och stödjande relation med vårdpersonalen, tydlig kommunikation och engagemang från närstående är alla viktiga faktorer för att underlätta livsstilsförändringar. Utbildning och information om sjukdomen spelar en nyckelroll för att stärka patienternas motivation att genomföra förändringar i sin vardag. / Background: Type 2 diabetes is a chronic disease that is affected by factors such as obesity, inactivity and genetics. Symptoms include increased thirst and fatigue. Diagnosis requires measurement of blood glucose over time and treatment focuses on lifestyle changes and medication. Complications including cardiovascular disease and vision loss. Self-care is important in the treatment. Through person-centered care, the nurse can promote the patient's well-being and support him to manage the disease. Aim: The aim of the study is to investigate patients' experience of self-care in diabetes type 2. Method: A Qualitative literature study, to make an integrated overview of qualitative research articles where nine articles have been analyzed to identify new themes. Findings: Shows five themes: Lifestyle change is a challenge, lifestyle change provides well-being, communication with the nurse affects, self-care as a way to prevent complications, patients' knowledge of the disease affects. Conclusion: Self-care is crucial to managing the disease. A positive and supportive relationship with the healthcare staff, clear communication and commitment from relatives are all important factors in facilitating lifestyle changes. Education and information about the disease play a key role in strengthening patients' motivation to implement changes in their everyday lives.

Bakgrund: Diabetes typ 2 är en kronisk sjukdom vars prevalens ökar varje år, som bidrar till ett omfattande folkhälsoproblem. Förändrade levnadsvanor och egenvård är av stor betydelse vid behandling av typ 2-diabetes. För att säkerställa att personen får god individuell vård och behandling, är det viktigt att undersöka personens upplevelser av att leva med typ 2-diabetes i vardagen. På så sätt kan sjuksköterskan erbjuda vård utifrån den unika individens behov. Syftet:Syftet var att belysa personers upplevelser av att leva med diabetes typ 2 i det dagliga livet. Metod: En litteraturstudie som är baserad på sammanställning av 12 vetenskapliga primära artiklar med kvalitativ ansats. Artiklarna inhämtas genom strukturerad sökning i databaserna Cinahl och PubMed. Artiklarna granskades med hjälp av en granskningsmall för kvalitativa studier och analyserades genom kvalitativ innehållsanalys. Resultat: Tre huvudkategorier och nio underkategorier identifierades. Huvudkategorierna var: känslomässiga reaktioner, Upplevelser av livsstilsförändringaroch Upplevelser av stöd. Underkategorierna var: upplevelser av oro och rädsla, upplevelser av stress och psykisk påverkan, upplevelser av kostförändringar, upplevelser av fysisk aktivitet, upplevelser av medicinering och blodsockermätningar, utmaning till följd av komplikationer, betydelsen av familjens stöd, upplevelser av möten med sjukvården och samhällets attityd. Konklusion: Personer med diabetes typ 2 upplevde olika grader av utmaningar i det dagliga livet. Utmaningar förknippade med det nya sättet att leva med hänsyn till den kulturella aspekten. Det förekom att personens kunskap och tillgång till information om diabetes typ 2 är en viktig faktor till följsamheten till behandling och egenvård. Genom personcentrerad vård och individuellt anpassad information kan följsamheten förbättras. För att främja personcentrerad vård hos personer med diabetes typ 2, krävs kunskap och förståelse om deras vardag. / Background: Diabetes type 2 is a chronic disease with prevalence increasing every year. The disease contributes to a major public health problem. Lifestyle changes and self-care are of major importance in the management of type 2 diabetes. To ensure that the person receives good care and treatment, it is important to explore the person's experience with type 2 diabetes in everyday life. In this way nurses will be able to provide care based on the unique individual's needs. Purpose: The purpose of the study was to highlight persons’ experiences of living with type 2 diabetes in a daily life. Method: A literature study which is based on a compilation of 12 scientific primary articles with a qualitative approach. Articles were obtained through a structured search in the databases Cinahl and Pubmed. The articles were reviewed using a review template designed for qualitative studies and analyzed through qualitative content analysis. Results: Three main categories and 9 subcategories were identified. The categories were: emotional reactions, experiences of lifestyle changes and experiences of support. The subcategories were: experiences of anxiety and fear, experiences of stress and psychological impact, experiences of dietary changes, experiences of physical activity, experiences of medication and blood sugar measurements, challenge due to complications, the importance of family support, experiences of meetings with healthcare and society’s attitude. Conclusion: Persons with type 2 diabetes experienced varying degrees of challenges in their daily life. Challenges associated with the new way of life with regard to the cultural aspects. It appeared that the person's knowledge and access to information about type 2 diabetes is an important factor in adherence to treatment and self-care. Through person-centered care and individually adapted information, compliance can be improved. In order to promote person-centered care in persons with type 2 diabetes, knowledge and understanding of their everyday life is required.

Bakgrund: Med en ökande prevalens av diabetes typ 2 globalt, är behovet av effektiv omvårdnad och stöd för livsstilsförändringar viktigt. Distriktssköterskor spelar en nyckelroll i att främja hälsosamma beteenden hos dessa patienter. Syfte: Syftet med studien är att undersöka hur distriktssköterskor motiverar patienter med diabetes typ 2 till att genomföra livsstilsförändringar. Metod: Studien baseras på en kvalitativ intervjuundersökning med induktiv ansats. Semistrukturerade intervjuer genomfördes med distriktssköterskor inom primärvården, i studiens fall vårdcentraler. Data analyserades genom en kvalitativ innehållsanalys där det reflekterades över innehåll och eventuella mönster i distriktssköterskornas upplevelser och praxis identifierades. Resultat: Studien visar att personcentrerad vård, aktivt lyssnande och empati är avgörande för att motivera patienter med diabetes typ 2 till livsstilsförändringar. Distriktssköterskorna betonar anpassning av stödet till varje patients unika behov och vikten av patientinvolvering i vårdbeslut. Teamarbete och samarbete över professionella gränser är också centrala för att erbjuda koordinerad vård. Diabetesskolan och anhörigas involvering framhålls som viktiga resurser för att stödja och motivera patienterna. Konklusion: Studien understryker distriktssköterskors centrala roll i att främja livsstilsförändringar hos patienter med diabetes typ 2 och föreslår ytterligare forskning för att utveckla riktlinjer och utbildningsprogram som stärker denna aspekt av diabetesvården. / Background: With an increasing prevalence of type 2 diabetes globally, the need for effective care and support for lifestyle changes is important. District nurses play a key role in promoting healthy behaviors in these patients.  Aim: The aim of the study is to investigate how district nurses motivate patients with type 2 diabetes to implement lifestyle changes.  Method: The study is based on a qualitative interview survey with an inductive approach. Semi-structured interviews were conducted with district nurses in primary care, in this study health care centers. Data were analyzed through qualitative content analysis by reflecting on the content and identifying any patterns in the district nurses' experiences and practices.  Findings: The study shows that person-centered care, active listening and empathy are essential to motivate patients with type 2 diabetes to make lifestyle changes. The district nurses emphasize the adaptation of support to each patient's unique needs and the importance of patient involvement in care decisions. Teamwork and collaboration across professional boundaries are also central to offering coordinated care. The diabetes school and the involvement of relatives are emphasized as important resources for supporting and motivating the patients.  Conclusion: The study highlights the central role of district nurses in promoting lifestyle changes in patients with type 2 diabetes and suggests further research to develop guidelines and educational programs that strengthen this aspect of diabetes care.

Inledning: Diabetes typ 2 är en metabol sjukdom som har ökat i hela världen. Diabetes medför stora hälsoproblem som kan leda till förtidig död och funktionshinder. Fysisk aktivitet är en faktor som kan förändra diabeteskomplikationer och förbättra människors möjlighet att hantera symptomen av diabetes. Syftet med litteraturöversikten är att identifiera effekterna av fysisk aktivitet vid diabetes typ 2 bland vuxna. Metod: Denna studie är en litteraturöversikt där tio originalartiklar har använts för att genomföra denna studie och fyra teman framkom som förklarar effekten av fysisk aktivitet vid diabetes typ 2. Resultat: Olika träningsform såsom aerob- kombinerad- och styrketräning samt effekt av medicinering vid diabetes typ 2 visar att diabetes kan förbättras genom fysisk aktivitet. Diskussion: Fysisk aktivitet anses som viktigt för att bekämpa symptom av diabetes typ 2. Olika former av träning förbättrar diabetes typ 2. Mer forskning behövs för att bidra till kliniska rekommendationer. / Introduction: Diabetes type 2 is a metabolic disease that has increased all over the world. Diabetes causes huge health problems that lead to premature death and disabilities. Physicalactivity is a factor that can improve diabetes complications and ameliorate the management of the symptoms related to diabetes. The aim of this literature review is to identify effects of physical activity in diabetes type 2 among adults. Methods: This study is a literature review where ten original articles were used to carry out this study and five themes were developed to explain the effects of physical activity in diabetes type 2. Results: Different types of training such as aerobic training, combined training, resistance training and also the effect of medicine showed that diabetes type 2 can be improved through physical activity. Discussion: Physical activity is important to fight the symptoms of diabetes type 2. Different types of training improve in various ways diabetes type 2. More researches are needed to contribute to clinical recommendations.

Background: Fifty percent of medications are not taken as prescribed. This is a major public health issue yet there is very limited evidence on the factors associated with medicines adherence in people with mild to moderate Intellectually Disabilities and diabetes (IDD). This study evaluated the frequency of, and factors associated with, medicines non-adherence in this group compared to people without ID but with diabetes (non-IDD).Methods: A systematic review of the literature informed the theoretical model tested. A two-stage, sequential mixed methods study with 111 people with type 1 and 2 diabetes, (IDD = 33, non-IDD = 78) was then carried out. Stage one (quantitative) compared frequency of medication adherence in the group overall, IDD and non-IDD. Univariate and multiple regression analysis evaluated associations between factors (ID, depression, side effects, self-efficacy and perceived level of social support) and medicines non-adherence. Stage two (qualitative) explored findings of stage one with 12 stage one participants' carers using semi-structured interviews. Results: Data were collected between July 2014 and May 2016. The frequency of medicines adherence was similar in the IDD and non-IDD population (70% vs 62%, p = 0.41). The theoretical model did not predict medicines non-adherence. After controlling for support with medicines and complexity of regime (number of medications and use of insulin), depression was an independent predictor in the non-IDD and group overall (p < 0.001). In the IDD group, perceived side effects was an important, but non-significant, predictor of non-adherence (p = 0.06). Carers' perceptions of adherence and depression were consistent with stage one findings. Conclusions: Optimising adherence to diabetes medicines is equally challenging in IDD and non-IDD populations. Associations between independent factors and adherence differed between the two groups: in the non-IDD population, depressive symptoms were associated with non-adherence whereas in the IDD population perceived level of side effects appeared most dominant. Due to small sample sizes findings were inconclusive therefore, a sufficiently powered study further investigating the relationship between adherence and side effects in people with ID and diabetes is recommended.

O diabete melito é uma doença metabólica com alta prevalência na população e quando no estado descompensado pode causar diversas complicações metabólicas e clínicas, entre elas a osteoporose. Entretanto, ainda não foram completamente esclarecidos os mecanismos pelos quais o diabete diminui a densidade mineral óssea e aumenta o risco a fraturas. Recentemente foram descritos alguns genes que estão envolvidos no turnover ósseo: OPG, RANK e RANKL. Além disso, o uso de hipoglicemiantes orais como as tiazolidinedionas (TZD), pode influenciar negativamente o metabolismo ósseo. Com a finalidade de identificar marcadores sensíveis de alteração do metabolismo ósseo foram investigadas as relações entre a expressão dos genes OPG, RANK e RANKL em células do sangue periférico e a resposta a TZDs em pacientes com DM2. Foram selecionados 52 indivíduos (36 diabéticos e 16 normoglicêmicos), no Instituto Dante Pazzanese de Cardiologia. Os indivíduos diabéticos foram tratados com pioglitazona (15, 30 e 45 mg/ dia/ via oral) por 16 semanas. Foram colhidas amostras de sangue, antes e após o tratamento para determinação de exames laboratoriais e extração de RNA total. A expressão de mRNA dos genes OPG, RANK e RANKL foi quantificada e avaliada por RT-PCR em tempo real, empregando-se o GAPD como controle endógeno. Observou-se que nos pacientes DM2 após o tratamento com pioglitazona, houve diminuição da glicemia de jejum, glicemia pós-prandial, insulina, Hb1Ac, índices HOMA-IR e HOMA-&#946; e aumento nas concentrações séricas de HDL, demonstrando a eficácia do tratamento. Ao comparar a expressão dos genes entre o grupo DM2 (sem tratamento) e o grupo normoglicêmico (NG), foi evidenciado um aumento da expressão de OPG no grupo NG em relação ao grupo DM2, e ao analisar a expressão entre as mulheres, constatou-se aumento da expressão de RANK no grupo DM2 em relação ao grupo NG. Além disso, ao correlacionar a expressão dos genes com as dosagens dos parâmetros bioquímicos, constatou-se que o aumento da expressão de RANK e RANKL está relacionado com o aumento das concentrações de cálcio ionizado e diminuição da expressão de OPG. Esses dados sugerem que a atividade osteoclástica está aumentada nos pacientes DM2 e com o tratamento o quadro osteoporótico pode ser agravado. / The diabetes mellitus is a metabolic disease with high prevalence in the population and can cause various metabolic and clinic complications, including osteoporosis, when it is decompensated. However, the mechanisms by which diabetes decreases bone mineral density and increases the risk of fractures are not completely clarified. Recently some genes which are involved in bone turnover were described: OPG, RANK and RANKL. Moreover, the treatment using oral hypoglycemic drugs such as thiazolidinediones (TZD), may negatively affect the bone metabolism. In order to identify sensitive markers related to the bone metabolism, were investigated the relationship between the expression of genes OPG, RANK and RANKL in peripheral blood leukocytes and the response to TZDs treatment in patients with DM2. Fifty-two individuals were selected (36 diabetics and 16 normoglycemics) at Dante Pazzanese Institute of Cardiology. Diabetic patients were treated with pioglitazone (15, 30 and 45 mg I day I oral) during 16 weeks. Blood samples were collected for biochemical analyses and total RNA extraction, before and after treatment. Gene expression of the genes OPG, RANK and RANKL in peripheral blood mononuclear cells was evaluated by Real Time PCR, using the GAPD housekeeping gene as the endogenous reference. In DM2 patients after treatment with pioglitazone there was reduction in their fasting glycemia, postprandial glycemia, insulin, Hb1Ac, HOMA-IR and HOMA-&#946; indices, and their serum concentrations of HDL increased, which demonstrates the effectiveness of the treatment. The bone profile markers have not altered after treatment, suggesting an anabolic action of the insulin in bone metabolism of these patients. Normoglycemics (NG) group gene expression, when compared with DM2 group (with no treatment), had increased OPG expression. Besides, RANK expression in group DM2 was higher than NG group when it was analyzed among women. Furthermore, having correlated the expression of the genes with the biochemical parameters data, the increase on RANK and RANKL gene expression is related to increased concentrations of ionized calcium and to decreased expression of OPG gene. These results are suggestive that osteoclastic activity is higher in DM2 patients, the treatment can exacerbate osteoporosis severity and the bone markers does not have enough sensibility to differentiate changes in individuals with type 2 diabetes mellitus.

Bakgrund: Diabetes typ 2 är en av de stora folksjukdomarna i västvärlden och numer även i utvecklingsländerna. Då patienterna är i behov av korrekt information för att lära sig att hantera och leva med sjukdomen är det viktigt att sjuksköterskor har kunskap om hur patienterna upplever information från vården. Syfte: Syftet var att utforska vad för erfarenheter patienter med diabetes typ två har av information från vården.  Metod: En litteraturstudie som är baserad på tidigare forskning om diabetes typ två och information. Tolv vetenskapliga artiklar med kvalitativ ansats har analyserats med textanalys. Resultat: Resultatet i denna uppsats visar att patienterna efterlyser information som är anpassad till dem som unika individer och som är lätt att förstå och hantera, då de behöver verktyg för sin egenvård. Fyra teman som framkom: Svårigheter att ta emot och anpassa sig efter information, Information anpassad till att klara av dagligt liv, Skillnader på information från läkaren och sjuksköterskan och Anpassad information. Diskussion: Resultatet diskuteras bl a i förhållande till Orems teori kring egenvård. Då patienterna ofta har svårt att anpassa till sin sjukdom behöver de stöd i form av information för att klara av att leva ett så normalt liv som möjligt. Detta blir allt viktigare då diabetes typ två är en sjukdom som kryper allt lägre ner i åldrarna och det därmed är något man ska leva länge med. / Background: Diabetes type 2 is one of the largest forms of lifestyle disease in the developed countries, but in later years, also in development countries. Patients are in need of accurate information to learn how to manage and live with the disease. Therefore it is important that nurses have knowledge of how patients perceive information from health care.  Aim: The aim of the present study was to investigate what experiences patients with diabetes type two has regarding information from health care. Method: A literature study based on previous research regarding diabetes type two and information to patients. Twelve scientific articles with qualitative approach was analysed with text analysis. Result: The results show that the patients call for information that is tailored to them as unique individuals and that is easy to understand and adapt to, as they need tools for their self-care. Four themes emerged: Difficulties to accept and adapt to information, Information adapted to cope with daily life, Differences in information from the physician and the nurse and Accessible information. Discussion: The results are discussed in relation to Orem theory of self-care. Since patients often have difficulty adjusting to their disease, they need support in terms of information to be able to live as normal a life as possible. This becomes increasingly important, as diabetes type two is a disease that younger and younger ages, and it is therefore something they have to live a long time with.

O diabete melito é uma doença metabólica com alta prevalência na população e quando no estado descompensado pode causar diversas complicações metabólicas e clínicas, entre elas a osteoporose. Entretanto, ainda não foram completamente esclarecidos os mecanismos pelos quais o diabete diminui a densidade mineral óssea e aumenta o risco a fraturas. Recentemente foram descritos alguns genes que estão envolvidos no turnover ósseo: OPG, RANK e RANKL. Além disso, o uso de hipoglicemiantes orais como as tiazolidinedionas (TZD), pode influenciar negativamente o metabolismo ósseo. Com a finalidade de identificar marcadores sensíveis de alteração do metabolismo ósseo foram investigadas as relações entre a expressão dos genes OPG, RANK e RANKL em células do sangue periférico e a resposta a TZDs em pacientes com DM2. Foram selecionados 52 indivíduos (36 diabéticos e 16 normoglicêmicos), no Instituto Dante Pazzanese de Cardiologia. Os indivíduos diabéticos foram tratados com pioglitazona (15, 30 e 45 mg/ dia/ via oral) por 16 semanas. Foram colhidas amostras de sangue, antes e após o tratamento para determinação de exames laboratoriais e extração de RNA total. A expressão de mRNA dos genes OPG, RANK e RANKL foi quantificada e avaliada por RT-PCR em tempo real, empregando-se o GAPD como controle endógeno. Observou-se que nos pacientes DM2 após o tratamento com pioglitazona, houve diminuição da glicemia de jejum, glicemia pós-prandial, insulina, Hb1Ac, índices HOMA-IR e HOMA-&#946; e aumento nas concentrações séricas de HDL, demonstrando a eficácia do tratamento. Ao comparar a expressão dos genes entre o grupo DM2 (sem tratamento) e o grupo normoglicêmico (NG), foi evidenciado um aumento da expressão de OPG no grupo NG em relação ao grupo DM2, e ao analisar a expressão entre as mulheres, constatou-se aumento da expressão de RANK no grupo DM2 em relação ao grupo NG. Além disso, ao correlacionar a expressão dos genes com as dosagens dos parâmetros bioquímicos, constatou-se que o aumento da expressão de RANK e RANKL está relacionado com o aumento das concentrações de cálcio ionizado e diminuição da expressão de OPG. Esses dados sugerem que a atividade osteoclástica está aumentada nos pacientes DM2 e com o tratamento o quadro osteoporótico pode ser agravado. / The diabetes mellitus is a metabolic disease with high prevalence in the population and can cause various metabolic and clinic complications, including osteoporosis, when it is decompensated. However, the mechanisms by which diabetes decreases bone mineral density and increases the risk of fractures are not completely clarified. Recently some genes which are involved in bone turnover were described: OPG, RANK and RANKL. Moreover, the treatment using oral hypoglycemic drugs such as thiazolidinediones (TZD), may negatively affect the bone metabolism. In order to identify sensitive markers related to the bone metabolism, were investigated the relationship between the expression of genes OPG, RANK and RANKL in peripheral blood leukocytes and the response to TZDs treatment in patients with DM2. Fifty-two individuals were selected (36 diabetics and 16 normoglycemics) at Dante Pazzanese Institute of Cardiology. Diabetic patients were treated with pioglitazone (15, 30 and 45 mg I day I oral) during 16 weeks. Blood samples were collected for biochemical analyses and total RNA extraction, before and after treatment. Gene expression of the genes OPG, RANK and RANKL in peripheral blood mononuclear cells was evaluated by Real Time PCR, using the GAPD housekeeping gene as the endogenous reference. In DM2 patients after treatment with pioglitazone there was reduction in their fasting glycemia, postprandial glycemia, insulin, Hb1Ac, HOMA-IR and HOMA-&#946; indices, and their serum concentrations of HDL increased, which demonstrates the effectiveness of the treatment. The bone profile markers have not altered after treatment, suggesting an anabolic action of the insulin in bone metabolism of these patients. Normoglycemics (NG) group gene expression, when compared with DM2 group (with no treatment), had increased OPG expression. Besides, RANK expression in group DM2 was higher than NG group when it was analyzed among women. Furthermore, having correlated the expression of the genes with the biochemical parameters data, the increase on RANK and RANKL gene expression is related to increased concentrations of ionized calcium and to decreased expression of OPG gene. These results are suggestive that osteoclastic activity is higher in DM2 patients, the treatment can exacerbate osteoporosis severity and the bone markers does not have enough sensibility to differentiate changes in individuals with type 2 diabetes mellitus.