Há muitas alterações nos sistemas fisiológicos de indivíduos com diabetes melittus em função dos constantes momentos de hiperglicemia, principalmente alterações relacionadas ao aumento dos riscos cardiovasculares. O objetivo desse estudo foi avaliar as respostas do controle glicêmico pelo monitor contínuo de glicose e da pressão arterial (PA), frequência cardíaca (FC) e sua variabilidade expressa pelos valores de RMSSD em diabéticos tipo II submetidos a testes de avaliação antes e após a realização de treinamento aeróbio e resistido. Participaram desse estudo 9 voluntários diabéticos tipo II do sexo masculino (45 a 65 anos) divididos em 3 grupos: DTA (n=7), diabéticos submetidos a seis semanas de treinamento aeróbio; DTR (n=5), diabéticos submetidos a treinamento resistido e GDC (n=5), diabéticos sem qualquer treinamento regular. Os voluntários realizaram testes laboratoriais, ergoespirometria e teste de fadiga em leg press antes e após o treinamento físico. Os resultados foram analisados estatisticamente pelo teste t de Student e pelo teste de Kruskal Wallis. Os voluntários tiveram a cinética da concentração de glicose mensurada pelo monitor contínuo e analisada qualitativamente antes, durante e após a realização da ergoespirometria e do teste de fadiga por 60 minutos. Como resultados o grupo DTA apresentou menores valores de concentração de glicose pela monitorização contínua e o grupo DTR a melhor resposta na cinética dessa curva, apresentando expressivo decaimento na mesma. Em relação à resposta pressórica, somente a PA diastólica (PAD) foi menor estatisticamente para o grupo DTA pós treinamento aeróbio no repouso. Não houve diferenças entre os valores pré e pós treinamentos em relação à FC e os voluntários do grupo DTA apresentaram maiores valores de RMSSD em repouso e o do grupo DTR incrementos desses valores na recuperação dos testes, mostrando maior ação parassimpática no controle autonômico cardíaco dos diabéticos submetidos a treinamentos. Os indivíduos do grupo GDC apresentaram decremento nesse valor, sugerindo piora no controle autonômico cardíaco. Como conclusão geral, este estudo sugere que indivíduos diabéticos tipo II que realizaram treinamento aeróbio e resistido apresentaram benefícios complementares no controle glicêmico registrado pelo monitor contínuo em repouso e no período de recuperação de exercício, respectivamente, adaptações que parecem estar associadas à melhora da ação parassimpática/vagal no controle autonômico cardíaco e, sugere, também, ser o treinamento físico aeróbio o que permite melhor organização hemodinâmica nas respostas de PAD. / There are many changes in physiological systems of people with diabetes melittus due to the constant moments of hyperglycemia, mainly related to increasing of cardiovascular risk. The aim of this study was evaluate the responses of glycemic control by continuos glucose monitoring and blood pressure (BP), heart rate (HR) and its variability expressed by the values of RMSSD in type II diabetics undergoing evaluation tests before and after performing aerobic and resistance training. Participants were 9 volunteers type II diabetic male (45-64 years) divided in 3 groups: DTA (n=7), diabetics undergoing six weeks of aerobic training; DTR (n=5), diabetics undergoing resistance training and GDC (n=5), diabetics without any regular training. The volunteers underwent laboratory tests, spirometry and fatigue tests on leg press before and after physical training. The results were statistically analyzed by Students t and Kruskal Wallis tests. The volunteers had the kinetics of glucose concentration measured by the continuos monitor and qualitatively analyzed before, during and after the spirometry and the fatigue tests for 60 minutes. As a result the DTA group had lower glucose concentration by continuos monitoring and DTR the best response in the kinetic curve, showing important decrease in it. In relation to the BP response, only diastolic BP (DBP) was statistically lower for the DTA group after aerobic training. There were no differences between pre and post training in HR and the DTA group showed higher RMSSD at rest and the DTR group showed increments of these values in the tests recovery showing higher parasympathetic action on cardiac autonomic control in diabetics patients with training. Individuals in the GDC group showed decrement this value, suggesting deterioration in cardiac autonomic control. As a general conclusion, this study suggests that type II diabetic individuals who performed aerobic and resistance training showed additional benefits in glycemic control by continuos monitor recorded at rest and during exercise recovery, respectively, adaptations that seem to be associated with improvement in parasympathetic action in cardiac autonomic control, and also suggests that aerobic exercise training has better organization hemodynamic in responses of DBP.

Introdução: O Diabetes mellitus tipo 1 (DM1) cursa com produção ausente ou irrisória de insulina e é a forma responsável pelos casos mais graves de distúrbios glicêmicos. O DM1 exerce forte influência sobre o crescimento fetal. Enquanto a hiperglicemia estimula o crescimento fetal devido à hiperinsulinemia, nas pacientes com vasculopatias a placentação inadequada pode levar o feto à restrição. Objetivos: identificar alterações de crescimento fetal e avaliá-las quanto a sua associação com o controle glicêmico materno e de marcadores laboratoriais de função renal. Métodos: foram avaliadas, de forma prospectiva em coorte observacional, 60 gestantes com DM1 que iniciaram o pré-natal no primeiro trimestre. A associação entre a classificação de peso ao nascimento com as seguintes variáveis foi analisada: média glicêmica, frequência de hipo e hiperglicemia, frequência de hipo e hiperglicemia grave, hemoglobina glicada, frutosamina, ácido úrico, creatinina e proteinúria de 24 horas. A predição do crescimento fetal também foi estudada. Resultados: Desvios do crescimento fetal em pacientes com DM1 ocorreram em 41% dos casos (n=25). Observou-se que 10% das gestações resultaram em PIG (n=6) e 31%, em GIG (n=19). Níveis aumentados de média glicêmica (p =0,006), baixa frequência de hipoglicemias (p = 0,027) e alta frequência de hiperglicemias (p = 0,014) se associaram a GIG no terceiro trimestre. Em todos os trimestres, valores séricos mais elevados de ácido úrico, creatinina e proteinúria de 24hs, se associaram de maneira significativa, ao grupo PIG. Foi construído um modelo, com taxa de acerto de 80.3%, para a predição de crescimento fetal com os valores de terceiro trimestre da média glicêmica e da creatinina. Conclusões: Foram identificadas variáveis relacionadas ao controle glicêmico materno e à marcadores laboratoriais de função renal que se associaram a alterações no crescimento fetal. Usando algumas dessas variáveis foi possível construir um modelo para predição do crescimento fetal com boa acurácia / Introduction. Diabetes mellitus type 1 (DM1) is described as absent or negligible production of insulin and it is responsible for the most severe cases of glycemic disorders. DM1 has a strong influence on fetal growth. In pregnant women the hyperglycemia stimulates fetal growth, and the vasculopathy influences the placentation process, which may lead to growth restriction. Objective. To identify fetal growth disorders and their association with maternal glycemic control and laboratory markers of renal function. Methods. Sixty pregnant women with DM1 were prospectively followed from the first trimester in an observational cohort. The association between birthweight classification with the following parameter were investigated: glycemic mean, frequency of hypo and hyperglycemia, frequency of severe hyper and hypoglycemia, glycated hemoglobin, fructosamine, uric acid, creatinine and proteinuria of 24 hours. The prediction of fetal growth was also investigated. Results. Abnormal fetal growth was observed in 41% (n= 25). Large for gestational age (LGA) was observed in 31.7% (n=19) and small for gestational age (SGA) in 10% (n= 6). High values of glycemic mean (p = 0.006), low frequency of hypoglycemia (p = 0.027) and high frequency of hyperglycemia (p = 0.014) were significantly associated with LGA fetal growth in the third trimester. In all trimesters, the SGA fetal growth was significantly associated with higher serum values of uric acid, creatinine and proteinuria of 24 hours. The prediction model for fetal growth, using values of glycemic mean and creatinine, was significant in the third trimester with an accuracy of 80.3%. Conclusions. The maternal glycemic control and the laboratory markers of renal function associated with the fetal growth disorders in pregnancies with DM1 were identified. Using these parameters it was possible to predict with a good accuracy the fetal growth in DM1

Thesis (M.Sc.)--University of Alberta, 2010. / A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Master of Science in Population Health, School of Public Health. Title from pdf file main screen (viewed on March 18, 2010). Includes bibliographical references.

School plays critical roles in facilitating and inhibiting the safety, development, and well-being of adolescents with T1DM. However, their school-based lived experiences have been under-investigated. This study aimed to explore those experiences for adolescents with T1DM in Taiwan. In conducting the study, Heidegger’s hermeneutic phenomenological approach was used. Fourteen Taiwanese adolescents with T1DM were enrolled between June 2009 and July 2010 through purposive snowball sampling. Data were collected using audio-recorded, semi-structured interviews and analyzed using the hermeneutic circle and West’s (1998) structural analysis steps, supported by qualitative analysis software NVivo 9.0. Reflective journaling, peer debriefing, memo writing, and member checking were performed to enhance the trustworthiness of the findings. Six interrelated themes were identified in the adolescents’ school-based lived experiences. They are (a) the same and different, (b) covert and overt, (c) hyper- and hypoglycemia, (d) independent and dependent, (e) derailing and being on track, and (f) dark clouds and silver lining. In the stressful context of school, the adolescents’ diabetes self-management is challenged. Multiple factors, including unaccepted disease identity; social anxiety and pressure; intrusive, ignorant school personnel and classmates; and transition to independent self-management threaten the adolescents’ health and well-being at school. To optimize diabetes self-management effectiveness, interventions should include the adolescents and their parents, classmates, and school personnel to ease burdens that the adolescents bear. Future interventions should also facilitate the adolescents’ autonomy, self-efficacy, diabetes knowledge and self-management, and capacity to alleviate social pressure. / text

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / abstract / toc / Social Work and Social Administration / Master / Master of Philosophy

Diss. (sammanfattning) Uppsala : Univ., 2002. / Härtill 5 uppsatser.

The apparent reversal of trend from modern drugs to herbal medicine is partly due to the fact that synthetic drugs have always shown adverse reactions and other undesirable side effects. Hence, the use of medicinal plants for the treatment of diseases such as diabetes is very common especially in the rural areas. Majority of these plants are used based on the experience and indigenous knowledge without identification of the therapeutic agents. There is enormous wealth of medicinal plants in the world yet many of them have not been discovered or studied scientifically to substantiate their ethno-medicinal usages. Ethnobotanical study has been the method often used to search for locally important plant species for the discovery of crude drugs with low side effects. An ethnobotanical survey was conducted on the medicinal plants commonly used for the management of diabetes mellitus in Nkonkobe Municipality, Eastern Cape of South Africa. Information was obtained through structured questionnaire administered to traditional healers and herbalists in the region. The study revealed 15 species of plants belonging to 13 families. Strychnos henningsii and Leonotis leonorus among others were repeatedly mentioned by the traditional healers as the two mostly used plants for the management of diabetes mellitus. The infusion and decoction of the roots, leaves and barks of these plants are the methods of preparation. The antioxidant potential of aqueous bark extract of S. henningsii was investigated both in vivo and in vitro using spectroscopic method. The antioxidant activity of the extract against hydrogen peroxide (H2O2), 2,2′-azinobis[3-ethylbenzothiazoline6-sulfonic acid] diammonium salt (ABTS), as well as reducing power was concentration dependent. The extract exhibited lower and average scavenging activities against 1,1diphenyl2picrylhydrazyl (DPPH) and nitric oxide (NO) radicals with IC50 value of 0.739 and 0.49 mg/ml respectively. The administration of the plant extract at 250, 500 and 1000 mg/kg significantly increased the activities of the antioxidant enzymes in the hepatotoxic rats induced with carbon tetrachloride. On the other hand, the stem bark extract had lower effect on lipid peroxidation level except at the dose of 250 mg/kg. The effect of oral administration of S. henningsii extract was evaluated in normal Wistar rats for 28 days. The observed result indicated non- toxic effect of sub-acute administration of plant extract to the animals except at certain doses. This is because, there was no apparent damage to some haematological and biochemical parameters used in assessing organ specific toxicity. However, the alterations observed on platelet, white blood cells and its differentials imply parameter and dose selective toxicity when repeatedly consumed on daily basis at the doses investigated. This study also investigated the antidiabetic activities of the extract at the doses of 125, 250 and 500 mg/kg body weight in diabetic rats induced with streptozotocin -nicotinamide for 15 days. The extract appreciably (P <0.05) reduced the blood glucose level, feed and water intake while the best result was obtained at 250 mg/kg. Similarly, the level of triacylglycerol at the three doses investigated was significantly decreased. In addition, the glucose tolerance was reduced to near normal level after 90 min at certain doses. The clinical significance of the extract on some biochemical and haematological parameters lessen both hepatic and renal damages. Anaemic condition in diabetic animals was also improved after plant extract administration. However, no significant effect was observed in white blood cells and some of its differentials. The extract demonstrated strong glucose utilization in 3T3-L1 cells with a response of 278.63 percent of the control at 12.5μg/ml while that of Chang liver cells was 103.54 percent. The cytotoxicity result revealed non toxic effects of the extract to both cell lines. Treatment of 3T3 L1 cells with the extract did not reduce lipid accumulation. The extract inhibited the activity of α- glucosidase and α- amylase in a concentration dependent manner with IC50 values of 38 μg/ml and 60.9 μg/ml respectively. The percentage protein antiglycation of S. henningsii was 18.4, 38.2 and 61.2 perceent for 0.25, 0.5 and 1 mg/ml respectively while aminoguanidine a known inhibitor of protein glycation was 87.2 percent at 1 mg/ml. The FRAP assay values of the extract was 357.05 μmol Fe (II)/g. The findings from this study support the folkloric usage of this plant for the management of diabetes mellitus in the region.

Orientador: Belmiro Gonçalves Pereira / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-05T02:01:55Z (GMT). No. of bitstreams: 1 Rehder_PatriciaMoretti_M.pdf: 882101 bytes, checksum: becab9efdb8c91f9a2aad0ddb010855c (MD5) Previous issue date: 2005 / Resumo: A prevalência de anticorpos antifosfolípides em gestantes diabéticas é alta, ocasionando alterações gestacionais e perinatais. O objetivo do estudo foi diagnosticar e tratar as gestantes diabéticas com anticorpos presentes e descrever os resultados gestacionais e perinatais. Foram analisadas 56 gestantes diabéticas que deram entrada no Pré-Natal Especializado do CAISM/Unicamp, entre julho de 2003 a março de 2004. Todas as que aceitavam participar do estudo foram submetidas à coleta de sangue para dosagem de anticorpos antifosfolípides (anticoagulante lúpico e anticorpo anticardiolipina). Se um ou outro anticorpo estivesse presente, a gestante seria tratada com AAS e Heparina. Foram caracterizados os perfis da gestante, da evolução da gestação e do recém-nascido. Foram diagnosticados anticorpos antifosfolípides em 7% das 56 gestantes e os resultados gestacionais e perinatais foram descritos. Nas gestantes diabéticas com anticorpos antifosfolípides a duração do diabetes foi de cinco em uma das gestante e dez anos nas outras três gestantes. A idade variou entre 27 e 38 anos e uma das gestantes era primigesta, outra secundigesta e as outras duas multíparas. As gestantes com anticorpos antifosfolípides, que foram tratadas, tiveram resultados gestacional e perinatal satisfatórios / Abstract: The prevalence of antiphospholipid antibodies in pregnant women with pre-gestational diabetes is high, causing gestational and perinatal alterations. The purpose of this study was to diagnose and treat diabetic pregnant women with presence of antibodies and describe the gestational and perinatal results. An analysis was made of 56 diabetic pregnant women who enrolled in the pre-natal specialization at CAISM/UNICAMP, between July, 2003 and March, 2004. All the diabetic pregnant women who agreed to participate in the study had blood collected for antiphospholipid antibody dosage (lupus anticoagulant and anticardiolipin antibody). If any other antibodies were present, the pregnant woman would be treated with Aspirin and Heparin. The following data with reference to the pregnant woman were recorded: age, gestational age, time of diabetes mellitus duration, treatment prior to and during gestation, previous illnesses, hypertension in pregnancy, amniotic liquid index, parturition, way of giving birth, Apgar index, fetal malformation, fetal hypoglycemia and birth weight. Antiphospholipid antibodies were diagnosed in 7% of the 56 pregnant women and their gestational and perinatal results were described. In the diabetic pregnant women with antiphospholipid antibodies, the duration of the diabetes was from five to ten years, that is to say, pregnant women with long-standing diabetes. The pregnant women with antiphospholipid antibodies ranged from 27 to 38 years of age, and some of the descriptions indicated that they had gone through a bad obstetric experience. The pregnant women with antiphospholipid antibodies, who were treated, had satisfactory gestational and perinatal results / Mestrado / Tocoginecologia / Mestre em Tocoginecologia

This study was designed to explore how Chinese elderly informants with diabetes experience and manage their illness at home. The method used in conducting this study was the phenomenological perspective of qualitative research. The Intent of the study was to understand the human experience of living with diabetes and the sociocultural context in which it is lived. Data collection and analysis ran concurrently. Data were collected through a series of interviews with nine Chinese informants who were diagnosed with late onset diabetes and were undergoing insulin treatment at home. Informants' ages ranged for a 69 to 90 years old. All informants are first generation immigrants in Canada. The specific questions that directed this study addressed the Chinese elderly informants' experience of living with diabetes, the meanings they assigned to living with diabetes, and the ways Chinese informants managed their diabetes. Theoretical sampling guided sample selection and determined sample size. The data were constructed based on a total of 21 interviews with the nine informants. As the researcher explored how the informants lived with diabetes, informants gave detailed accounts of how they viewed diabetes. Within the context of how they viewed diabetes, informants described an entire process they went through to make decisions in everyday life as they sought help and managed their illness. Based on informants' accounts, a decision making model was formulated. Informants gave detailed accounts of each step of the decision-making process, together with descriptions of meanings they assigned to each step. The data showed how informants made sense of their experience as they went through each phase of the decision-making process. The descriptions also revealed an "inner logic" used by informants to direct choices they make regarding health matters. In terms of nursing practice, these findings support the need to attend to client decision-making, from the clients' perspectives. The findings also address nurses' need to reevaluate their professional role in relation to clients' needs and expectations. With regard to nursing research, the findings suggest the need to further explore the topic of decision making from both the clients' and nurses' perspectives. / Applied Science, Faculty of / Nursing, School of / Graduate