Introdução: O consumo de alimentos com elevado índice glicêmico e carga glicêmica tem sido associado ao aumento no risco de desenvolvimento de síndrome metabólica, importante precursor da doença cardiovascular e do diabetes mellitus tipo 2. Entretanto, esses achados ainda são inconsistentes e a utilização do índice glicêmico e da carga glicêmica para prevenção ou tratamento da síndrome metabólica e dos fatores de risco que a compõe ainda é controversa. Objetivos: Validar o diabetes mellitus autorreferido e verificar a associação do índice glicêmico e da carga glicêmica com a síndrome metabólica e seus componentes. Métodos: Foram utilizados dados provenientes do Inquérito de Saúde de São Paulo (ISA-Capital 2008) referentes a adultos e idosos de ambos os sexos residentes nessa cidade. Trata-se de estudo transversal, de base populacional, com amostra probabilística de indivíduos residentes em domicílios permanentes localizados na área urbana do município. As informações utilizadas são provenientes de um questionário estruturado, dois recordatórios alimentares de 24 horas, exames bioquímicos, valores aferidos de pressão arterial e medidas antropométricas (peso, estatura e circunferência da cintura). Foram estimadas as prevalências de diabetes mellitus e síndrome metabólica para o município de São Paulo. A validação diabetes mellitus autorreferido foi realizada mediante cálculo da sensibilidade, especificidade e valores preditivos positivo e negativo. O consumo alimentar habitual foi obtido por meio da incorporação dos dados alimentares no software Multiple Source Method. A associação entre índice glicêmico e carga glicêmica da dieta e síndrome metabólica e seus componentes foi verificada por meio de modelos de regressão logística estimados segundo faixa etária. Todas as análises levaram em consideração o desenho amostral do estudo. Resultados: As prevalências de diabetes mellitus e síndrome metabólica no município de São Paulo foram estimadas em 8,0 por cento e 30,2 por cento , respectivamente. A sensibilidade do diabetes mellitus autorreferido foi 63,8 por cento (IC 95 por cento : 49,2-76,3), a especificidade 99,7 por cento (IC 95 por cento : 99,1-99,9), o valor preditivo positivo 95,5 por cento (IC 95 por cento : 84,4-98,8) e o valor preditivo negativo 96,9 por cento (IC 95 por cento : 94,9-98,2). O índice glicêmico associou-se com a lipoproteína de alta densidade (OR: 1,16; IC 95 por cento : 1,02-1,32) em adultos e com a síndrome metabólica (OR: 1,24; IC 95 por cento : 1,1-1,37), a glicemia de jejum (OR: 1,15; IC 95 por cento : 1,01-1,31) e a pressão arterial (OR: 1,26; IC 95 por cento : 1,05-1,51) em idosos. Conclusão: O dado de diabetes mellitus autorreferido é válido, especialmente entre idosos residentes no município de São Paulo. Os resultados evidenciam a necessidade do rastreamento do diabetes mellitus em indivíduos assintomáticos que apresentem um ou mais fatores de risco para essa condição, principalmente na população adulta. No presente estudo, o IG da dieta associou-se à SM, glicemia de jejum e pressão arterial elevadas em idosos e apenas ao HDL-c baixo em adultos. As diferentes respostas entre os adultos e idosos podem sugerir que o índice glicêmico tem ação distinta entre os grupos etários. Ressalta-se que a qualidade do carboidrato parece ser mais importante do que a junção da qualidade-quantidade do carboidrato consumido para os parâmetros metabólicos avaliados na população da cidade São Paulo. / Introduction: High glycemic index and glycemic load intake has been associated with an increased risk for developing metabolic syndrome, an important precursor of cardiovascular disease and type 2 diabetes mellitus. However, these findings are inconsistent and the use of glycemic index and glycemic load for prevention or treatment of metabolic syndrome and the risk factors components is still controversial. Objectives: To validate self-reported diabetes mellitus and evaluate the association between glycemic index, glycemic load and metabolic syndrome and its components. Methods: Data were used from the Health Survey of São Paulo (ISA-Capital 2008) related to adults and elderly of both sexes living in this city. It is cross-sectional population-based study of individuals living in permanent homes located in the urban area of the municipality. Information used came from a structured questionnaire, two 24-hour dietary recalls, biochemical analysis, blood pressure and anthropometric measurements (weight, height and waist circumference). Prevalences of diabetes mellitus and metabolic syndrome were estimated for the city of São Paulo. The validation of self-reported diabetes mellitus was made by calculating the sensitivity, specificity, positive and negative predictive values. Usual food intake was achieved by the incorporation of food data in Multiple Source Method software. The association between glycemic index and glycemic load of the diet and metabolic syndrome and its components was verified by logistic regression models according to age group. All analysis took into account the sampling design of the study. Results: Diabetes mellitus and metabolic syndrome prevalences in São Paulo city were 8.0 per cent and 30.2 per cent , respectively. The sensitivity of self-reported diabetes mellitus was 63.8 per cent (95 per cent CI: 49.2 to 76.3), specificity was 99.7 per cent (95 per cent CI: 99.1 to 99.9), the positive predictive value was 95.5 per cent (95 per cent CI: 84.4 to 98.8) and the negative predictive value was 96.9 per cent (95 per cent CI: 94.9 to 98.2). Glycemic index was associated with high density lipoprotein cholesterol (OR: 1.16; 95 per cent CI: 1.02 to 1.32) in adults and with metabolic syndrome (OR: 1.24; 95 per cent CI: 1.1 to 1, 37), fasting blood glucose (OR: 1.15; 95 per cent CI: 1.01 to 1.31) and blood pressure (OR: 1.26; 95 per cent CI: 1.05 to 1.51) in elderly. Conclusion: Self- report diabetes mellitus data is valid, especially among elderly people living in São Paulo. The results show the need for diabetes mellitus screening in asymptomatic individuals who have one or more risk factors for this condition, especially in adults. Glycemic index was associated with metabolic syndrome and elevated fasting blood glucose and blood pressure in elderly and only with low high density lipoprotein cholesterol in adults. The different responses among adults and elderly may suggest that glycemic index has distinct action between age groups. Carbohydrate quality seems to be more important than the joint quality-quantity of the ingested carbohydrate for metabolic parameters evaluated in the population of São Paulo city.

Adolescents with Type I and Type II diabetes need to monitor blood glucose and food intake, administer insulin, and participate in activities including physical education during school hours to maintain glycemic control. Glycemic management programs (GMPs) exist for the improvement of diabetes management during school hours. The purpose of this project was to evaluate a GMP in a school system in a rural area in the Southeastern United States. The goal was to determine if the existing GMP met objectives and to make recommendations for continuation, revision, or discontinuation of the GMP. The logic model provided the basic framework for the evaluation of the GMP by using a graphic flowchart depicting health outcomes prior to and after the implementation of the program. The review consisted of approximately 2,100 students from 9th to 12th grade, and out of those students there were 77 participants from 2010 and 89 participants from 2015 with diagnosis of diabetes. A t-test outcome evaluation found the updated GMP was associated with the lowering of hemoglobin A1c readings. Mean A1c in 2009 was 8.6% (180 - 190 mg/dl), with the mean decreasing to 7.2% (150 mg/d) in 2015. Changes in the program led to 1-to-1 care management based on children's individual needs and parental involvement. Findings show that the GMP improved glycemic management by empowering and individualizing care. This project contributes to positive social change by contributing to data from the Diabetes Prevention Program Research Group study showing that prevention of onset of Type II diabetes mellitus in adults and adolescents is successful through early detection of prediabetes in childhood.

<p>Abstract</p><p>Title: The GI- method –bluff or the path to healthy life?</p><p>Number of pages: 41</p><p>Tutor: Lowe Hedman</p><p>Author: Annika Westlund</p><p>Course: Media and Communication Studies C</p><p>Period: Fall 2006</p><p>University: Division of Media and Communications Studies C</p><p>Purpose/Aim: The aim of this essay was to investigate how the site GI viktkoll describes glycemic index on their website. The intention was also to investigate how the media presented GI through articles and how they used doctors and dieticians to appear trustworthy. Another aim was to investigate what effect GI viktkoll could have on its readers.</p><p>Method/Material: I have chosen a qualitative method where I did a discourse analysis of the articles which were presented on the GI viktkolls website during a period of three weeks. This was my main method in the essay. I also did two interviews with educated professionals. The articles on the website were thereby the main material I used in the essay.</p><p>Main results: My result shows that GI viktkoll do have an underlying aim in wanting to influence its readers ina specific way. Therefore my result shows that it is important as a reader, to be aware of that GI viktkoll might not present a critical way of thinking and every aspect of the phenomenon. GI viktkoll also has influence on people because they have power to change peoples mind about the phenomenon GImethod in the society. GI viktkoll only presents the healthy way of living through the GI method, although there still there is a lot of disagreement from other directions such as doctors and dieticians about the actual effects of the GI method on healthy people.</p><p>Keywords: glycemic index, media culture, encoding/decoding, discourse analysis.</p>

Type 1 diabetes is one of the most common pediatric chronic illnesses. Adolescents are at risk for poorer glycemic control; however, youth whose parents remain involved in diabetes care are in better control. The current study examined parental involvement (PI) using a multi-method, multi-source approach in a sample of 255 youth (Age M = 12.83). The Diabetes Family Responsibility Questionnaire, Parental Monitoring of Diabetes Care Scale, and 24-Hour Diabetes Interview assessed two types of PI, parental responsibility and parental monitoring. Global and specific assessment served to cross-corroborate indicators of PI related to HbA1c. Higher levels of monitoring related to lower HbA1c for both parent- and youth-report; however, the effect decreased after controlling for socioeconomic status (SES). Additionally, monitoring mediated the relation between age and HbA1c. Controlling for SES, youth whose parents demonstrated higher levels of monitoring were in better glycemic control. Both research and clinical implications are discussed.

Individual growth curve (IGC) modeling evaluated longitudinal trajectories of glycemic control and diabetes care of youth with Type 1 Diabetes (T1D) over three years. IGC modeling allowed comparison of confounded sociodemographic predictors of disease outcomes that included ethnicity, SES, parent marital status, family structure, as well as disease duration, to determine the relative impact of these factors in the evolution of HbA1c and diabetes care throughout adolescence. At baseline, participants recruited from two pediatric endocrinology clinics included 198 youth, ages 9-15 (M age = 12.65, 77% Caucasian, 74% lived with married biological parents, M SES = 45.70) with average HbA1c of 8.43% and reported diabetes care behaviors consistent with ADA recommendations. Glycemic control did not deteriorate significantly, but IGC modeling detected a trend of a steady decline in HbA1c of .01% each year. Youth with married biological parents had HbA1c levels approximately 1.23% lower than youth with alternative parent marital status throughout adolescence, t = 4.03, p < .001, although an age by marital status interaction, t = -2.34, p < .05, indicated the impact of parent marital status on HbA1c decreased at age 17. Analyses revealed significant annual declines in blood glucose monitoring frequency, t = -7.61, p < .001, eating frequency, t = -9.04, p < .001, and exercise frequency, t = -7.87, p < .001. Alternatively, the consumption of carbohydrates and fats remained relatively stable throughout adolescence. Consideration of sociodemographic predictors and disease duration further clarified trajectories of disease care behaviors. Throughout adolescence, African American youth reported lower blood glucose monitoring frequency than Caucasian youth. Youth with lower SES exercised less frequently and demonstrated poorer dietary consumption than youth with higher SES. Youth from families with alternative parent marital status ate and exercised less frequently compared to youth from married biological families. However, youth from single-parent homes exercised more frequently than those from two-parent homes. Longer disease duration related to declines in blood glucose monitoring frequency, yet better dietary consumption. Results may inform development of interventions for youth at risk of poor glycemic control and diabetes management across ethnicity, SES, and parent marital status groups.

A la lumière des analyses des activités langagières du physiologiste Claude Bernard, nous étudions la création du sens dans trois manuels tunisiens et la construction d'un nouveau langage dans les débats des d'élève tunisiens pour rendre compte du phénomène de la régulation de la glycémie à travers des modèles. En proposant une stratégie innovante dans l'enseignement de la régulation de la glycémie, nous explicitons les étapes des démarches de modélisation suivies par les élèves. Le type d'analyse mené dans cette recherche a permis d'explorer les stratégies de synchronisation de la polyphonie inhérente au discours des scientifiques, des concepteurs de manuels et des élèves pour créer un nouveau sens et de pointer quelques conditions de possibilités pour aboutir à une synchronisation réussie même dans le cas d'une polyphonie complexe comme celle des élèves tunisiens qui sont bilingues. / We use the analyses of the linguistic activities of the physiologist Claude to study the creation of the direction in three Tunisian textbooks. We study also the construction of a new language in the debates by proposing a strategy innovating in the teaching of the glycemic control. We clarify the stages of the approach of modeling followed by the pupils. Tunisian Pupil gives an account of the phenomenon of the glycemic control through models. The type of analysis carried out in this research made it possible to explore the strategies of synchronization of the polyphony inherent in the speech of the scientists, the authors of textbooks and the pupils to create a new sense. We highlighted some conditions of possibilities to lead to a successful synchronization, even in the case of a complex polyphony as that of the Tunisian pupils who are bilingual.

Doctor of Philosophy / Department of Human Nutrition / Mark D. Haub / Objective: The objective was to compare the postprandial glycemic and insulinemic responses to nutrition bars containing either cross-linked RS type 4 (RS4[subscript]XL) or standard wheat starch in normoglycemic adults (n=13; age= 27±5 yr; BMI=25±3 kg/m²). Methods: Volunteers completed three trials during which they consumed a glucose beverage (GLU), a puffed wheat control bar (PWB), and a bar containing RS4[subscript]XL matched for available carbohydrate content. Serial blood samples were collected over two hours and glucose and insulin concentrations were determined and the incremental area under the curve (iAUC) was calculated. Results: The RS4[subscript]XL peak glucose and insulin concentrations were lower than the GLU and PWB (p<0.05). The iAUC for glucose and insulin were lower following ingestion of RS4[subscript]XL compared with the GLU and PWB trials. Conclusions: These data illustrate, for the first time, that directly substituting standard starch with RS4[subscript]XL, while matched for available carbohydrates, attenuated postprandial glucose and insulin levels in humans. It remains to be determined whether this response was due to the dietary fiber and/or resistant starch aspects of the RS4[subscript]XL bar. Keywords: insulin sensitivity, diabetes, dietary fiber, prebiotic, glycemic index

Master of Science / Department of Animal Sciences and Industry / Teresa L. Slough / Teresa L. Slough / There is increasing interest in the use of point-of-care glucometers to monitor glucose concentrations in horses with metabolic disorders. The first study reported herein compared equine glucose concentrations obtained by a handheld glucometer using whole blood or plasma, a YSI 2300 bench top glucose analyzer using whole blood or plasma, and a SEVEN continuous glucose monitoring (CGM) device that measured glucose in interstitial fluid to readings obtained by a standard laboratory glucose analyzer utilizing plasma. In addition, glucose concentrations obtained by the CGM were compared to those obtained by the handheld glucometer using whole blood or plasma. Post-prandial increases and decreases in glucose concentrations were detected utilizing all glucometers tested. When glucose measurements obtained with the CGM in interstitial fluid were compared to glucose measured using the handheld glucometer in plasma or whole blood, glucose measurements from plasma had better reproducibility. Although the CGM could be a useful instrument for collecting nearly continuous data for the researcher and clinician, there are technical difficulties related to the CGM that must first be overcome. The second study was designed to compare the effects of consuming a twice-daily meal of sweet feed (SF) to ad libitum access to a molasses-based block (BL) supplement on patterns of interstitial glucose concentrations in horses. A novelty effect of the BL was observed, in which horses consumed increased quantities in the first 12 h. Treatments had no effect on intake of forage in this study. The range and means of glucose values were similar between treatments, and significant glucose responses to treatments had lag times that were indirectly similar, even though molasses intake was greater for horses on BL. Variability between horses was noted in quantity of BL consumed as well as timing and magnitude of glucose responses. Based on the results of this experiment, there does not appear to be a clear advantage to either treatment, SF or BL, in attenuating post-prandial glucose increases or in minimizing glucose fluctuations in the horse.

Doctor of Philosophy / Department of Grain Science and Industry / Yong-Cheng Shi / Wheat bran is high in dietary fiber. Resistant starch (RS) is considered a source of dietary fiber. Wheat bran and RS have different functional properties and may not have the same nutritional properties. This dissertation covers two areas of importance in cereal chemistry and human nutrition: wheat bran and RS. Wheat bran chemical and physical influence of nutritional components Wheat bran has become a hot topic due to positive nutritional correlations, and industrial /humanitarian needs for healthy ingredients. Evolving wheat bran into a demanded product would impact the industry in a positive way. The overall aim of this research was to understand chemical and structural composition, to provide avenues for wheat bran development as a healthy food ingredient. To achieve this goal, antioxidant properties in dry wheat milling fractions were examined, effects of wheat bran particle size on phytochemical extractability and properties were measured, and substrate fermentation was investigated. It was noted that mixed mill streams, such as mill feed, have antioxidant properties (0.78 mg FAE/g; 1.28 mg/g total antioxidant capacity; 75.21% DPPH inhibition; 278.97 [mu]mol FeSO[subscript]4/g) originating from the bran and germ fractions. Additionally, extraction of reduced particle size whole wheat bran increased measured values for several assays (185.96 [mu]g catechin/g; 36.6 [mu]g/g; 425 [mu]M TE), but did not increase volatile fatty acid production during in vitro rumen fermentation over unmilled bran. RS digestion, glycemic response and human fermentation In vitro action of enzymes on digestion of maize starches differing in amylose contents were studied. The objectives of this study were to investigate the exact role of [alpha]-amylase and amyloglucosidase in determining the digestibility of starch and to understand the mechanism of enzymatic actions on starch granules. Starch digestibility differed (30-60%) without combination of enzymes during in vitro assay. Further investigations utilized human glycemic response and fermentation with consumption of a type 3 RS without dietary fiber (AOAC method 991.43). Blood glucose response provided lower postprandial curves (glycemic index value of 21) and breath hydrogen curves displayed low incidences fermentation (40%) with consumption of the type 3 RS, due to the structure of starch and digestion by enzymatic action.

Atualmente, o diabetes mellitus (DM) é uma doença onerosa para cofres públicos, devido às complicações micro e macrovasculares usualmente devido a não adesão à terapêutica. Tornando importante identificar novas variáveis que influenciam a não adesão à farmacoterapia, principalmente na atenção primária, onde os estudos no Brasil são escassos. Objetivo: Avaliar os fatores que influenciam a adesão a farmacoterapia em pacientes com diabetes tipo 1 (T1DM) e diabetes tipo 2 (T2DM) atendidos em uma unidade básica de saúde. Métodos: Esse é um estudo transversal realizado em pacientes com T1DM e T2DM com idades entre 18 a 90 anos, usuários de insulina e agentes anti-diabéticos selecionados de uma unidade básica de saúde do município de Franca - SP. Os instrumentos MedTake (MT), Morisky-Green (TMG), Índice de Complexidade da Farmacoterapia (ICFT), Índice de Complicações do Diabetes (CDI) e Teste Auto-Compliance (ACT) foram aplicados em todos pacientes por um único pesquisador do estudo. Os pacientes foram divididos em T1DM e T2DM com pontuações no TMG>80 para o grupo aderente e TMG<=80 para o grupo não aderente. Uma análise de regressão logística foi realizada para avaliar o efeito das variáveis na adesão ao tratamento, assim usamos como variável dependente o TMG e as variáveis independentes foram: clínicas, sociodemográficas, relacionadas aos medicamentos, CDI e Auto-Compliance. Esse modelo produziu odds ratio (OR) com medidas de associação com seus respectivos intervalos de confiança (IC). Os IC que não incluíram 1 foram considerados estatisticamente significantes (p<0.05). Para controlar os possíveis efeitos de confusão do sexo, idade e tempo de diagnóstico, o modelo de regressão logística múltipla produziu OR ajustadas. Resultados: Houve forte associação entre depressão e não adesão a farmacoterapia nos pacientes com T1DM nas faixas etárias de 41-60 anos, OR=4.6(1.4-14.2) fato que não ocorrem nas outras faixas etárias. A insuficiência cardíaca congestiva (ICC) foi associada a não adesão à farmacoterapia em pacientes com T2DM OR=2.3(1.1-5.1).9 Conclusão: Equipes multidisciplinares, gestores e formuladores de políticas públicas de saúde devem considerar a depressão e ICC no manejo dos pacientes com DM em relação a não adesão à farmacoterapia / Currently, diabetes is disease onerous to public safes due to micro and macrovasculares complications and non-adherence to therapeutic. In this sense, is crucial to identify new variables that influence the non-adherence to pharmacotherapy, mainly in the primary care, where the studies in Brazil are scared. Objective: To evaluate the factors that influence the adherence to pharmacotherapy in patients with type 1 diabetes (T1DM) and type 2 diabetes (T2DM) attended in the a primary health care unit. Methods: This is a cross-sectional study in patients with T1DM and T2DM aged 18-90 years, insulin and anti-diabetic drugs users selected from a primary health care unit in Franca-SP. The MedTake (MT), Morisky-Green (TMG), Pharmaco-Complexity Index (CPI), Diabetes Complication Index (CDI) and Self-Compliance Test (ACT) instruments were applied in all patients by a single study investigator. Patients were divided into T1DM and T2DM with scores in the TMG > 80 for the adherent group and TMG <= 80 for the non-adherent group. A logistic regression analysis was performed to evaluate the effect of the variables on the adherence to the treatment, so we used as a dependent variable the TMG and the independent variables were: clinical, sociodemographic, drug related, CDI and AutoCompliance. This model produced odds ratios (OR) with measures of association with their respective confidence intervals (CI). The CI that did not include 1 were considered statistically significant (p <0.05). To control the possible confounding effects of gender, age and time of diagnosis, the multiple logistic regression model produced adjusted OR. Results:There was a strong association between depression and non-adherence to pharmacotherapy in patients with T1DM in the age groups of 41-60 years, OR = 4.6 (1.4- 14.2), a fact that does not occur in other age groups. Congestive heart failure (CHF) was associated with non-adherence pharmacotherapy in patients with T2DM OR = 2.3 (1.1- 5.1). Conclusions: Multidisciplinary teams, managers and formulators of public health policies should consider depression and CHF in the management of patients with DM in relation to non-adherence to pharmacotherapy