Background: Findings are inconsistent regarding the degree to which depression may exert a negative impact on glycemic control in patients with type 2 diabetes. We therefore aimed to examine the longitudinal relationship between depression, behavioral factors, and glycemic control. Methods: In a prospective component of a nationally representative sample, 866 patients with type 2 diabetes aged ≧18 years completed a standardized assessment including a laboratory screening, questionnaires, and diagnostic measures. Subsequent to baseline (t0), patients were tracked over a period of 12 months (t1). Depression was assessed according to DSM-IV and ICD-10 criteria. Glycemic control was determined by levels of glycosylated hemoglobin (HbA1c); a level of ≧7% was judged as unsatisfactory. Regression analyses were performed to analyze the prospective relationship between depression, medication adherence, diabetes-related health behavior, and HbA1c. Results: Patients with depression at t0 revealed increased rates of medication nonadherence (adjusted OR: 2.67; CI: 1.38–5.15) at t1. Depression (adjusted regression coefficient: β = 0.96; p = 0.001) and subthreshold depression (β = 1.01; p < 0.001) at t0 also predicted increased problems with diabetes-related health behavior at t1. Adjusted ORs for poor glycemic control (HbA1c ≧7%) at t1 were also increased for patients with baseline depression (2.01; CI: 1.10–3.69). However, problems with medication adherence as well as problems with diabetes-related health behavior at t0 did not predict poor glycemic control at t1. Conclusions: In a prospective representative study of patients with type 2 diabetes, baseline depression predicted problems with medication adherence, problems with health-related behaviors, and unsatisfactory glycemic control at follow-up.

Obesity is the most common clinical disorder and is associated with various medical conditions in dogs. Appropriate dietary management potentially provides weight loss in a safe, healthy, and efficacious manner. In order to elucidate whether dietary fiber, carnitine, diacylglycerol (DAG), and low glycemic index (LGI) act on such dietary components, a series of studies was conducted: 1) the combination of dietary fiber/carnitine effect on short term (3 and 7 h) satiety and long term (6 weeks) canine weight loss, 2) the combination of dietary LGI/high glycemic index (HGI) starches and DAG/triacylglycerol (TAG) effect during a 9 week canine weight loss period, and 3) the DAG effect on triglyceride rich lipoprotein (TRL) metabolism isolated from canine plasma 3-4 h postprandially. The combination of dietary fiber/carnitine supplementation decreased both food and energy intake at 3 h post-feeding, suggesting that this combination diet provided 3 h post-meal satiety. This combination supplement also increased postprandial plasma B- hydroxybutyrate (BHB) at d 42 and body fat and weight loss at d 42 from baseline. This combination supplement did not alter plasma vitamin A distributions or concentrations although it contained high vitamin A as B-carotene. In the second study, the LGI diets resulted in a more pronounced body weight loss than the HGI diets due to lower diet digestibilities. These data are consistent with LGI diets decreasing metabolizable energy and consequently consuming less energy compared to the HGI diets. The DAG diets lowered postprandial plasma TAG at weeks 1 and 8 in and increased plasma BHB at week 8, suggesting an increase in fat oxidation. The combination of DAG/LGI decreased postprandial total cholesterol at week 8. Lipoprotein concentrations were not altered by diet types. Fasting lipoprotein lipase (LPL) and hepatic lipase (HL) activities were not affected by diets. In the final study, DAG ingestion decreased TRL and plasma TAG concentrations vs. TAG ingestion. The DAG enriched meal increased non-esterified fatty acid, monoacylglycerol, and 1,3-DAG and decreased TAG in TRLs which may be attributed to larger TRL particle size compared to the TAG meal. Consequently, the DAG derived TRLs showed increased affinity of core TAG for LPL and HL in vitro. Moreover, the intravenous injection of the DAG derived canine TRLs into mice underwent more rapid blood clearance associated with the greater hepatic uptake compared to the TAG derived TRL injection. In conclusion, the combination of dietary fiber/carnitine and DAG/LGI preferably reduced body weight and stimulated fat oxidation, which promotes overall weight loss. The postprandial plasma TAG lowering effect of DAG is the result, at least partially, from the efficient clearance of TRLs from blood circulation and their ability to act as a more efficient substrate for plasma lipolytic enzymes.

PURPORSE¡GThis purpose of the study is to investigate the effectiveness of diabetes shared care model (DSCM)and the factors associated with extent of glycemic control. METHOD¡GWe analyzed 212 patients who completed the five shared care visits and 739 patients who completed the second follow-up visit. Patients are recruited from a department of Endocrinology of medical center located in southern part of Taiwan. Data used in this study were collected from the patients¡¦ medical records. To evaluate effectiveness of diabetes shared care model¡]dietary compliance, exercise behavior compliance, clinical indicators¡^and to examine the factors associated with the hemoglobulin A1c is the purpose of the study. RESULT¡G In 212 patients completing the 5 visits, the compliance of carbohydrate consumption was significantly improved, however, there was no significant improvement in those of calories and fat consumption. Further analysis in 739 patients who completed the second follow-up visit, we found that the compliance of calories and fat consumption was significantly improved. The compliance of carbohydrate was improved, but not reaching significant difference. Although the compliance of 212 patients¡¦ exercise behavior was not significantly improved, the compliance of 739 patients¡¦ exercise behavior was significantly improved. The improvement of clinical indicators following participating the DCSM are as followed¡G 1.The hemoglobulin A1c¡]before¡G8.1% vs after¡G7.9%¡AP=0.04¡^¡Bfasting plasma glucose¡]before¡G164.1mg/dL vs after¡G136.8 mg/dL¡AP<0.01¡^¡Btotal cholesterol ¡]before¡G200.9mg/dL vs after¡G187.3 mg/dL¡AP<0.01¡^¡Blow density lipoprotein¡]LDL¡^¡]before¡G121.0mg/dL vs posttest¡G113.1 mg/dL¡AP<0.01¡^¡Bhigh density lipoprotein¡]HDL¡^¡]before¡G42.6mg/dL vs posttest¡G46.2 mg/dL¡AP<0.01¡^of 212 patients were significantly improved. On the other hand, the triglyceride¡]pretest¡G159.9mg/dL vs after¡G152.2 mg/dL¡AP=0.71¡^¡Bsystolic blood pressure¡]before¡G132.5mmHg vs after¡G137.3 mmHg¡AP=0.34¡^and diastolic blood pressure¡]before¡G79.5 mmHg vs after¡G78.4 mmHg¡AP=0.09¡^of 212 patients were not significantly improved. 2.In 739 patients who only completing the second follow-up visit, the hemoglobulin A1c¡Bfasting plasma glucose¡Bdiastolic blood pressure were significantly improved but the systolic blood pressure was remain unchanged. Finally, multivariate regression modeling was used to investigate the factors associated with extent of glycemic control improvement (first visit HbA1c-annual visit HbA1c) in 212 patients competing the annual visit. After adjusting for age and sex, patients¡¦ sex, level of first visit hemoglobulin A1c and level of first visit triglyceride was associated with the extent of glycemic control.

Individual day-to-day management and effective control of type 1 diabetes (T1D) is ultimately driven by decisions made by the individual. Individuals with attention deficit hyperactivity disorder (ADHD) have a higher tendency to be inattentive, impulsive, and hyperactive. Attention deficits and impulsivity among adolescents and adults with T1D could result in poor diabetes management through infrequent self-monitoring of blood glucose and inadequate insulin dosing – key components of achieving optimal glycemic control. This study included 7,380 adolescents and young adults, ages 13-25 years, participating in the T1D Exchange clinic registry (median age 17.4 years, duration 7.7 yrs, 50% female, 81% white). Participants were classified into 3 groups for the primary analyses using participant reported diagnosis and medication use: 1) No ADHD; 2) ADHD with current medication; 3) ADHD without current medication. Groups were compared in logistic and linear regression models for: self-monitoring of blood glucose (SMBG) /day, missed insulin dose ≥1 time/week, HbA1c, and at least 1 diabetic ketoacidosis (DKA) and severe hypoglycemic (SH) event in the past 3 months. Overall, 774 (10%) participants reported a diagnosis of ADHD of whom 371 currently took medication. Mean SMBG/day was 4.7, 5.0, and 4.9 in the ADHD w/o meds, ADHD with meds, and no ADHD groups, respectively. ADHD patients w/o meds (36%, P=0.02) or with meds (39%, P=0.003) were more likely to report missing insulin doses compared with no ADHD pts (30%). Mean HbA1c was higher in ADHD w/o meds (9.0%, P<0.001) and ADHD with meds (8.9%, P=0.002) compared with no ADHD pts (8.6%). The odds of having at least one DKA event in the past 3 months was 1.8 and 1.5 times higher in the ADHD w/o meds (P<0.001) and ADHD with meds (P=0.01) group compared with no ADHD. The ADHD w/o meds group was significantly more likely to have had a SH event (OR 1.7 95% CI 1.2-2.3; P<0.001) compared with the no ADHD group but the occurrence of SH in the ADHD with meds group was similar to the no ADHD. Results of this study supported the working hypothesis that ADHD without treatment with medication has a negative impact on aspects of diabetes management and glycemic control. Participants with ADHD with and without medication were more likely to miss insulin doses, less likely to use an insulin pump, more likely to have high HbA1c levels, and had a higher frequency of DKA and SH. These results have important public health implications for adolescents and young adults with T1D who are already at risk for poor glycemic control. Since ADHD has a meaningful impact on glycemic outcomes it is important for providers of adolescents and young adults with T1D to review history and signs of an ADHD diagnosis along with diagnosis of other psychosocial disorders with their patients and consider recommending psychosocial services.

Hyperglycemia in adult cardiac surgery may result in post-operative sternal wound infections, pneumonia, renal failure, increased length of stay, and cost. The Surgical Care Improvement Project (SCIP) (2006) requires blood glucose control in cardiac surgery at 6:00 am on post-operative day one (POD1) and post-operative day two (POD2) to be 200mg/dL or less. Enhanced Recovery After Surgery (ERAS) guidelines use a Maltodextrin 12.5% carbohydrate beverage six hours and two hours pre-operative of general surgery to improve post-operative outcomes, cost, and length of stay. One study replicated ERAS guidelines in adult coronary artery bypass grafting surgery patients finding patients had decreased length of stay and improved glycemic control six hours postoperatively. The purpose of this quality improvement project is to outline a proactive approach to the modifiable risk factor of pre-operative fasting. This quality improvement project describes a pre-operative fasting carbohydrate protocol for non-emergent, adults, scheduled for cardiac surgery at 10:00am or later, with a hemoglobin A1C of 8.4% or less, and a body mass index of 35 or less. The protocol is named the Hungry Sweet Heart Protocol and an implementation plan is described for a community hospital located in Tucson, AZ. Updating practices of strict NPO status prior to cardiac surgery is a proactive measure to improve glycemic control and adherence to SCIP guidelines post-operatively. Interdisciplinary teams, including DNPs, are perfectly suited to guide this implementation.

Abstract Title: The GI- method –bluff or the path to healthy life? Number of pages: 41 Tutor: Lowe Hedman Author: Annika Westlund Course: Media and Communication Studies C Period: Fall 2006 University: Division of Media and Communications Studies C 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. 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. 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. Keywords: glycemic index, media culture, encoding/decoding, discourse analysis.

No description available.

Stress induced hyperglycaemia is prevalent in critical care. Since the landmark paper published by Van den Berghe et al. (2001) a great deal of attention has been paid to intensive insulin therapy in an ICU setting to combat the adverse effects of elevated glucose levels and poor glycaemic control. Glycaemic control protocols have been extensively developed, tested and validated within an ICU setting. However, little research has been conducted on the effects of a glycaemic control protocol in a less acute ward setting. There are many additional challenges presented in a ward setting, such as the variation in meals and levels of activity between patients, from day to day and throughout the day. A simple compartment model is used to describe the nature of insulin and glucose metabolism in patients of the Cardiothoracic Ward (CTW). A stochastic model of the fitted insulin sensitivity parameter is generated for this cohort and validated against cohorts of similar characteristics. The stochastic model is then used to run simulations of predictive control on 7 CTW patients, which shows significantly tighter glucose control than what is obtained with regular clinical procedures. However, the rate of severe hypoglycaemia is an unacceptably high 4.2%. The greatest challenge in maintaining tight glycaemic control in such patients is the consumption of meals at irregular times and of inconsistent quantities. Insulin sensitivity was compared to extensive hourly clinical data of 36 ICU patients. From this data a sepsis score of value 0-4 was generated as gold standard marker of sepsis. Comparing the sepsis score to insulin sensitivity found that insulin sensitivity provides a negative predictive diagnostic for sepsis. High insulin sensitivity of greater than Si = 8 x 10⁻⁵ L mU⁻¹ min⁻¹ rules out sepsis for the majority of patient hours and may be determined non-invasively in real-time from glycaemic control protocol data. Low insulin sensitivity is not an effective diagnostic, as it can equally mark the presence of sepsis or other conditions.

Thesis (M.A.(MHS))-University of Pretoria, 1999. / Summary in English and Afrikaans.

Thesis(MSc Food Sc )--Stellenbosch University, 2002. / ENGLISH ABSTRACT: Consumers are becoming more health conscious. Furthermore, time is a scarce human resource and therefore convenience is an important consideration when food choices are being made. A South African food company identified this trend and decided to develop a product that capitalised on these demands of health and convenience. The decision was made to develop a low-fat, low-cholesterol, low-saturated fatty acid, low-trans fatty acid, high-fibre wheat product with an intermediate glycemic index (GI). The market in Stellenbosch was scouted to determine whether a similar product already existed. Six products that made nutrient-, health- or any other claims were identified. Not one of the identified products, however, conformed to meet the requirements of the Department of Health for the product characteristics that were set. Therefore, the decision was made to continue the development of the low-fat, low-cholesterol, low-saturated fatty acid, low-trans fatty acid, high-fibre wheat product with an intermediate glycemic index (GI). To qualify as a low-fat product, the product had to contain less than 3 % fat. The ingredients were chosen with their fat content in mind. Fruit pulp is widely used in the preparation of baked low-fat products and was also used in this study to eliminate the use of butter, margarine and oil, but also to achieve the additional product criteria that was set by the food company, namely a chewy texture and a fruity flavour. Ingredients like soya flour, oatmeal, oats and wheat bran were chosen to increase the fibre content of the product, because all of these products have a fibre content of 10 g or more per 100 g. Two products were developed during 23 experiments. Except for the high fibre claim, both products met the criteria that were set before the development started, namely a low-fat, low-cholesterol, low-saturated fatty acid, low-trans fatty acid, high-fibre content and a calculated intermediate glycemic index (GI). One of the two concept products that were developed were chosen by an experienced panel to serve as basic product for an empirical study on the effect of different fibre levels on the glycemic index. Five different fibre levels were formulated by manipulating the amounts of wheat bran and oatmeal. The basic formula contained 6,25 % fibre and the other fibre levels were identified as: 4,39; 5,31; 7,45 en 8,17 %. The fibre levels were equal-distant. The prediction was made that the GI-value of the product will decrease as the fibre levels increase and the theoretical calculations confirmed this prediction. The real GI-values that were determined by blood glucose testings, however, showed an increase in GI-value up to the 6,25 % fibre level, followed by a.decrease in GI-value to the 8,17 % fibre level. It became apparent that more than just fibre played a role in the GI-values of the products. It is proposed that the results explained by fibre behaviour, starch gelatinisation and starch hydrolysis. Hundred households in Stell enbosch tested the developed product. Two fieldworkers identified 25 consumers in four retail stores in Stellenbosch and gave them the product and the questionnaire, which they had to complete at home after tasting the product. The questionnaires were then collected from the respondents' houses. A recognised measurement instrument, which is used by the South African food industry to determine the acceptability of a newly developed product, was used for assesing the results. The results showed that the orange flavour of the product led to a low overall acceptability of the developed product and that the other product concept (that was developed during the recipe development phase and not chosen by the panel) should be considered for testing its market potential. Another facet of the questionnaire determined the effect of buying practices, health consciousness and consumer knowledge on the consumer acceptability of the low-fat, high-fibre wheat product with an intermediate-GI-value. No correlation between these factors and consumer acceptability of the low-fat, high-fibre wheat product with an intermediate-GI-value were found. / AFRIKAANSE OPSOMMING: Die verbruiker word al meer gesondheidsbewus: Terselfdertyd is tyd 'n skaars menslike hulpbron, en word gerief gevolglik 'n belangrike oorweging tydens voedselkeuses. 'n Suid-Afrikaanse voedselmaatskappy het hierdie neigings geidentifiseer en besluit om 'n produk te ontwikkel wat aan hierdie vereistes van gesondheid en gerief voldoen. Daar is besluit om 'n lae vet-, lae cholesterol-, lae versadigdevetsuur-, lae transvetsuur-, hoe veselgraanproduk met 'n intermediere glukemiese indeks (GI) te ontwikkel. Die Stellenbosse mark is verken om vas te stel of daar reeds soortgelyke produkte op die mark was. Ses produkte wat nutrientinhoud-, gesondheid- of ander aansprake maak, is geidentifiseer. Geeneen van die produkte het egter aan die Departement van Gesondheid se konsepregulasies betreffende die etikettering van voedingsmiddels vir bogenoemde produkeienskappe voldoen nie. Gevolglik is besluit om met die ontwikkeling van die lae vet-, lae cholesterol-, lae versadigdevetsuur-, lae transvetsuur-, hoe veselgraanproduk met 'n intermediere GI voort te gaan. Om as 'n laevetproduk te kon kwalifiseer, moes die produk minder as 3 % vet bevat. Die bestanddele moes dus met inagneming van hul vetinhoud gekies word. Vrugtepulp word algemeen gebruik in die bereiding van gebakte laevetprodukte en is ook in hierdie studie gebruik om die gebruik van botter, margarien of olie te vermy, maar ook om aan die addisionele produkkriteria wat deur die maatskappy gespesifiseer is, naamlik 'n sagte tekstuur en vrugtige geur, te voldoen. Bestanddele soos soja-, hawermeel, hawer- en koringsemels is gekies om die veselinhoud van die produk te verhoog, aangesien hierdie bestanddele meer as 10 g vesel per 100 g bevat. Twee produkte is deur middel van 23 eksperimente ontwikkel. Met die uitsondering van die hoeveselinhoudaanspraak, het beide produkte aan die vereistes wat gestel is, naamlik 'n laevet-, laecholesterol-, laeversadigdevetsuur-, laetransvetsuur- en 'n hoeveselinhoud en 'n beraamde intermediere GI, voldoen. Een van die konsepprodukte is deur 'n ervare paneel gekies vir die empiriese studie waar die effek van verskillende veselvlakke op die GI bepaal is. 'n Standaard formule is aangepas om vyf verskillende veselvlakke te verkry deur die koringsemel- en hawermeelhoeveelhede te manipuleer. Die basisformule het 6,25 % vesel bevat en twee veselvlakke is daarbo en -onder as ge·identifiseer: 4,39; 5,31; 7,45 en 8,17 %, dit wil sê, veselvlakke met dieselfde grootte verskille. Daar is voorspel dat die GI-waarde van die produkte sou daal met 'n toename in die veselinhoud van die produk en die teoretiese berekeninge van die GI-waarde het hierdie voorspelling gestaaf. Die werklike GI-waardes wat met behulp van bloedglukoseresponse bepaal is, het egter 'n toename in GI-waarde tot by die 6,25 % veselvlak, gevolg deur 'n afname tot by die 8,17 % veselvlak aangedui. Dit het duidelik geword dat meer as slegs die veselinhoud 'n rol gespeel het by die GI-waarde van die produk. Die resultate is gevolglik aan die hand van die veselgedrag, styselgelatinisasie en styselhidrolise verklaar. Die verbruikersaanvaarbaarheid van die ontwikkelde laevet-, hoeveselproduk is by 100 huishoudings in Stellenbosch getoets. Twee veldwerkers het die verbruikers in vier kleinhandelaars in Stellenbosch genader en produkte met 'n gepaardgaande vraelys aan hulle oorhandig. Die produkte is tuis qeevalueer en die vraelyste is weer ingesamel. Ook vervat in die vraelys was 'n erkende meetinstrument wat deur die Suid-Afrikaanse voedselindustrie gebruik word vir die bepaling van verbruikersaanvaarbaarheid van 'n nuutontwikkelde produk. Uit die resultate het dit geblyk dat die lemoengeur van die produk gelei het tot die lae verbruikersaanvaarbaarheid van die ontwikkelde produk, en dat die ander produkkonsep (wat tydens die resepontwikkelingsfase ontwikkel is, en nie deur die ervare paneel gekies is nie) vir bemarkingspotensiaal getoets hoort te word. Die data wat uit die vraelyste ingesamel is, is ook gebruik om die effek van aankooppraktyke, gesondheidsbewustheid en verbruikerskennis op die verbruikersaanvaarbaarheid van die laevet-, hoeveselgraanproduk met 'n interrnediere-Gl-waarde te bepaal. Daar is geen verwantskap tussen hierdie faktore en die verbruikersaanvaarbaarheid van die laevet-, hoëveselgraanproduk met 'n intermedlere-Gl-waarde, gevind nie.