Background: The One Drop vertical bar Mobile app supports manual and passive (via HealthKit and One Drop's glucose meter) tracking of self-care and glycated hemoglobin A(1c) (HbA(1c)). Objective: We assessed the HbA(1c) change of a sample of people with type 1 diabetes (T1D) or type 2 diabetes (T2D) using the One Drop vertical bar Mobile app on iPhone and Apple Watch, and tested relationships between self-care tracking with the app and HbA(1c) change. Methods: In June 2017, we identified people with diabetes using the One Drop vertical bar Mobile app on iPhone and Apple Watch who entered two HbA(1c) measurements in the app 60 to 365 days apart. We assessed the relationship between using the app and HbA(1c) change. Results: Users had T1D (n=65) or T2D (n=191), were 22.7% (58/219) female, with diabetes for a mean 8.34 (SD 8.79) years, and tracked a mean 2176.35 (SD 3430.23) self-care activities between HbA(1c) entries. There was a significant 1.36% or 14.9 mmol/mol HbA(1c) reduction (F=62.60, P<.001) from the first (8.72%, 71.8 mmol/mol) to second HbA(1c) (7.36%, 56.9 mmol/mol) measurement. Tracking carbohydrates was independently associated with greater HbA(1c) improvement (all P<.01). Conclusions: Using One Drop vertical bar Mobile on iPhone and Apple Watch may favorably impact glycemic control.

Bakgrund: Hemoblobin-A1c är ett mått på blodsockrets medelvärde efter mellan 60-90 dagar och är en grundläggande indikator på blodsockerkontrollen hos patienter med typ 2-diabetes. Kondition- och styrketräning har visat sig kunna påverka hemoglobin-A1c och används därför som en av flera behandlingsformer hos patienter med typ-2 diabetes. Emellertid verkar det finnas en bristande enighet vad gäller den effektiva dosen av fysisk träning och den mest effektiva kombinationen av styrka gentemot konditionsträning. Syfte: Syftet med denna studie var att systematiskt granska och sammanställa den senaste forskningen vad gäller effekten av fysisk träning vid typ 2-diabetes. Metod: Studien genomfördes som en systematisk litteraturstudie med meta-analys i enlighet med PRISMA riktlinjer. Databaserna som användes i artikelsökningarna var PubMed, Web of Science, Sport Discus, Cinahl och Medline. Studiens inklusionskriterier var studier på engelska, studier som undersöker både män-och eller kvinnor i olika åldersgrupper, studier som undersöker effekten av fysisk träning på hemoglobin-A1c samt randomiserade kontrollerade studier. Resultat: Effekten av fysisk träning visade en signifikant skillnad på hemoglobin-A1c hos patienter med typ 2-diabetes. Effektstorleken på hemoglobin-A1c mellan grupperna var -0.434 efter interventionerna p &lt;0.001. Av samtliga studier var det 11 av 22 som åstadkom ett värde av hemoglobin-A1c som visar &lt;7%. Sekundära resultatet av fysisk träning på typ 2-diabetes påvisades vara en signifikant minskning i den totala kroppsvikten i sex av samtliga inkluderade studier. Slutsats: Fysisk träning verkar vara en viktig komponent för att minska hemoglobin-A1c hos patienter med typ 2-diabetes. / Background: Hemoglobin-A1c is a measure of long‐term glycemiais after between 60-90 days and is a good indicator of glucose control in patients with type-2 diabetes. Both strenght and aerobic exercise seem to have benefical effects on Hemoglobin-A1c and, thus, the management of type 2 diabetes. However, the consensus on the effective dose of exercise and the most effective combination of strength versus aerobic have been inconsistent. Purpose: The purpose of this study was to systematically review and compile the latest research regarding the effect of physical exercise in type 2 diabetes. Method: The study was conduced as a systematic review with meta-analysis according to PRISMA guidelines. The study was conducted as a systematic review with meta-analysis. The databases used in this study, were PubMed, Web of Science, Sport Discus, Cinahl and Medline. The study’s inclusion criteria were studies in english, studies including both men and-or women in different ages, studies examining the effect of physical exercise on hemoglobin-A1c, and studies of a randomized controlled design. Results: The effect of physical training showed a significant difference between groups. The effect size on hemoglobin-A1c between groups was -0.434 after the interventions p &lt;0.001. In this study, it was 11 of 22 studies that achieved a value of hemoglobin-A1c showing &lt;7%. Secondary results of physical training on type-2 diabetes were found to be a significant decrease in total body weight in six of all included studies. Conclusion: Physical training seems to be an important component of reducing hemoglobinA1c in patients with type 2-diabetes. / <p>Presentationen ägde rum hemifrån var och för sig via Zoom på grund av smittrisken för coronavirus. </p>

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.

Background: In order to provide good diabetes care it is important for the health care professionals to share patients’ personal understanding of living with diabetes, which differs from a professional understanding of the illness. Patients’ beliefs about health, illness, control and cure are predictive of the outcome of lifestyle changes and pharmacological treatment. Narratives about illness could be used to elucidate what people believe to be central to their experience of an illness and its management. The overall aim of this thesis was to investigate experiences of diabetes and diabetes care among people with type 2 diabetes and district nurses responsible for diabetes care within primary health care. Methods: Forty-four patients diagnosed with diabetes during the previous 2 years were interviewed about their personal understanding of illness and experiences of care. They also participated in an intervention study consisting of group sessions during 9 months. The intervention focused on the patients’ understanding of living with diabetes and was directed at the patients and their nurses (n = 5). The outcome variables haemoglobin A1c (HbA1c), lipids, blood pressure (BP) and body mass index (BMI) as well as well-being, treatment satisfaction and diabetes symptoms of the intervention group were compared with those in a control group (n = 60). Another ten patients were interviewed about their views of their lives. Seventeen nurses in diabetes care were interviewed about their views of their work with patients. The narrative, thematic interviews and focus group interviews were analysed using qualitative content analysis. Findings: Patients’ personal understanding of illness included the categories “image of the disease”; “meaning of the diagnosis”; “integration of the illness”; “space for the illness”; “responsibility for care”; and “future prospects”. Patients’ narratives about their lives included views of knowledge, and capacity, motivation and courage, aspects important for effective self-management. Patients’ views on clinical encounters in diabetes care, interpreted as satisfying or not, included the themes “being in agreement v. in disagreement about the goals”; “being autonomous and equal v. being forced into adaptation and submission”; “feeling worthy as a person v. feeling worthless”; “being attended to and feeling welcome v. being ignored”; and “feeling safe and confident v. feeling unsafe and lacking confidence”. The results of the intervention study with group sessions showed improvements in metabolic balance and treatment satisfaction in the intervention group. At the 1-year follow-up the mean difference between groups in HbA1c was 0.94% (95% confidence interval (CI) 0.58–1.29). Nurses’ views of their work included the themes “Perspectives on illness and caring are not easily integrated into views of disease and its treatment”; “Nurses view their knowledge as more important than the patients’ knowledge”; Nurses’ conscience is challenged by some of their nursing decisions”; “The individuality of each patient is undermined when patients are regarded as a collective group”; and “Nurses are confirmed in their role of nurses by patients who assume a traditional patient role”. Conclusion: These results demonstrate that the understanding of illness and care differs between patients and nurses working in diabetes care; furthermore, that an intervention involving patients and their nurses based on patients’ personal understanding of illness is effective with regard to metabolic control and treatment satisfaction. The cost of the intervention is moderate. Also, we believe that it is possible to clinically implement this intervention within the existing resources for primary health care.

Studies demonstrate localized neuro-retinal dysfunction in patients with diabetes and no visible diabetic retinopathy (DR). Poor glycemic control is a strong risk factor for DR. We hypothesized that poor glycemic control predicts increased areas of localized neuro-retinal dysfunction in patients with diabetes. Forty-eight adolescents with diabetes and 45 controls were tested using the standard (103 hexagons) multifocal electroretinogram (mfERG). Negative binomial regression analysis was conducted with number of abnormal hexagons (delayed responses) as the dependent variable and glycated hemoglobin (HbA1c), disease duration, age and sex as covariates. Results indicate that a one-unit increase in HbA1c predicts an 80% (p = 0.002) increase in the number of abnormal hexagons when controlling for age. Increased areas of neuro-retinal dysfunction are predicted by worsening glycemic control in patients with no visible DR. Standard mfERG may be useful in monitoring patients with diabetes and identifying those who may be at risk of developing DR.

Studies demonstrate short-wavelength cone pathway dysfunction in patients with diabetes and no clinically visible DR. Poor glycemic control, as measured by hemoglobin A1c (HbA1c), is a strong risk factor for DR. We hypothesized that raised HbA1c was associated with short-wavelength cone sensitive visual evoked potential (S-VEP) and electroretinogram (sERG) dysfunction. Forty adolescents with diabetes and 39 controls were tested using the S-VEP. Latencies to a short-wavelength stimulus were delayed in patients at low contrasts. Patient S-VEP latencies were not associated with HbA1c when controlling for age and time since diagnosis. Twenty-one adolescents with diabetes and 19 controls were tested using the sERG. Implicit times of the b-wave were delayed but not associated with HbA1c when controlling for time since diagnosis.Patient PhNR amplitudes were reduced. A one-unit increase in HbA1c was associated with a 15% sERG PhNR amplitude reduction (p=0.004). The sERG PhNR may be a potential biomarker for DR.

Studies demonstrate localized neuro-retinal dysfunction in patients with diabetes and no visible diabetic retinopathy (DR). Poor glycemic control is a strong risk factor for DR. We hypothesized that poor glycemic control predicts increased areas of localized neuro-retinal dysfunction in patients with diabetes. Forty-eight adolescents with diabetes and 45 controls were tested using the standard (103 hexagons) multifocal electroretinogram (mfERG). Negative binomial regression analysis was conducted with number of abnormal hexagons (delayed responses) as the dependent variable and glycated hemoglobin (HbA1c), disease duration, age and sex as covariates. Results indicate that a one-unit increase in HbA1c predicts an 80% (p = 0.002) increase in the number of abnormal hexagons when controlling for age. Increased areas of neuro-retinal dysfunction are predicted by worsening glycemic control in patients with no visible DR. Standard mfERG may be useful in monitoring patients with diabetes and identifying those who may be at risk of developing DR.

Studies demonstrate short-wavelength cone pathway dysfunction in patients with diabetes and no clinically visible DR. Poor glycemic control, as measured by hemoglobin A1c (HbA1c), is a strong risk factor for DR. We hypothesized that raised HbA1c was associated with short-wavelength cone sensitive visual evoked potential (S-VEP) and electroretinogram (sERG) dysfunction. Forty adolescents with diabetes and 39 controls were tested using the S-VEP. Latencies to a short-wavelength stimulus were delayed in patients at low contrasts. Patient S-VEP latencies were not associated with HbA1c when controlling for age and time since diagnosis. Twenty-one adolescents with diabetes and 19 controls were tested using the sERG. Implicit times of the b-wave were delayed but not associated with HbA1c when controlling for time since diagnosis.Patient PhNR amplitudes were reduced. A one-unit increase in HbA1c was associated with a 15% sERG PhNR amplitude reduction (p=0.004). The sERG PhNR may be a potential biomarker for DR.

Diabetes disproportionately affects minority populations. Social support, and more specifically marriage, has been found to buffer the negative effects of diabetes and depression. Data collected from African Americans with type 2 diabetes in Atlanta and NHANES data were compared to examine whether marriage affects health status and mental health. Approximately, 1742 African Americans aged 18-80 were included in this study. Chi square analysis revealed that married men had lower rates of depression (15.9% vs. 24.7%) compared to unmarried men (p < 0.05), but the same effect was not found in women. The findings show that marriage was not associated with HbA1c, but was associated with rates of depression. The lack of association of HbA1c with marriage may be because marriage may not be the best proxy of social support in the African American community. Future research should focus on alternative forms of social support such as cohabitation, extend family, and friend.

Diabetes mellitus (DM) is a syndrome of multiple etiologies resulting from lack of insulin and / or the inability of insulin properly exercise its effects. It is considered the world, a public health problem by the position it occupies with high epidemiological incidence and prevalence, besides causing macrovascular and microvascular complications. The DM has two main forms, type 1 (DM1), which appears mostly in childhood or adolescence and type 2 (DM2), the most frequent, accounting for 85% to 90% of cases, usually of insidious onset, especially after 40 years of age, affecting obese individuals in 90% of the time. Cardiovascular diseases (CVD) are responsible for approximately 52% of deaths of patients with DM. The strategy of prevention of these chronic complications essentially depend on the adequate control of blood glucose and other comorbidities, including dyslipidemia and hypertension (SAH). This ivestigação was conducted to evaluate the effect of pharmaceutical intervention on glycemic control in outpatients suffering from DM2.Trata is a longitudinal study with intervention, using 100 subjects during query consecutively diagnosed with DM2 in private clinic endocrinology from May 2011 to February 2012. All patients answered a questionnaire and underwent pharmaceutical intervention, conducted by the researcher. After this intervention, there was a significant reduction of 45% CI 95% in A1C levels. Thus, there was still improvement in outcomes among women (69%) (p = 0.01) and the following parameters: fasting glucose (p = 0.000), frequency of exercise (p = 0.0001), adoption of low-calorie diet (p = 0.0001), adherence to drug therapy (p = 0.024) and BMI (p = 0.012). / O diabetes mellitus (DM) é uma síndrome de etiologia múltipla decorrente da falta de insulina e/ou da incapacidade da insulina exercer adequadamente seus efeitos. É considerado, mundialmente, um problema de saúde pública pela posição epidemiológica que ocupa com altas taxas de incidência e prevalência, além de acarretar complicações macrovasculares e microvasculares. O DM apresenta duas formas principais, o tipo 1 (DM1), que aparece principalmente na infância ou na adolescência e o tipo 2 (DM2), a mais freqüente, responsável por 85% a 90% dos casos, geralmente de instalação insidiosa, principalmente após os 40 anos de idade, acometendo indivíduos obesos em 90% das vezes. As doenças cardiovasculares (DCV) são responsáveis por aproximadamente 52% das mortes dos portadores de DM. A estratégia de prevenção destas complicações crônicas dependem, fundamentalmente, do adequado controle da glicemia e de outras comorbidades, entre elas a dislipidemia e a hipertensão arterial sistêmica (HAS). A presente ivestigação foi conduzida visando avaliar o efeito da intervenção farmacêutica no controle da glicemia de pacientes ambulatoriais portadores de DM2.Trata-se de um estudo longitudinal com intervenção, utilizando-se 100 sujeitos durante consulta, consecutivamente, com diagnóstico de DM2 em ambulatório privado de endocrinologia no período de maio de 2011 a fevereiro de 2012. Todos os voluntários responderam a um questionário e sofreram intervenção farmacêutica, realizada pelo pesquisador. Após esta intervenção, ocorreu uma redução significativa de 45% IC 95% nos níveis de A1C. Diante disso, observou-se ainda melhora nos resultados entre as mulheres (69%) (p=0,01) e nos seguintes parâmetros: glicemia de jejum (p=0,000), frequência de exercícios físicos (p=0,0001), adoção da dieta hipocalórica (p= 0,0001), adesão à terapia medicamentosa (p= 0,024) e IMC (p= 0,012).