Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

Thesis PlanA (M.S.)--University of Wisconsin--Stout, 2009. / Includes bibliographical references.

Theses (M.S)--Marshall University, 2007. / Title from document title page. Includes abstract. Document formatted into pages: contains vii, 96 pages. Bibliography: p.87-92.

No description available.

Thesis (M.Fam.Med.)--University of the Witwatersrand, Faculty of Health Sciences, 2014. / Background The combined influence of processes of care, lifestyle advice and drug treatment on glycaemic control in Type 2 diabetes in primary care settings is not well documented. Aim To describe the provision of lifestyle advice, selected processes of care and drug treatment to, and assess the influence of these factors on glycaemic control in, a sample of adults with type 2 diabetes mellitus attending the Johan Heyns Community Health Centre in Sedibeng District, Gauteng. Methods A cross-sectional design was used. Participants consisted of 200, consecutively chosen, adult volunteers with type 2 diabetes. Information on demographics, reported receipt of lifestyle advice and anthropomorphic measurements was collected through questionnaire-based interviews. This was followed by a record review of all participants’ clinic files for information on current drug management, co-morbid medical conditions and documentation of processes of care, in the preceding 12 months, in respect of HbA1c, blood pressure (BP), weight, waist circumference (WC) and body mass index (BMI) monitoring. HbA1c values were used to ascertain glycaemic control. Performance of processes of care was assessed in accordance with Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) guidelines. Parsimonious models for glycaemic control were constructed through multivariate logistic regression. Results Mean age of the sample was 58 years with 58% in the 50-64 year age group. Blacks (88%) and females (63%) were in the majority. Over two-thirds had diabetes for under 10 years and 98% had at least one co-morbid condition, mainly hypertension (92%). Obesity was noted in 65%, while 95% of females and 83% of males had a WC that conferred substantial cardio-metabolic risk. Receipt of advice on any of diet, exercise or weight control from a health professional in the preceding 12 months was reported by 79%, with 67% reporting receipt of advice on all three. Under 2% of patient records met the SEMDSA standard for processes of care for HbA1c, weight, WC and BMI monitoring, while 93% achieved the standard for BP monitoring. Exclusive oral treatment was prescribed in 62%, and the majority of these were on combined metformin and sulphonylurea; 5% were on insulin monotherapy. Optimal glycaemic control (HbA1c < 7%) was noted in only 25% of the sample. On multivariate analyses, the presence of CCF conferred higher odds of controlled glycaemia (OR = 3.17, P = 0.035). Compared with insulin monotherapy, treatment with either combined metformin and insulin (OR = 0.216, P = 0.02), or with the combination of all 3 drug classes ( metformin, sulphonylurea and insulin) (OR = 0.185, P = 0.027), conferred lower odds of glycaemic control. Conclusions This study highlights substantial shortcomings in the compliance with key processes of care and the achievement of optimal glycaemic control for type 2 diabetes mellitus in the current research setting. An inverse association was noted between glycaemic control and the use of combined oral and insulin drug therapy. Measured processes of care and reported receipt of lifestyle advice showed no association with glycaemic control. CCF co-morbidity conferred improved odds of controlled glycaemia.

Background: Type 2 diabetes mellitus (T2DM) is defined by an increase in serum glucose, however, this leads to the belief that only the serum glucose levels need be monitored and treated. Hence many other risk factors such as obesity, lipids and blood pressure which increase the risk of coronary heart disease, myocardial infarction, stroke and peripheral vascular disease are neglected. Consequently, T2DM patients that are at greater risk of developing cardiovascular disease (CVD), are often not receiving optimal comprehensive care. Aims: To identify the treatment gaps of cardiovascular risk factors in patients with T2DM using both national and international current treatment guidelines. Methods: Using a public sector database, data was obtained on the treatment of 666 T2DM patients. Records of patients were selected on the basis of established T2DM diagnoses, receiving oral hypoglycaemic and/or insulin therapy. The following patient data was recorded: demographics (age, gender, ethnicity), systolic blood pressure (SBP), diastolic blood pressure (DBP), glycated haemoglobin (HbA1c), total cholesterol (TC), triglycerides (TG), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C) , family history, cardiovascular history and all chronic medications. The following parameters were applied to the cohort: SBP <130 mmHg, DBP <80 mmHg. In the event of proteinuria: SBP ≤120 mmHg, DBP ≤70 mmHg. HbA1c <7.0%, TC <4.5 mmol/L, LDL-C <2.5 mmol/L, HDL-C >1.0 mmol/L (males), HDL-C >1.2 mmol/L (females) and TG <1.7 mmol/L. In patients with established CVD, LDL-C target: ≤1.8 mmol/L. Results: The study cohort consisted of 666 T2DM-patients. 55% females. Mean age was 63 years (SD: 11.8), mean HbA1c was 8.7% (SD: 2.4). The mean SBP and DBP readings for the cohort were 133.66 (SD: 19.9) and 78.07 mmHg (SD: 11.6), respectively. Mean LDL-cholesterol was 2.6 mmol/L (SD: 0.9). 26.2% reached HbA1c of ≤7%, 45.8% reached ≤130/80 mm Hg blood pressure targets, 53.8% reached LDL-C of ≤2.5mmol/L and all 3 were reached by 7.5% of the cohort. TC ≤4.5 mmol/L was reached by 53.8%, 60.2% reached TG ≤1.7mmol/L, 58.6% males and 52.8% females reached HDL-C targets of ≥1.0 mmol/L and ≥1.2 mmol/L, respectively. There were 17.9% of patients with CVD reaching targets of LDL-C ≤1.8 mmol/L whilst 16.4% of patients with nephropathy reaching targets of ≤120/70 mm Hg. Almost half (48.2%) were not receiving lipid-lowering therapy, yet would be deemed eligible for therapy. Blood pressure targets may have been better reached with appropriate dosage reductions in addition to the introduction of further antihypertensive combination therapy. CVD was present in 15.5%. Conclusions: T2DM patients are at high-risk for CVD. Many trials have demonstrated the benefits of targeting CVD risk factors (HbA1c, blood pressure, serum lipids) in T2DM. Less than 10% of CVD risk factor targets were reached by the study cohort despite treatment guideline recommendations. The data from the study suggests poor control of modifiable cardiovascular risk factors and significant under treatment of T2DM in clinical practice. Whether improvement lies in the form of therapeutic titration adjustment or an increase in patient education, there needs to be a more aggressive multi-factorial therapeutic approach to treating this high risk group of patients in order to reduce overall morbidity, mortality and improve patient outcomes.

Thesis (Ph. D.)--Rutgers University, 2009. / "Graduate Program in Nursing." Includes bibliographical references (p. 81-87).

Thesis (M.S.)--Ball State University, 2009. / Title from PDF t.p. (viewed on Nov. 30, 2009). Includes bibliographical references (p. [59]-63).

The increasing prevalence causes great burden to global health. Although there is not yet an agreement on the effect of SMBG for non-insulin-treating type 2 DM patients in comprehensive management, some guidelines recommended all diabetes patients should conduct SMBG. This literature review of 5 meta-analyses and 13 randomized controlled clinical trials assessed the effectiveness of SMBG in glucose control (HbA1c), detection of hypoglycemia, non-glycemic outcomes and potential influence factors(duration of diabetes, baseline HaB1c level, SMBG frequency, SMBG duration, co-interventions) of SMBG efficacy on type 2 diabetes patients not using insulin. The method of this literature review is through a comprehensive electronic literature search of Ovid MEDLINE, EMBASE, the Cochrane Library and China Journals Full-text Database. Both English and Chinese language literatures were reviewed. All meta-analysis and randomized controlled trials of type 2 diabetes non-insulin-using patients taking SMBG to improve the glycemic control and other outcomes were included. In these studies, absolute HbA1c reduction, recognized episodes of hypoglycemia, wellbeing, QALY, DALY, complication morbidity, mortality were used as outcome measures if available. A score list based on the PRISMA Statement was used to evaluate the quality of meta-analyses. 5 meta-analysis all reported a statistical significant but clinical modest-moderate difference in HbA1c reduction between SMBG and non-SMBG group, a new published randomized controlled trial with small cohort enrolled in none of the meta- analyses did not support this conclusion. Evidence showed frequency of SMBG did not influence the efficacy of SMBG, co-interventions as education/consultation, regimen change played a positive roll on SMBG efficacy. Whether baseline HbA1c, duration of diabetes or SMBG itself have an effect on SMBG efficacy was still unknown. There is inadequate evidence of SMBG efficacy of detection of hypoglycemia of patient-oriented outcomes. No eligible Chinese article was defined to enroll in this review. This review did not support to suggest all type 2 diabetes patients not using insulin to conduct SMBG at the frequency the guidelines recommended. Carefully designed and longer-term trials are needed to obtain evidence that is more robust. Further investigation would provide more evidence of the characteristics of potential influence factors, which may help to define the specific population or optimal mode that guarantee the greatest efficacy of SMBG. / published_or_final_version / Public Health / Master / Master of Public Health

Objective：Low vitamin D has been implicated in the development of type 2 diabetes. However, whether vitamin D continues to have a clinically significant effect in existing diabetes is unclear. The objective of this study was to examine the association of serum vitamin D with glycemic control in established type 2 diabetes. Methods: This was a retrospective analysis of medical records. Characteristics of 487 patients with type 2 diabetes were stratified by vitamin D status and serum glycosylated hemoglobin (HbA1c). Vitamin D deficiency among the subjects was studied. The relationship between vitamin D and glycemic control was explored by multiple linear regression, multivariate analysis of variance (MANOVA) and chi-square test. Patients were stratified into overweight and non-overweight group based on body mass index (BMI), and the association of serum vitamin D concentration with glycemic control was evaluated in each group. Insulin resistance and C-peptide as mediators between vitamin D and HbA1c was tested. The impact of vitamin D on cholesterol metabolism was also assessed. Results: (1) Vitamin D deficiency was highly prevalent, accounting for 88.3% of the study sample. (2) Serum vitamin D levels were significantly inversely associated with serum HbA1c. This correlation was stronger in overweight group than in non-overweight group. There was no significant relationship between serum vitamin D levels and fasting plasma glucose (FPG). HbA1c was significantly lower in vitamin D insufficiency group than in vitamin D severe deficiency group. (3) Insulin resistance partially mediated the association between vitamin D and HbA1c. (4) No significant association of Vitamin D with low density lipoprotein (LDL) or high density lipoprotein (HDL) was found in this study. Conclusions: There was an inverse association between serum vitamin D levels and HbA1c. The inverse correlation of serum vitamin D level and HbA1c was stronger in overweight group than in non-overweight group, which indicates patients with obesity might benefit more from vitamin D supplementation. / published_or_final_version / Public Health / Master / Master of Public Health