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Type 2 diabetes (T2DM) has an estimated incidence of nearly 11 million US adults aged 65 years and older. Evidence suggests that the quality of the marital relationship is an important factor for diabetes related health outcomes affecting self-management and adherence (Kiecolt-Glaser & Newton, 2001). However, an individual in need may compensate for primary support that is unavailable or not optimal by looking for other sources of support, which may be important for health outcomes (Rini, et al., 2008). The present study examined compensation for poor spousal support through other social relationships. A total of 12,640 participants reported they had diabetes and were married (Male = 6,317 and Female = 6,323), and of this group 1,084 men and 583 women had died over the course of the study period. Women reported lower spousal support, but significantly more aggregated social support across relationships than men. Few persons reported low spousal support and low support compensation, rendering the cell sizes highly unequal and the associated data uninterpretable. Ancillary analyses were conducted with the idea that some variance in total compensation support may moderate mortality risk finding that higher aggregated social support across non-spousal relationships was associated with lower risk of death accounting for ~3% of the variance in the final model. The current findings demonstrate how an individual can compensate for a poor primary support relationship through a broader support network. These findings should guide future research to focus on how individuals build, maintain, and seek support from social relationships.

Thesis (Ph.D.)--University of Alberta, 2009. / A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Nutrition and Metabolism, Agricultural, Food and Nutritional Science. Title from pdf file main screen (viewed on September 25, 2009). Includes bibliographical references.

Background: Diabetes is an increasing problem in Hong Kong. Physical activity is an integral part of diabetes care but received surprisingly few attention locally. This study is the first study with focus on physical activity in Type 2 diabetes in Hong Kong. / Conclusion: There is a need to implement physical activity programs for the diabetes patients in Hong Kong. Stage-matched intervention for increasing physical activity level should be introduced into the current diabetes management routine. / Methods: For this cross-sectional study, 576 patients were recruited from two specialized diabetes clinics in Hong Kong for telephone interview. The interview included measures of physical activity (by IPAQ), mental distress (by DASS21), diabetes self-care (by SDSCA), self-care self-efficacy (by DES), exercise efficacy, attitude and subjective norm towards exercise, time-spent on exercise, instrumental social support, and various indicators of diabetes control (HbA1c, blood pressure, LDL-cholesterol). Regression models were fitted to identify determinants of physical activity, mental distress, and diabetes self-care. Structural equation modeling was used to model the inter-relationships between the variables. / Results: About half of the patients did not meet international guidelines of physical activity for diabetes patients. Exercise efficacy and attitudes towards exercise are the two dominant factors that predict physical activity level and exhibit significant difference between key stages of change. Level of mental distress was very low and did not correlate with physical activity or diabetes self-care. / Mui, Wai Ho. / Adviser: Joseph T.F. Lau. / Source: Dissertation Abstracts International, Volume: 73-02, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 167-191). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

In Africa, use of medicinal plants for the treatment of diabetes is very common. However, efficacy on co-administering of medicinal plants with therapeutic drugs hasn't been fully determined, especially for African medicinal plants. The current study focused on assessing the in vitro modulation effects of three popular African medicinal plants, namely: Aloe ferox, Sutherlandia frutescens and Prunus africana (including five commercial preparations containing these medicinal plants) on two of the most important anti-diabetic drug metabolising enzymes, Cytochrome P450 (CYP450) 2C9 and CYP3A4 and a key drug efflux transporter, P-glycoprotein (P-gp). Vivid® microsome-based screening kits were used to assess inhibitory potency of plants preparations on CYP2C9 and CYP3A4 enzymes activities. The study showed that P. africana was a more potent inhibitor of CYP2C9 and CYP3A4 activity than the corresponding positive controls Ginkgo biloba and St. John's wort, which are known to cause clinically significant drug-herb interactions. S. frutescens leaf extract demonstrated potent to moderate inhibition on both the tested CYP activities, while its commercial products (Promune® and Probetix®) possessed moderate to mild inhibitory effects on the activities of both CYPs. Potent inhibitory effect on CYP2C9 and CYP3A4 was seen with Aloe Ferox®. Prosit® and Aloes powder® showed potent to moderate inhibition on CYP2C9 activity and moderate to mild inhibition on CYP3A4 activity. In addition to CYP450 activity, the present study also investigated the effects of the selected medicinal plant products on the activity of the main drug efflux protein, P-gp. A screening assay was specifically developed to assess the potential for herbal remedies to interact with P-gp mediated drug absorption. The assay is based on the principle of the reversal of drug resistance in modified Caco-2 cells specifically altered to express high iv efflux protein activity. These cells display a multidrug resistance phenotype and the addition of a plant extract containing a P-gp inhibitor or substrate will inhibit or compete with any cytotoxic drug and consequently reverse the drug resistance. The suitability of the assay was confirmed using a known P-gp inhibitor. The study observed that the anti-proliferation effect of vinblastine was significantly enhanced in vinblastine-resistant Caco-2 cells, which have high P-gp expression, when they were exposed to the selected African herbal preparations. This observation indicates that the studied plant preparations may alter P-gp functionality and therefore lead to interference with the absorption of co-administered drugs. The outcomes of this study provide useful information on whether there are any potential drug-herb interactions between the commonly used African medicinal plants and oral anti-diabetic drugs, at the level of CYP and P-gp drug metabolism and could contribute to better therapeutic management of Type II diabetics. However these predicted interactions will need to be verified in a clinical setting.

Mini-dissertation was submitted in partial compliance with the requirements for the Master’s Degree in Technology: Homoeopathy, Durban University of Technology, 2012. / It was reported by the International Diabetes Federation (IDF) Diabetes Atlas, in 2003, that a prevalence figure of 3.4% exists for the 24 million South Africans between the ages of 20 and 79, with an expected increase to 3.9% by 2025. Considering that patients with diabetes are at increased risk of cardiovascular disease, blindness, amputation and renal failure it is therefore not surprising that the costs associated with diabetes are estimated to increase worldwide. It is clear that according to the current trends in dietary and exercise practices, South Africa will be affected by the rise in obesity and subsequent diabetes mellitus. It is critical that a concerted effort involving all parties concerned be made to combat this rapidly increasing problem (Rheeder, 2006:20). AIM The purpose of this double-blind, randomized clinical trial was to compare the effectiveness of Momordica charantia homoeopathic mother tincture as compared to Momordica charantia 6CH, in the treatment of type 2 diabetes mellitus in patients on Metformin. METHODOLOGY Thirty patients were recruited and were selected for the study on the basis of inclusion and exclusion criteria. These participants were then randomly and equally divided into two groups. Each participant attended a total of four consultations with the researcher, over a two month period, at the Durban University of Technology (DUT) Homoeopathic Day Clinic. At the commencement of the first consultation, each participant received the subject information letter (Appendix A) for perusal and the informed consent form (Appendix B) to sign. Following this, the researcher took a full, detailed iv case history (Appendix F) and performed a physical examination (Appendix G) of each patient. Participants were required to have a Glycosylated haemoglobin (HbA1C) test performed following the first and fourth consultations. Participants were also required to complete daily Log Sheets (comprising self administered fasting blood glucose readings using issued Bayer Ascensia Elite Glucometers) for the entire duration of the study (8 weeks). SPSS version 18 was used to analyse the data. A p value < 0.05 was considered as statistically significant. The time effect was assessed for intra-group comparison whereas the time x group treatment effect was assessed for inter-group comparison. Means were calculated for both fasting blood glucose and glycosylated haemoglobin for the two respective groups and tabulated in order to describe the data obtained (Descriptive statistics). RESULTS Both groups reflected a statistically non significant decrease in fasting blood glucose levels with no significant differences between the two groups when comparing reduction in fasting blood glucose levels. Group 1 (Momordica charantia homoeopathic mother tincture) reflected a non significant increase in glycosylated haemoglobin (HbA1C) levels while Group 2 (Momordica charantia 6CH) reflected a statistically significant increase over time in HbA1C levels. There were no significant differences between the two groups when comparing reduction in HbA1C levels. / M

This research explicated the use of exploratory data analysis in describing type II diabetes mellitus among the Navajo Indians. A sample of 98 diagnosed diabetics was obtained from a retrospective chart review and had a 1.3:1 female to male ratio, a median age of 58.6 years, and a mean duration for diabetes of 7.66 years. Other characteristics included a median age at diagnosis of 50 years, a median weight prior to diagnosis (expressed in percent desired weight) of 140%, and a median blood glucose value at time of diagnosis of 241 mg/dl. The distribution patterns for age, weight, and blood glucose revealed several asymmetry problems which had implications for the appropriateness of using parametric statistics in numerical summarizations. Bivariate analyses revealed a negative association between age at diagnosis and percent desired weight prior to diagnosis. This finding identifies the risk that obesity brings to the young and that aging brings to the non-obese, Navajo Indian.

CONTEXTO: as mulheres na pós-menopausa com diabetes mellitus não insulino-dependente (DMNID) constituem um grupo com maior risco de doença cardiovascular, visto serem muitas delas obesas, hipertensas e hiperlipidêmicas. A tibolona pode se constituir opção viável para a terapêutica de reposição hormonal nessas pacientes, no entanto são necessários estudos que avaliem as implicações clínicas, modificações metabólicas e resultados terapêuticos da tibolona nesse grupo de pacientes. OBJETIVO: determinar o perfil de segurança clínico-laboratorial da terapia com tibolona em pacientes na pós-menopausa portadoras de DMNID. TIPO DE ESTUDO: prospectivo, longitudinal, aberto e não controlado. LOCAL: Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. PARTICIPANTES: 24 pacientes na pós-menopausa portadoras de DMNID, tratadas com 2,5 mg/dia de tibolona, pelo período de 6 meses. VARIÁVEIS: avaliação clínica, medidas antropométricas (IMC, RCQ e % Gordura), dosagens hormonais (FSH, LH, T4 livre, TSH), bioquímica sangüínea (uréia, creatinina, bilirrubinas, TGO, TGP, glicose e hemoglobina glicosilada) e ultra-sonografia transvaginal (espessura endometrial e volume uterino). ANÁLISE ESTATÍSTICA: teste não-paramétrico de Kolmogorov-Smirnov, análise de variância para medidas repetidas e teste “t" pareado para dois períodos, sendo adotado nível de significância de 5%. RESULTADOS: após 6 meses, todas as pacientes permaneceram em uso da medicação. Como efeitos colaterais, 8,3% apresentaram cefaléia, 8,3% mastalgia e 16,6% sangramento genital. Houve melhora na % de gordura corporal (43,15 ? 6,39 vs 41,76 ? 5,20; p=0,01) e na pressão arterial diastólica (87,29 ? 7,36 vs 78,33 ? 11,67; p=0,0005). Não houve variações significativas na pressão arterial sistólica, freqüência cardíaca, IMC e RCQ, bem como nos parâmetros bioquímicos. Houve diminuição dos sintomas climatéricos (22,17 ? 7,15 vs 3,08 ? 3,33; p=0,0001). A avaliação ultra-sonográfica não revelou variações do volume uterino e espessura endometrial. CONCLUSÃO: a utilização de tibolona durante um período de 6 meses, mostrou bom perfil de segurança clínico-laboratorial em pacientes na pós-menopausa portadoras de DMNID. / CONTEXT: Postmenopausal women with non-insulin-dependent diabetes mellitus (NIDDM) represent a high risk group since many of them are obese, hypertensive and hyperlipidemic, with a higher risk for cardiovascular disease. Tibolone may represent a viable option for the hormonal replacement therapy of these patients. There is the need for studies assessing the clinical implications, metabolic modifications and therapeutic results of tibolone in this group of patients. OBJECTIVE: To determine the clinical-laboratory safety profile of tibolone treatment in postmenopausal women with NIDDM over a period of 180 days. TYPE OF STUDY: Prospective, longitudinal, open and uncontrolled. PLACE: University Hospital, Faculty of Medicine of Ribeirão Preto. PARTICIPANTS: 24 postmenopausal women with NIDDM treated with 2.5 mg/day tibolone. VARIABLES: Clinical evaluation, anthropometric measurements (BMI, WHR and % body fat), blood determinations (FSH, LH, free T4, TSH, urea, creatinine, bilirubins, GOT and GPT, glucose, and glycosylated hemoglobin), and transvaginal ultrasonography (endometrial thickness and uterine volume). STATISTICAL ANALYSIS: Non-parametric Kolmogorov-Smirnov test, repeated measures analysis of variance and paired t-test for two periods, with the level of significance set at 5 %. RESULTS: After 6 months, all patients continued to use the medication. Side effects were headache in 8.3% of patients, mastalgia in 8.3%, and genital bleeding in 16.6%. There was an improvement in % body fat (43.15 ? 6.39 vs 41.76 ? 5.20; p=0.01) and diastolic arterial pressure (87.29 ? 7.36 vs 78.33 ? 11.67; p=0.0005). There were no significant variations in systolic arterial pressure, heart rate, BMI or WHR in the biochemical parameters. There was a reduction in the climacteric symptoms (22.17 ? 7.15 vs 3.08 ? 3.33; p=0.0001) and ultrasonography showed no changes in uterine volume or endometrial thickness. CONCLUSION: Treatment with tibolone for 180 days showed a good clinical-laboratory safety profile in postmenopausal women with NIDDM.