Bakgrund: Personer som drabbas av diabetes utgör ett stort hälsoproblem världen över och förekomsten ökar. En stor del av anledningen till den globala diabetesepidemin är förändrade livsstilsfaktorer, framför allt avseende människors kost och motionsvanor som leder till övervikt. En tidig upptäckt av personer som är i riskzon och även att påbörja livsstilsbehandling kan både fördröja och förebygga att personer utvecklar diabetes typ 2 samt kardiovaskulär sjukdom. Vinsten är både att minska mänskligt lidande och ekonomiska besparingar.Syfte: Syfte med litteraturöversikten var att belysa patienter och personals erfarenheter av hindrande och främjande faktorer avseende livsstilsförändringar hos patienter med prediabetes i primärvården.Metod: Studien genomfördes som en litteraturöversikt genom en systematisk, metodisk och kritisk granskning av 16 vetenskapliga artiklar. Databaserna PubMed och Cinahl har använts för datainsamling. Artiklarna analyserades i en trestegsmetod.Resultat: Utifrån analysen av resultaten i de granskade artiklarna framkom fyra huvudteman: Erfarenheter och upplevelser av att få en prediabetesdiagnos med undertema Information, Livsstilsförändringar med underteman motivation, ekonomi och fysisk aktivitet, Socialt stöd med undertema matkultur och Vårdpersonalens roll med undertema olika hanteringar och stöd som påverkade patienternas hindrande och främjande faktorer till livsstilsförändringar. Främjande faktorer för att göra livsstilsförändringar var att få information om diagnosen och om vilka livsstilsförändringar som behövs utföras för att undvika att utveckla diabetes typ 2 samt stöd både från närstående och vårdpersonalen. Hindrande faktorer för att göra livsstilsförändringar var brist på att ta diagnosen på allvar, oförmåga att ha ekonomi för hälsosam kost, möjlighet till fysisk aktivitet, kulturella matpreferenser samt brist på stöd från både närstående och vårdpersonal.Slutsats: Genom att hälso- och sjukvårdspersonal blir medvetna om vilka hinder och främjande faktorer som finns kan detta ligga till grund för hur man bemöter och upprättar en relation i enlighet med Travelbees omvårdnadsteori till en patient med prediabetes i primärvård. Förhoppningsvis kan studien användas som en kunskapskälla för hälso- och sjukvårdspersonal vid önskvärda livsstilsförändringar. Nyckelord: Prediabetes, motivation, livsstilsförändringar, distriktssköterska, primärvård / Background: People suffering from diabetes constitute a major health problem worldwide and the incidence is increasing. A large part of the reason for the global diabetes epidemic is changed lifestyle factors, above all regarding people's diet and exercise habits that lead to obesity. An early detection of people who are at risk and also starting lifestyle treatment can both delay and prevent people from developing type 2 diabetes and cardiovascular disease.The benefit is both a reduction in human suffering and financial savings.Purpose: The purpose of the literature study was to shed light on patients' and staff's experiences of hindering and promoting factors regarding lifestyle changes in patients with prediabetes in primary care.Method: The study was conducted as a literature review through a systematic, methodical and critical review of 16 scientific articles. The databases PubMed and Cinahl have been used for data collection. The articles were analyzed in a three-step method.Results: Based on the analysis of the results in the reviewed articles, four main themes emerged: Experiences and experiences of receiving a prediabetes diagnosis with the subtheme Information, Lifestyle changes with the sub-theme motivation, finances and physical activity, social support with the sub-theme food culture and the role of the healthcare staff with the sub-theme different handling and support which affected the patients' hindering and promoting factors to lifestyle changes.Conclusion: Promoting factors for making lifestyle changes were getting information about the diagnosis and about which lifestyle changes need to be made to avoid developing diabetes type 2, as well as support both from relatives and the healthcare staff. Obstructing factors for making lifestyle changes were lack of taking the diagnosis seriously, inability to have finances for a healthy diet, opportunity for physical activity, cultural food preferences and lack of support from both relatives and healthcare professionals. By making healthcare professionals aware of the barriers and promoting factors that exist, this can form the basis of how to treat and establish a relationship in accordance with Travelbee's nursing theory with a patient with prediabetes in primary care. Hopefully, the study can be used as a source of knowledge for healthcare professionals in the case of desirable lifestyle changes.Key words: Prediabetes, motivation, lifestyle changes, district nurse, primary care.

Bakgrund: Prediabetes är en fas före typ-2 diabetes associerad med en avvikande glukoshomeostas. Livsstilsförändringar som viktminskning, kostförändring och regelbunden fysisk aktivitet minskar den relativa risken att utveckla typ-2 diabetes. Att förstå barriärer och facilitatorer för fysisk aktivitet underlättar ett salutogent förhållningssätt till en persons livsstil, psykiska välmående samt fysiska hälsa. Syfte: Syftet var att förstå och identifiera barriärer och facilitatorer för fysisk aktivitet bland personer med prediabetes och se vilka interventioner som studerats. Metod: Litteraturöversikt baserad på Polit och Beck’s modell (2021) med 15st vetenskapliga artiklar av kvantitativ, kvalitativ och blandad design som inkluderades efter sökning i databaserna PubMed och Cinahl. Resultat: Facilitatorer för ökad fysisk aktivitet finns hos de som upplevde en förbättring av sin hälsa, hade flera sociala kontakter som gav uppmaning och uppmuntran och hade bättre socioekonomiska förutsättningar. De barriärer som identifierats var hos de som rapporterade ohälsa, ej ville prioritera fysisk aktivitet eller hade sämre socioekonomiska förutsättningar, väder, brist på träningslokaler eller friluftsområden och demografiska faktorer (ålder, kön, ). De interventioner som identifieras syftade till att stärka egenförmåga, utvärdera tekniska hjälpmedel och riskmedvetenhet. Slutsats: Eftersom facilitatorer och barriärer för fysisk aktivitet varierar mellan individer med prediabetes bör god kommunikation och en bra relation med patienter vara av stor betydelse. Distriktssköterskor och annan hälso- och sjukvårdspersonal bör utforska patientens individuella uppfattningar om prediabetes och därmed riskmedvetenhet när de utformar insatser eller interventionsstrategier för att stärka egenförmåga, motarbeta barriärer och hjälpa till att utveckla och upprätthålla fysiska aktiviteter. / Background: Prediabetes is a phase before type 2 diabetes associated with an abnormal glucose homeostasis. Lifestyle changes such as weight loss, dietary changes and regular physical activity reduce the relative risk of developing type 2 diabetes. Understanding barriers and facilitators to physical activity facilitates a salutogenic approach to a person's lifestyle, psychological well-being and physical health. Purpose: The aim was to understand and identify barriers and facilitators to physical activity among people with prediabetes and see which interventions have been studied. Method: Literature review based on Polit and Beck's model (2021) with 15 scientific articles of quantitative, qualitative and mixed methods that were included after searching the databases PubMed and Cinahl. Results: Facilitators for increased physical activity are found in those who experienced an improvement in their health, had several social contacts that provided encouragement and encouragement and had better socio-economic conditions. The barriers identified were those who reported illness, did not want to prioritize physical activity or had poorer socio-economic conditions, weather, lack of training facilities or outdoor areas and demographic factors (age, gender, BMI). The interventions identified were aimed at strengthening self-efficacy, evaluating technical aids and risk awareness. Conclusion: Since facilitators and barriers to physical activity vary between individuals, good communication and relationship with patients is of great importance. District nurses or other health care professionals should look for individual perceptions of prediabetes and risk awareness when designing interventions to strengthen self-efficacy, counteract barriers and help develop and maintain physical activities.

An estimated 86 million Americans in the United States age 20 and older are classified as prediabetic. Prediabetes is defined as an individual having a higher blood sugar than normal increasing the risk for developing type 2 diabetes (T2DM). T2DM is among the top ten leading causes of death in the United States and costs an estimated 245 billion dollars annually. Interventions need to take place among patients with prediabetes in order to prevent the T2DM epidemic from compounding. This study examined the effects of a six-week low carbohydrate diet on A1C values, weight and BMI, and cardiovascular markers among patients with prediabetes. A retrospective chart review examined 1,169 patients with prediabetes that met inclusion criteria from July 2013 to April 2016. Patients had completed a six-week low carbohydrate diet program with weekly clinic visits with a nurse practitioner and followed the prescribed low carbohydrate diet. A significant difference in means was found when comparing pre A1C values (M= 5.93, SD= 0.20) and post A1C values (M= 5.57, SD= 0.25); (t (1142) = 49.3, p = 0.00), pre intervention weight (M= 227.0, SD= 52.0) and post intervention weight (M = 209.5, SD = 48.0); (t (1168) = 79.3, p = 0.00), and pre BMI (M = 36.8, SD = 7.0) and post BMI (M = 34.0, SD = 6.6); (t (1168) = 77.8, p = 0.00). Additionally, statistical significance was found for cardiovascular markers including systolic and diastolic blood pressures, total cholesterol, LDL, HDL and triglycerides. These findings suggest that a low carbohydrate diet is effective at improving metabolic risk factors for prediabetes and preventing the progression to T2DM. Low carbohydrate diets should be further examined for long term effectiveness and could be recommended to patients with prediabetes in order to reverse the epidemic of T2DM.

Dementia is a serious public health concern in the United States, with a prevalence of 5.2 million. There is currently no effective way to prevent or cure dementia, and the precise etiology is unknown, but it appears there are multiple risk factors. Prediabetes (PD) has been identified as a risk factor although the scientific evidence is conflicting. This study is important to those at high risk for dementia and to healthcare professionals who lack substantiated dementia prevention strategies. The purpose of this case control study was to determine whether PD is associated with dementia in adults aged 65-95 years and whether the association varies according to demographic (age, gender, race, and socioeconomic status [SES]) and health (atherosclerosis, body weight, cerebrovascular disease, dyslipidemia, hypertension, and stroke) risk factors. The ecosocial theory was selected to bridge the study findings to life-course exposures and risk factors. Cases (n = 574) and controls (n = 2,157) were sampled from a large ambulatory care dataset, and multivariable logistic regression was used to test the research hypotheses. No unadjusted association between PD and dementia was found (OR 1.08, 95% CI = .854, 1.241, p = .604). The regression analysis revealed no association between PD and dementia; however, atherosclerosis, hypertension, low body weight, and low/average SES were found to be significantly and independently associated with dementia. A stratified analysis revealed that race and SES did not alter the effect of PD on dementia. The implications for positive social change include the potential reduction of incident dementia through initiatives targeted toward demographic and health risk factors including atherosclerosis, hypertension, low body weight, and low/average SES.

Background: Prediabetes (PD) defined as having glucose values above normal but not high enough to be diagnosed as diabetes, is known to be a risk factor for type 2 diabetes and associated complications. Early prevention efforts can reverse the condition or delay the development of type 2 diabetes. This study examines the sociodemographic risk factors for PD in women. Methods: Using secondary data from National Health and Nutrition Examination Survey NHANES 2005-2006, chi-square analysis was done to find the prevalence of the disease among different categories of women with respect to age, ethnicity, and socioeconomic status. Univariate and multivariate analyses were performed to determine the associations of the sociodemographic factors with PD among women. A p-value of <0>.05 and 95% confidence intervals were used to determine statistical significance throughout all the analyses performed. Results: In total, 3,461 cases were included in the study analysis. Cases with indications of PD were found in 716 (20.7%) of the sample. Increased age was consistently associated with PD in women [χ=392.3(3), p<.001]. Prevalence of PD peaked for those aged 60 and above. Results of multivariate analysis suggested that being non-Hispanic Blacks was associated with increased likelihood of PD. Education was found to be significantly associated with PD but an inverse relationship could not be established. Conclusions: As an increase in age was found to be associated with PD in women, early screening and education regarding lifestyle changes can help reverse the condition. Minority groups should be an important focus for PD prevention efforts.

OBJECTIVE: T2D is a metabolic disease that is a significant health problem throughout many populations. Increased incidence of T2D across the age spectrum makes preventive measures for this disease a top healthcare priority. Physiological changes such as expression of pro-inflammatory T cell cytokines, insulin resistance, and pancreatic beta cell dysfunction play major roles in the onset of T2D. Current treatments include lifestyle changes with oral medications and/or synthetic insulin therapy. While treatments aim to normalize blood glucose and increase insulin sensitivity in patients diagnosed with T2D, efforts are growing to find preventative therapies for prediabetes, a condition where blood glucose levels are higher than normal but are under the threshold determined for a diabetes diagnosis. Metformin, a well-known first-line recommendation for treating T2D, in conjunction with lifestyle modification may be a viable preventative measure to delay the onset of T2D. Previous study results have created momentum to generate data promoting metformin use as an off-label preventative drug for T2D. To identify a therapeutic intervention that may help to shift T cell cytokine profiles from being pro-inflammatory and diabetogenic to anti-inflammatory, we investigated the effects of metformin on immune cell function in prediabetic patients. It is known that one effect of metformin is activating AMPK, which secondarily decreases inflammation. We therefore hypothesized metformin affects immune cell function by modulating genes in the AMPK pathway. METHODS: We recruited 49 subjects using EPIC database to screen patients with appointments at the Nutrition and Weight Management Center at Boston Medical Center. Forty-nine pre-metformin and 13 post- metformin blood samples were collected from subjects at baseline and after three months of taking metformin, respectively. Ficoll was utilized to separate and extract PBMCs. I activated PBMCs with LPS or CpG for 24 hours, and anti-CD3/CD28 for 24 or 40 hours. Then I isolated and reverse transcribed RNA, producing cDNA. We ran a human AMPK signaling qRT-PCR array on the 40-hour anti-CD3/CD28 activated PBMCs from 4 randomly chosen subjects and analyzed data to investigate candidate targets in the AMPK pathway possibly modulated by metformin. I designed primers for six chosen targets and ran qRT-PCR comparing the pre- and post-metformin dataset of 13 subjects, using the generated human gene-specific primers to see if these genes were affected across the dataset. RESULTS: Total sample population was n=13. The majority of subjects were African American females. The study participants were considered prediabetic when A1C measured between 5.7-6.4%. Median A1C and BMI averaged at 5.8% and 38.6 kg/m2  2.48 (mean  SEM), respectively. There was an expected decrease in BMI as metformin is associated with weight loss. To understand how metformin may affect genes in the AMPK pathway, qRT-PCR array analysis of the 40-hour anti-CD3/CD28 activated PBMCs in a subset of 4 subjects was used to create a volcano plot. The plot demonstrated that out of the possible gene candidates, SLC2A4, LIPE, INSR, CRY1, GAPDH, and STK11 had the greatest log2 fold change and –log (p-value). Further analysis on the 4 subjects compared delta Ct values and relative gene expression showing CRY1, a circadian function gene, had a significant decrease in expression (p=0.03, n=4, paired t-test). Primers were designed for the six candidate genes and used to run qRT-PCR on the entire dataset of 13 subjects. There was a significant decrease in expression of STK11 in 24-hour non-stimulated PBMCs (p=0.008, n=12, paired t-test) and CRY1 in 24-hour anti-CD3/CD28 activated PBMCs (p=0.04, n=12, paired t-test). There was a significant increase in expression of SLC2A4 in 24-hour CpG activated PBMCs (p=0.02, n=12, paired t-test). Furthermore, GLUT4 was detected in CpG activated immune cells and gene expression was increased in cells from subjects post-metformin treatment. CONCLUSIONS: Further investigation is required to examine how metformin decreases the expression of CRY1 and how this decrease associates with pro-inflammatory cytokine expression. STK11 expression was decreased in non-stimulated cells but did not show any trend in the activated conditions. Additional research is warranted to see if these results can be repeated, and if so, more work will be needed to define the link between CRY1/STK11 and metformin-driven AMPK activation in immune cells. Protein expression analysis will be required to support our gene expression data. Overall, these findings initiate our understanding of how AMPK activation and changes in cellular metabolism activate pathways leading to cytokine secretion by immune cells. Further study of the downstream effects of metformin and how it may change inflammatory cytokine profiles will strengthen the evidence identifying metformin as a viable preventative therapy for prediabetic patients.

Introduction: Prediabetes is major risk factor for the development of Type 2 Diabetes Mellitus (T2DM). One-third of the population in the United States has prediabetes, but 90% remain undiagnosed because healthcare providers are not performing screenings, making this a public health challenge. The purpose of this process improvement project was to implement prediabetes screening, prediabetes identification, and a referral process to a nutritionist to prevent or delay the onset of T2DM in patients in two Federally Qualified Health Centers. Methods: This was a quality improvement project conducted over a six-week period after receiving exemption from the University’s Internal Review Board. The Knowledge to Action framework was used to guide implementation of screening, prediabetes identification, management, and referral process. The outcomes were to measure the number and percent of screenings performed after provider education on prediabetes screening, those at risk for prediabetes, and the evidence-based interventions providers chose for management. The prediabetes risk assessment tool (PRAT) was the “Are you at risk for Type 2 Diabetes?” It was administered in both English and Spanish to adults who were not pregnant and had no previous diagnosis of Type 1 Diabetes Mellitus or T2DM. The preferred interventions included referral to a nutritionist, encourage 5%-7% total body weight loss, and/or 150 minutes of exercise per week. The PRAT and interventions data were coded, extracted into SPSS Version 25, and analyzed. Descriptive statistics were used to report patient characteristics, quantity of screenings performed, evidence-based recommendations offered, and patient risk factors for prediabetes. Results: In both clinics, 41% (n=269) of patients screened were found to be at risk for prediabetes. The most self-reported risk factor for prediabetes was family history of T2DM. Healthcare providers mostly provided education on weight loss and exercise, and recommended/referred less than 20% (n=49) of patients for nutritional education. The screening rates in the clinics were 52% (n=92) at site A and 72% (n=177) in site B, falling below the goal of 100%. Conclusions: There remains a gap in provider knowledge and use of evidence-based recommendations to decrease patients’ risk for prediabetes. The authors project that implementation of the PRAT and evidence-based interventions in the electronic health record would positively impact future screening results. This project set the benchmark for future efforts to educate, encourage, and measure providers successes.

No description available.

The National Diabetes Prevention Program (National DPP) was established by Congress in 2010, with a focus on disseminating the evidence-based Lifestyle Change Program (LCP). This 12-month program consists of 26 lessons covering various topics related to goal setting, tracking food and physical activity, motivation, and support groups. Many organizations, including Cooperative Extension (CE), have adopted this program. In the first study conducted by the Virginia Cooperative Extension (VCE), the outcomes of the prediabetes LCP were examined across different age groups and delivery modalities. It was found that distance learning LCPs had slightly higher enrollment levels compared to in-person programs (51% vs. 49%). Moreover, participants aged 60 and older had a significantly higher attendance rate in the distance learning program. The VCE LCP resulted in 49 participants (35%) achieving at least a 5% weight loss, with 29 of them being 60 years or older. When considering the program delivery method, a higher percentage of individuals enrolled in distance learning programs (53%) achieved at least a 5% weight loss. Additionally, 86 participants (62%) engaged in an average of 150 minutes of physical activity per week, with a higher percentage in the in-person programs (64%) and among those aged 60 and older (67%). In Study 2, the distance learning LCP implementation fidelity was evaluated across five states, along with its association with program outcomes. The evaluation tool assessed structural and instructional implementation components. The results indicated that certain structural components directly influenced increased physical activity among participants. Additionally, the coaches' preparedness for the sessions directly impacted participants' weight loss. In addition to implementation fidelity, age was identified as an independent factor affecting weight loss percentage and attendance. Overall, the findings from both studies underscore the significance of effective implementation fidelity to program design in achieving desired health outcomes. The LCP shows promise as an intervention for individuals at risk of developing type 2 diabetes and can be effectively implemented through both in-person and distance learning methods by Cooperative Extension programs nationwide. / Doctor of Philosophy / The prevalence of diabetes and prediabetes in the United States is a significant concern. The Centers for Disease Control (CDC) reported that around 34.2 million people in the U.S. have diabetes, with approximately 96 million adults having prediabetes in 2022. Lifestyle changes, such as increasing physical activity and losing weight, can reduce the risk of prediabetes progressing to diabetes. In response, the CDC established the National Diabetes Prevention Program (National DPP) in 2010, focusing on an evidence-based Lifestyle Change Program (LCP). The LCP is a 12-month program covering various topics and has been adopted by organizations like Cooperative Extension (CE). Two studies were conducted to assess the effectiveness and implementation of the LCP. The first study, carried out by the Virginia Cooperative Extension (VCE), compared outcomes of distance learning and in-person LCPs among adults of different ages. It found slightly higher enrollment levels in distance learning programs and observed a higher attendance rate among participants aged 60 and older in the distance learning program. The study showed that the VCE LCP resulted in a 35% weight loss for 49 participants, with 59% of them being 60 years or older. Distance learning programs also had higher success rates in achieving a 5% weight loss and 150 minutes of physical activity per week. The second study evaluated the implementation fidelity of the distance learning LCP conducted by Cooperative Extension in five states. It found that certain program components, both structural and instructional, directly influenced participants' physical activity levels. The preparedness of coaches for the sessions significantly impacted weight loss outcomes. In addition to implementation fidelity, age was identified as an independent factor affecting weight loss and attendance. Both studies underscore the importance of effective program implementation fidelity to program design in achieving desired health outcomes. The findings support the LCP as a promising intervention for individuals at risk of developing type 2 diabetes. It highlights its effectiveness through both in-person and distance learning methods implemented by Cooperative Extension programs nationwide.

Background: Diabetes is an important cause of morbidity, mortality, and health-system costs worldwide. The growing burden of T2DM particularly in developing countries has directed more attention to primary prevention. This cross-sectional study assessed the prevalence of T2DM and its risk factors among general and diabetic populations of the Zamboanga Peninsula, Philippines. Methods: This was a multi-center community-based cross-sectional study. 2624 individuals 40 years old or older residents (100 persons per Barangay of total 26 barangays) of the Zamboanga Peninsula province have been chosen via door-to-door systematic random sampling procedure. Personal demographic, anthropometric and lifestyle information was collected using a structured questionnaire. Weight, height, WC, BMI, and HbA1c test was were obtained through participant measurements. Results: Valid data of 2572 (98.01%) individuals analyzed, mean ±SD of age was 57.39 ± 10.41 and 1843 (71.7%) of participants were women. Based on ADA 2018 guideline, the prevalence of T2DM and prediabetes were 18.3% and 26.7%, respectively. The frequency of having T2DM and prediabetes was higher in older people (p< 0.05). Urban areas had a significantly higher prevalence of diabetes, prediabetes compared with rural areas (p< 0.01). 54.4 % of the population had a normal body mass index while 45.6% of the population were overweight (32.1 %) or obese (13.5%), and 65% had high or elevated WC. There was a significant association between BMI /central obesity and glucose abnormalities (P<0.01). The prevalence of overweight, obesity and abdominal obesity was significantly higher in women and the older age groups had significantly lower BMIs/ abdominal obesity than younger age groups. 40.4% of the participants had HTN and the prevalence of HTN was significantly higher in the older age groups and female participants. The prevalence of HTN and family history of diabetes were higher in T2DM patients and individuals with prediabetes (P<0.01). Based on the FINDRISC score, the risk of developing diabetes was high or very high in 17.6% and moderate in 20.0% of the population. Conclusion: The prevalence of T2DM and prediabetes was higher in this study compared to previous surveys in the country. This finding highlights the need for public health efforts to improve T2DM risk factors such as obesity and hypertension in this population. / Thesis / Master of Science (MSc)