Prediabetes is associated with an elevated risk for developing type 2 diabetes (T2DM) and associated cardiovascular complications. Lifestyle factors such as physical activity (PA) and dietary intake are strongly implicated in the development of metabolic disease, yet few Americans meet PA and dietary recommendations. Middle-aged and older adults are at increased risk for developing prediabetes and T2DM due to age-related muscle loss, increased fat mass, and alterations in glucose handling. In addition, this segment of the population is least likely to meet PA guidelines, particularly the resistance training (RT) recommendation of completing a whole body routine 2x/week. Ideally, individuals would alter their lifestyle in order to meet PA guidelines and habitually consume a healthy diet, to decrease disease risk. However, behavior change is difficult and optimal strategies to promote and maintain changes have yet to be determined. Furthermore, behavior change interventions tend to be time-, cost-, and resource-intensive, limiting the ability for efficacious programs to be translated into community settings and broadly disseminated. Evidence suggests that health-related behaviors, particularly diet and exercise habits, tend to cluster together. Thus, intervening on one behavior (e.g. PA) may elicit a spillover effect, promoting alterations in other behaviors (e.g. diet), though findings to date are conflicting. The purpose of this dissertation was to determine if participation in a social cognitive theory-based RT program targeting the initiation and maintenance of RT exerts a spillover effect and is associated with alterations in dietary intake and/or non-RT PA in a population at risk for T2DM. Data from the 15-month Resist Diabetes study was analyzed to evaluate this possibility. Sedentary, overweight/obese (BMI 25-39.9 kg/m2 ), middle-aged and older (50 -69 years) adults with prediabetes (impaired fasting glucose and/or impaired glucose tolerance) completed a 3 month initiation phase where they RT 2x/week in a lab-gym with an ACSM-certified personal trainer. Participants then completed a 6-month faded contact maintenance phase, and a 6-month no-contact phase during which they were to continue RT on their own in a public facility. No advice or encouragement was given to participants to alter dietary intake or non-RT PA habits. At baseline, and months 3, 9, and 15, three non-consecutive 24-hour diet recalls were collected to evaluate dietary intake and quality, the Aerobics Institute Longitudinal Study Questionnaire was completed to evaluate non-RT PA, and body mass, body composition, and strength (3 repetition maximum on leg and chest press) were measured. At months 3, 9, and 15 social cognitive theory (SCT) constructs were assessed with a RT Health Beliefs Questionnaire. In the first study, dietary intake was assessed at baseline and after 3 months of RT. Using paired sample t-tests, reductions in intake of energy (1914 ± 40 kcal vs. 1834 ± 427 kcal, p = 0.010), carbohydrate (211.6 ± 4.9 g vs. 201.7 ± 5.2 g, p = 0.015), total sugar (87.4 ± 2.7 g vs. 81.5 ± 3.1 g, p = 0.030), glycemic load (113.4 ± 3.0 vs. 108.1 ±3.2, p= 0.031), fruits and vegetables (4.6±0.2 servings vs. 4.1±0.2 servings, p= 0.018), and sweets and desserts (1.1 ± 0.07 servings vs. 0.89 ± 0.07 servings, p = 0.023) were detected from baseline to month 3. No changes in other dietary intake variables were observed. These findings supported additional investigation in this area. The second study assessed changes in overall diet quality (Healthy Eating Index [HEI]-2010 scores) and non-RT PA over the initiation, maintenance, and no-contact phases using mixed effects models. Demographic, physiological, and psychosocial factors that may predict alterations to diet quality and non-RT PA were also explored. Energy and carbohydrate intake decreased with RT (β= -87.9, p=.015 and β= -16.3, p<.001, respectively). No change in overall dietary quality (HEI-2010 score: β= -0.13, p=.722) occurred, but alterations in HEI-2010 sub-scores were detected. Maintenance of RT was accompanied by an increase in MET-min/week of total non-RT PA (β=153.5, p=0.01), which was predicted by increased self-regulation for RT (β=78.1, p=0.03). RT may be a gateway behavior leading to improvements in other health-related behaviors among adults with prediabetes. These results support the use of singlecomponent vs. multi-component interventions. This may have broad translational potential for the development of time-, resource-, and cost-efficient lifestyle interventions which can improve multiple health-related behaviors and decrease disease risk. / Ph. D.

Bakgrund: Diabetes utgör den fjärde största orsaken till förtidig död i världen. Sjukdomen medför ofta komplikationer, ökad risk för hjärtkärlsjukdom och lidande för patienter och närstående. Diabetesrelaterad vård kostar samhället stora resurser. Personer med prediabetes har möjlighet att förhindra eller skjuta upp insjuknande i typ 2 diabetes genom livsstilsförändringar. Att arbeta med livsstilsförändringar för att främja hälsa och förhindra sjukdom är essentiellt för distriktssköterskan. Syfte: Syftet var att belysa patienters erfarenheter av livsstilsförändringar vid prediabetes. Metod: Metoden var en kvalitativ litteraturöversikt med systematisk ansats, baserad på sökningar i tre vetenskapliga databaser. 15 primärstudier analyserades med Thomas och Hardens metod för tematisk syntes av kvalitativ forskning i systematiska litteraturöversikter. Resultat: Patienters erfarenheter av livsstilsförändringar presenterades i fyra huvudteman. Att få en diagnos belyste huruvida diagnosen var en anledning till att göra livsstilsförändringar eller inte. Temat betydelsen av stöd visade att stöd var avgörande för att göra och bibehålla livsstilsförändringar. Försvårande faktorer beskrev aspekter som försvårade livsstilsförändringar. Temat strategier belyste strategier som användes för att underlätta livsstilsförändringar och hantera hinder. Slutsats: Resultatet visade ett brett spektrum av erfarenheter. Betydelsen av stöd var framträdande. Förändringsmotivation påverkades av huruvida tillståndet upplevdes kontrollerbart eller inte. Uppoffringar och inskränkt livskvalitet var försvårande. Resultatet bidrar med förståelse för prediabetespatienters erfarenheter av livsstilsförändringar. Detta kan implementeras i omvårdnaden för att stärka tilltro till egen förmåga och patientdelaktighet. / Background: Diabetes is the fourth leading cause of premature death in the world. The disease often causes complications, increases the risk of cardiovascular disease and causes suffering for patients and their relatives. Diabetes-related care costs society great resources. People with prediabetes can prevent or postpone the onset of type 2 diabetes through lifestyle changes. Working with lifestyle changes to promote health and prevent disease is essential for the district nurse. Aim: The aim was to illustrate patients' experiences of lifestyle changes in prediabetes. Method: A qualitative literature review with a systematic approach was conducted, based on searches in three scientific databases. 15 primary studies were analysed using Thomas and Harden's method for thematic synthesis of qualitative research in systematic literature reviews. Results: Patients' experiences of lifestyle changes were presented in four main themes. Receiving a diagnosis highlighted whether the diagnosis was a reason to make lifestyle changes or not. The meaning of support showed that support was crucial for implementing and maintaining lifestyle changes. Complicating factors described aspects that made lifestyle changes more difficult. Strategies highlighted strategies used to facilitate lifestyle changes and manage barriers. Conclusion: The result showed a wide range of experiences. The importance of support was prominent. Motivation was influenced by perceptions of diabetes and whether the condition was perceived as controllable. Sacrifices and reduced quality of life were aggravating. The result contributes to an understanding of prediabetes patients' experiences of lifestyle changes. This can be implemented in nursing practice to strengthen confidence in self-efficacy and patient participation.

Bakgrund Risken att insjukna i prediabetes eller diabetes typ 2 är störst hos överviktiga med en ohälsosam livsstil. En sådan livsstil kan orsaka förhöjt plasmaglukos vilket i sin tur kan leda till diabetes typ 2 och även andra sjukdomar. Genom livsstilsförändringar kan en sådan utveckling motverkas, och även vändas, vilket kan leda till att värdena på plasmaglukos återgår till det normala. Syfte Syftet var att beskriva sjuksköterskors hälsofrämjande åtgärder för livsstilsförändring hos patienter med prediabetes eller diabetes typ 2. Metod Studien är en litteraturöversikt där resultatet baseras på 13 vetenskapliga artiklar publicerade mellan år 2014 och 2022. Artiklarna är av kvalitativ design, kvantitativ design samt mixed method. Datainsamlingen gjordes i databaserna PubMed och CINAHL. Resultat Sjuksköterskans förhållningssätt mot patienten, att träffa andra i samma situation och dela erfarenheter samt involvera anhöriga ansågs vara viktiga åtgärder. Information om livsstilsförändring och fysisk aktivitet samt vilken kost som är hälsosam är sådant som sjuksköterskan kan delge patienterna för att öka deras kunskap och förutsättning att lyckas förändra sin livsstil. Slutsats Sjuksköterskor kan skapa förutsättningar för patienter att genomföra livsstilsförändring, där förhållningssättet är en viktig del. En annan del är att förmedla kunskap och delge patienten den information som behövs för att förstå vad livsstilsförändring innebär. / Background Overweight people whose lifestyle consists of unhealthy food and being sedentary are at greater risk of developing prediabetes or diabetes type 2. Such lifestyle can cause elevated plasma glucose which in turn can lead to type 2 diabetes and also other dangerous diseases. Through lifestyle changes one can counteract, and even reverse, an elevated plasma glucose and return to normal values. Aim The aim was to describe nurses' health promotion measures for lifestyle change in patients with prediabetes or type 2 diabetes. Method The study is a literature review where the results are based on 13 articles published between 2014 and 2022. The articles are of qualitative design, quantitative design and mixed method. The data collection was done in the databases PubMed and CINAHL. Results The nurse's approach to the patient, organizing meetings where patients in a similar situation can meet and share experiences and involving relatives were important measures. Information about what lifestyle change and physical activity and what kind of diet is healthy are things that the nurse needs to share with the patients in order to increase their knowledge and prerequisite for success. Conclusions Nurses can create conditions for patients to implement lifestyle change, where the approach to the patient is an important part. Another part is to impart knowledge and provide the patient with the information needed to understand what lifestyle change entails.

Diabetes has caused many deaths worldwide but can be combated at least partially by diet and physical activity. The gut microbiome shows correlation with both type 1 and type 2 diabetes, has modulatory effects on the immune system and implicates brain functions through the gut-brain axis, in part by microbial metabolites. Diet has long been known to impact the microbiome but exercise has gained interest within the last decade, with studies mostly done on rodents and athletes with somewhat positive results on its modulation of the microbiome. This literature study aims to evaluate whether exercise can influence the microbiome for healthy, prediabetic, and diabetic cohorts and what this might mean for host health. The database PubMed was searched for articles in January 2021 and inclusion criteria yielded 7 articles for review. These differed in methods, cohorts, and exercise interventions, and therefore cannot grant any strong evidence but indicate along with previous research that exercise affects the microbiome, with slight differences in responses depending on the individual’s current state and exercising methods. / Diabetes har orsakat många dödsfall världen över men kan bekämpas åtminstone delvis med hjälp av diet och fysisk aktivitet. Tarmens mikrobiom har visats korrelera med både typ 1 och typ 2 diabetes, har reglerande effekter på immunsystemet och inverkar på hjärnfunktioner genom tarm-hjärna-axeln, delvis via metaboliter från mikroberna. Det har länge varit känt att mat kan påverka mikrobiomet, men träning har också väckt intresse över det senaste årtiondet med studier som fokuserat mest på möss och atleter med någorlunda positiva resultat för dess förändring av mikrobiomet. Denna litteraturstudie syftar till att undersöka om träning kan ha effekt på mikrobiomet hos såväl friska människor som prediabetiker och diabetiker, och vad detta kan betyda för hälsan. En litteratursökning gjordes i databasen PubMed i januari 2021 som efter sortering enligt inkluderande kriterier gav 7 artiklar för granskning. Dessa använde olika metoder, undersökta grupper och träningsupplägg, vilket försvårar jämförelser men indikerar i linje med tidigare forskning att träning påverkar mikrobiomet, med en del skillnader i resultat beroende på individens status och träningsupplägg.

Introduction Patients with serious psychiatric disorders have an increased morbidity and mortality in somatic diseases and elevated prevalence of both diabetes and prediabetes. This increased frequency of somatic diseases is believed to be associated with life style choices and side effects of the antipsychotic medication. Aim In our study we investigated the prevalence of diabetes and prediabetes and compared metabolic risk factors and treatments between patients with and without serious psychiatric disorders in patients with diabetes in Region Örebro County (RÖC). Material and methods The prevalence of diabetes and prediabetes was determined in 944 patients identified from psychiatric outpatient clinics in RÖC. Information about risk factors and treatments were acquired by retrospective examination of medical records. Results Diabetes was identified in 113 patients and prediabetes in 42 patients. In patients with diabetes and serious psychiatric disorders men had significantly higher levels of HbA1c (p&lt;0.01) and creatinine (p&lt;0.01) compared to women, whereas women had higher BMI (p&lt;0.05). No significant differences in HbA1c and BMI were found between patients with psychiatric disorders and all patients in RÖC with diabetes. Patients with psychiatric disorders did however have a significantly higher number of current smokers and a lower prescription of antihypertensive medication. Conclusions The prevalence of diabetes and prediabetes were 12.0% and 4.4%, respectively, in patients with serious psychiatric disorders. Our study indicates no difference in glycaemic control between psychiatric and non-psychiatric patients with diabetes, but there are differences in certain risk factors connected to diabetes.

INTRODUCTION: Type 2 diabetes mellitus (T2DM), once thought to be an adult disease, now affects large numbers of children. The prevalence of T2DM in children increased 35% between 2001 and 20091 and while it appears to now be leveling off, it is clear that much of the burden of disease falls disproportionately on ethnic minorities. It is well known that there are changes occurring in the microvasculature well before diabetes is diagnosed, and these changes are thought to contribute to micro- and macrovascular complications. Therefore, prediabetes, which is a time of mild hyperglycemia that exists between normal glucose metabolism and overt diabetes, provides a target for behavior modification and potentially the prevention of complications. The mainstay of treatment for diabetes has been lifestyle intervention and treatment with metformin. Research has shown that both intensive lifestyle interventions and metformin are effective for the treatment of T2DM. However, much of this knowledge comes from studies on adults and is simply inferred to youth. Thus, at this time it is still unknown to what extent treatments including lifestyle intervention and metformin should be used, or how they should be utilized, in youth. This is especially true for youth with prediabetes, as this is likely where prevention of the disease needs to occur to have the greatest overall benefit. PROPOSED STUDY: Thus, the proposed study will directly compare two groups treated with standard of care and either metformin daily or intensive lifestyle intervention with a CrossFit™ training modality. The primary outcome is treatment failure and development of diabetes. A secondary outcome is achievement of normoglycemia and its durability. CONCLUSIONS: This study will be the first to examine the longer term outcomes of the use of metformin in youth as well as the effects of high intensity functional training (HIFT) using the CrossFit™ modality. While there is accumulating evidence about the safety of the use of metformin in youth, most studies are of short duration and this study will provide longer term results. Additionally, CrossFit™, a relatively new exercise modality, has not been tested in the literature on youth and as a form of combined aerobic and resistance training, it may provide and effective and interesting means of lifestyle intervention and reversion to normoglycemia in adolescents. In conclusion the results from this study will provide significant clinical relevance.

No description available.

Diabetes is a growing health concern among those in rural locations. Rural residents smoke more, exercise less, have less nutritious diets and are more likely to be obese than urban residents. Evidence-based diabetes prevention programs targeting behavior change are available to this population yet participation remains low. This study examined the self-reported barriers and health beliefs of those who declined participation in a diabetes prevention program (DPP). Of 269 clients identified to be at risk for developing Type II Diabetes (T2D), only 85 answered the phone and 33 were interviewed to discuss their health beliefs and reasons for not participating in a diabetes prevention program. Almost half of the participants who expressed their lack of desire to participate in the DPP cited a low level of interest and not seeing any personal benefit as their primary reasons. Participants were closed off when asked what it would take to get them to participate in the program with 63% citing “nothing” as the most common answer when questioned as to what would encourage their participation. In order to limit barriers to participation in prevention-based programs for rural populations special attention needs to address improving general interest and knowledge about the efficacy of a DPP.

The challenge of diabetes prevention is to reduce the financial and human costs of diabetes by preventing new cases and enacting social change. African Americans and Hispanics Americans have a high incidence of Type 2 diabetes because of factors that place them at risk for prediabetes. The purpose of this project was to plan the implementation and evaluation of a Type 2 diabetes prevention program in a medical office clinical setting. The clinic of interest was located in the downtown area of the city and provided care mostly to African American population. The Iowa model of evidence-based practice formed the theoretical framework for the study. The goal was to decrease the number of African Americans patients who will convert from prediabetes to Type 2 diabetes in the medical office clinic. The program was planned using the information from the Center for Disease Control and Prevention Road to Health toolkit. The outline covered a 6-week program. A pretest will be given to assess baseline knowledge of diabetes and diabetes prevention. The same test will be given after the implementation to evaluate if the program enhanced diabetes and diabetes prevention knowledge. Six months after the implementation of the program, nurses will complete a chart review to evaluate how many patients converted from pre-diabetes to Type 2 diabetes since the implementation of the project. The project will lead to the integration of a Type 2 diabetes prevention program in a medical clinic. It will increase the number of African Americans with prediabetes who will engage in lifestyle modification behavior. The project will also decrease the incidence of Type 2 diabetes among African Americans and reduce the health disparity of diabetes among the population.

Introduction: Several national trials have demonstrated the efficacy of lifestyle interventions on decreasing the incidence of type 2 diabetes in adults with prediabetes. Behavior change pertaining to physical activity (PA) and diet were central to these lifestyle interventions; however it is likely a majority of adults with prediabetes are not currently meeting public health guidelines for PA and dietary intake. Little information is available on different influences of behavior central to prediabetes treatment. Given these findings, further investigation into potential influences on the efficacy of prediabetes service provision is warranted. Purpose: This dissertation aimed to explore prediabetes service provision to identify potential influences on PA and dietary intake in adults with prediabetes. Methods: The first study used Grounded Theory methodology to obtain opinions on necessary components of an optimal diabetes prevention program from health professionals (n=20) and adults with, or at high risk of, prediabetes (n=12). The second, third, and fourth studies involved individuals with prediabetes (N=232) in Northern Alberta, Canada. Participants completed a mailed survey assessing various demographic, health and behavior influences in August-September, 2008. Results: Data from Study 1 identified four influences on behavior change in adults with prediabetes: service provision, knowledge or confusion, motivational influences, and goal-setting. Potential strategies to increase effectiveness of prediabetes programs were also identified. In Study 2, individuals with prediabetes achieving PA guidelines (38%) reported higher physical and mental health-related quality of life compared to those not meeting PA guidelines. In Study 3, a number of preferences for PA and PA programming were identified. Activity status, health, and demographic variables all demonstrated significant influence on different PA preference variables. In Study 4, behavior-specific social cognitive theory constructs including self-efficacy, outcome expectations, and goal formation demonstrated significant associations with each other and PA, fat, and fibre intake. Conclusions: Evidence suggests it is possible to prevent or delay the progression of prediabetes to diabetes with small changes in body weight, physical activity and dietary intake. The results reported in this dissertation identified a number of factors that may influence potential success of a prediabetes program to promote behavior change and increase the public health impact of prediabetes prevention programs.