Syfte: Att undersöka patienters upplevelser av livskvalitet vid nydiagnostiserad typ 2 Diabetes Mellitus. Metod: En empirisk studie med en kvalitativ ansats som innefattade tio deltagare med nydiagnostiserad typ 2 Diabetes Mellitus. Semistrukturerade intervjuer genomfördes utifrån en intervjuguide där insamlad data analyserades med kvalitativ manifest innehållsanalys. Resultat: Studien resulterade i fyra huvudkategorier och tio subkategorier. Upplevelsen av att få ett diagnosbesked varierade mellan deltagarna, för vissa deltagarna var beskedet inte förvånande medan andra upplevde känslor av chock och förnekelse. Deltagarna upplevde positiva förändringar, exempelvis viktnedgång och förbättrad hälsa men även negativa förändringar, exempelvis att vara beroende av läkemedel. Vissa upplevde ingen förändring alls. Typ 2 Diabetes Mellitus påverkade inte deltagarnas fysiska eller psykiska hälsa i de flesta fall. Deltagarna ansåg det som viktig att få stöd från både omgivningen och hälso- och sjukvården. Konklusion: Känslorna över ett diagnosbesked kunde variera men upplevelsen av livskvalitet påverkades inte av Typ 2 Diabetes Mellitus i de flesta fall i studien. Patientens inställning till att leva med Typ 2 Diabetes Mellitus inverkade på förmågan till att utföra egenvård, och distriktsköterskans stöd och engagemang ansågs vara betydelsefullt i sjukdomsprocessen. / Aim: To examine patients’ experiences of the quality of life in newly-diagnosed type 2 Diabetes Mellitus. Method: An empirical study with a qualitative approach that included ten participants with newly diagnosed type 2 Diabetes Mellitus. Semi-structured interviews were conducted on the basis of an interview-guide and the collected data was analyzed using qualitative manifest content analysis. Results: The study resulted in four main categories and ten subcategories. The experience of receiving a diagnosis varied between the participants, some participants did not experience the news as surprising, while others experienced feelings of shock and denial. The participants experienced positive changes, for example weight loss and improved health but also negative changes, such as being dependent of medicine. Some participants experienced no change at all. Type 2 Diabetes Mellitus did not affect the participants’ physical and mental health. The participants considered it important to get support from both surrounding people and health care. Conclusion: The feelings of a diagnosis could vary but the experience of quality of life is not affected by Type 2 Diabetes Mellitus in most cases in the study. The patient's attitude to living with Type 2 Diabetes Mellitus affects the ability to perform self-care, and the district nurse support and involvement is considered to be important in the process of the disease.

Bakgrund: Typ 2-diabetes är en kronisk sjukdom som står för 90 procent av alla diabetesfall i världen och beräknas öka de kommande åren, på grund av bland annat ohälsosamma levnadsvanor såsom kost och fysisk aktivitet. Egenvård innebär att patienten tar ansvar och för att hantera det behövs kunskap och stöd från vårdpersonalen. Syfte: att beskriva upplevelser av egenvården vid typ 2-diabetes, med fokus på livsstilsförändringar. Metod: En allmän litteraturöversikt baserad på tolv kvalitativa vetenskapliga artiklar genomfördes. Resultat: Det har framkommit olika upplevelser av egenvården och dessa har kategoriserats i teman med subteman: 1) Känsla av kontroll: Olika uppfattningar av betydelsen av typ 2-diabetes, 2) Upplevelser av livsstilsförändringar: Kostomläggning och Fysisk aktivitet och 3) Upplevelser av omvårdnadsåtgärder: Rådgivning, Motiverande samtal, MI och Gruppbaserad patientutbildning. Slutsats: Att ändra på sin livsstil kan upplevas som krävande och omställningen behöver stödjas och anpassas utefter patientens behov. Klinisk betydelse: Patientens upplevelser av egenvård med behov, krav och brister kan fungera som ett kunskapsverktyg för vårdpersonalen vid omvårdnaden av typ 2-diabetes. / Background: Type 2-Diabetes is a chronic disease that accounts for 90 percent of all diabetes cases in the world and is expected to increase in the upcoming years, due to unhealthy habits such as diet and physical activity. Self-management means that the patient takes responsibility and in order to manage it knowledge is needed and support from caregivers. Objective: To describe the experiences of self-management in Type 2-Diabetes, focusing on lifestyle changes. Method: A literature review based on twelve qualitative scientific articles were conducted. Results: It has turned out that there have been different experiences of self-management and these have been categorized into themes with subthemes: 1) Sense of control: Different views of the importance of Type 2-Diabetes, 2) Experiences of lifestyle changes: Change of diet and Physical activity and 3) Experiences of nursing interventions: Counseling, Motivational interviewing, MI and Group-based patient education. Conclusion: To change the lifestyle may be perceived as demanding and conversion needs to be adjusted to the patient's needs. Clinical significance: Patient’s experiences of self-management with needs, demands and deficiencies can serve as a knowledge tool for the care staff in the care of Type 2-Diabetes.

<p>Bakgrund: I dagens samhälle flödar information från många olika håll. Kunskap förmedlas till patienter och anhöriga av olika professioner utan samordning, vilket kan leda till missförstånd. För patienter med diabetes typ 2 är det viktigt att få information som kan förstås och som är relevant för deras sjukdom. Genom patientutbildning kan patienten sedan bedriva egenvård och ta kontroll över sjukdomen. Syfte: Syftet med studien var att se hur patienter med nydiagnostiserad typ 2 diabetes förstår egenvård efter besök hos diabetessköterskan. Metod: En empirisk, kvalitativ intervjustudie genomfördes och innehållet analyserades med kvalitativ innehållsanalys inspirerad av Graneheim och Lundman. Resultat: Det framkom under intervjuerna att ungefär hälften av deltagarna förväntade sig att drabbas av diabetes, då det fanns i släkten. Diabetes var naturligt att få vid en viss ålder, med eller utan egenvård. De flesta hade gjort förändring av kostvanor och rökning under de första månaderna efter diagnosen och fått bekräftat att egenvården gjort nytta. Många kände oro inför att inte orka fortsätta med de förändringar, men var ändå inte oroliga för framtiden. Andra hade fortsatt stor tillförsikt och visste att resultatet berodde på dem själv. Slutsats: Med eller utan tidig egenvård hade sjukdomen kommit ändå. Den första tiden efter diagnosen genomfördes förändringar och egenvården kändes viktig. När sedan känslan av att ”må bra” återkom, dalade motivationen. Med täta besök hos diabetessköterskan motiverades patienterna att fortsätta.</p> / <p>Background: In today's society, information flowing from many different directions. Knowledge communicated to patients and families of different professions, without coordination, which can lead to misunderstandings. For patients with diabetes type 2, it is important to get information that is understandable and relevant to their illness. Through patient education, the patient may then engage in self-care and take control of the disease. Aim: The purpose of this study was to see how patients with newly diagnosed type 2 diabetes understand self-care after visiting the nurse. Method: An empirical, qualitative interviews were carried out and contents were analyzed using qualitative content analysis inspired by Granheim and Lundman. Results: It emerged during the interviews that about half of the participants expected to suffer from diabetes, when there was a family history. Diabetes was natural to get at a certain age, with or without self-care. Most patients had made changes in diet and smoking during the first months after being diagnosed and confirmed that self-care was useful. Many felt concerned about not being able to continue with the changes, but was not worried about the future. Others had continued very confident and knew that the outcome depended on themselfs. Conclusion: With or without early self-care the disease would had come anyway. The first time after beeing diagnosed, change and self-care feelt important. When the sense of "feel good" reappeared, the motivation faded. With frequent visits to the nurse, the patients were motivated to continue.</p>

<p><strong>Background:</strong> Type 2-diabetes is now a public health problem, which constitutes 85-90 percent of diabetes care. The district nurse´s role in treating a diabetic (/person with diabetes) does not only comprise pure medical treatment but also support, advice and training to the individual. In our profession as nurses, we have found that medical knowledge in patients with Typ 2-diabetes is not always enough to obtain changes in lifestyles.</p><p><strong>A</strong><strong>im:</strong><strong> </strong>The purpose of this study was to investigate the illness perceptions in patients with Type 2-diabetes and their impact on health behavior.</p><p><strong>Method:</strong> This qualitative study used grounded theory as a method.<strong> </strong></p><p><strong>Results: </strong>The informants described in the interviews, their perceptions of living with Type 2-diabetes. The analysis revealed the main category <em>periodic health</em> <em>behavior </em>built up on and related to five categories developed in data: <em>preventive health awareness, guilt, confidence in medical treatment, motivational problems and periods of insight.</em></p><p><strong>Conclusion: </strong>This study contributes to understanding of patients with Type 2 - diabetes their beliefs about illness and how it affects everyday lives.<strong></strong></p><p><strong>Keywords: </strong>Believes, District nurses, Groundey Theory, Illness perception, Type 2-diabetes</p>

Background: Type 2-diabetes is now a public health problem, which constitutes 85-90 percent of diabetes care. The district nurse´s role in treating a diabetic (/person with diabetes) does not only comprise pure medical treatment but also support, advice and training to the individual. In our profession as nurses, we have found that medical knowledge in patients with Typ 2-diabetes is not always enough to obtain changes in lifestyles. Aim: The purpose of this study was to investigate the illness perceptions in patients with Type 2-diabetes and their impact on health behavior. Method: This qualitative study used grounded theory as a method. Results: The informants described in the interviews, their perceptions of living with Type 2-diabetes. The analysis revealed the main category periodic health behavior built up on and related to five categories developed in data: preventive health awareness, guilt, confidence in medical treatment, motivational problems and periods of insight. Conclusion: This study contributes to understanding of patients with Type 2 - diabetes their beliefs about illness and how it affects everyday lives. Keywords: Believes, District nurses, Groundey Theory, Illness perception, Type 2-diabetes

Bakgrund: I dagens samhälle flödar information från många olika håll. Kunskap förmedlas till patienter och anhöriga av olika professioner utan samordning, vilket kan leda till missförstånd. För patienter med diabetes typ 2 är det viktigt att få information som kan förstås och som är relevant för deras sjukdom. Genom patientutbildning kan patienten sedan bedriva egenvård och ta kontroll över sjukdomen. Syfte: Syftet med studien var att se hur patienter med nydiagnostiserad typ 2 diabetes förstår egenvård efter besök hos diabetessköterskan. Metod: En empirisk, kvalitativ intervjustudie genomfördes och innehållet analyserades med kvalitativ innehållsanalys inspirerad av Graneheim och Lundman. Resultat: Det framkom under intervjuerna att ungefär hälften av deltagarna förväntade sig att drabbas av diabetes, då det fanns i släkten. Diabetes var naturligt att få vid en viss ålder, med eller utan egenvård. De flesta hade gjort förändring av kostvanor och rökning under de första månaderna efter diagnosen och fått bekräftat att egenvården gjort nytta. Många kände oro inför att inte orka fortsätta med de förändringar, men var ändå inte oroliga för framtiden. Andra hade fortsatt stor tillförsikt och visste att resultatet berodde på dem själv. Slutsats: Med eller utan tidig egenvård hade sjukdomen kommit ändå. Den första tiden efter diagnosen genomfördes förändringar och egenvården kändes viktig. När sedan känslan av att ”må bra” återkom, dalade motivationen. Med täta besök hos diabetessköterskan motiverades patienterna att fortsätta. / Background: In today's society, information flowing from many different directions. Knowledge communicated to patients and families of different professions, without coordination, which can lead to misunderstandings. For patients with diabetes type 2, it is important to get information that is understandable and relevant to their illness. Through patient education, the patient may then engage in self-care and take control of the disease. Aim: The purpose of this study was to see how patients with newly diagnosed type 2 diabetes understand self-care after visiting the nurse. Method: An empirical, qualitative interviews were carried out and contents were analyzed using qualitative content analysis inspired by Granheim and Lundman. Results: It emerged during the interviews that about half of the participants expected to suffer from diabetes, when there was a family history. Diabetes was natural to get at a certain age, with or without self-care. Most patients had made changes in diet and smoking during the first months after being diagnosed and confirmed that self-care was useful. Many felt concerned about not being able to continue with the changes, but was not worried about the future. Others had continued very confident and knew that the outcome depended on themselfs. Conclusion: With or without early self-care the disease would had come anyway. The first time after beeing diagnosed, change and self-care feelt important. When the sense of "feel good" reappeared, the motivation faded. With frequent visits to the nurse, the patients were motivated to continue.

The major part of care in type 2 diabetes is in the hands of the patient so the focus of educational interventions should be on the person behind the disease. An experience-based group education programme that actively promotes participants’ reflection and understanding has been designed and implemented in cooperation with the Swedish Pharmacy. The regression model presented in Paper I revealed the importance of self-perceived role in diabetes management. Blood glucose control two years after baseline was improved for participants who described themselves as having an active role in their treatment, compared to those taking on a passive or a compliant role. Paper II described the resulting categories from content analysis of three open-ended questions about participants’ role, goal and support needs in diabetes management. The people taking care of diabetes most effectively and needing least support were called Disease Managers; those following the health professionals’ orders and depending on regular controls were categorised as Compliant, whereas the Disheartened had difficulties in achieving good metabolic control and often described both medical and social obstacles. These three self-management profiles were strongly correlated to metabolic outcomes. In Paper III perceptions of diabetes management were reassessed: perceptions were only stable in approximately half of participants, thus providing evidence for a dynamic model of learning self-management in diabetes. The three self-management profiles still correlated with metabolic outcomes. In paper IV the long-term metabolic outcome (HbA1c) of the study population was investigated. Metabolic control was stable up to seven years following the intervention, in contrast to the metabolic deterioration often present in diabetes. The main message of this thesis is that participants’ self-perceived role had a major influence on metabolic outcomes. Assessing self-management profiles both in diabetes and possibly other chronic conditions can help health care providers to tailor their educational efforts accordingly. Furthermore, this experience-based patient education programme outside the framework of routine diabetes care has the potential to stabilise metabolic control on the long run effectively.

The aim of the present thesis was to further increase our understanding of mechanisms contributing to and maintaining cellular insulin resistance in type 2 diabetes (T2D). For this reason, the effects of high glucose and insulin levels on glucose transport capacity and insulin signaling, with emphasis on insulin receptor substrate 1 (IRS-1) were assessed in fat cells. Altered levels of IRS-1 have previously been observed in adipose tissue from insulin-resistant and T2D subjects. A high glucose level (≥15 mM) for 24 h exerted only a minor impairment on glucose transport capacity in human adipocytes, as opposed to rat adipocytes. However, when combined with a high insulin level (104 µU/ml), basal and insulin-stimulated glucose transport was significantly impaired in both human and rat adipocytes. This was associated with a depletion of IRS-1 and IRS-2 protein levels in rat adipocytes, as a result of post-translational changes and altered gene transcription, respectively. In human adipocytes was only IRS-1 protein levels reduced. The high glucose/high insulin setting achieved maximal impairment of glucose transport within 6 h. Subsequent incubations of rat adipocytes under physiological conditions could partially restore insulin sensitivity. Interestingly, in both human and rat fat cells, decreased levels of IRSs occurred after the establishment of impaired glucose transport, suggesting that the observed depletion of IRSs is a consequence rather than a cause of insulin resistance. Nonetheless, IRS depletion is likely to further aggravate insulin resistance. Tyrosine phosphorylation of IRS-1 upon insulin stimulation activates the signaling pathway that mediates glucose transport. Pre-treatment of human adipocytes with high glucose and insulin levels was not associated with any alterations in the total IRS-1 Tyr612 phosphorylation following 10 min insulin stimulation. However, a significant increase in basal Tyr612 phosphorylation was observed. Furthermore, a rise in basal IRS-1 Ser312 phosphorylation was found. This is associated with reduced IRS-1 function and is considered to target IRS-1 to degradation pathways, and thus could potentially explain the observed decrease in IRS-1 protein levels. Our results imply an enhanced activation of insulin’s negative-feedback control mechanism that inhibit IRS-1 function. This could potentially have contributed to the observed impairment of insulin action on glucose transport in these cells. Accordingly, we have also shown that the downstream activation of protein kinase B upon insulin-stimulation is significantly impaired in human adipocytes exposed to the high glucose/high insulin setting, indicating a defect in the signaling pathway mediating glucose transport. We also investigated whether there are humoral factors in the circulation of T2D patients that contribute to peripheral insulin resistance. Human adipocytes cultured for 24 h in medium supplemented with 25% serum from T2D subjects, as compared to serum from non-diabetic subjects, displayed significantly reduced insulin-stimulated glucose uptake capacity. The effect could neither be attributed to glucose, insulin, FFA, TNF-α or IL-6 levels in the serum, but other circulating factor(s) seem to be of importance. In conclusion, chronic conditions of elevated glucose and/or insulin levels all impair insulin action on glucose turnover, but to different extents. A clear distinction between rat and human fat cells in the response to these different milieus was also observed. Alterations in the function of the key insulin signaling protein IRS-1 might be involved in the mechanisms underlying the impaired glucose uptake capacity. IRS-1 reduction however, occurs after but probably aggravates the existing insulin resistance. The effects of high glucose and/or insulin levels may be of importance in T2D, but additional novel factors present in the circulation of T2D patients seem to contribute to cellular insulin resistance.

Typ 2 diabetes är den vanligaste diabetesformen i Sverige och har samband med vår vällevnad. Tidigare studier visar att sjukdomen är mer vanlig bland fysiskt inaktiva och bland människor med ett ökat energiintag. Syftet med studien var att kartlägga sjuksköterskans hälsofrämjande arbete i primärvården vid typ 2 diabetes. En kvalitativ intervjustudie användes för att samla data. Fem sjuksköterskor från olika vårdcentraler i gamla Skaraborgs län deltog. Analysen av intervjuerna resulterade i ett huvudtema och fem underteman. Resultatet visar på att sjuksköterskorna aktivt arbetar med att motivera patienterna till att ändra kostvanor och öka den fysiska aktiviteten i den icke- farmakologiska behandlingen. Sjuksköterskorna använde information, patientrelation, konkret arbete, patientens villkor och mål som verktyg för att få patienterna motiverade. Att förespråka kost och fysisk aktivitet anses vara mycket viktig uppgift för sjuksköterskorna och utgör en central del i deras arbete. / Type 2 diabetes is the most common form of diabetes in Sweden today and is related to our lifestyle. Previous studies indicate that the disease is more common among physical inactive people and in people with increased energy intake. The aim of this study was to survey how nurses´ in primary health care promote lifestyle change in patients with type 2 diabetes. A qualitative interview study was used for data collection. Five nurses from different primary health care settings in old Skaraborgs county participated. The analyses of the interviews resulted in one major theme and five sub themes. The result shows that nurses work actively to motivate patients to change dietary habits and start with daily physical activity as a part of non-drug therapy. The nurses´ used information, nurse- patient relationship, concrete work, goals and the patient terms as tools to get patients motivated. Promoting diet and physical activity is a central part of the nurses’ daily work.

Många kvinnor med typ 2-diabetes misslyckas med sin egenvård och komplikationer tillstöter. Denna studie sammanfattar ett antal forskningsresultat som beskriver kvinnors upplevelser av att leva med typ 2-diabetes. Syftet med litteraturstudien var att beskriva hur kvinnor med typ 2-diabetes upplever att leva med sin sjukdom.  Dessa upplevelser påverkar hur kvinnan kan sköta sin egenvård men också ge information om hur sjuksköterskan kan stödja kvinnan. Orems egenvårsteori kopplas till kvinnans egenvård och sjuksköterskans roll. Vidare var syftet även att granska artiklarnas kvalitet utifrån den metodologiska aspekten urvalsmetod. Denna studie utformades som en deskriptiv litteraturstudie baserade på tio artikar med kvalitativ ansats. Resultatet från dessa artiklar visade att upplevelserna kan delas in i fem olika kategorier. 1. Upplevelse av utmaningar med egenvården och livsstilsförändringar 2. Upplevelse att hantera sina känslor 3. Upplevelse av motivation och engagemang 4. Upplevelse av omgivningens stöd 5. Upplevelse av interaktion med vårdgivare Slutsatsen från studien är att kvinnor med typ 2-diabetes har många erfarenheter runt sin diagnos som påverkar hennes egenvårdskapacitet. Granskningen av artiklarnas kvalitet utifrån den metodologiska aspekten urvalsmetod visar att urvalet är kritiskt för resultatet. I alla studier som är baserade på urval bör urvalsmetod granskas kritiskt innan några slutsatser tas. / Many women with type 2 diabetes fail in their efforts with self care management. The consequence are medical complications. The purpose of this paper is to look at a number of research articles describing women’s experiences relating to their diabetes diagnosis. These experiences affect the woman's ability to self care but also guides the nurse in her profession on how to best support the woman. Orem's self care deficit theory is tied to the diabetic woman and her self care but also to the role of the nurse. There is also an analysis of the sampling methods used in each of the articles. This study was done as a descriptive litterature study based on ten qualitative research articles. The result from the analysis of the articles shows that the experiences of the diabetic women can be sorted into five categories. 1.     Self-care and lifestyle change 2.     Coping with ones own feelings and emotions 3.     Motivation and engagement 4.     The surrounding support  5.     The interaction with the caregiver/medical expertise. The conclusion that can be made from this study is that women with type 2 diabetes have a lot of emotional experiences relating to the diagnosis that affects their self care management. The analysis of the sampling methods used in each of the articles show that it is critical for the result how the sampling was done and care should be exercised before drawing any conclusions from the results.