AN ABSTRACT OF THE THESIS OF Sarah Sheffer, for the Master of Science degree in Food and Nutrition, presented on September 3, 2009, at Southern Illinois University Carbondale. TITLE: "R. U. A. HEALTHY KID?"- NON-INVASIVE SCREENING FOR RISK FACTORS FOR TYPE 2 DIABETES AT VIENNA GRADE SCHOOL MAJOR PROFESSOR: Dr. Sharon Peterson It is estimated that 1 in 3 children born after the year 2000 will develop some form of diabetes (CDC, 2007). Through Public Act 92-0703, the state of Illinois has started requiring screening for T2DM at the 6th and 9th grade school physicals following the ADA guidelines (IDHS, 2006). The ADA recommends screening children ten and older with a BMI ≥ 85th percentile for two additional risk factors for T2DM (ethnic minority, positive family history of T2DM, hypertension, acanthosis nigricans) (ADA, 2000). While much research has been done, few studies in the U.S. have looked at traditionally "low risk" populations (Sinha 2002, Whitaker 2004, Arslanian 2005). Our study sought to further understand the prevalence of risk factors in a predominantly Caucasian elementary school (K-8 grade). Our study (N=299) found approximately 67% of students to have 1 or more risk factors for T2DM and classified 17 students "at risk" for T2DM. Following Illinois Public Act 92-0703, only 1 student would have been identified "at risk" for T2DM. When comparing "at risk" status, all risk factors except ethnicity were found statistically significant (p< 0.001). Hypertensive "at risk" students were more likely to be morbidly obese (p< 0.001). Our study also found more risk factors as BMI increased.

The cross sectional study investigated the association of tobacco smoke, vitamin D status, anthropometric parameters, and kidney function in Turkish immigrants with type 2 diabetes (T2D) living in the Netherlands. Study sample included a total of 110 participants aged 30 years and older (males= 46; females= 64). Serum cotinine, a biomarker for smoke exposure, was measured with a solid-phase competitive chemiluminescent immunoassay. Serum 25-hydroxyvitamin D [25(OH)D] was determined by electrochemiluminescence immunoassay (ECLIA). Measures of obesity including: body weight, body mass index (BMI), waist circumference (WC), and hip circumference (HC) were measured. Waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were calculated. Urine albumin was measured by immunoturbidimetric assay. Urine creatinine was determined using the Jaffe method. All statistical analyses were performed using SPSS, version 19.0 (SPSS Inc., Chicago, IL, USA). Independent samples t-test, chi-squared tests, multiple linear regression and logistic regression analysis were used. Cotinine levels were positively associated with cholesterol to HDL ratio and atherosclerosis-index. Serum 25(OH)D levels were negatively associated with diastolic blood pressure. Gender-specific associations between anthropometric measures and high sensitivity C-reactive protein (hs-CRP) levels were observed. Hs-CRP was positively associated with WC and WHR in males and WHtR in females. Microalbuminuria (MAU), as determined by albumin-to-creatinine ratio, was present in 21% of the Turkish immigrants with T2D. Participants with hypertension were 6.58 times more likely (adjusted odds ratio) to have positive MAU as compared to normotensive participants. Our findings indicate that serum cotinine, 25(OH)D, hs-CRP, and MAU may be assessed as a standard of care for T2D management in the Turkish immigrant population. Further research should be conducted following cohorts to determine the effects of these biomarkers on CVD morbidity and mortality.

Type 2 diabetes is a devastating disease that has been rising in prevalence in the United States over the last 70 years, a rise which has paralleled the obesity epidemic and use of artificial sweeteners. This is especially concerning due to the many detrimental comorbid complications stemming from this potentially longstanding disease, including retinopathy, nephropathy, and neuropathy. Xylitol is an alternative sweetener that has been gaining popularity due to its intense sweetening power, as well as reported antidiabetic effects. Studies on rats induced with type 2 diabetes have found that xylitol helps in reducing blood glucose and insulin secretion, as well as increase protein and fat metabolism, post prandial satiety, and oxygen free radical destruction. These promising results have provided ample evidence to test the effects of xylitol on humans. The proposed study will examine the results of daily xylitol intake (0%, 2.5%, 5%, and 10%) on blood sugar levels over 1 year in newly diagnosed type 2 diabetics. Plasma samples will be taken 3 times during the study period to examine HbA1c, fasting blood glucose, Glucagon-Like Peptide 1, Cholecystokinin, and Superoxide Dismutase. At the end of 1 year of treatment, patient samples will be averaged into 6 month and 12 month results for each parameter and compared using ANOVA and student T-tests. We will test whether the results of this study mirror those seen in previous research on rats, that the antidiabetic effects of xylitol increase relative to concentration. This study hopes to provide further evidence on the need for xylitol supplementation in the diet of type 2 diabetics, either independently or to augment medical treatment, in helping to prevent progression of disease and reduce comorbid complications.

No description available.

Titre de l'écran-titre (visionné le 8 novembre 2023) / Un contrôle glycémique adéquat est essentiel chez les personnes vivant avec le diabète de type 2 (DT2) afin de prévenir les complications sur le long terme, dont les maladies cardiovasculaires. La prise en charge du DT2 doit donc permettre d'optimiser le contrôle glycémique via de saines habitudes de vie, dont l'alimentation est une partie intégrante, et l'utilisation de médication antihyperglycémiante. Toutefois, la relation entre la qualité alimentaire, l'intensité de la médication antihyperglycémiante et la qualité du contrôle glycémique n'a jamais été évaluée dans un contexte de vraie vie. Ce mémoire présente un portrait détaillé du DT2 et des approches préconisées pour sa prise en charge, ainsi qu'une étude transversale dont l'objectif était d'évaluer la relation entre la qualité de l'alimentation et l'intensité de la pharmacothérapie chez des adultes québécois vivant avec un DT2. Les résultats montrent que, globalement, il n'y avait aucune évidence d'association entre la qualité alimentaire et l'intensité de la médication antihyperglycémiante. Cependant, chez les personnes plus jeunes (hommes <50 ans, femmes <60 ans) et chez celles sans histoire de dyslipidémie et d'hypertension artérielle, la qualité alimentaire était inversement associée à l'intensité du traitement antihyperglycémiant. De plus, l'intensité de la pharmacothérapie antihyperglycémiante était inversement associée à la qualité du contrôle glycémique. Une tendance statistique suggérait également une relation favorable entre la qualité de l'alimentation et du contrôle glycémique. Ces résultats suggèrent un manque d'adéquation entre la qualité alimentaire et l'intensité de la pharmacothérapie au sein de cette cohorte d'adultes avec un DT2. La nature de cette relation résulte assurément d'interactions entre une multitude de caractéristiques individuelles et systémiques détaillées dans ce mémoire. Le développement d'approches favorisant la complémentarité entre de saines habitudes alimentaires et l'utilisation de médication antihyperglycémiante devrait tenir compte de ces facteurs afin de faciliter l'optimisation du contrôle glycémique et la prévention des complications. / Optimisation of glycemic management is essential in people living with type 2 diabetes (T2D) to prevent long-term complications, such as cardiovascular diseases. In this context, T2D management relies on healthy lifestyle habits, of which diet is a crucial part, and glucose-lowering medication use to reach and maintain glycemic targets. However, no study has yet assessed the relationship between diet quality, glucose-lowering medication intensity and glycemic management quality in a real-life setting. This thesis presents important concepts regarding T2D and its management, followed by a cross-sectional study whose objective was to assess the relationship between diet quality and glucose-lowering medication intensity among individuals living with T2D from Quebec. Results show that, overall, there was no evidence of an association between diet quality and glucose--owering medication intensity. However, in people who were younger (men <50 years, women <60 years) and in those without a personal history of dyslipidemia and hypertension, diet quality was inversely associated with pharmacotherapy intensity. Furthermore, glucose-lowering medication intensity was inversely correlated to glycemic management quality in the overall cohort. A statistical trend also suggested a favorable association between diet and glycemic management quality. These results suggest a lack of adequacy between diet quality and glucose-lowering medication intensity among this cohort of adults living with T2D. This relationship is likely the result of interactions between numerous individual and systemic characteristics, which are detailed in this thesis. Approaches promoting diet quality along with medication use in a complementary fashion should consider these elements in an effort to ease glycemic management optimization and prevent T2D complications.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Mélangez obésité, diabète et chirurgie bariatrique et vous obtiendrez ce mémoire. Il y sera question d’obésité, de son étiologie et de ses complications. Parmi celles-ci, nous traiterons majoritairement du diabète de type 2 (DT2) et de sa pathophysiologie. Lorsque nous combinons ces deux maladies, nous nous trouvons devant une combinaison complexe qui demande une intervention thérapeuthique. La plus efficace connue à ce jour est, sans contredit, la chirurgie bariatrique. La résolution du DT2 se produit rapidement après la chirurgie bariatrique, et ce indépendamment de la perte de poids. À ce jour, les mécanismes qui pourraient expliquer ces phénomènes sont mal compris. L’amélioration du DT2 varie selon le type de procédures. La dérivation biliopancréatique (DBP) est la chirurgie qui a le plus grand impact sur le renversement de la résistance à l’insuline, avec une résolution de la maladie jusqu’à 98 % des patients. Différents mécanismes ont été proposés, pour expliquer cet effet, comme la modulation de certaines hormones gastro-intestinales telles que le GLP-1 et le GIP. Ces hormones varient après la chirurgie en raison du réarrangement de l’anatomie intestinale. De plus, la restriction calorique sévère est connue depuis longtemps pour ses effets rapides sur l’homéostasie du glucose. À l’aide de notre étude nous avons voulu déterminer le rôle de la restriction calorique dans l’amélioration rapide de la sensibilité à l’insuline ainsi que la fonction des cellules β suite à la DBP. Pour ce faire nous avons administré un repas test avant et après la DBP soit au jour 3-4-5 post-opératoire afin de mesurer l’apport calorique, les courbes d’excursion glycémique ainsi que la sensibilité et la sécrétion d’insuline. Nous avions un groupe DT2 pairé à des sujets normo glycémiques (NG). Dans une autre étude effectuée parallèlement, un autre groupe de DT2 a subit le même repas test avant et après une restriction calorique identique à celle mesurée en post-opératoire. Ce même groupe était aussi en post opératoire. Les résultats ont démontrés une améloration du HOMA-IR chez les DT2 au jour 3 post DBP ainsi qu’après la restriction calorique. L’index de disposition (ID) s’améliore rapidement chez les DT2 autant après la DBP qu’après la restriction calorique. L’ID était plus haut chex les NG et ne changeait pas suivant la DBP. Les changements du glucagon like peptide-1, du gastric inhibitory peptide, du peptide tyrosine tyrosine, la ghrelin et du polypeptide pancréatique n’étaient pas associés avec la variation de l’ID observé chez les participant Il s’est avéré que l’amélioration de la résistance à l’insuline et de la fonction des cellules β sont similaires après trois jours de restriction calorique comparativement avec la DBP; et ce indépendamment des changements au niveau des incrétines. La restriction calorique est donc un mécanisme majeur dans la résolution du DT2 après la DBP. Mon mémoire fournit les bases physiologiques et cliniques afin de mieux comprendre ces mécanismes.

Diabetes typ 2 är en endokrin sjukdom där insulinfrisättningen från pankreas betaceller är nedsatt, vilket leder till insulinresistens. Det är en tyst och smygande sjukdom som främst upptäcks när patienter har utvecklat komplikationer. De vanligaste komplikationerna är ögon, njure, fot och hjärt- och kärlsjukdomar. Ärftlighet, hög ålder, fysisk inaktivitet och fetma är vanliga orsaker till diabetes typ 2, vilket gör att livsstilsförändringar exempelvis ökad fysisk aktivitet, viktminskning och sunda matvanor är betydelsefullt vid behandlingen av sjukdomen. Aktuellt examensarbete syftar till att beskriva vuxna patienters upplevelser av livsstilsförändringar vid diabetes typ 2. Det bygger på en litteraturstudie bestående av åtta kvalitativa artiklar. Resultatet består av följande huvudteman, en förändrad tillvaro, känna sig åsidosatt och känna sig hälsosam. Dessa huvudteman är uppbyggda av fem subteman så som ”kroppen spelar roll”, ”en inre kamp för livsstilsförändringar”, ”behov av information”, patientens möte med sjukvården”, ”bryta gamla vanor” och ”upplevelser av livsstilsförändringar”. Resultatet visar att drabbas av diabetes typ 2 innebär förändringar i patientens vardag, vilket ger känslan av en förändrad tillvaro. Det framkommer i resultatet att patienterna får ett otillfredsställande möte med hälso- och sjukvårdspersonal, vilket leder till att de känner sig åsidosatta. Därtill får patienterna en bristfällig information om diabetes typ 2, vilket innebär att de erhåller en ofullständig upplysning om livsstilsförändringar och komplikationer. Slutligen upplevde patienterna livsstilsförändringar som nödvändiga men svåra och energikrävande. Slutsatsen tydliggör patienternas behov av stöd, undervisning och vägledning, vilket är bra att sjuksköterskan blir medvetet om.

Background: Obstructive Sleep Apnea (OSA) is a chronic breathing disorder that is estimated to affect 20% of the US adult population. Intermittent hypoxia and sleep fragmentation caused by OSA likely affects cardiometabolic function. Individuals with OSA might be at risk of developing hypertension and type 2 diabetes (T2DM), with a dose-response relationship related to OSA severity. The objective of this study was to estimate the association between severity of OSA at diagnosis with 1) incidence of hypertension incidence of hypertension and 2) incidence of T2DM. Methods: We conducted a retrospective cohort study of Kaiser Permanente members diagnosed with OSA during 2000-2005. Adults without baseline hypertension or T2DM were eligible. Patients were excluded if hypertension or T2DM was diagnosed within one year prior to OSA diagnosis, and right censored at the end of follow-up or at the time Kaiser Permanente membership ended. Kaplan-Meier curves and Cox Proportional Hazard models were used to estimate the association between OSA severity and incident hypertension and incident diabetes. Results: Overall 719 patients were diagnosed with OSA during the study periods; 614 were included as those at risk of developing either hypertension (N=265) or T2DM (N=489). Overall, 261 had severe OSA at diagnosis. Those with severe OSA were more likely to be middle aged, overweight, and have prevalent hypertension or T2DM. Among those without prevalent hypertension at OSA diagnosis, 47.4% (126/266) were subsequently diagnosed with hypertension. Among those without prevalent T2DM at OSA diagnosis, 16.3% (80/491) were subsequently diagnosed with T2DM. After adjusting for BMI and prevalent T2DM, the hazard rate of incident hypertension among patients with severe OSA was 1.35 (95%CI: 0.88-2.06) compared to the rate among patients with mild OSA. The hazard rate of incident T2DM among patients with severe OSA was 1.49 (95%CI: 0.83-2.67) compared to the rate among patients with mild OSA after adjusting for BMI and prevalent hypertension. Discussion: We found high incidence rates of hypertension and T2DM among adults diagnosed with OSA. Severe OSA at diagnosis was associated with increased risk of either incident hypertension or T2DM, but not significantly (for p≤0.05).

African-American women (AAW) have had the largest increase in diagnosed diabetes in the US. Few studies have focused solely on dietary changes (one of the foundations for diabetes self-care), particularly in the context of family and the role of AAW. The purpose of this descriptive ethnographic study was to explicate cultural influences on food practices of AAW with type 2 diabetes (T2DM) in order to inform the health care community as well as future development of culturally-tailored interventions. Specific aims were to describe typical daily food practices and identify cultural influences on food practices of AAW with T2DM. Symbolic Interactionism, a sensitizing framework for viewing AAW with T2DM as a subculture, guided this study. Purposeful sampling was used to recruit 20 AAW who: were between 35 and 70 years of age, had been diagnosed with T2DM, shopped and prepared meals for their families, and attended church functions where food was served . Data collection consisted of one-one-one interviews and participant observation of church fellowship dinners, grocery shopping, and food preparation. A social anthropological approach to content analysis was used to describe behavioral regularities in food practices. Trustworthiness was maintained by an audit trail. Findings indicate that for informants in this study, who had diabetes ranging from 2 to 30+ years, there is a constant struggle between cultural food practices and eating healthier because of diabetes, particularly within the home setting where a majority of daily food practices take place. Difficulties in making dietary modifications result from conflicts between the need to change dietary practices to control diabetes and personal food preferences, as well as the preferences of people within the participants' social network. In addition, difficulties derive from AAW's emotional dedication to the symbolism of food and traditional cultural food practices. AAW are the gatekeepers for family food practices and are the keys to healthy dietary practices. This study begins to fill the research gap regarding cultural dietary food practices of this population. With increased knowledge, researchers and health care providers will be better able to improve AAW food practices, and ultimately improve diabetes control in this high-risk population. / text