No abstract available. / Thesis (DPhil)--University of Pretoria, 2010. / Biokinetics, Sport and Leisure Sciences / unrestricted

Question: Can passive static stretching lower blood glucose in an at-risk population? Design: Randomised, within-participant experimental study. Participants: 22 adults (17 males) either at increased risk of Type 2 diabetes or with Type 2 diabetes. Intervention: The participants reported to the laboratory 2. hr after eating a meal, and drank 355. ml of fruit juice (∼43. g carbohydrate). Thirty minutes later, they underwent either a 40. min passive static stretching regimen or a mock passive stretching regimen. Stretching consisted of six lower body and four upper body static passive stretches. For the mock stretches, the same positions were adopted, but no tension was applied to the musculature. Outcome measures: Blood glucose levels for both the stretching and mock stretching were analysed from a finger prick sample using a hand-held glucometer. Values were obtained at baseline (0. min), during the regimen (20. min), and after the regimen (40. min) on both study days. Results: Compared to mock stretch, stretching resulted in a significantly greater drop in blood glucose at 20. min (mean difference 28. mg/dL, 95% CI 13 to 43; or 1.57. mmol/L, 95% CI 0.72 to 2.39). This effect was also statistically significant at 40. min (mean difference 24. mg/dL, 95% CI 9 to 39; or 1.35. mmol/L, 95% CI 0.50 to 2.17). Conclusion: These results suggest that passive static stretching of the skeletal muscles may be an alternative to exercise to help lower blood glucose levels.

Background: Self-monitoring of blood glucose (SMBG) can inform on the timing of hyperglycaemia; however there is currently no standardised approach to utilise these data to improve glycaemic control in type 2 diabetes patients. Aims: To assess the efficacy of structured blood glucose testing in guiding an insulin titration algorithm in poorly controlled, insulin-treated type 2 diabetes patients. The secondary aim was to compare change in HbA1c between the study subjects and matched controls receiving standard treatment. Methods: This six-month prospective intervention recruited 39 poorly controlled (HbA1C ≥ 8.5% or 69.4 mmol/mol), type 2 diabetes subjects using twice-daily biphasic insulin from two public hospitals in Tshwane, South Africa. Patients were asked to perform structured SMBG over 4 weeks and return monthly for consultations where physicians titrated insulin doses using a standardised algorithm guided by the data collected. Post-hoc analysis was performed to assess glycaemic control of study participants compared to those receiving standard treatment. Results: It was found that mean HbA1c decreased over the study period by 1.89% (95% CI: -2.46 to -1.33, p-value<0.001). Mean SMBG and mean fasting plasma glucose (FPG) decreased by 1.6 mmol/L (95% CI: -2.5 to -0.6 mmol/L, p-value: 0.002) and 1.5 mmol/L (95% CI: -2.2 to -0.2 mmol/L, p-value: 0.024), respectively. Hypoglycaemic event rate (≤3.9 mmol/L) was 33.08 events per patient-year. Total daily insulin use increased by a mean 40.12 units.day-1 (SE: 7.7, p-value<0.001); weight increased by an average 3.98 kg (95% CI: 2.56 to 5.41, p-value <0.001) over the study period. Study participants were found to have a greater mean (SE) reduction of 0.777% (0.404) in HbA1c compared to patients receiving standard care, which fell short of statistical significance (95% CI: -1.569 to 0.015%, p-value: 0.054) due to lack of power (56.5%) in the post-hoc comparison. Conclusion: A structured SMBG programme that advises monthly algorithmic insulin titration can improve glucose control in type 2 diabetes patients using insulin, with moderate hypoglycaemic events and weight gain. / Dissertation (MSc)--University of Pretoria, 2016. / National Research Foundation (NRF) / Roche Products (South Africa) / School of Health Systems and Public Health, University of Pretoria / School of Medicine, University of Pretoria / School of Health Systems and Public Health (SHSPH) / MSc / Unrestricted

Periodontitis (PD) and type 2 diabetes mellitus (T2D) are chronic inflammatory diseases in which the host immune system encounters changes in its T and B cell distribution and function. Both disorders are increasingly prevalent in the U.S. and while T2D is a risk factor for periodontal disease, PD can exacerbate diabetes. Previous studies have unsuccessfully attempted to determine the underlying molecular mechanism for the relationships between T2D and periodontitis. To test directly the effect of T2D on periodontitis, I quantified cytokine production by gingival immune cells from three types of subjects: healthy, periodontal disease and T2D with periodontal disease, using single cells purified via flow cytometry and assessed for function with an enzyme-linked immunospot (ELISPOT) assay. The cells were sorted into subtypes according to CD45+, CD4+, CD8+, CD11b+, CD19+ and/or CD56+ expression, were stimulated by PMA, ionomycin or LPS, and were aliquoted into a well of a 96-well ELISPOT plate for 36 hours. Outcomes showed that CD4+ is the predominant cell population in lymphocytes and that gingiva tissues from periodontitis/T2D group produced higher concentrations of cytokines characteristic of the Th1 T cell subset, namely IL-2, IL-10, TNF-α and IFN-γ (p<0.05, <0.001, <0.001, <0.01, respectively) compared to tissues from either healthy or periodontitis group. This work illustrates that T2D increases inflammation in periodontitis through an increase in Th1 T helper cell function.

Obesity is a significant health care problem, affecting more than one third of the United States population and is an important risk factor for Type 2 Diabetes Mellitus (T2D). Adipose tissue expansion results in the recruitment and accumulation of macrophages, which secrete proinflammatory cytokines that impair insulin signaling. Adenosine regulates inflammation by signaling through G-protein coupled receptors (GPCRs), such as the A2b adenosine receptor (A2bAR). Recently a role for adenosine receptors has been described in the differentiation of osteoblasts and adipocytes. This thesis tests the hypothesis that the A2bAR regulates adipose tissue dynamics at the level of preadipocyte differentiation and macrophage inflammation. This thesis showed that activation of the A2bAR inhibited preadipocyte differentiation. A2bAR-induced adipocyte inhibition was dependent on the expression of Krüppel-like factor 4 (KLF4), which is important for stem cell maintenance and renewal. A2bAR knockdown enhanced adipogenesis in vitro and A2bAR knockout (KO) mice had more adipocytes as compared to wild type (WT) mice, suggesting enhanced adipogenesis in the absence of the A2bAR. The translational potential of this work is strengthened by the previous finding of elevated A2bAR expression in adipose tissue of obese individuals as well as our new finding of a close correlation between the expression of A2bAR and KLF4 in adipose tissue of obese individuals. A2bAR KO mice have impaired insulin resistance, in part due to reduced levels of insulin receptor substrate-2 (IRS-2). Proinflammatory cytokines have been shown to reduce IRS-2 levels. Given the role of the A2bAR in regulating inflammation, the contribution of A2bAR signaling in macrophages to insulin resistance was elucidated. Transgenic mice that express A2bAR only in macrophages were generated. Intriguingly, restoration of A2bAR signaling in macrophages ameliorated insulin resistance, glucose tolerance, and fat and liver tissue insulin signaling. As expected, tissue and plasma proinflammatory cytokine levels were reduced to that of WT mice. This suggested that the protective effect of A2bAR signaling on insulin resistance was due in large part to A2bAR control of macrophage cytokine expression. This thesis highlights the importance of A2bAR signaling in adipogenesis and in regulating inflammation in the setting of obesity and T2D.

Diabetes, a major public health challenge in St. Kitts, has been a focus of international public health community research. Although researchers have demonstrated that diabetes self-management education is a cost-effective strategy for the prevention of diabetes-related complications, they have yet to establish whether there is adequate education occurring in treatment settings with diabetic patients. The purpose of the study was to implement and evaluate the short-term effectiveness of a diabetes self-management education intervention on diabetes-related knowledge and accepted behavioral changes to decrease risk for complications. Based on a self-care approach, this education intervention was designed to improve diabetes-related knowledge and self-management behaviors. To test and evaluate the pre and post intervention effect, a convenience sample of 15 patients diagnosed with Type 2 diabetes attending a scheduled diabetic clinic completed the Diabetes Knowledge Test and a researcher-designed sociodemographic survey, which included self-report of blood glucose self-monitoring and foot care behaviors. The results of these analyses indicated that the participants’ knowledge level increased (p = < .001). However, Chisquare and Fisher’s exact tests determined no significant changes in the participants’ self management behaviors. The results may be attributed to the short time frame of the intervention. The implications for positive social change include opportunities to improve inter-professional collaboration in programs that will create positive effects on diabetic self care and reduce the incidence of negative health outcomes. Furthermore, the use of a self-care approach by health care professionals could be a key factor in strengthening diabetes knowledge, engagement, and self-management for Type 2 diabetic patients.

Indiana University-Purdue University Indianapolis (IUPUI) / Immigrants are at elevated risk for not having their diabetes treatment appropriately intensified, likely resulting in poorly-controlled diabetes and increased morbidity and mortality. Immigrant status is a powerful sociodemographic cue, yet its influence on providers’ diabetes treatment decisions is unknown. The study objective was to determine the effect of patient immigrant status on providers’ decisions to (1) take no action, (2) add an oral hypoglycemic agent (OHA), (3) add/switch to insulin, or (4) refer the patient to an endocrinologist. Participants were 140 medical students/professionals (‘providers’). Providers viewed profiles (videos + vignettes) for virtual patients differing in immigrant status (born in Mexico or U.S.; other characteristics held constant). Analyses were completed at the group (‘nomothetic’) and individual (‘idiographic’) levels. Nomothetic results indicated providers were less likely to refer foreign-born patients to endocrinology than U.S.-born patients (p=0.03). No differences were detected for the other three treatment likelihood ratings. Idiographic results indicated that about half of provider decisions were influenced by patient immigrant status (i.e., Cohen’s d≥0.50) across all four treatment decisions. Effect size data show an almost even split between higher treatment ratings for foreign-born vs. U.S.-born patients for three decisions (take no action, add an OHA, add/switch to insulin), explaining why group-level differences for these ratings did not emerge (i.e., they were cancelled out). This study found that providers are less likely to refer foreign-born patients to endocrinology, potentially leading to therapeutic inertia. In addition, half of individual-level provider decisions were meaningfully influenced by patient immigrant status. However, traditional group-level analyses mask these important individual-level differences. These systematic differences in treatment based on non-relevant factors could lead to unintended adverse outcomes for the foreign-born population.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20568号 / 医博第4253号 / 新制||医||1022(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 原田 浩, 教授 武藤 学, 教授 戸井 雅和 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

No description available.

Background: A cross-sectional design was employed to ascertain the relationship between dairy consumption and insulin resistance (IR) in 272 middle-aged, nondiabetic women. Methods: Participants kept a seven-day weighed food record to report their diets, including consumption of dairy foods. IR was assessed using the homeostatic model assessment (HOMA), using the following formula: fasting plasma insulin (µU/ml) x fasting plasma glucose (mg/dL)/405. The Bod Pod was used to examine body fat percentage, and accelerometry over a seven-day period was used to assess physical activity. HOMA values were log-transformed and regression analysis and the General Linear Model procedure were used to determine how mean HOMA differed across low, moderate, and high dairy intake groups. Results: (Mean ± SD) age: 40.1 ± 3.0 years, physical activity (average activity counts for one week, divided by 1,000): 2700.1 ± 781.9, body fat percentage: 31.7 ± 6.9, weight (kg): 66.1 ± 10.0, fasting glucose (mg/dL): 86.7 ± 5.9, fasting insulin (µU/mL): 7.0 ± 4.2, energy intake (kcal/day): 2051.9 ± 319.1, kcal from carbohydrate (%): 55.7 ± 6.2, kcal from protein (%): 13.8 ± 2.5, kcal from fat (%): 30.5 ± 5.8, soluble fiber (g per 1,000 kcal): 1.7 ± 0.9, insoluble fiber (g per 1,000 kcal): 3.8 ± 1.9, dairy intake (servings/day): 1.1 ± 1.0, HOMA: 1.5 ± 1.0, log-transformed HOMA: 0.3 ± 0.6. Those in the highest quartile for dairy consumption had significantly higher log-transformed HOMA (0.41 ± 0.53) than those in the moderate (0.22 ± 0.55) or low (0.19 ± 0.58) consumption categories (F = 6.90, p = 0.0091). This relationship remained significant after controlling for all covariates (F = 4.71, p = 0.030). Controlling for physical activity strengthened the relationship between dairy consumption and IR by 7%. Adjusting for body weight, percent of kcal from fat, and insoluble and soluble fiber intake also strengthened the relationship. Controlling for energy intake and body fat percentage weakened the relationship by 32% and 13%, respectively, though it remained significant. Conclusion: High dairy consumption is significantly associated with IR in middle-aged, nondiabetic women.