Type 2 diabetes (T2DM) is a growing concern worldwide, particularly among Aboriginal Canadians. Diet has been associated with diabetes risk, and dietary pattern analysis (DPA) provides a method in which whole dietary patterns may be explored in relation to disease. Factor analysis (FA) and reduced rank regression (RRR) of data from the Sandy Lake Health and Diabetes Project identified patterns associated with incident T2DM at follow-up. A RRR-derived pattern characterized by tea, hot cereal, and peas, and low intake of high-sugar foods and beef was positively associated with diabetes; however, the relationship was attenuated with adjustment for age and other covariates. A FA-derived pattern characterized by processed foods was positively associated with incident T2DM in a multivariate model (OR=1.38; CIs: 1.02, 1.86 per unit), suggesting intake of processed foods may predict T2DM risk.

Darbo objektas: Fizinis aktyvumas, mityba ir antrojo tipo cukrinis diabetas. Darbo tikslas: Įvertinti fizinio aktyvumo, mitybos ir antrojo tipo cukrinio diabeto sąsają. Darbo uždaviniai: 1. Įvertinti vyresnio amžiaus sveikų žmonių ir sergančių 2 tipo cukriniu diabetu kūno masės indeksą, išsilavinimą ir rūpinimąsi savo sveikata. 2. Įvertinti vyresnio amžiaus sveikų žmonių ir sergančių 2 tipo cukriniu diabetu fizinio aktyvumo ypatumus. 3. Įvertinti vyresnio amžiaus sveikų žmonių ir sergančių 2 tipo cukriniu diabetu mitybos ypatumus. Hipotezė: 2 tipo cukriniu diabetu sergantys asmenys yra fiziškai pasyvesni ir vartoja daržovių bei vaisių mažiau nei asmenys nesergantys 2 tipo cukriniu diabetu. Asmenys sergantys 2 tipo cukriniu diabetu yra fiziškai pasyvūs, bet vartoja mažiau saldumynų, bei dažniau valgo pusryčius. Išvados: 1. Tarp sergančių, 2 tipo cukriniu diabetu, asmenų vyrauja nutukimas. Didžioji dalis tiriamųjų savo sveikatą vertina petenkinamai. 2. 2 tipo cukriniu diabetu sergantys asmenys nėra pakankamai aktyvūs, jie lyginant su nesergančiais juda dvigubai mažiau. 3. Sergantys asmenys dažniau valgo pusryčius, nei nesergantys 2 tipo cukriniu diabetu. Sergantieji vartoja mažiau alkoholio ir saldumynų. / Object of study: Lifestyle, physical activity, nutrition and type 2 diabetes mellitus. Aim of study: To evaluate link between the physical activity, nutrition and the second type of diabetes mellitus. Goals of study: 1. Rate of older people with type 2 diabetes body mass index, education and carrying their health. 2. Rate of older people with type 2 diabetes physical activity characteristics. 3. Rate of older people with type 2 diabetes nutrition features. Hypothesis: Persons with type 2 diabetes mellitus are moving and eating vegetables less than persons without type 2 diabetes mellitus. Persons with type 2 diabetes are physically passive, but consume less sweets and more frequent eating breakfast. Conclusion of study: 1. Among the persons with type 2 diabetes mellitus dominating obesity. Most of the patients their health valuating by average. 2. Persons with type 2 diabetes mellitus are not active enough. 3. The patients with type 2 diabetes mellitus eating more often than persons without type 2 diabetes mellitus. It is also less using alcohol.

There is growing interest in the potential role of omega-3/fibre-rich seeds in attenuating obesity and other cardiovascular disease (CVD) risk factors in individuals with type 2 diabetes mellitus (T2DM). Preliminary data suggests that consumption of white Salvia hispanica L. (Salba®) seeds prolongs satiety and may aid weight loss. This randomized, double-blind, parallel study assessed the efficacy and safety of Salvia hispanica in overweight/obese individuals with T2DM on weight, body composition, glycemic control and other CVD risk factors. Fifty-eight participants consumed a hypocaloric diet including Salvia hispanica or an energy-and-fibre-matched control over 24 weeks. Greater reductions in weight, waist circumference and inflammation occurred in the Salvia hispanica group versus control. There were no significant between-group differences in safety parameters, glycemic control or other CVD risk factors. Salvia hispanica seeds may support weight loss in overweight/obese individuals with T2DM. Further research is needed to determine whether these effects are maintained.

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Background and aims: The overall aim of this thesis was to increase knowledge regarding the occurrence of childhood onset T1D and T2D in Sweden and in relation to that describe and elucidate important aspects on two grave complications to diabetes; end-stage renal disease (ESRD) and mortality. The two first studies included in this thesis aimed to describe and analyze the cumulative incidence of childhood onset T1D in Sweden and to assess the occurrence of undetected T2D in Swedish children. The aim with the third study was to describe the cumulative incidence of ESRD, and to analyze how ESRD risk differs with age at-onset and sex. The aim of the fourth study was to show how parental socioeconomic status (SES) affects all cause mortality in Swedish patients with childhood onset T1D. Study populations: The foundation for the studies on T1D was data from the Swedish Childhood Diabetes Registry (SCDR). When studying ESRD we also included adult onset T1D cases from the Diabetes Incidence Study in Sweden (DISS). The study on T2D was a population-based screening study where BMI was measured in 5528 school-children and hemoglobin A1c was measured in children with overweight according to international age and sex specific BMI cut-offs. To study ESRD and mortality, we linked the SCDR to various nationwide registers containing individual information on SES, mortality and ESRD. Results: The incidence rates of childhood onset T1D has continued to increase in Sweden 1977–2007. Age- and sex-specific incidence rates varied from 21.6 (95% CI 19.4–23.9) during 1978–1980 to 43.9 (95% CI 40.7– 47.3) during 2005–2007. Cumulative incidence by birth-cohorts has shifted to a younger age at-onset over the first 22 years of incidence registration. From the year 2000 there was a significant reverse in this trend (p<0.01). In contrast to the increase of T1D, we found no evidence of undetected T2D among Swedish school children. Despite a relatively high incidence in T1D in Sweden there is low cumulative incidence of ESRD, 3.3% at maximum 30 years of duration. We found difference between the sexes regarding long-term risk of developing ESRD that was dependent on the age at onset of T1D. When analyzing how socioeconomic status affects mortality in different age at death groups, we found that having parents that received income support increased mortality up to three times in those who died after 18 years of age. Conclusion: The incidence of childhood onset T1D continued to increase in Sweden 1978-2007. Between the years 1978-1999 there was a shift to a younger age at-onset, but from the year 2000 there is a change in this shift indicating a possible trend break. The prevalence of T2D among Swedish children up to 12 years of age is probably very low. There is still a low cumulative incidence of T1D associated ESRD in Sweden. The risk of developing ESRD depends on age at-onset of T1D, and there is a clear difference in risk between men and woman. Excess mortality among subjects with childhood onset T1D still exists, and low parental socioeconomic status additionally increased mortality in this group.

Background: Physical activity (PA) is an important component of type 2 diabetes management, yet the amount and type of PA support provided by different types of health care providers (HCPs) is largely unknown. Purpose: This study identified differences in the amount and type of PA supports provided by HCPs, and determined whether HCPs use the Canadian Diabetes Association (CDA) PA guidelines or Canada’s Physical Activity Guide (CPAG) in practice. Methods: Eight of 14 Winnipeg Regional Health Authority primary care clinics specializing in diabetes education agreed to participate in the study. In-person interviews were conducted with health care providers (n=48) and patients with type 2 diabetes (n=26). HCPs were given a total PA support score based on scores in three subcategories behaviour change support (BC), assessment/prescription support (AP) and information/referral/community resources support (IRCR), as reported by HCPs themselves and patients. Results: There was no difference in PA support between the 3 HCP types, but there was a significant difference between HCP report and patient report of PA support. Just over one half of HCPs report using the CDA guidelines unprompted or prompted. Conclusions: HCPs recognize the importance of PA in type 2 diabetes management, but implementing strategies to increase certain types of PA support and facilitate understanding between HCPs and patients would allow for optimal PA counseling in primary care.

Objectives: The incidence of type 2 diabetes mellitus (DM2) is on the rise worldwide. The primary objective was to determine the prevalence of nutrient inadequacy and excessiveness in persons with DM2 with and without diabetic peripheral neuropathy (DPN). Study Design: A validated semi-quantitative food frequency questionnaire was used to determine the prevalence of inadequacy of nutrients with an estimated average requirement; the mean intake of nutrients with an adequate intake; and the proportion of persons not meeting the recommendations for the acceptable macronutrient distribution range (AMDR). Results: Differences were observed in the prevalence of inadequacy of vitamin A and the proportion of persons not meeting the AMDR for total fat, linoleic acid and carbohydrate. Conclusion: The aforementioned nutrients may have a significant role in the progression/development of DPN and should be studied in further detail. We recommend a balanced diet and use of a multi-vitamin for persons with DM2.

There is growing interest in the potential role of omega-3/fibre-rich seeds in attenuating obesity and other cardiovascular disease (CVD) risk factors in individuals with type 2 diabetes mellitus (T2DM). Preliminary data suggests that consumption of white Salvia hispanica L. (Salba®) seeds prolongs satiety and may aid weight loss. This randomized, double-blind, parallel study assessed the efficacy and safety of Salvia hispanica in overweight/obese individuals with T2DM on weight, body composition, glycemic control and other CVD risk factors. Fifty-eight participants consumed a hypocaloric diet including Salvia hispanica or an energy-and-fibre-matched control over 24 weeks. Greater reductions in weight, waist circumference and inflammation occurred in the Salvia hispanica group versus control. There were no significant between-group differences in safety parameters, glycemic control or other CVD risk factors. Salvia hispanica seeds may support weight loss in overweight/obese individuals with T2DM. Further research is needed to determine whether these effects are maintained.

<p>Abstract</p><p>Problem: African Americans face a disparate risk for renal disease development secondary to type 2 diabetes (T2D), and African-American women have shown to be at the highest risk. Despite this, there is minimal research on African American's awareness of renal disease and existing renal disease risk perceptions, and none focused specifically on African-American women with T2D. Although the literature has shown that a portion of this disparate risk is due to modifiable social and cultural factors, there is still a significant amount of unexplained risk. Since past research has shown that risk perceptions can influence preventative behaviors, it is important to gain an in-depth understanding of renal disease beliefs and existing risk perceptions among high-risk African-American women with T2D. Once risk perceptions are better understood in this population, interventions can be developed to correct inaccurate beliefs and risk perceptions and aim to decrease renal disease risk.</p><p>Methods: Three different methods of analyses were employed in this dissertation, including: 1) a systematic review of the literature, 2) an exploratory, descriptive, qualitative study, and 3) a quantitative secondary analysis, including descriptive statistics, a cluster analysis and mixed modeling. The Common Sense Model guided all three studies and these three methods of evaluation helped us to gain a more complete understanding of renal disease risk perceptions in African Americans, particularly African-American women with T2D, and provided guidance for future intervention research in this population. </p><p>Conclusions: The findings of this dissertation illustrated there is a significant gap in the literature on African American's renal disease awareness and risk perceptions, yet the available research was used to guide the in-depth interviews with African-American women with T2D. Overall, African Americans underestimate their renal disease risk and lack an understanding of the disease, even in the presence of risk factors. African-American women, in particular, related renal disease directly to the end-stages of the disease, perceived a greater risk for other complications of diabetes, and exhibited significant fear related to their perceived consequences of the disease. This fear frequently initiated maladaptive coping mechanisms, which influenced risk perceptions negatively and hindered preventative behaviors. This study also found that health care providers rarely discussed the disease and often exhibited provider control. Therefore, these findings suggest an urgent need for clinical practice suggestions and intervention research aimed at correcting inaccurate risk perceptions. The secondary analysis findings showed that a culturally relevant intervention with coping skills training resulted in significant improvements in renal disease risk factors among high-risk African-American women with T2D; however, we cannot be sure which facets of the intervention or control care for equal attention may have influenced these outcomes, and renal disease beliefs and risk perceptions were not assessed in the parent study. Therefore, the knowledge gained from this dissertation can be used to guide intervention research that evaluates change over time in renal disease risk representations, risk perceptions, coping procedures and outcomes among participants at high-risk for renal disease.</p> / Dissertation