OBJECTIVE: Prolonged elevation of blood glucose levels in Type 2 Diabetes is related to a host of medical complications, most of which are mediated by micro and macro vascular damage. Importantly, diabetes is associated with accelerated cognitive decline and compromised brain health as the cerebral vasculature undergoes negative changes stemming from hyperglycemia. It is hypothesized that participants in the Look Ahead Brain study with higher HbA1c levels will exhibit worse performance on the cognitive measures, specifically on tasks assessing executive function. METHODS: Data on participants from the Look Ahead study who also participated in the Look Ahead Brain ancillary study (n = 113) were analyzed. This included HbA1c levels at year 10 (the year that participants were administered the cognitive assessment), mean HbA1c, and change in HbA1c from baseline to year. In order to assess executive function the results on two cognitive tests, the Modified Stroop Color and Word Test and the Trail Making Test, were analyzed. Then, relationships between HbA1c and performance on each of these cognitive tasks were analyzed using two approaches. First, the cohort was split into two group based on HbA1c (HbA1c ≤ 7% vs HbA1c > 7%). The latter of the two groups represented participants will poorer glycemic control. Second, linear correlations were assessed using the full range of HbA1c values as a continuous variable. RESULTS: There were no significant differences between HbA1c groups and performance on either of the cognitive tests. Interestingly, although not statistically significant, those with higher HbA1c levels performed slightly better on cognitive tasks. Correlation analyses revealed further trends in the direction opposite than expected, such that higher HbA1c levels were associated with better scores on both tests. CONCLUSION: The surprising results of this study are evidence of the fact that a great deal has yet to be learned about the effects of T2DM and cognitive decline. There are many potential future directions for the Look Ahead Brain data, and further analyses might provide clarifications to the results of this study.

No description available.

No description available.

The purpose of this study was to determine the prevalence of known risk factors associated with diabetes among James Moody Adams (JMA) clinic patients in order to develop and test educational material and clinical interventions to reduce the incidence of pre-diabetes and uncontrolled Type II Diabetes. The research objectives for this study focused on: 1. prevalence of Type II Diabetic patients at the Clinic; 2. pre- and post-test knowledge level of patients regarding their Type II Diabetes; 3. relationship between dependent variables (body mass index [BMI], blood glucose level, blood pressure, waist circumference, level of tobacco use, and level of depression) and the independent variables (age, gender, family history of diabetes, socio-demographical data [education level, level of income], literacy, and exercise regimen, medication, and diabetes knowledge); 4. effectiveness of a nutritional and lifestyle modification intervention program to control Type II Diabetes. Two hypotheses tests: 1. decrease blood glucose levels of Type II Diabetes Mellitus patients; 2. decrease weight by 5 percent among pre-diabetic and Type II Diabetes Mellitus patients. A follow-up survey determined participant's reflection on key dimensions of the study and impact of unforeseen political unrest that occurred during this study. The methodology was a case study with clinical and educational intervention across a 6 months. The population included patients presenting at the JMA clinic at onset of the study; an initial sample of 96 reduced to 48 due in part to political unrest was still within power test specification. Instrumentation include researcher developed, standard of care clinical practice and standardized forms. Analyses utilized descriptive statistics and t-test. Significant gain was determined for diabetic knowledge (p < 0.001); and significant decrease in Type II Diabetic blood glucose with p = 0.031. An important conclusion is that implementing a Type II Diabetic prevention program is feasible and effective in this study. Future recommendations include replication of the study and implementation of protocols and education that were successful in this study. / Ph. D.

Diss. (sammanfattning) Stockholm : Karol inst., 2003. / Härtill 5 uppsatser.

Ensaio clinico randomizado, constituído por 82 adultos com Diabetes Mellitus tipo 2, desenvolvido em Pachuca, Hidalgo no México, cujo objetivo foi avaliar os efeitos da utilização do protocolo Staged Diabetes Management no controle metabólico (pressão arterial sistólica e diastólica, índice de massa corporal, glicemia de jejum e capilar, hemoglobina glicada, colesterol total, HDL, LDL, triglicérides), conhecimento da doença e cuidados. A população constituiu-se pelas pessoas atendidas no período de junho a dezembro de 2007. Formaram-se dois grupos, aleatoriamente, um intervenção e outro controle. O grupo intervençao recebeu atenção de uma equipe multiprofissional, de acordo com as diretrizes do protocolo MDE e intervenções educativas grupais durante oito semanas, com carga horária de 16 horas e dois seguimentos trimestrais. O grupo controle manteve-se conforme rotina do serviço. As avaliações foram realizadas no início do estudo e nos terceiro e sexto meses seguintes. Para o processamento dos dados, utilizou-se o programa estatístico SPSS-15 e para as análises estatísticas, o teste t Student para as variáveis contínuas, qui-quadrado para as variáveis categóricas e o teste Wilks\' lambada para análise de associações inter grupos. A população do estudo ficou constituída por 41 pessoas adultas com DM2, respectivamente nos grupos intervenção e controle. No grupo intervenção houve predominância do sexo feminino (70,7%) enquanto que, no controle, do sexo masculino (51,2%). Em ambos, a faixa etária predominante foi de 50 |- 60 anos; as maiores freqüências foram para escolaridade \"primária\", ocupação \"empregado\" e estado civil \"casado\". Entre os parâmetros do controle metabólico alterados, destacam-se para os grupos, a pressão arterial sistólica perfil glicêmico, colesterol e triglicérides. Antes das intervenções os grupos apresentavam-se semelhanças, exceto para o sexo. Na análise de associações intra grupos, observaram-se mudanças significantes (p<0,005), na seguintes variáveis: entre a primeira e segunda medidas, houve diferenças nos valores da pressão arterial sistólica (t=2, 31, p=0,026); índice de massa corporal (t=5, 21, p=0,001); glicemia capilar (t=7, 06, p=0,001; glicemia plasmática (t=2, 09, p=0,043); hemoglobina glicada (t=4, 26, p=0,001); colesterol (t=3, 78, p=0,001); triglicérides (p=3, 38, p=0,002). Na terceira medida observaram-se diferenças significantes para as variáveis da pressão arterial sistólica (t=3, 61, p=.0001); pressão arterial diastólica (t=2, 42, p=0,002); Índice de Massa Corporal (t=4, 56, p=0,001); glicemia capilar (t=7, 98, p=0,001; glicemia plasmática (t=2, 89, p=0,006); hemoglobina glicada (t=9, 53, p=0,001); colesterol (t=6, 18, p=0,001); triglicérides (t=5, 52, p=0,001). O grupo controle mostrou diferenças significativas após a intervenção, na glicemia capilar e plasmática, porém, as médias são superiores às do grupo intervenção e fora dos parâmetros normais. Observaram-se diferenças significantes nos índices de conhecimentos (t=11.42, p<. 001), destacando-se que, aos três meses, no grupo intervenção houve aumento destes índices. Na análise de associação entre os grupos, observou-se que a variável pressão arterial sistólica, índice de massa corporal, glicemia capilar, hemoglobina glicada, colesterol, LDL e triglicérides, dos grupos intervenção e controle, entre as três medidas estão interagindo, indicando que o comportamento dos grupos não são os mesmos através das medidas. Os resultados do estudo apontaram para efeitos positivos das intervenções propostas no controle metabólico, no entanto, sugerem-se estudos para investigar a relação custo e benefício quando comparados a outros estudos de intervenções junto às pessoas com diabetes mellitus. / This randomized clinical essay was performed with 82 adults with Type II Diabetes Mellitus, in Pachuca, Hidalgo, Mexico. The purpose was to assess the effects that using the Staged Diabetes Management protocol had over metabolic control (systolic and diastolic blood pressure, body mass index, fasting and capillary glucose, glycosylated hemoglobin, total cholesterol, HDL, LDL, triglycerides), knowledge about the disease, and care. The population consisted of people seen from June to December 2007. Two groups, intervention and control, were composed at random. The intervention group was seen by a multiprofessional team, as recommended in the Staged Diabetes Management protocol, and received a total of 16 hours of group interventions during eight weeks, with two quarterly follow-up appointments. The control group was provided with the regular service. Assessments were performed at the beginning of the study and in the third and sixth following months. Data processing was done using the SPSS-15 statistical software, Student t test for statistical analyses, for continuous variable, chi-square, for categorical variables, and the Wilks\' lambada test to analyze intergroup association. Each group was composed of 41 adults with Type 2 Diabetes Mellitus. In the intervention group, most participants were women (70.7%) whereas in the control group, men prevailed (51.2%). In both, the predominant age group was 50 |- 60 years; the highest frequencies were in \"primary education\", \"employed\", and \"married\". Among the parameters for altered metabolic control, special emphasis is given to systolic blood pressure, glucose profile, cholesterol and triglycerides. Prior to the interventions, the groups were similar except in terms of gender. The intragroup association analysis showed there were significant changes (p<0.005) in the following variables, between the firts and second measurements: systolic blood pressure (t=2.31, p=0.026); body mass index (t=5.21, p=0.001); capillary glucose (t=7.06, p=0.001; plasma glucose (t=2.09, p=0.043); glycosylated hemoglobin (t=4.26, p=0.001); cholesterol (t=3.78, p=0.001); triglycerides (p=3.38, p=0.002). In the third measurement it was observed there were significant changes for the variables regarding systolic blood pressure (t=3.61, p=0. 0001); diastolic blood pressure (t=2.42, p=0.002); Body Mass Index (t=4.56, p=0.001); capillary glucose (t=7.98, p=0.001; plasma glucose (t=2.89, p=0.006); glycosylated hemoglobin (t=9.53, p=0.001); cholesterol (t=6.18, p=0.001); triglycerides (t=5.52, p=0.001). The control group showed significant differences after intervention on capillary and plasma glucose; however, the means are above those of the intervention group and not within the normal standards. Significant differences were observed in the knowledge rates (t=11.42, p<<. 001), and it is worth emphasizing that, at three months, in the intervention group, those rates increased. The analysis of the association between the groups showed that there is an interaction among the variables systolic blood pressure, body mass index, capillary glucose, glycosylated hemoglobin, cholesterol, LDL and triglycerides in the intervention. This shows that the groups\' behaviors are not the same. The results revealed that the proposed interventions have positive effects over the metabolic control, however, further studies are needed in order to analyze cost effectiveness in comparison with other studies of intervention among people with diabetes mellitus.

Submitted by Suzana Dias (suzana.dias@famerp.br) on 2018-10-18T19:07:46Z No. of bitstreams: 1 LucianaNevesCosensoMatin_tese.pdf: 9100904 bytes, checksum: 8377e4f9c53810a2aa89b71e454e7aea (MD5) / Made available in DSpace on 2018-10-18T19:07:47Z (GMT). No. of bitstreams: 1 LucianaNevesCosensoMatin_tese.pdf: 9100904 bytes, checksum: 8377e4f9c53810a2aa89b71e454e7aea (MD5) Previous issue date: 2017-02-02 / Several trials have shown that dipeptidyl peptidase-4 (DPP-4) inhibitors, used to treat patients with diabetes mellitus type 2 (T2DM), improve endothelial function. Objectives: The current study investigated the effects of vildagliptin, a DPP-4 inhibitor, compared to glibenclamide on endothelial function and arterial stiffness (AS) in patients with T2DM and hypertension (HT). Casuistics and Methods: This trial was a prospective randomized, open label, controlled by drug. Fifty patients aged over 35 years with T2DM and hypertension, without cardiovascular disease, were randomly allocated to treatment with vildagliptin (n=25) or glibenclamide (n=25). Both groups used metformin. A 24-h non-invasive ambulatory blood pressure monitoring and assessment of endothelial function were performed before and after 12 weeks of treatment. Endothelial function was evaluated by peripheral artery tonometry (Endo- PAT 2000), measuring the reactive hyperemia index (RHI) and arterial stiffness. AS was also evaluated by augmentation index (Aix@75), pulse wave velocity (PWV) and central systolic blood pressure (cSBP) parameters with a portable compact digital BP recorder Mobil-O-Graph® 24-hour PWA monitor. The primary study outcome was change in the RHI after vildagliptin vs. glibenclamide treatment. Results: There were no changes in RHI in the vildalgliptin group (before 2.348 ± 0.5868; after 2.2408 ± 0.6019, P = 0.742) or in the glibenclamide group (before 2.3636 ± 0.5163; after 2.3375 ± 0.4996, P = 0.950) and no difference between groups (P = 0.5479). There was no difference between vildagliptin and glibenclamide treatment in AIx@75 PAT (P = 0.696), in 24-hs: cSBP (P = 0.274) and in PWV (P = 0.324). Conclusions: Vildagliptin in patients with T2DM and HT did not change endothelial function and AS during 12 weeks. Thus, this drug has a neutral effect on vascular function, providing its effectiveness for the treatment of patients with cardiovascular disease. / Vários estudos demonstraram que os inibidores da dipeptidyl peptidase-4 (DPP-4), usados no tratamento de pacientes portadores de diabetes mellitus do tipo 2 (DM 2), melhoraram a função endotelial. Objetivos: O presente estudo avaliou os efeitos da vildagliptina, um inibidor de DPP-4, comparado à glibenclamida (sulfonilureia), na função endotelial, na rigidez arterial e na pressão arterial de 24 horas de pacientes com DM 2 e hipertensão arterial (HA). Casuística e Métodos: Este foi um estudo prospectivo, randomizado, aberto, controlado por fármaco, que incluiu cinquenta pacientes com idade superior a 35 anos, com DM 2 e HA, livres de doença cardiovascular, randomizados para tratamento com vildagliptina ou glibenclamida. Metformina foi adicionada a todos os pacientes. A monitorização ambulatorial de pressão arterial de 24 horas e avaliação da função endotelial foram realizadas antes e após 12 semanas de tratamento. A função endotelial foi avaliada pela tonometria arterial periférica (Endo-PAT 2000), que calcula o índice de hiperemia reativa (IHR) e a rigidez arterial por meio do augmentation index (Aix@75). A rigidez arterial também foi avaliada por parâmetros do Aix@75, velocidade da onda de pulso (VOP) e pressão arterial sistólica central (PSc) por meio de monitorização ambulatorial de 24 horas usando Mobil-O-Graph® PWA. O desfecho primário foi variação do IHR após tratamento com vildalgiptina comparado ao tratamento com glibenclamida. Resultados: Não houve diferença no IHR no grupo da vildagliptina (antes 2,348 ± 0,5868; depois 2,2408 ± 0,6019, P = 0,742) ou no grupo da glibenclamida (antes 2,3636 ± 0,5163; depois 2,3375 ± 0,4996, P = 0,950) e entre os grupos (P = 0,5479). Similarmente, o tratamento com vildagliptina e glibenclamida não produziu efeitos no AIx@75 PAT (P = 0,696), na 24-hs: PSc (P = 0,274) e na VOP (P = 0,324). Conclusões: O tratamento durante 12 semanas com vildagliptina em pacientes portadores de DM 2 e HA não alterou a função endotelial e nem a rigidez arterial. Assim, este fármaco apresenta uma ação neutra na função vascular, confirmando sua segurança no tratamento de pacientes com doença cardiovascular.

No description available.

Bakgrund: I Sverige finns det cirka 365 000 diabetiker. Diabetes typ II är en kronisk sjukdom som gör att de som har denna sjukdom behöver ha kontinuerlig kontakt med en sjuksköterska. I denna kontakt är det viktigt att sjuksköterskan ser alla patienter som individer med olika behov. Diabetes typ II uppkommer bland annat på grund av övervikt, matvanor, stillasittande livsstil samt rökning. Behandlingen består av ändrade kost- och motionsvanor, tabletter eller insulin. Syfte: Syftet med studien var att belysa hur patienter med diabetes typ II upplever sin sjukdom samt mötet med sjukvården. Metod: Studien är en allmän litteraturstudie baserad på 11 vetenskapliga artiklar som blev analyserade. Resultat: Efter analys av artiklar framkom tre centrala teman som utgör resultatet: Att få sjukdomsbeskedet, Rädsla för komplikationer och förnekelse, Att ta kontroll över sjukdomen och acceptera sjukdomen. Diskussion: De tre centrala fynd som presenteras i diskussionen är: Ett övergripande fynd om hälsa. Ett andra fynd om bristande information och ett sista fynd om skillnader mellan män och kvinnors syn på att leva med diabetes typ II. / Background: In Sweden there is about 365 000 diabetics. Type II diabetes is a chronic disease which makes this into a disease where the diabetic need to have a continues contact with a nurse. In this meeting it is important that the nurse sees the patients like individuals with a variation of needs. Type II diabetes occurs from various reasons like overweight, diet, sedentary lifestyle and smoking. The treatment consists of changed diet- and exercise habits, tablets or insulin. Aim: The aim of the studie was to enlight how patients with type II diabetes experience their disease and the meetings with the health care system. Method: A literature review based on 11 articles that got analysed. Results: The analysis of the articles resulted in three central themes that represents the results: To receive the diagnosis, fear of complications and denial, to take control of the disease and to accept the disease. Discussion: The three central findings that were represented in the discussion where: An overall finding about health. Another finding was lack of information and the last finding is about differences in men and women view of living with type II diabetes.

This thesis is a series of investigations into the regulation of skeletal muscle mitochondrial metabolism. Novel regulatory mechanisms regarding mitochondrial fatty acid oxidation are continually being identified and alterations in skeletal muscle mitochondrial metabolism have been implicated in the pathogenesis of type II diabetes (T2DM). Therefore, advancing our basic understanding of mitochondrial regulatory processes is required to provide insight into the progression of T2DM. In study one, the utilization of knockout mice for the putative mitochondrial fatty acid transport protein FAT/CD36, showed that mitochondrial FAT/CD36 plays a functional role in mitochondrial long chain fatty acid (LCFA) oxidation. Specifically, FAT/CD36 was found to be located on the outer mitochondrial membrane (OMM) upstream of acyl-CoA synthetase. In study two, it was observed that in rat muscle, malonyl-CoA (M-CoA) inhibition kinetics of carnitine palmitoyltransferase I (CPT-I) display a more physiological IC50 in permeabilzed muscle fibre bundles (PmFB) compared to isolated mitochondria. These data suggest that the cytoskeleton may have a role in regulating M-CoA inhibition. Additionally, a significant effect of LCFA-CoA on M-CoA inhibition kinetics was observed. These data indicate that M-CoA content does not need to decrease to promote an increase in CPT-I flux. Finally, in a model of T2DM (ZDF rat), submaximal ADP-stimulated respiration rates and the content of adenine nucleotide translocase 2 (ANT2) content were depressed compared to lean control animals. Resveratrol treatment in ZDF rats recovered these declines concomitantly with improving insulin-stimulated skeletal muscle glucose uptake and the cellular redox state. A number of novel findings are presented, specifically, 1) a functional role for mitochondrial FAT/CD36 in mitochondrial LCFA oxidation was confirmed and the topology of this protein along the OMM is expanded upon, 2) M-CoA inhibition kinetics of CPT-I were re-evaluated in PmFB and a regulatory role of LCFA-CoA on M-CoA inhibition kinetics is established, and 3) submaximal ADP-stimulated respiration rates and ANT2 content are depressed in the ZDF rat and resveratrol supplementation prevents these decrements.