Dissertations / Theses on the topic 'Non-insulin-dependent diabetes – Diet therapy'

This thesis reports on studies validating a modification of 'minimal' model analysis of the FSIVGTT to measure insulin resistance specifically in NIDDM subjects and its use along with a mixed meal test incorporating measurement of specific insulin and proinsulin concentrations to quantify changes in beta-cell function and insulin resistance following two years of diet or sulphonylurea treatment in established NIDDM. All NIDDM subjects displayed severe beta-cell dysfunction (post-prandial insulinopenia and hyperproinsulinaemia) and insulin resistance when compared to age and sex matched normals. Therapeutic interventions failed to normalise either of these abnormalities. Dietary therapy resulted in improved glycaemic control, weight loss and improved insulin sensitivity but most especially improved beta-cell function (increased post-prandial insulin secretion, reduced proinsulin concentrations) at the one year assessment. Two years post-diagnosis post-prandial proinsulin concentrations continued to fall whilst insulin concentrations mirrored those at the time of presentation. Sulphonylurea therapy also resulted in improved glycaemic control but with significant weight gain. Insulin sensitivity tripled over the two year period and beta-cell function also improved after initial increases in both post-prandial insulin secretion and proinsulin concentrations at the one year assessment Reduced 'glucose toxicity' appeared to be a major factor affecting the changes in the measured parameters in both groups of subjects. For diet treated individuals, it is suggested that this reduction rapidly maximises beta-cell function and insulin sensitivity to a predetermined level. Maintenance of glycaemic control subsequently is dependent of factors more difficult (diet, exercise, weight) or impossible to control (time). For sulphonylurea treated subjects, reduction in 'glucose toxicity' was important in improving beta-cell function and insulin sensitivity but the drugs themselves exerted an independent effect, especially on sustained increases in insulin secretion. It is suggested that the continuous use of sulphonylureas may play a causal role in the ultimate deterioration in glycaemic control frequently seen in patients who initially appear to benefit from their effects.

INTRODUCCIÓ: La teràpia nutricional és un dels pilars del tractament de la diabetis tipus 2 (DM2). Diverses organitzacions nacionals i internacionals de nutrició i diabetis recomanen el consum de peix (preferentment peix blau) com a mínim 2 cops a la setmana per prevenir la malaltia cardiovascular. Tot i això, existeixen molt pocs estudis que hagin investigat els efectes de la inclusió del peix blau en el control glucèmic i la sensibilitat a la insulina de pacients amb DM2. OBJECTIUS: L’objectiu primari d’aquesta tesi va ser investigar els efectes d’una dieta rica en sardina en els valors d’hemoglobina glicosilada (HbA1c) de pacients amb DM2 sense tractament antidiabètic. Els objectius secundaris van ser investigar els efectes de la intervenció dietètica en la resistència a la insulina, les concentracions d’adiponectina, marcadors d’inflamació, la pressió arterial, la freqüència cardíaca, el perfil lipídic, la microbiota intestinal, la composició d’àcids grassos en membranes d’eritròcits i la qualitat de vida dels pacients. METODOLOGIA: 35 pacients amb DM2 sense tractament antidiabètic van ser randomitzats per seguir una dieta amb recomanacions generals per la DM2 (grup control: GC), o una dieta amb recomanacions generals per la DM2 enriquida amb 100g de sardina en llauna 5 cops a la setmana (grup sardina: GS) durant 6 mesos. Abans i després de la intervenció dietètica es van determinar l’antropometria, hàbits alimentaris i història dietètica, l’HbA1c, la glucosa, la insulina, l’adiponectina, marcadors d’inflamació, la pressió arterial, la freqüència cardíaca, la composició d’àcids grassos en membranes d’eritròcits i la composició de grups bacterians específics de la microbiota intestinal. Abans i després de la intervenció dietètica també es va avaluar la qualitat de vida dels pacients. RESULTATS: L’HbA1c i la glucosa en dejú van disminuir en els dos grups als 6 mesos de la intervenció dietètica (GS: -0,2 ± 0,1% HbA1c, -9,6 ± 5,4 mg/dL glucosa; GC: -0,3 ± 0,1% HbA1c, -5,2 ± 5,5 mg/dL glucosa) sent només significativa la reducció de l’HbA1c en el GC (p=0,01) respecte els valors basals. Els dos grups d’intervenció van disminuir de manera significativa la insulina plasmàtica (GS: -35%, p=0,01; GC:-22,6%, p=0,02) i el model homeostàtic de resistència a la insulina (HOMA-IR) (SG: -39,2%, p=0,007; CG: -21,8%, p=0,04) als 6 mesos respecte els valors basals. Tot i això, només el GS va incrementar l’adiponectina en plasma en comparació amb l’inici de l’estudi (+40,7%, p=0,04). L’índex omega-3 va augmentar significativament d’un 5,3% a un 8% al GS respecte el GC (p=0,001). Les dues intervencions dietètiques van disminuir les concentracions del fílum Firmicutes (GS i GC: p=0,04) i van incrementar les de grup E. coli (GS: p=0,01, CG: p=0,03) respecte els valors basals. Només el GS va diminuir el ratio Firmicutes/Bacteroidetes (p=0,04) i va incrementar el grup Bacteroides- Prevotella (p=0,004). Tot i que la pressió arterial i el perfil lipídic no es van modificar en resposta a la dieta enriquida amb sardina, si va disminuir la freqüència cardíaca (p=0,01). Els pàrametres de qualitat de vida valorats no es van modificar de manera significativa en el GS en comparació amb el GC. CONCLUSIONS: Els resultats d’aquesta tesi suggereixen que la inclusió de 100g de sardina 5 dies a la setmana durant 6 mesos no millora el control glucèmic però podria tenir efectes beneficiosos sobre el risc cardiovascular de pacients amb DM2 aconseguint valors òptims d’índex omega-3. A més, l’increment d’adiponectina observat en el GS podria indicar beneficis en la inflamació metabòlica, i la modificació de bactèries intestinals específiques en resposta a la dieta rica en sardina revela l’estreta relació entre components dietètics i la microbiota intestinal. Igualment, els resultats mostren que tan una dieta amb recomanacions generals per la DM2 com una dieta rica en sardina poden millorar la resistència a la insulina de pacients amb DM2.
BACKGROUND: Nutrition therapy is the cornerstone of treating diabetes mellitus. The inclusion of fish (particularly oily fish) at least two times per week is recommended by current international dietary guidelines for type 2 diabetes. In contrast to a large number of human studies examining the effects of oily fish on different cardiovascular risk factors, little research on this topic is available in patients with type 2 diabetes. OBJECTIVES: The main objective of this thesis was to investigate the effects of a sardine-enriched diet on glycemic control of drug-naïve patients with type 2 diabetes. The secondary objectives were to investigate the effects of the dietary intervention on insuline resistance, adiponectin, inflammatory markers, blood pressure, heart rate, lipid profile, gut microbiota, erythrocyte membrane fatty acid (EMFA) composition and quality of life of drug-naïve patients with type 2 diabetes. METHODS: 35 drug-naïve patients with type 2 diabetes were randomized to follow either a type 2 diabetes standard diet (control group: CG), or a standard diet enriched with 100 g of sardines 5 days a week (sardine group: SG) for 6 months. Anthropometric, dietary information, quality of life evaluation, fasting glycated hemoglobin, glucose, insulin, adiponectin, inflammatory markers, blood pressure, heart rate, EMFA and specific bacterial strains were determined before and after intervention. RESULTS: There were no significant differences in glycated hemoglobin and fasting glucose between groups at the end of the study (SG: -0,2 ± 0,1% HbA1c, -9,6 ± 5,4 mg/dL fasting glucose; CG: -0,3 ± 0,1% HbA1c, -5,2 ± 5,5 mg/dL fasting glucose). Both groups decreased plasma insulin (SG: −35.3 %, P  =  0.01, CG: −22.6 %, P  =  0.02) and homeostasis model of assessment - insulin resistance (HOMA-IR) (SG: −39.2 %, P  =  0.007, CG: −21.8 %, P  =  0.04) at 6-months from baseline. However only SG increased adiponectin in plasma compared to baseline level (+40.7 %, P  =  0.04). The omega-3 index increased 2.6 % in the SG compared to 0.6 % in the CG (P  =  0.001). Both dietary interventions decreased phylum Firmicutes (SG and CG: P  =  0.04) and increased E. coli concentrations (SG: P  =  0.01, CG: P  =  0.03) at the end of the study from baseline, whereas SG decreased Firmicutes/Bacteroidetes ratio (P  =  0.04) and increased Bacteroides-Prevotella (P  =  0.004) compared to baseline. Although blood pressure and lipid profile did not show any significant changes after the sardine dietary intervention, heart rate only decreased significantly in SG from baseline (P=0.01). The quality life parameters did not differ between groups at the end of the study. CONCLUSIONS: The results of this thesis suggests that the inclusion of 100 g of sardines 5 days a week during 6 months does not improve glycemic control but it could have beneficial effects on cardiovascular risk of drug-naïve patients with type 2 diabetes by achieving optimal levels of Omega-3 Index. Furthermore, the increase observed in adiponectin levels in SG might indicate beneficial effects on metabolic inflammation, and the gut specific bacterial strains modification in response to sardine diet revealed the close relationship between dietary components and gut microbiota. Additionally, the results show that a diet based on general dietary recomendations for type 2 diabetes and also a diet enriched with sardines could improve insuline resistance of drug-naïve patients with type 2 diabetes.

Diet recommendations to achieve target metabolic control for prevention of micro and macrovascular complications have been outlined. Although previous studies in individuals with type 2 diabetes have identified certain factors associated with adherence to diet recommendations, adherence is multi-factorial in nature and includes demographic, biological and psychosocial variables. Our main objective was to identify factors associated With dietary behaviour among individuals with type 2 diabetes attending an out-patient clinic. Furthermore, we attempted to identify factors associated with frequency of seeing the dietitian and stages of change far lower fat intake. Principal hypothesis: those who are younger, female, lower in body mass index (BMI), higher in education level, exposed to a dietitian in the past year, higher in stage of change, having greater nutrition knowledge, greater perception of risk and benefits as well as fewer perceived barriers, would consume less total and saturated fat. (Abstract shortened by UMI.)

Cette etude pilote de six mois examinait si l'autogestion (AG) intensive par un agent secreteur d'insuline avait pour consequence une glycemie amelioree en comparaison avec une gestion standard (GS) chez les individus atteints de diabete de type 2. Des patients ont ete randomises soit a l'AG avec du repaglinide (n=8), ou du glyburide (n=6) ou a la GS (n=5). Des analyses biochimiques, alimentaires, comportementales, et d'activite physique ont ete effectuees. Les deux groupes de l'AG ont recu un enseignement d'autogestion en fonction du taux de glucose sanguin et une evaluation nutritionnelle qualitative. Le groupe AG (n=11) a suivi la cedule 65% du temps et a fait des ajustements 29% du temps. Une relation inverse significative a ete trouvee entre le changement de l'Alc et le pourcentage de temps d'ajustements accomplis correctement (r=0.64, p=0.035). La difference de masse corporelle entre l'AG et la GS n'etait pas significative, tout comme la masse corporelle moyenne a six mois. Une recherche plus approfondie avec un echantillon de plus grande taille serait necessaire afin d'explorer les avantages potentiels de la gestion du diabete via l'autogestion de medicaments oraux.

Although the benefits of exercise to non-insulin-dependent diabetes mellitus (NIDDM) are well-known, individuals with NIDDM are at risk for macrovascular and microvascular complications associated with an abnormal systolic blood pressure (SBP) elevation during exercise. In order to compare the SBP and rating of perceived exertion (RPE) response between individuals with NIDDM and apparently healthy controls during submaximal exercise, eight individuals representative of each group completed a 10-minute submaximal treadmill exercise trial at 65% of functional capacity. Heart rate, blood pressure and RPE were monitored throughout the trial. Between group comparisons were made for SBP and RPE response, and the frequency of exercise SBP response _> 200 mmHg was investigated. No significant differences were observed in either SBP or RPE response between groups during the submaximal treadmill trials. In addition, none of the subjects from either group achieved a SBP ? 200 mmHg. While this study indicates that exercise at 65% of functional capacity is safe for this particular group of subjects with NIDDM, additional research is warranted to investigate cardiovascular response to exercise in a broader subject pool representative of the entire NIDDM population.
School of Physical Education

This study was conducted to determine if improvements in glucose tolerance could be demonstrated following an acute bout of progressive resistance exercises. Fourteen individuals, not currently weight training, were assigned to two groups using the guidelines established by the WHO for NIDDM and normal (CON), based on the results of a three hour 75 g (-1.2M) load oral glucose tolerance test (OGTT). Eight blood samples were collected during the OGTT and assayed for glucose, insulin, and C-peptide. Each subject from the NIDDM (n=7) and CON (n=7) groups participated in a familiarization period, including a IRM, with eight different Nautilus selectorized exercise machines utilizing both the upper and lower body. A 3 set x 10 repetition exercise protocol based on the IRM was conducted and followed 18 hours later by another OGTT. Two day diets were replicated from the prior OGTT. Analysis of variance failed to demonstrate significant differences in the total responses or at any specific sampling points from pre to postprotocol for glucose (p=0.53), C-peptide (p=0.07) or the C-peptide:insulin ratio (p=0.16) in either group. Blood insulin levels from pre to postprotocol were significantly reduced (p=0.001) by 24% and 22% for the NIDDM and CON groups, respectively. These data suggest that a single series of progressive resistance exercises improve insulin uptake by the tissues without augmenting glucose disposal.
School of Physical Education

Thesis (B. Sc.(Hons.))--University of Adelaide, Dept. of Physiology, 1997.
"Metabolic response to energy restriction and diet in NIDDM"--Spine title. Includes bibliographical references (leaves 24-32).

It is currently accepted that the most appropriate diet in the treatment of non-insulin-dependent diabetes mellitus "eNIDDM"e is high in carbohydrates, high in fibre and low in fat. Dietary fibre reduces the rate of carbohydrate absorption, which may have a beneficial effect on insulin action. Furthermore, high fibre diets also increase the amount of carbohydrates which are not absorbed from the small intestine. These malabsorbed carbohydrates are fermented by the bacterial population in the large intestine, producing short chain fatty acids "eSCFA"e, including propionate, which has been shown to alter liver carbohydrate metabolism. This thesis investigated the actions of slowed carbohydrate absorption and carbohydrate malabsorption in streptozotocin-induced "eSTZ"e diabetic rats. High carbohydrate diet supplemented with guar gum, a soluble dietary fibre, fed to STZ diabetic rats improved insulin sensitivity. investigation of the alterations in the stomach and small intestine demonstrated that guar increased the viscosity of the meal in the intestine. The action of increased fermentation, producing more propionate, was investigated by supplementing propionate into the diets of STZ diabetic rats or when perfused into isolated rat livers. No changes in insulin action or liver glucose metabolism were measured. in addition, it was shown that guar gum reduces food intake in STZ diabetic rats. Mild reductions in food intake in STZ diabetic rats were shown to increase insulin action. In summary, STZ diabetic rats fed high carbohydrate, high fibre diets reductions in food consumption and slowed carbohydrate absorption are important factors which may lower blood glucose concentrations and increase insulin action. increased SCFA production is unlikely to contribute significantly to the improvements in insulin action.

Previous studies reported that noncompliance to diabetes treatment may result in a series of health complications. To further understand patients’ noncompliance to meal plans, a study on meal planning strategy was developed. Through a survey Certified Diabetes Educators determined which meal planning strategies were the most effective in encouraging patients’ compliance to meal plan according to age groups (18 and under, 19 to 49, 50 to 70, and 71 and above) and recency of diagnosis (newly- and non-newly diagnosed) with Type 2 diabetes. Results identified that nutrition labels had the greatest mean rating for effectiveness in age groups 18 and under, 19 to 49, and 50 to 70; and healthy food choices had the greatest mean rating for effectiveness with age group 71 and above.
Department of Family and Consumer Sciences

Type 2 diabetes (T2DM) currently affects more than three million African American adults with double the number expected by 2025. The most effective and safest treatment for T2DM is lifestyle change therapy, including healthful eating, monitoring of blood glucose, and physical activity. However, current lifestyle change interventions are limited in their scope to alter the behaviors of individuals to more healthful ones. These limitations may be attributed, in part, to a lack of attention given to enhancing an individual’s psychosocial process variables, such as resilience, coping skills, selfleadership, and empowerment. Incorporating resilience education into lifestyle change therapies is a novel approach that addresses the behavior modification limitations of current interventions by aiming to enhance psychosocial process variables. Therefore, the purpose of this project was to conduct a six-month pilot study to determine the feasibility of our resilience and diabetes self-management intervention, The Diabetes Coaching Program: Transforming Lives Through Resilience Education, in a convenience sample of African American adults (n=16) with T2DM. The intervention included four weekly resilience and diabetes education classes and eight bi-weekly support group sessions. Survey data and blood samples were collected at baseline and at six months. Twelve participants completed the study (75% retention). Results indicated that higher perceived stress scores were associated with less resilience, fewer adaptive coping skills, lower selfleadership, lower diabetes empowerment and greater depressive symptoms. However, diabetes empowerment was the only psychosocial process variable to be significantly enhanced by the intervention at six months. Weight, BMI, HbA1c, total cholesterol, LDL cholesterol, blood pressure, and IGF-1 levels were significantly decreased at six months, whereas, lymphocyte proliferation and physical activity were significantly increased. These data indicate that our intervention has the potential to improve diabetes selfmanagement among African Americans with T2DM and increase positive health outcomes, though further studies are needed to confirm these findings. Additionally, several lessons were learned from conducting the pilot study that may be useful for improving the intervention for future studies, including: recruitment and retention strategies; cultural competency issues; the use of complementary and alternative medicine practices by African Americans with T2DM; and approaches for increasing participant self-assessment and goal-setting.
text

by Lynn Wah Wong Tsang.
Consent form in Chinese.
Thesis (M.Phil.)--Chinese University of Hong Kong, 1997.
Includes bibliographical references (leaves 127-145).
Declaration --- p.i
Acknowledgments --- p.ii
Table of Contents --- p.iii
List of Tables --- p.vii
List of Figures --- p.x
List of Appendix --- p.xi
Chapter CHAPTER1 --- INTRODUCTION
Chapter 1.1 --- General Introduction --- p.2
Chapter 1.2 --- Literature Review --- p.6
Chapter 1.2.1 --- Classifications of Diabetes Mellitus --- p.6
Chapter 1.2.2 --- Diagnostic Criteria of Diabetes Mellitus --- p.6
Chapter 1.2.3 --- Characteristics of NIDDM --- p.9
Chapter 1.2.4 --- Epidemiology of NIDDM --- p.13
Chapter 1.2.5 --- Pathophysiology of NIDDM --- p.16
Chapter 1.2.6 --- Determinants and Causes of NIDDM --- p.16
Chapter 1.2.7 --- Etiology and Risk Factors ofNIDDM --- p.20
Chapter 1.2.7.1 --- Genetic Factors --- p.20
Chapter 1.2.7.2 --- Environmental Factors --- p.20
Chapter 1.2.7.2.1 --- Physical Inactivity --- p.20
Chapter 1.2.7.3 --- Body Weight and Fat Distribution --- p.21
Chapter 1.2.7.4 --- Gestational Diabetes Mellitus --- p.22
Chapter 1.2.7.5 --- Impaired Glucose Tolerance --- p.23
Chapter 1.2.8 --- Complications --- p.23
Chapter 1.2.9 --- Oral hypoglycaemic agents --- p.25
Chapter 1.2.9.1 --- Insulin Secretagogues --- p.25
Chapter 1.2.9.2 --- Metformin --- p.26
Chapter 1.2.9.3 --- Apha-Glucosidase Inhibitors --- p.26
Chapter 1.2.9.4 --- Insulin Sensitizers --- p.27
Chapter 1.2.10 --- Oral Hypoglycaemic Agent Failure --- p.27
Chapter 1.2.11 --- Use of Insulin in NIDDM --- p.28
Chapter 1.2.12 --- Combination Therapy --- p.30
Chapter CHAPTER2 --- RESEARCH DESIGN AND METHODS
Chapter 2.1 --- Study Protocol --- p.37
Chapter 2.2 --- Objectives --- p.37
Chapter 2.3 --- Overall Design --- p.38
Chapter 2.3.1 --- Selection of Patients --- p.38
Chapter 2.3.1.1 --- Inclusion Criteria --- p.38
Chapter 2.3.1.2 --- Exclusion Criteria --- p.40
Chapter 2.3.2 --- Recruitment Period --- p.40
Chapter 2.3.2.1 --- Screening Period --- p.40
Chapter 2.3.2.2 --- Pre-Run-In Period --- p.41
Chapter 2.3.3 --- Run-in Period --- p.42
Chapter 2.3.3.1 --- Stabilization --- p.43
Chapter 2.3.3.2 --- Randomization --- p.44
Chapter 2.3.3.2.1 --- Combination Group --- p.45
Chapter 2.3.3.2.2 --- Insulin Group --- p.47
Chapter 2.3.4 --- Evaluation Periods --- p.48
Chapter 2.3.5 --- Study Medications --- p.49
Chapter 2.3.6 --- Clinical Assessments --- p.50
Chapter 2.4 --- Withdrawals --- p.50
Chapter 2.5 --- Investigations --- p.51
Chapter 2.6 --- Analytical Methods --- p.52
Chapter 2.7 --- Statistical Analysis --- p.53
Chapter CHAPTER3 --- RESULTS
Chapter 3.1 --- Study Population --- p.56
Chapter 3.2 --- Randomization --- p.58
Chapter 3.3 --- Study Results --- p.63
Chapter 3.3.1 --- Indices of Glycaemic Control and Lipids --- p.63
Chapter 3.3.1.1 --- Glucose Values --- p.63
Chapter 3.3.1.2 --- Glucosylated Haemoglobin and Glycated Plasma Protein Concentration --- p.64
Chapter 3.3.1.2.1 --- Glucosylated Haemoglobin --- p.64
Chapter 3.3.1.2.2 --- Glycated Plasma Protein Concentration --- p.68
Chapter 3.3.1.3 --- Plasma Lipid Concentrations --- p.69
Chapter 3.3.2 --- Clinical Determinants --- p.70
Chapter 3.3.2.1 --- Blood Pressure Measurements --- p.70
Chapter 3.3.2.2 --- Body Weight Evaluations --- p.71
Chapter 3.3.3 --- Insulin Types Used --- p.76
Chapter 3.3.4 --- Insulin Dosage Requirements --- p.76
Chapter 3.3.5 --- Subjective Well Being and Acceptability of Insulin Injection --- p.78
Chapter 3.3.6 --- Hypoglycaemic Events --- p.85
Chapter 3.3.7 --- Subsequent Study Discontinuation --- p.85
Chapter 3.3.8 --- Responders versus no Responders --- p.86
Chapter CHAPTER4 --- GENERAL DISCUSSION
Chapter 4.1 --- Summary of Results --- p.92
Chapter 4.2 --- Acute and Long Term Effects of --- p.101
Combination Therapy
APPENDIX --- p.111
REFERENCES --- p.127
Chapter 2 --- Abstracts summarized recent data not incorporated in this thesis --- p.147

In Sub-Saharan Africa, the rapid increase in the prevalence of diabetes has resulted in significant public health and socioeconomic liability in the face of scarce resources. Faced with a growing pandemic of non-communicable diseases, developing countries need to be proactive in investigating alternative cost-effective interventions, with the primary aim being to minimize illness and maximize health benefits relative to the limited available resources. The aim of this research study was to quantify the economic impact of an exercise intervention as a preventative strategy for type 2 diabetes in a developing country. The research also sought to investigate if there was an economic case for physical activity as a primary and secondary preventative measure in the management of non-communicable diseases. The study was quantitative in nature and used both primary and secondary data to conduct the cost analysis. A questionnaire was administered to 40 patients at a diabetic clinic in a peri-urban community health care centre. Secondary data, consisting of clinic records and an extensive literature review, was used to source the remaining inputs needed for the cost analysis. Results revealed that the implementation costs of a physical activity intervention exceeded the costs of a pharmaceutical programme. Physical activity resulted in decreased productivity loss, with significant economic implications at a household level. Evidence reviewed in the literature suggested that physical activity could be used in primary prevention as a viable substitute to pharmaceutical therapy. For secondary disease prevention, however, physical activity was complementary in the production of health benefits, limiting disease progression and morbidity caused by illness.
Dissertation (MBA)--University of Pretoria, 2014.
lmgibs2015
Gordon Institute of Business Science (GIBS)
Unrestricted

Type 2 Diabetes Mellitus (Type 2 DM) is present in the populations of almost all the countries in the world and is a significant disease burden in most developed countries. Evidence suggests that populations in Africa develop Type 2 DM at an increasing rate as they reject their traditional lifestyles. Furthermore, newly released figures by the Medical Research Council of South Africa indicate that diabetes is the 10th most common cause for total life years lost in females in South Africa. Exercise is a low cost, non-pharmacological intervention that has been shown to be effective in metabolic control. Exercise is still vastly under-utilised in the management of Type 2 DM, especially in urban black females with Type 2 DM. This study was designed to determine the effectiveness of an exercise intervention to decrease haemoglobin A1c (HbA1c) over period of 12 weeks in Type 2 DM black female subjects, aged 40to 65 years. This study consisted of three phases. Data captured in the first two phases were utilised to plan the exercise intervention. Questionnaires and focus groups were used in the first two phases of the stud. The final phase of the study consisted of a randomized controlled trial. For this phase 157 female subjects who were recruited at the Mamelodi hospital diabetes outpatient clinic, were randomized to either an experimental or a control group. It was found that the subjects had little knowledge about their disease and that they lead a sedentary lifestyle. Subjects felt that Type 2 DM had a negative impact on their lives. Their attitudes bout Type 2 DM showed a dependence on health professionals and they disagreed with the attitude that they should be involved in decision-making about their health care. The results of the focus groups indicated that patients viewed walking and household chores as suitable exercise for them. Personal barriers to exercise were lack of knowledge, tiredness and health-related stress. Subjects expected that exercise would increase the functional capabilities, increase their knowledge and improve their well being. These findings were used to plan the exercise intervention, which consisted of a home-based exercise programme and fortnightly exercise sessions at the Mamelodi hospital. Subjects also had to complete a diary of their physical activities at home. An analysis of co-variance (ANCOVA) was used to compare the experimental and control groups with respect to change in HbA1c and the secondary outcomes such as walking distance and quality of life outcomes. It was found that the exercise intervention was no more efficacious (p=0.05) than a supervised self-relaxation training intervention to decrease HbA1c, over a period of 12 weeks. The exercise group was however able to walk a significantly further distance (p<0.01) than the control group after the 12-week intervention. While not significantly different between groups (p=0.80), the positive well-being improved significantly within both groups (p<0.01). It is possible to improve blood glucose control by means other than medication in urban black female patients with Type 2 DM. The patients are willing to change their sedentary lifestyle to a more active one, but several environmental and personal barriers impact negatively o their attempts to do so. The role of the health care worker is to identify these barriers and to accompany the patient on the road to a healthier lifestyle. However, this population of women may need more assistance and support initially to take self-responsibility for their diabetes self-management eventually.
Thesis (PhD)--University of Pretoria, 2006.
Physiotherapy
unrestricted

Diabetes mellitus belongs to diseases frequently occurring in childhood and adulthood. Insufficient knowledge of this disease and an unsatisfactory compensation for diabetes leads to development of late complications that have a negative impact on one's, as well as the family's, life and create an economic problem for society as a whole. The thesis focuses on the main characteristics of the disease, symptoms, diagnosis and treatment. Complications of the disease, including advice for patients themselves and their prevention are described in more detail. Social aspects (work inclusion of a diabetic, invalidity and reduced work capacity, driving of motor vehicles) are also emphasised. The research part containing 18 questions aims to find out to what extent the Czech public is informed about the problematic areas of this disease. It also assesses the feasibility of obtaining information from individuals of different ages and places of residence (city vs. village) regarding diabetes. These hypotheses were stated within the scope of the research: 1. Individuals older than 50 years of age are better informed about diabetes than individuals of a younger age. 1. Individuals living in a city have a better access to information concerning diabetes than individuals living in a village. The data was obtained from questionnaire research, in which respondents older than 18 years of age participated. The data collection took place in Bechyně Spa Ltd. 58 % of the resultant questionnaires were completed by women and 42 % by men.

Intermittent fasting (IF) is a recently popularized meal timing strategy whereby individuals abstain continuously from any energy intake for 16 to 20 hours each day, subsequently condensing energy intake into a short period spanning 4 to 8 hours. We aimed to test the effects of intermittent fasting in 10 individuals with Type 2 Diabetes Mellitus in conjunction with recommendations to consume a high protein diet in a 6 to 8 week withdrawal study. This study consisted of three phases: baseline, intervention, and follow-up. During the 2-week baseline and intervention phases participants consumed meals at regular times. Biochemical, anthropometric, and physical activity measurements were taken at the end of each phase. Participants reported morning, afternoon and evening self-monitored blood glucose and fasting duration on a daily basis, in addition to completing a remote food photography diary three times within each study phase. Despite the short duration of the intervention phase, intermittent fasting led to significant decreases in weight, BMI, morning SMBG, and overall reductions in waist circumference, C-reactive protein, energy intake, carbohydrate intake, and fat intake. There were significant variations between participants in response to intermittent fasting in respect to changes in lipids and insulin sensitivity, which could not be explained by baseline biochemical or anthropometric measures, fasting duration, energy intake, or physical activity. Upon cessation of intermittent fasting, biochemical changes regressed towards baseline values during the follow-up period. Intermittent fasting was well tolerated by most participants, and no severe adverse events were noted. Morning nausea was the most common complaint, which abruptly ceased when medication timing was changed.

Fan, Rongrong.
Thesis (Ph.D.)--Chinese University of Hong Kong, 2011.
Includes bibliographical references (leaves 130-150).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstract also in Chinese.

alpha-Glucosidase from yeast was used to screen for alpha-glucosidase inhibitory activities in Chinese herbal medicines. Seventy crude extracts were studied. The extracts of Semen Fagopyri Esculenti, Herba Euphorbiae Humifusae, Radix Polygoni Multiflori, Cortex Cinnamomi, Radix Paeoniae Rubra, and Radix Paeoniae Alba exhibited alpha-glucosidase inhibitory activities. These herbs have high potential for finding active compounds to develop into new antidiabetic drugs.
In this study, an assay technique involving brush border membrane vesicles was developed to screen for glucose uptake inhibitory actions in sixteen compounds from natural sources. Two compounds, namely naringenin and desoxyrhaponticin, were demonstrated to exhibit moderate inhibitory action on glucose uptake in rabbit intestinal brush border membrane vesicles, and showed very strong inhibitory action in rat everted intestinal sleeves. The kinetics study indicated that they behave as competitive inhibitors on glucose uptake. Moreover, they could reduce the level of the glucose uptake in the diabetic rat intestinal and renal membrane vesicles. In vivo study further demonstrated that desoxyrhaponticin could significantly reduce the glucose levels after a single oral administration of glucose in neonatal streptozotocin-induced diabetic rats, but not naringenin. These results suggest that naringenin and desoxyrhaponticin may be useful in the control of hyperglycemia. They act by inhibiting glucose uptake in the intestine and glucose reabsorption in the renal proximal tubules.
On the other hand, several synthetic compounds based on the structure of valienamine were found to show strong inhibition on intestinal alpha-glucosidases such as sucrase, glucoamylase and maltase. The strongest inhibitor was further studied. It could reduce the postprandial plasma glucose level of neonatal streptozotocin-induced diabetic rats. These results demonstrated that it has the potential to develop inter an oral antihyperglycemic agent.
The objective of this study is to improve the postprandial hyperglycemic conditions of diabetes by two approaches: (1) inhibiting the digestive enzymes (alpha-glucosidases), and (2) inhibiting active glucose transport in the small intestine. We have screened for new inhibitors of alpha-glucosidase and monosaccharide cotransporters from natural products and their derivatives. These compounds may be useful in the management of type 2 diabetes and diabetic complications.
Type 2 diabetes mellitus accounts for 90-95% of all diabetic cases and has become a major health concern over the world. There is increasing evidence that postprandial hyperglycemia, a hallmark of diabetes, plays a critical role in the development of type 2 diabetes and cardiovascular complications. Therefore the early identification of postprandial hyperglycemia and its effective control can offer the potential for early intervention and prevention of diabetic complications.
Li Jianmei.
"August 2006."
Adviser: Christopher H. K. Cheng.
Source: Dissertation Abstracts International, Volume: 68-03, Section: B, page: 1592.
Thesis (Ph.D.)--Chinese University of Hong Kong, 2006.
Includes bibliographical references (p. 161-180).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstracts in English and Chinese.
School code: 1307.

By the year 2025, it is anticipated that over 300 million individuals world wide will have type 2 diabetes, with a projected increase from 84 to 288 million (170%) in developing countries and from 51 to 72 million (42%) in developed countries. Diabetes leads to a markedly increased risk of heart disease and renal failure and to expensive and debilitating retinopathy and neuropathy. Cognitive decline is also increased. As there is accumulating evidence of the beneficial effects of moderate carbohydrate, low fat dietary patterns compared to high carbohydrate diets, this thesis will focus on the effects of moderate carbohydrate high protein dietary patterns (total carbohydrate: protein: fat ratio of 40%:34%:26%) on glycemic control, risk factors for macrovascular disease and cognitive function. Information on two key areas in type 2 diabetes will be presented, 1. Acute effects of dietary patterns, moderately carbohydrate restricted and high in protein on glucose levels assessed using continuous glucose monitoring systems (CGMS) with verification of these results through a small repeat study. 2. Chronic effects of energy restricted dietary patterns, moderately carbohydrate restricted and high in protein on glucose levels, HbA1c, cognitive function, cardiovascular disease (CVD) risk markers and renal function. In the acute study, we recruited 23 subjects with type 2 diabetes. The participants were randomized to each of 4, 3-day interventions in a cross over design with a 4 day wash out period in which the carbohydrates were distributed differently at each meal; carbohydrates evenly distributed across the day, or carbohydrates loaded at breakfast, lunch or dinner. Glucose levels were continuously measured using CGMS. Outcomes were assessed by postprandial peak glucose (Gmax), time spent above 12 mmol/L (T>12) and total area under the glucose curve (AUC20). The intervention showed that an even distribution of carbohydrates did not optimise blood glucose control, whereas carbohydrates loaded at the lunch time meal provided the most favourable postprandial profile. To verify these results we conducted a repeat study. Six of the previous participants accepted the invitation to return and complete the even distribution arm of the study after a 20 week time lag. The intervention showed that although HbA1c, fasting blood glucose (FBG), AUC, exercise and ambient temperature remained constant there was a significant effect of change in sunlight hours on Gmax, suggesting an effect of sunlight. To assess the chronic effects of energy restricted dietary patterns on the determinants of HbA1c, cognitive function, CVD risk markers and renal function under conditions of weight loss, we recruited 82 participants with type 2 diabetes. These participants were randomised to one of two high protein energy restricted dietary patterns that differed in cholesterol content, for a 12 week period, in a parallel design. A sub group of these participants completed cognitive function testing with (n=34) or without (n=17) CGMS at baseline and at 8 weeks. After 8 weeks of the intervention the determinants of HbA1c under conditions of energy restriction were evaluated. The intervention showed the change in FBG accounted for most of the variance in change in HbA1c, but % energy reduction also contributed independently of FBG. Both energy restricted high protein diets equally improved glycemic control, particularly T>12, AUC, HbA1c and FBG. Fifty one participants completed cognitive testing to evaluate the effect of weight loss and blood glucose control on cognition. Cognitive function was not altered by time, diet, baseline lipid levels. Working memory was predicted by FBG. Short term memory was predicted by FBG, Gmax and AUC24. Sixty five participants completed 12 weeks of the intervention to assess CVD risk markers and renal function. Renal function was maintained and CV markers improved on both dietary patterns, with greatest improvement in HDL-C observed in the group consuming a high protein, energy restricted dietary pattern, high in dietary cholesterol. In conclusion, in the context of a high protein, carbohydrate restricted dietary pattern, cognitive function and renal function did not change, while glycemia and CV risk profiles improved with weight loss over the short term. Under conditions of energy balance diurnal glucose profiles were optimal when the carbohydrates were loaded in the lunch meal.
http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1342253
Thesis (Ph.D.) - University of Adelaide, School of Molecular and Biomedical Science, 2008

Kwan, Yee Mei.
Thesis (D.Nurs.)--Chinese University of Hong Kong, 2013.
Includes bibliographical references (leaves 152-171).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstract also in Chinese; appendixes includes Chinese.

Chan Siu-Wah.
Thesis (M.Phil.)--Chinese University of Hong Kong, 2006.
Includes bibliographical references (leaves 173-200).
Abstracts in English and Chinese; appendix in Chinese.
Table of Contents --- p.i
Abstract --- p.v
論文摘要 --- p.ix
Acknowledgments --- p.xii
Table of Figures --- p.xiii
Table of Tables --- p.xvii
Chapter Chapter 1. --- Introduction --- p.1
Chapter Chapter 2. --- Literature Review --- p.3
Chapter 2.1 --- Diabetes Mellitus (DM)： Overview --- p.3
Chapter 2.1.1 --- Diagnosis and Diagnostic Criteria --- p.4
Chapter 2.1.2 --- Classifications of Diabetes Mellitus --- p.8
Chapter 2.1.3 --- Management of Type 2 Diabetes Mellitus --- p.15
Chapter 2.2 --- Diabetes Mellitus Complications： Overview --- p.25
Chapter 2.2.1 --- Microvascular Complications --- p.26
Chapter 2.2.2 --- Macrovascular Complications --- p.31
Chapter 2.3 --- Type 2 Diabetes Mellitus - A Rising Global Burden --- p.32
Chapter 2.3.1 --- Prevalence of Type 2 Diabetes Mellitus --- p.32
Chapter 2.3.2 --- Prevalence of Type 2 Diabetes Mellitus in Hong Kong --- p.36
Chapter 2.3.3 --- Mortality and Morbidity of Type 2 Diabetes Mellitus in Hong Kong --- p.40
Chapter 2.4 --- cost of Type 2 Diabetes Mellitus - Under-explored Area in Hong Kong and Asia --- p.46
Chapter 2.4.1 --- Cost of Type 2 Diabetes Mellitus in the USA --- p.48
Chapter 2.4.2 --- Cost of Type 2 Diabetes Mellitus in Europe --- p.57
Chapter 2.4.3 --- Cost of Type 2 Diabetes Mellitus in Asia-Pacific --- p.61
Chapter 2.5 --- Hong Kong Healthcare System --- p.65
Chapter 2.5.1 --- Hospital Authority in Hong Kong (Public Healthcare Sector) --- p.67
Chapter 2.5.2 --- Hong Kong Healthcare Financing System --- p.73
Chapter 2.6 --- New Emerging Drug Treatment for Type 2 DM in Hong Kong Chinese - Rosiglitazone --- p.77
Chapter 2.6.1 --- Clinical Efficacy and Tolerability of Rosiglitazone --- p.77
Chapter 2.6.2 --- Cost-effectiveness of Rosiglitazone --- p.78
Chapter Chapter 3. --- Hypothesis and Objectives --- p.81
Chapter 3.1 --- Cost of Type 2 Diabetes Mellitus in Hong Kong Chinese --- p.81
Chapter 3.1.1 --- Hypothesis --- p.81
Chapter 3.1.2 --- Objectives --- p.81
Chapter 3.2 --- Cost-effectiveness Analysis of Metformin + Rosiglitazone vs. Metformin + Glibenclamide for Type 2 DM Patient Whose Diabetes is not Adequately Controlled by Metformin Alone from a Payer's Perspective --- p.82
Chapter 3.2.1 --- Hypothesis --- p.82
Chapter 3.2.2 --- Objectives --- p.83
Chapter Chapter 4. --- Cost of Type 2 Diabetes Mellitus in Hong Kong Chinese --- p.84
Chapter 4.1 --- Subjects and Methods --- p.84
Chapter 4.1.1 --- Subjects --- p.84
Chapter 4.1.2 --- Methods --- p.85
Chapter 4.1.3 --- Validity and Reliability of the Chinese Questionnaire --- p.96
Chapter 4.2 --- Results --- p.96
Chapter 4.2.1 --- Subjects' Characteristics --- p.96
Chapter 4.2.3 --- Comorbidity --- p.102
Chapter 4.2.4 --- Complications --- p.102
Chapter 4.2.5 --- Costs of Type 2 DM --- p.104
Chapter 4.3 --- Discussions --- p.123
Chapter Chapter 5 --- Cost-effectiveness Analysis of Metformin + Rosiglitazone vs. Metformin + Glibenclamide for Type 2 DM Patient Whose Diabetes is not Adequately Controlled by Metformin Alone from a Payer's Perspective --- p.134
Chapter 5.1 --- Methods --- p.134
Chapter 5.1.1 --- Model Overview --- p.134
Chapter 5.1.2 --- "Success, Failure and Discontinuation Rates" --- p.138
Chapter 5.1.3 --- Resources Use and Costs --- p.142
Chapter 5.1.4 --- Health-Related Quality of Life (HRQOL) --- p.148
Chapter 5.1.5 --- Base Case Analysis --- p.149
Chapter 5.1.6 --- Sensitivity Analyses --- p.149
Chapter 5.2 --- Results --- p.150
Chapter 5.2.1 --- Base Case Model - CE Analysis: cost per controlled Type 2 DM patient --- p.150
Chapter 5.2.2 --- Sensitivity Analysis- CE Analysis: cost per controlled Type 2 DM patient --- p.151
Chapter 5.2.3 --- Base Case Model - CE Analysis: cost per EQ5D utility score --- p.154
Chapter 5.2.4 --- Sensitivity Analysis- CE Analysis: cost per EQ5D utility score --- p.155
Chapter 5.3 --- Discussions --- p.158
Chapter Chapter 6. --- Conclusions --- p.163
Appendix --- p.165
References

Additionally, cyclosporin A, an inhibitor of the mitochondrial permeability transition (MPT) pore, failed to prevent hIAPP-induced DeltaPsim collapse, cytochrome c and AIF release and caspase-3 activation, indicating that the MPT pore was not involved in hIAPP-induced apoptosis. On the other hand, potential crosstalk between the extrinsic and intrinsic apoptotic pathways was demonstrated by cleavage of Bid by caspase-8 in the apoptotic process triggered by hIAPP.
It is widely accepted that human islet amyloid polypeptide (hIAPP) aggregation plays an important role in the loss of insulin-producing pancreatic beta cells. Insulin secretion impairment and cell apoptosis can be due to mitochondrial dysfunction in pancreatic beta cells. hIAPP-induced cytotoxicity is mediated by the generation of reactive oxygen species (ROS). Phycocyanin (PC) is a natural compound from blue-green algae that is widely used as food supplement. Currently, little information is available about the effect of hIAPP on mitochondrial function of beta cells and protection of PC against hIAPP-induced cytotoxicity. In this thesis, I hypothesize that hIAPP may impair beta cell function with the involvement of mitochrondrial dysfunction, and this effects could be attenuated by PC. Therefore, the aim of this study was to investigate the role of mitochondria in hIAPP-induced apoptosis, the in vitro protective effects of PC and explore the underlying mechanisms.
It was found that hIAPP induced apoptosis in INS-1E cells with the disruption of mitochondrial function, as evidenced by ATP depletion, mitochondrial mass reduction, mitochondrial fragmentation and loss of mitochondrial membrane potential (DeltaPsim). Further molecular analysis showed that hIAPP induced changes in the expression of Bcl-2 family members, release of cytochrome c and apoptosis-inducing factor (AIF) from mitochondria into cytosol, activation of caspases and cleavage of poly (ADP-ribose) polymerase. Interestingly, the hIAPP-induced mitochondrial dysfunction in INS1-E cells was effectively restored by co-treatment with PC.
Our results showed that hIAPP inhibited the INS-1E cell growth in a dose-dependent manner. However, cytotoxicity of hIAPP was significantly attenuated by co-incubation of the cells with PC. hIAPP induced DNA fragmentation and chromatin condensation, which were key characteristics of cell apoptosis. These changes were inhibited by PC as examined by TUNEL assay and DAPI staining. Moreover, PC significantly prevented the hIAPP-induced overproduction of intracellular ROS and malonaldehyde (MDA), as well as changes of activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) enzymes. Furthermore, hIAPP triggered the activation of mitogen-activated protein kinases (MAPKs) such as c-Jun N-terminal kinase (JNK) and p38 kinase, and these effects were effectively suppressed by PC.
Taken together, I have demonstrated for the first time the involvement of mitochondrial dysfunction in hIAPP-induced INS-1E cell apoptosis, which was attenuated by PC through attenuating oxidative stress, modulating JNK and p38 pathways and reducing mitochondrial dysfunction.
Li, Xiaoling.
Adviser: Juliana Chung Ngor Chan.
Source: Dissertation Abstracts International, Volume: 73-01, Section: B, page: .
Thesis (Ph.D.)--Chinese University of Hong Kong, 2010.
Includes bibliographical references (leaves 150-159).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstract also in Chinese.