Prediction of postprandial blood glucose under intra-patient variability and uncertainty and its use in the design of insulin dosing strategies for type 1 diabetic patients

In this thesis I propose a novel method to estimate the dose and injection-to-meal time for low-risk intensive insulin therapy. This dosage-aid system uses an optimization algorithm to determine the insulin dose and injection-to-meal time that minimizes the risk of postprandial hyper- and hypoglycaemia in type 1 diabetic patients. To this end, the algorithm applies a methodology that quantifies the risk of experiencing different grades of hypo- or hyperglycaemia in the postprandial state induced by insulin therapy according to an individual patient’s parameters. This methodology is based on modal interval analysis (MIA). Applying MIA, the postprandial glucose level is predicted with consideration of intra-patient variability and other sources of uncertainty. A worst-case approach is then used to calculate the risk index. In this way, a safer prediction of possible hyper- and hypoglycaemic episodes induced by the insulin therapy tested can be calculated in terms of these uncertainties.

Patienters upplevelser av livskvalitet vid nydiagnostiserad typ 2 Diabetes Mellitus : En intervjustudie

Syfte: Att undersöka patienters upplevelser av livskvalitet vid nydiagnostiserad typ 2 Diabetes Mellitus. Metod: En empirisk studie med en kvalitativ ansats som innefattade tio deltagare med nydiagnostiserad typ 2 Diabetes Mellitus. Semistrukturerade intervjuer genomfördes utifrån en intervjuguide där insamlad data analyserades med kvalitativ manifest innehållsanalys. Resultat: Studien resulterade i fyra huvudkategorier och tio subkategorier. Upplevelsen av att få ett diagnosbesked varierade mellan deltagarna, för vissa deltagarna var beskedet inte förvånande medan andra upplevde känslor av chock och förnekelse. Deltagarna upplevde positiva förändringar, exempelvis viktnedgång och förbättrad hälsa men även negativa förändringar, exempelvis att vara beroende av läkemedel. Vissa upplevde ingen förändring alls. Typ 2 Diabetes Mellitus påverkade inte deltagarnas fysiska eller psykiska hälsa i de flesta fall. Deltagarna ansåg det som viktig att få stöd från både omgivningen och hälso- och sjukvården. Konklusion: Känslorna över ett diagnosbesked kunde variera men upplevelsen av livskvalitet påverkades inte av Typ 2 Diabetes Mellitus i de flesta fall i studien. Patientens inställning till att leva med Typ 2 Diabetes Mellitus inverkade på förmågan till att utföra egenvård, och distriktsköterskans stöd och engagemang ansågs vara betydelsefullt i sjukdomsprocessen.

What is important for you? A qualitative interview study of living with diabetes and experiences of diabetes care to establish a basis for a tailored Patient-Reported Outcome Measure for the Swedish National Diabetes Register

OBJECTIVES: There is a growing emphasis on the perspective of individuals living with diabetes and the need for a more person-centred diabetes care. At present, the Swedish National Diabetes Register (NDR) lacks patient-reported outcome measures (PROMs) based on the perspective of the patient. As a basis for a new PROM, the aim of this study was to describe important aspects in life for adult individuals with diabetes. DESIGN: Semistructured qualitative interviews analysed using content analysis. SETTING: Hospital-based outpatient clinics and primary healthcare clinics in Sweden. PARTICIPANTS: 29 adults with type 1 diabetes mellitus (DM) (n=15) and type 2 DM (n=14). INCLUSION CRITERIA: Swedish adults (≥18 years) living with type 1 DM or type 2 DM (duration ≥5 years) able to describe their situation in Swedish. Purposive sampling generated heterogeneous characteristics. RESULTS: To live a good life with diabetes is demanding for the individual, but experienced barriers can be eased by support from others in the personal sphere, and by professional support from diabetes care. Diabetes care was a crucial resource to nurture the individual's ability and knowledge to manage diabetes, and to facilitate life with diabetes by supplying support, guidance, medical treatment and technical devices tailored to individual needs. The analysis resulted in the overarching theme 'To live a good life with diabetes' constituting the two main categories 'How I feel and how things are going with my diabetes' and 'Support from diabetes care in managing diabetes' including five different categories. CONCLUSIONS: Common aspects were identified including the experience of living with diabetes and support from diabetes care. These will be used to establish a basis for a tailored PROM for the NDR.

Compreendendo o significado de qualidade de vida segundo idosos portadores de diabetes mellitus tipo II

Trata-se de uma pesquisa qualitativa com abordagem fenomenológica, objetivando descrever o significado de qualidade de vida, segundo relatos de idosos portadores de diabetes mellitus tipo II, e avaliar as repercussões da doença sobre sua vida. Entrevistamos 12 idosos diabéticos, no período de setembro a outubro de 2008, entre um e quarenta anos de evolução da doença. Foi feita a seguinte questão norteadora: Para o Sr. (a), o que significa qualidade de vida? A análise dos discursos mostrou facetas relevantes ligadas ao cotidiano do idoso com diabetes mellitus. Para eles, a qualidade de vida está intimamente relacionada à saúde física, independência na vida diária e econômica, integração social, suporte familiar e saúde mental-espiritual. A restrição alimentar foi o ponto de maior repercussão do diabetes sobre seu modo de viver. Verificou-se que cabe aos profissionais de saúde ampliar o diálogo profissional-paciente, promovendo autonomia e independência no cuidado e corresponsabilização.

The burden of physical activity on type 2 diabetes public healthcare expenditures among adults: a retrospective study

Background: Determinants of public healthcare expenditures in type 2 diabetics are not well investigated in developing nations and, therefore, it is not clear if higher physical activity decreases healthcare costs. The purpose of this study was to analyze the relationship between physical activity and the expenditures in public healthcare on type 2 diabetes mellitus treatment.Methods: Cross-sectional study carried out in Brazil. A total of 121 type 2 diabetics attended to in two Basic Healthcare Units were evaluated. Public healthcare expenditures in the last year were estimated using a specific standard table. Also evaluated were: socio-demographic variables; chronological age; exogenous insulin use; smoking habits; fasting glucose test; diabetic neuropathy and anthropometric measures. Habitual physical activity was assessed by questionnaire.Results: Age (r = 0.20; p = 0.023), body mass index (r = 0.33; p = 0.001) and waist-to-hip ratio (r = 0.20; p = 0.025) were positively related to expenditures on medication for the treatment of diseases other than diabetes. Insulin use was associated with increased expenditures. Higher physical activity was associated with lower expenditure, provided medication for treatment of diseases other than diabetes (OR = 0.19; p = 0.007) and medical consultations (OR = 0.26; p = 0.029).Conclusions: Type 2 diabetics with higher enrollment in physical activity presented consistently lower healthcare expenditures for the public healthcare system.

Influencia de la enfermedad periodontal en el control metabólico de pacientes con diabetes mellitus tipo 2: revisión de la literatura

There may be an interaction between periodontal disease and sonic systemic diseases such as diabetes mellitus The objective of this review was to verify by means of a review of clinical trials if is a positive association between periodontal disease and the glycerine control of type 2 diabetes mellitus (DM 2) patients Eleven articles that fit the study criteria were revised It was concluded that periodontal disease may influence the metabolic control of 2 Additional studies with larger sample sizes and longer follow up are necessary for a better clarification of this issue (Rev Med Chile 2010 138 1172 1178)

Glucose homeostasis in type 1 diabetic rats after acute physical activity

Physical activity is considered an extremely effective therapy in cases of type 1 diabetes (DM-1), as it promotes glucose uptake independent of insulin action. However, there are few studies on the effect of a single session of exercise on glucose uptake in DM-1 (i.e., in the absence of insulin). Therefore, the purpose of this study was to assess the effect of a single exercise session on glucose homeostasis in DM-1 rats. For this purpose, 30 male rats were divided into three groups: sedentary control (SC), sedentary diabetic (SD), and exercise diabetic (ED). DM was induced by administration of alloxan and identified by the value of fasting glucose. The physical activity consisted of a single swimming session at the anaerobic threshold intensity for diabetic rats (3.5% body weight overload) for 30 min. The oral glucose tolerance test (OGTT) was performed immediately after the physical activity. The animals were sacrificed 48 hr after the OGTT, and samples were taken from the blood, liver, gastrocnemius, and mesenteric and subcutaneous adipose tissue. We observed that DM caused significant reduction in body weight. A single session of physical activity did not modify the response to the OGTT or glucose. However, it resulted in increased HDL cholesterol and hepatic glycogen content. These results suggest that, despite not having an effect on glucose homeostasis, acute physical activity performed at anaerobic threshold intensity leads to beneficial changes in the context of type 1 diabetes.

Avaliação clínica e microbiológica de pacientes portadores de Diabetes mellitus do tipo 2

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Reorientando práticas de cuidado com o diabetes mellitus: a construção partilhada profissionais-usuários

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Circunferência da cintura na predição do Diabetes mellitus gestacional

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Prevalência de resistência à insulina, intolerância à glicose e diabetes mellitus tipo 2 em pacientes com síndrome doa ovários policísticos(SOP)

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Efeito do tratamento periodontal não-cirúrgico em pacientes portadores de Diabetes mellitus tipo 2 com doença periodontal: análises clínica, enzimática e microbiológica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação do efeito do tratamento periodontal não-cirúrgico sobre parâmetros clínicos e imunológicos em pacientes portadores de Diabetes mellitus Tipo 2: estudo clínico e imunológico

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Biomarcadores cardioinflamatórios em repouso e o efeito do exercício físico aeróbio agudo na resposta glicêmica e do lactato sanguíneo em adultos diabéticos do tipo 1

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Risks, Benefits, and Therapeutic Potential of Hematopoietic Stem Cell Transplantation for Autoimmune Diabetes

Type 1 diabetes mellitus is a chronic disease that results from the autoimmune response against pancreatic insulin producing beta cells. Apart of several insulin regimens, since the decade of 80s various immunomodulatory regimens were tested aiming at blocking some steps of the autoimmune process against beta cell mass and at promoting beta cell preservation. In the last years, some independent research groups tried to cure type 1 diabetes with an "immunologic reset" provided by autologous hematopoietic stem cell transplantation in newly diagnosed patients, and the majority of patients became free form insulin with increasing levels of C-peptide along the time. In this review, we discuss the biology of hematopoietic stem cells and the possible advantages and disadvantages related to the high dose immunosuppression followed by autologous hematopoietic stem cell transplantation.