Dissertations / Theses on the topic 'Diabetes – Risk factors'
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1
Orr, Neil John. "Patterns of care for diabetes: risk factors for vision-threatening retinopathy." Thesis, The University of Sydney, 2005. http://hdl.handle.net/2123/1421.
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OBJECTIVES: In Australia, diabetes causes significant morbidity and mortality. Whilst the need to prevent diabetes and its complications has been widely recognised, the capacity of health care systems - which organise diabetes care - to facilitate prevention has not been fully established. METHODS: A series of seven population-based case-control studies were used to examine the effectiveness of the Australian health care system and its capacity to manage diabetes. Six of the studies compared the patterns of care of patients who had developed advanced diabetes complications in 2000 (cases), to similar patients who remained free of the condition (controls) across Australia and for various risk groups. A secondary study investigated the role of treating GPs in the development of the outcome. RESULTS: A strong relationship between the patterns of care and the development of advanced diabetes complications was found and is described in Chapter 4. In Chapter 5, this same relationship was investigated for each Australian state and territory, and similar findings were made. The study in Chapter 6 investigated whether late diagnosis or the patterns of care was the stronger risk factor for advanced diabetes complications, finding that the greatest risk was associated with the latter. In Chapter 7 the influence of medical care during the pre-diagnosis period was explored, and a strong relationship between care obtained in this period and the development of advanced complications was found. In Chapter 8, which investigated the role of socio-economic status in the development of advanced complications, found that the risk of advanced diabetes complications was higher in low socio-economic groups. Chapter 9 investigated geographic isolation and the development of advanced diabetes complications and found that the risk of advanced complications was higher in geographically isolated populations. Finally, Chapter 10, which utilised a provider database, found that some GP characteristics were associated with the development of advanced diabetes complications in patients. CONCLUSION: A number of major risk factors for the development of advanced complications in Australia was found. These related to poorer diabetes management, later diagnosis, low socioeconomic status and geographic isolation. Strategies must be devised to promote effective diabetes management and the early diagnosis of diabetes across the Australian population.
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Orr, Neil John. "Patterns of care for diabetes: risk factors for vision-threatening retinopathy." University of Sydney, 2005. http://hdl.handle.net/2123/1421.
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Master of Public HealthOBJECTIVES: In Australia, diabetes causes significant morbidity and mortality. Whilst the need to prevent diabetes and its complications has been widely recognised, the capacity of health care systems - which organise diabetes care - to facilitate prevention has not been fully established. METHODS: A series of seven population-based case-control studies were used to examine the effectiveness of the Australian health care system and its capacity to manage diabetes. Six of the studies compared the patterns of care of patients who had developed advanced diabetes complications in 2000 (cases), to similar patients who remained free of the condition (controls) across Australia and for various risk groups. A secondary study investigated the role of treating GPs in the development of the outcome. RESULTS: A strong relationship between the patterns of care and the development of advanced diabetes complications was found and is described in Chapter 4. In Chapter 5, this same relationship was investigated for each Australian state and territory, and similar findings were made. The study in Chapter 6 investigated whether late diagnosis or the patterns of care was the stronger risk factor for advanced diabetes complications, finding that the greatest risk was associated with the latter. In Chapter 7 the influence of medical care during the pre-diagnosis period was explored, and a strong relationship between care obtained in this period and the development of advanced complications was found. In Chapter 8, which investigated the role of socio-economic status in the development of advanced complications, found that the risk of advanced diabetes complications was higher in low socio-economic groups. Chapter 9 investigated geographic isolation and the development of advanced diabetes complications and found that the risk of advanced complications was higher in geographically isolated populations. Finally, Chapter 10, which utilised a provider database, found that some GP characteristics were associated with the development of advanced diabetes complications in patients. CONCLUSION: A number of major risk factors for the development of advanced complications in Australia was found. These related to poorer diabetes management, later diagnosis, low socioeconomic status and geographic isolation. Strategies must be devised to promote effective diabetes management and the early diagnosis of diabetes across the Australian population.
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Chit, Moy Ley. "Bromelain and cardiovascular risk factors in diabetes." Thesis, London South Bank University, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.631731.
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The rising prevalence of diabetes worldwide now ranks alongside smoking, high blood pressure and cholesterol disorder as an independent major risk factor for Cardiovascular Disease (CVD). Conventional therapy and dietary management using dietary supplements have been under consideration as measures to prevent or ameliorate the risk of developing complications of CVD in diabetes. A systematic review of the literature on bromelain (a pineapple enzyme) and CVD identified 7 animal studies and 3 human studies. Animal studies were conducted more recently and showed more promising results on bromelain and CVD than human studies. Existing evidence derived from 3 human studies in the systematic review, carried out in the 1970’s despite poor study design and lacking appropriate information on trial outcomes suggested that bromelain may have an effect on CVD risk factors. This research was inconclusive. Potential mechanisms for bromelain suggested that it may be useful for reducing plasma fibrinogen, preventing aggregation of blood platelets, increasing fibrinolytic activity and acting as an anti-inflammatory agent which is closely related to the pathogenesis of CVD complications in diabetes. This indicated that research into bromelain may provide new insights to help reduce the risk factors associated with CVD complications for people with diabetes. A Randomized Controlled Trial (RCT) was initiated with the aim of assessing whether the dietary supplement (bromelain) had the potential to reduce plasma fibrinogen and other associated risk factors for CVD in diabetic patients. The RCT on 68 Chinese diabetic patients (32 males and 36 females; Han origin, mean age of 61.26 years (Standard Deviation, SD 12.62 years)) with at least one risk factor of CVD demonstrated that 12-week intervention of 1.05g/day bromelain failed to show a beneficial effect in reducing fibrinogen and other CVD risk factors such as blood lipids, blood glucose, C-Reactive Protein (CRP), anthropometric indicators and blood pressure. A placebo-controlled trial with a larger sample size with higher fibrinogen levels and/or individuals at greater risk of developing CVD would be needed in a future study. Exploring bromelain’s effect on inflammatory markers which could be a possible underlying mechanism in the pathogenesis of CVD in diabetes, may be a more fruitful focus for future research.
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Morgan, Eileen. "Type 1 diabetes - epidemiology, risk factors and complications." Thesis, Queen's University Belfast, 2015. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.678213.
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This thesis examined the incidence and temporal trends of Type 1 diabetes diagnosed in Northern Ireland children using data from the Northern Ireland Childhood Diabetes Register (NICDR). Overall, there was evidence of a departure from linearity in incidence with indications that rates are levelling off in recent years. Further analyses also indicated that birth cohort effects were evident in the incidence rates suggesting that exposures in early life may play an aetiological role in this condition. A systematic review and meta-analyses was performed in this thesis to investigate the association of childhood vaccinations and subsequent risk of Type 1 diabetes. Twelve studies investigating a range of vaccinations were included. Results provided no evidence to suggest an association between childhood vaccinations and risk of Type 1 diabetes. A study using data from the Clinical Practice Research Datalink (CPRD) was included in this thesis to report findings on depression and other complications in young people diagnosed with Type 1 diabetes. This study found that rates of depression were significantly higher in cases with diabetes compared to controls without diabetes. Results also showed elevated rates of microvascular complications and significantly higher rates of cardiovascular disease compared to matched controls. Another focus of this thesis was on mortality in individuals with Type 1 diabetes. Population-based studies reporting relative mortality in Type 1 diabetes diagnosed in young people were systematically reviewed. In total, 23 independent studies were included. Associations between relative mortality and study/ country characteristics were explored. In addition to this review, a further two UK-based studies were performed to investigate mortality, one using data from the NICDR and the other using the CPRD. Both studies found excess mortality rates in individuals with Type 1 diabetes when compared, respectively, to the general population and to a group of controls without diabetes.
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Becerra, Tomás Nerea. "Dietary factors associated with metabolic syndrome and type 2 diabetes risk." Doctoral thesis, Universitat Rovira i Virgili, 2017. http://hdl.handle.net/10803/460757.
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S’ha observat que els patrons dietètics s’associen de forma diferent al risc de desenvolupar la síndrome metabòlica (SM) i la diabetis tipus 2 (DT2). Amb l’objectiu d’entendre millor els diferents efectes dels patrons dietètics sobre el risc de desenvolupar aquestes malalties, és important analitzar el paper que juguen determinats grups d’aliments sobre el risc de desenvolupar el SM i la DT2.
L’objectiu de la present tesis ha estat avaluar l’associació entre el consum de carn, productes làctics i el risc d’incidència de SM o alguns dels seus components, així com avaluar l’associació entre el consum de llegums i el risc de desenvolupar DT2.
Els resultats van mostrar una associació inversa no significativa entre el consum total de productes làctics i el risc d’incidència de SM. El consum de productes làctics baixos en greix, llet descremada i iogurt (total, baix en greix i sencer) es va associar a un menor risc de SM i algun dels seus components. Contràriament, el consum de formatge es va associar a un major risc. De la mateixa manera, el consum de carn total també es va associar amb el risc de patir SM i algun dels seus components. Mentre que la carn vermella i la carn vermella processada es van associar a un menor risc de SM, el consum de carn blanca es va associar a un menor risc. Finalment, el consum de llegums totals, i en particular de llenties, es va associar a un menor risc d’incidència de DT2.
En conclusió, un consum elevat de productes làctics baixos en greix i iogurt (independentment el seu contingut en greix), conjuntament amb el consum preferent de carn blanques en lloc de carns vermelles o carns vermelles processades, i una alta freqüència de llegums podria ser beneficiós per a la prevenció del SM i la DT2 en individus Mediterranis amb alt risc cardiovascular.Se ha observado que los patrones dietéticos se asocian de manera distinta al riesgo de desarrollar síndrome metabólico (SM) y la diabetes tipo 2 (DT2). Con el objetivo de entender mejor los distintos efectos de los patrones dietéticos sobre el riesgo de desarrollar estas enfermedades, es importante analizar el papel que juegan determinados grupos de alimentos sobre el riesgo de desarrollar el SM y la DT2. El principal objetivo de la presente tesis ha sido evaluar la asociación entre el consumo de carne, productos lácteos y el riesgo de incidencia SM o alguno de sus componentes, así como evaluar la asociación entre el consumo de legumbres y el riesgo de desarrollar DT2. Los resultados mostraron una asociación inversa no significativa entre el consumo total de productos lácteos y el riesgo de incidencia de SM. El consumo de productos lácteos bajos en grasa, leche desnatada y yogur (total, bajo en grasa y entero) se asoció a un menor riesgo de SM y algunos de sus componentes. Contrariamente, el consumo de queso se asoció a un mayor riesgo. Del mismo modo, el consumo de carne total también se asoció con el riesgo de padecer SM y alguno de sus componentes. Mientras que la carne roja y la carne roja procesada se asociaron a un mayor riesgo de SM, el consumo de carne blanca se asoció a un menor riesgo. Finalmente, el consumo de legumbres totales, y en particular las lentejas, se asoció a un mejor riesgo de incidencia de DT2. En conclusión, un consumo elevado de productos lácteos bajos en grasa y yogur (independientemente del contenido en grasa), conjuntamente con consumo preferente de carnes blancas en lugar de carnes rojas o carnes rojas procesadas, y una alta frecuencia de legumbres, podría ser beneficioso para la prevención del SM y la DT2 en individuos Mediterráneos con alto riesgo cardiovascular.
It has been shown that dietary patterns are differently associated with the risk of metabolic syndrome (MetS) and type 2 diabetes (T2D). Whereas the Western diet seems to increase the risk of these chronic diseases, plant-based diets, such as the Mediterranean Diet (MedDiet), seem to decrease the risk. In order to better understand the different effects on disease risk among dietary patterns, it is important to analyze the role that specific food groups play on the risk of developing MetS and T2D. The main aim of the present dissertation was to evaluate the association between the consumption of meat and dairy products with the risk of MetS or the incidence of some of its individual components, as well as to assess the association between legumes consumption and T2D development risk. The results showed a non-significant inverse association between total dairy consumption and the risk of MetS incidence. The consumption of low-fat dairy products, low-fat milk and yogurt (total, low-fat and whole-fat yogurt) was associated with a lower risk of MetS and some of its individual components. Contrary, the consumption of cheese was positively associated with the MetS risk. Likewise, total meat intake was also associated with the risk of MetS and the development of some of its components. Whereas red meat and processed red meat were associated with a higher risk of MetS, poultry was associated with a lower risk. Finally, total legume consumption, particularly lentils, was associated with a lower risk of T2D incidence. In conclusion, high consumption of low-fat dairy products and yogurt (regardless the fat content), together with the preference for poultry rather than red meat or processed red meat, and high frequency consumption of legumes, would be beneficial for the prevention of MetS and T2D among Mediterranean individuals at high CVD risk.
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Hou, Wei Wei, and 侯薇薇. "Pubertal muscle mass and diabetes risks." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2015. http://hdl.handle.net/10722/208569.
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Type-2 diabetes is one of the most prevalent non-communicable diseases globally. The prevalence has increased rapidly in both developed and developing countries. Type-2 diabetes has become epidemic in China in the past three decades. With a relatively low obesity prevalence compared to western countries, such as the United States, the question has arisen as to why people in China are so susceptible to diabetes, but few studies have answered this question definitively. Asians have lower muscle mass than Caucasians which could be one possible explanation. This study aims to test the hypothesis that pubertal muscle mass acquisition, under the influence of testosterone, may be a risk factor for diabetes.
This study recruited from the population-representative Chinese “Children of 1997” birth cohort with 8327 participants (88% of all infants born in April and May 1997) in Hong Kong. Participants were aged 15 years at the time of this study. The main objective was to examine the association of pubertal muscle mass with diabetes risk factors, and to examine determinants of pubertal muscle mass in this non-western setting.
In June to August 2012, 502 participants from “Children of 1997” were recruited to complete a health assessment follow up at the Active Health Clinic in University of Hong Kong, including a questionnaire, blood tests and a physical examination. Multivariable linear regression was used to assess the associations of: (1) testosterone and pubertal muscle mass with diabetes risk factors, including fasting glucose, fasting insulin and homeostasis model assessment -insulin resistance (HOMA-IR), and any mediation of the association of testosterone with diabetes risk factors by pubertal muscle mass, and (2) environmental influences, including intergenerational influences, proxied by mother’s place of birth, and current life style influences (meat consumption and physical activity), with pubertal muscle mass.
Higher pubertal testosterone was associated with lower fasting glucose (-0.008, 95% confidence interval (CI) -0.015 to -0.002), fasting insulin (-0.44, 95% CI -0.57 to -0.31) and HOMA-IR (-0.090, 95% CI -0.12 to -0.063) after adjusting for potential confounders, i.e, sex, birth weight, highest parental education, mother’s place of birth and physical activity. The association was partially mediated by skeletal muscle mass and body fat percentage. Skeletal muscle mass was negatively associated with fasting glucose (-0.017, 95% CI -0.025 to -0.009), insulin (-0.876, 95% CI -1.033 to -0.719), and HOMA-IR (-0.180, 95% CI -0.214 to -0.147) after adjusted for potential confounders. High meat consumption (0.176, 95% CI 0.000 to 0.351) and physical activity (0.157, 95% CI 0.059 to 0.254) were both associated with higher skeletal muscle mass in adolescents; however birth weight and mother’s place of birth had no influence on pubertal skeletal muscle composition.
Higher pubertal muscle mass and testosterone are association with better glucose metabolism in adolescence. Food intake and physical activity may also influence the development of skeletal muscle, thus adolescence may be a sensitive period for the development of diabetes where interventions to increase muscle mass could have long-term protective effects.published_or_final_version
Public Health
Master
Master of Philosophy
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Walldén, (Fredriksson) Jenny. "Studies of immunological risk factors in type 1 diabetes." Doctoral thesis, Linköpings universitet, Pediatrik, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-12441.
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Background: Type 1 diabetes (T1D) is a chronic, autoimmune disease caused by a T cell mediated destruction of ß-cells in pancreas. The development of T1D is determined by a combination of genetic susceptibility genes and environmental factors involved in the pathogenesis of T1D. This thesis aimed to investigate diverse environmental and immunological risk factors associated with the development of T1D. This was accomplished by comparing autoantibody development, T cell responses and the function of CD4+CD25+ regulatory T cells between healthy children, children at risk of T1D and T1D patients. Results: Induction of autoantibodies in as young children as one year old, was associated with previously identified environmental risk factors of T1D, such as maternal gastroenteritis during pregnancy and early introduction of cow’s milk. We did not see any general increase in the activity of peripheral blood TH subtypes in children with HLA class II risk haplotypes associated with T1D, nor were HLA class II risk haplotypes associated with any aberrant cytokine production in response to antigenic stimulation of peripheral blood mononuclear cells. However children with a HLA class II protective haplotype showed an increased production of IFN-γ in response to enteroviral stimulation. CTLA-4 polymorphisms connected with a risk of autoimmune disease were associated with enhanced production of IFN-γ. Healthy children with ß-cell autoantibodies had a lower expression level of GATA-3 compared to health children with HLA risk genotype or children without risk. Instead, children with manifest T1D showed lower expression levels of T-bet, IL-12Rß1 and IL-4Rα. Both T1D and healthy children showed the same expression of the regulatory markers Foxp3, CTLA-4 and ICOS in peripheral blood mononuclear cells, and the amount of CD4+CD25+ T cells did neither reveal any differences. The regulatory T cells seemed also to be functional in children with T1D, since increased proliferation after depletion of CD4+CD25high cells from PBMC was demonstrated in T1D as well as in healthy children.However, T1D children did have more intracellular CTLA-4 per CD4+CD25high T cell, increased levels of serum C-reactive protein and higher spontaneous expression of IFN-α in CD25depleted PBMC, all which are signs of activation of the immune system. This suggests a normal or enhanced functional activity of regulatory T cells in T1D at diagnosis. Conclusions: Our findings emphasize that environmental risk factors do have a role in the development of ß-cell autoimmunity. Our results do not support a systemic activation of the immune system in pre-diabetes or T1D, but instead a possible up-regulation of regulatory mechanisms seems to occur after diagnosis of T1D, which probably tries to dampen the autoimmune reaction taking place.
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Walldén, Jenny. "Studies of immunological risk factors in type 1 diabetes /." Linköping : Department of Clinical and Experimental Medicine, Linköping University, 2008. http://www.bibl.liu.se/liupubl/disp/disp2008/med1075s.pdf.
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Pettigrew, Kerry A. "Association studies to identify genetic risk factors for diabetic nephropathy in type 1 diabetes." Thesis, Queen's University Belfast, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.479350.
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Penishkevych, Ya I., O. P. Kuchuk, O. O. Kuzio, and S. V. Tymofiychuk. "Risk factors for progression of diabetic retinopathy in patients with type 2 diabetes mellitus." Thesis, БДМУ, 2017. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/16914.
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Black, James Alexander. "Optimising cardiovascular risk management early in the diabetes disease trajectory." Thesis, University of Cambridge, 2016. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.709489.
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Schader, Lindsey Marie. "Comparison of Genetic Risk Factors Between Two Type II Diabetes Subtypes." Thesis, The University of Arizona, 2015. http://hdl.handle.net/10150/595048.
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Type 2 Diabetes (T2D) is an extremely heterogeneous disease, and the heritability of T2D is not fully accounted for. This study seeks to determine T2D subtypes based on clinical features before T2D diagnosis, and to test whether genetic risk factors differ between the subtypes. A sample of 13,459 White, GWAS study participants was obtained from FRAM, MESA, and ARIC. This sample consisted of 832 cases (individuals who developed T2D during follow-up) and 12,066 controls (did not develop T2D). K-means clustering was used to cluster individuals in the cases dataset based on metabolic and anthropometric characteristics. Cox proportional hazards models were used to test whether T2D genetic risk factors differed between the groups. The clustering analysis resulted in two clusters with cluster one consisting of a higher percentage of women with higher WHR, lower HDL, and higher FI as compared to cluster two. There were no statistically significant differences between the genetic risk factors of the two clusters. The most significant differences in genetic risk factors were associated with adiposity, suggesting some interaction between adiposity genes and the characteristic phenotypes of each cluster on T2D development. Further research is needed to replicate subtypes and to find significant genetic associations.
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Mendoza, Mathison Lilian Cristina. "Risk factors for hyperglycemia in pregnancy, and vitamin D as a prevention strategy in the DALI study." Doctoral thesis, Universitat Autònoma de Barcelona, 2021. http://hdl.handle.net/10803/673323.
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La present tesi doctoral se centra en l’estudi dels factors de risc i l’ús de la vitamina D com a estratègia de prevenció de la diabetis mellitus gestacional (DMG) en una població d’alt risc participants en l’estudi DALI (Intervenció d’estil de vida i vitamina D per a la prevenció de DMG) En el primer article, es descriu l’assaig controlat aleatoritzat DALI de vitamina D per a la prevenció de DMG. L’assaig controlat aleatoritzat DALI va avaluar la suplementació de vitamina D amb 1600 UI / dia, (+/- intervenció combinada d’estil de vida), en una població d’alt risc de DMG, des <20 setmanes de gestació fins al part. Els resultats primaris van ser les mesures subrogades de DMG: glucèmia plasmàtica en dejú (GPA), HOMA-IR i augment de pes intragestación. Hi va haver una petita millora en la GPA (-0,14 mmol / l; IC 95%: -0,28, -0,00) a les 35-37 setmanes de gestació, però no es va observar millora en cap resultat primari a les 24-28 setmanes. Una anàlisi post hoc va identificar com a variables independents per a la suficiència de vitamina D: l’ètnia europea (OR 19,84, CI95 5,87-67,08), l’estació de l’any de l’extracció (OR estiu vs. primavera 17,0 , IC 95 1,84-157,5, ns per altres estacions) i la presa de vitamines (OR 11,1, IC 95 3,01-41,2). En el segon article es descriuen els factors de risc d’hiperglucèmia gestacional (HG) en la població DALI, en diferents períodes de la gestació i punts de la sobrecàrrega oral de glucosa (SOG). Realitzem un sub-anàlisi observacional de l’estudi DALI, que va incloure a 971 dones, que es van sotmetre a una SOG a les <20, 24-28 i 35-37 setmanes (criteris IADPSG / WHO2013). Una regressió logística multivariant va seleccionar variables independents (incloent característiques basals maternes i de la gestació actual) per HG. Les característiques clíniques associades de forma independent amb HG van ser: <20 setmanes, intolerància a la glucosa prèvia (odds ratio (OR): 3,11; IC 95%: 1,41-6,85), DMG prèvia (OR: 2 , 22; IC 95%: 1,20-4,11), circumferència cervical (CC) (OR: 1,58; IC 95%: 1,06-2,36 per al tercil superior), freqüència cardíaca en repòs ( FCR, OR: 1,99; IC 95%: 1,31-3,00 per al tercil superior) i centre de reclutament; a les 24-28 setmanes, mortinat previ (OR: 2,92; IC 95%: 1,18-7,22), FCR (OR: 3,32; IC 95%: 1,70-6,49 per al tercil superior) i centre de reclutament; a les 35-37 setmanes, talla materna (OR: 0,41; IC 95%: 0,20-0,87 per al tercil superior). Les característiques clíniques associades de forma independent amb DMG / diabetis franca, diferien segons el punt de temps de la SOG (per exemple, la CC es va associar amb glucosa alterada en dejú a <20 setmanes, mentre que la FCR es va associar amb la glucosa postsobrecarga a <20 setmanes). En conclusió, en dones amb sobrepès / obesitat participants en l’estudi DALI, la suplementació amb vitamina D no va millorar substancialment les mesures subrogades de DMG definides com a resultats primaris (GPA, HOMA-IR, augment de pes intragestación). Les concentracions mitjana de vitamina D a l’inici de l’estudi van ser més altes del que s’esperava i els principals predictors de la suficiència de vitamina D van ser l’ètnia europea i la ingesta de multivitaminas. En aquesta població, els factors de risc d’HG diferien segons el període de la gestació i el punt de la SOG, i podrien ajudar a definir els criteris per a la detecció selectiva o els participants d’assajos de prevenció.”La presente tesis doctoral se centra en el estudio de los factores de riesgo y el uso de la vitamina D como estrategia de prevención de la diabetes mellitus gestacional (DMG) en una población de alto riesgo participantes en el estudio DALI (Intervención de estilo de vida y vitamina D para la prevención de DMG) En el primer artículo, se describe el ensayo controlado aleatorizado DALI de vitamina D para la prevención de DMG. El ensayo controlado aleatorizado DALI evaluó la suplementación de vitamina D con 1600 UI/día, (+/- intervención combinada de estilo de vida), en una población de alto riesgo de DMG, desde <20 semanas de gestación hasta el parto. Los resultados primarios fueron las medidas subrogadas de DMG: glucemia plasmática en ayunas (GPA), HOMA-IR y aumento de peso intragestación. Hubo una pequeña mejoría en la GPA (-0,14 mmol/l; IC 95%: -0,28, -0,00) a las 35-37 semanas de gestación, pero no se observó mejora en ningún resultado primario a las 24-28 semanas. Un análisis post hoc identificó como variables independientes para la suficiencia de vitamina D: la etnia europea (OR 19,84, CI95 5,87-67,08), la estación del año de la extracción (OR verano vs. primavera 17,0, IC 95 1,84-157,5, ns para otras estaciones) y la toma de vitaminas (OR 11,1, IC 95 3,01-41,2). En el segundo artículo se describen los factores de riesgo de hiperglucemia gestacional (HG) en la población DALI, en diferentes periodos de la gestación y puntos de la sobrecarga oral de glucosa (SOG). Realizamos un sub-análisis observacional del estudio DALI, que incluyó a 971 mujeres, que se sometieron a una SOG a las <20, 24-28 y 35-37 semanas (criterios IADPSG/WHO2013). Una regresión logística multivariante seleccionó variables independientes (incluyendo características basales maternas y de la gestación actual) para HG. Las características clínicas asociadas de forma independiente con HG fueron: <20 semanas, intolerancia a la glucosa previa (odds ratio (OR): 3,11; IC 95%: 1,41-6,85), DMG previa (OR: 2,22; IC 95%: 1,20-4,11), circunferencia cervical (CC) (OR: 1,58; IC 95%: 1,06–2,36 para el tercil superior), frecuencia cardíaca en reposo (FCR, OR: 1,99; IC 95%: 1,31–3,00 para el tercil superior) y centro de reclutamiento; a las 24-28 semanas, mortinato previo (OR: 2,92; IC 95%: 1,18-7,22), FCR (OR: 3,32; IC 95%: 1,70-6,49 para el tercil superior) y centro de reclutamiento; a las 35-37 semanas, talla materna (OR: 0,41; IC 95%: 0,20-0,87 para el tercil superior). Las características clínicas asociadas de forma independiente con DMG/diabetes franca, diferían según el punto de tiempo de la SOG (por ejemplo, la CC se asoció con glucosa alterada en ayunas a <20 semanas, mientras que la FCR se asoció con la glucosa postsobrecarga a <20 semanas). En conclusión, en mujeres con sobrepeso / obesidad participantes en el estudio DALI, la suplementación con vitamina D no mejoró sustancialmente las medidas subrogadas de DMG definidas como resultados primarios (GPA, HOMA-IR, aumento de peso intragestación). Las concentraciones promedio de vitamina D al inicio del estudio fueron más altas de lo esperado y los principales predictores de la suficiencia de vitamina D fueron la etnia europea y la ingesta de multivitaminas. En esta población, los factores de riesgo de HG diferían según el período de la gestación y el punto de la SOG, y podrían ayudar a definir los criterios para la detección selectiva o los participantes de ensayos de prevención.
The present doctoral thesis focuses on the study of risk factors and the use of vitamin D as a prevention strategy for gestational diabetes mellitus (GDM) in a high-risk population (pregnant overweight/obese women) enrolled in the DALI (Vitamin D And Lifestyle Intervention for GDM prevention) study. In the first article, the DALI vitamin D randomized controlled trial for GDM prevention is reported. The DALI vitamin D randomized controlled trial for GDM prevention tested vitamin D supplementation with 1600 IU/day, with or without combined lifestyle intervention in a high-risk population for GDM, starting at <20 weeks’ gestation until delivery. The primary study outcomes were the GDM surrogates, fasting plasma glucose (FPG), HOMA-IR and gestational weight gain (GWG). There was a small improvement in FPG (-0.14 mmol/l; 95%CI -0.28, -0.00) at 35-37 weeks’ gestation, but no improvement in any primary outcome was observed at 24-28 weeks’ gestation, when testing for GDM usually takes place. A post hoc analysis identified as independent variables for vitamin D sufficiency: European ethnicity (OR 19.84, CI95 5.87-67.08), season of measurement (OR summer vs. spring 17.0, CI 95 1.84-157.5, ns for other seasons) and taking vitamins (OR 11.1, CI 95 3.01-41.2). In the second article risk factors for hyperglycemia in pregnancy (HiP) in the DALI population, at different pregnancy periods and oral glucose tolerance test (OGTT) time points are described. We conducted an observational sub-analysis of the DALI study, including 971 women, who underwent an OGTT at <20, 24–28 and 35–37 weeks (IADPSG/WHO2013 criteria). A multivariate logistic regression selected independent variables (including baseline maternal and current pregnancy characteristics) for HiP. Clinical characteristics independently associated with HiP were: at <20 weeks, previous abnormal glucose tolerance (odds ratio (OR): 3.11; 95%CI: 1.41–6.85), previous GDM (OR: 2.22; 95%CI: 1.20–4.11), neck circumference (NC) (OR: 1.58; 95%CI: 1.06–2.36 for the upper tertile), resting heart rate (RHR, OR: 1.99; 95%CI: 1.31–3.00 for the upper tertile) and recruitment site; at 24–28 weeks, previous stillbirth (OR: 2.92; 95%CI: 1.18-7.22), RHR (OR: 3.32; 95%CI: 1.70-6.49 for the upper tertile) and recruitment site; at 35–37 weeks, maternal height (OR: 0.41; 95%CI: 0.20–0.87 for upper tertile). Clinical characteristics independently associated with GDM/overt diabetes differed by OGTT time point (for example, NC was associated with abnormal fasting glucose at <20 weeks, while RHR was associated with post-challenge glucose at <20 weeks and with both, fasting and post-challenge glucose at 24-28 weeks). In conclusion, in overweight/obese women enrolled in the DALI study, vitamin D supplementation did not substantially improve surrogate GDM measurements defined as primary outcomes (FPG, HOMA-IR, GWG) and did not modify secondary outcomes. Average vitamin D concentrations at baseline were higher than expected and major vitamin D sufficiency predictors were European ethnicity and multivitamin intake. In this population, risk factors for HiP differed by pregnancy period and OGTT time point and could assist in defining criteria for selective screening or participants of prevention trials.
Universitat Autònoma de Barcelona. Programa de Doctorat en Medicina
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Alkazemi, Dalal Usamah Zaid. "Modulating factors of serum oxysterol concentrations in daughters from gestational diabetes and non-gestational diabetes." Thesis, McGill University, 2007. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=100757.
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Pregestational and gestational diabetes (GDM) places the mother and her offspring at an increased risk for later development of insulin resistance and type 2 diabetes. Oxidative stress may mediate long-term disturbances in glucose homeostasis associated with type 2 diabetes and the metabolic syndrome. This thesis describes a cross-sectional study examining serum concentrations of free radical generated oxysterols as markers of oxidative stress in a cohort of teenage daughters from pregnancies with and without GDM. Daughters of GDM-pregnancies had a tendency of higher levels of serum oxysterols (7beta-hydroxycholesterol); however, this difference was not statistically significant after adjustment for total cholesterol. Serum oxysterols were significantly correlated with obesity measures such as waist circumference and BMI, which likely accounted for the tendency for higher measures of oxysterol concentrations in the GDM daughters. Oxysterols represent potentially important biomarkers for oxidative stress in adolescent girls as their levels track with the metabolic syndrome risk factors.Le diabète pré-gestationnel et le diabète de gestation (DG) augmentent le risque dedéveloppement d'une future résistance à l'insuline et de diabète de type 2 autant pourla mère que pour l'enfant. Le stress oxydatif est un facteur potentiel impliqué dans ledéséquilibre du glucose sanguin associé au diabète de type 2 et au syndromemétabolique. La présente thèse est une étude sectionnelle croisée, ayant pour but demesurer des marqueurs du stress oxidatif, notamment la concentration des oxystérolsgénérés par les radicaux libres dans le sérum d'adolescentes, nées de mères ayantprésenté ou non un diabète de gestation. Nos résultats montrent des concentrationsd'oxystérols (7P-hydroxycholesterol) plus élevées dans le sérum de filles issues degestations diabétiques à comparer aux filles de mères n'ayant pas eu de DG.Cependant, la différence entre les deux groupes n'était pas statistiquementsignificative après un ajustement au cholestérol total. La concentration d'oxystérolsétait significativement corrélée aux marqueurs d'obésité, notamment la circonférencede la taille et l'index de masse corporelle, possiblement à l'origine de la tendance desoxystérols à être plus élevés dans le cas des adolescentes issues de gestationsdiabétiques.
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Fhärm, Eva. "Treatment of cardiovascular risk factors in type 2 diabetes time trends and clinical practice /." Umeå : Department of Public Health and Clinical Medicine, Umeå university, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-30686.
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Donders, Servaes Hubert Joan. "Correlations between haemostasis parameters and several cardiovascular risk factors in man." [Maastricht : Maastricht : Rijksuniversiteit Limburg] ; University Library, Maastricht University [Host], 1992. http://arno.unimaas.nl/show.cgi?fid=5696.
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Zigmont, Victoria Ann. "Behavioral and Pharmacoepidemiological Risk Factors and Mediators for Type II Diabetes Mellitus." The Ohio State University, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=osu1448978472.
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Marinho, Niciane Bandeira Pessoa. "AvaliaÃÃo do risco para diabetes mellitus tipo 2 entre adultos de Itapipoca-CearÃ." Universidade Federal do CearÃ, 2010. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=5796.
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CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel SuperiorFundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico
O diabetes mellitus tipo 2 à uma doenÃa de importÃncia crescente na saÃde pÃblica, jà que sua incidÃncia e prevalÃncia tÃm avanÃado de forma assustadora, sendo causada por uma combinaÃÃo de fatores genÃticos e estilo de vida. Em face disso, a saÃde pÃblica indica a prevenÃÃo primÃria para identificar os fatores de risco para DM2 e traÃar estratÃgias com vistas a evitar a exposiÃÃo ao risco, retardando ou impedindo o aparecimento da doenÃa. Objetivou-se avaliar o risco para o desenvolvimento do DM2 entre adultos de Itapipoca-CE. Trata-se de pesquisa quantitativa, com delineamento transversal e observacional, realizada no perÃodo de janeiro a marÃo de 2010, com 419 usuÃrios da EstratÃgia SaÃde da FamÃlia do municÃpio de Itapipoca-CE, com idades entre 20 e 59 anos. Para a coleta de dados aplicou-se um formulÃrio no qual se registraram dados sociodemogrÃficos e clÃnicos e o Finnish Diabetes Risk Score. Os dados foram armazenados no Excel, sendo processados no Statistical Package for Science Social versÃo 18.0. O estudo foi aprovado pelo Comità de Ãtica em Pesquisa da Universidade Federal do Cearà sob protocolo 346/09. Dos 419 usuÃrios participantes, 88,1% eram do sexo feminino; a mÃdia de idade foi de 37 anos; 60,4% eram casados ou mantinham uniÃo estÃvel; 39,4% cursaram atà o ensino fundamental incompleto e 58,2% pertenciam Ãs classes econÃmicas D/E. Em relaÃÃo aos fatores de risco para DM2, 25,3% tinham idade ≥ 45 anos; 59,7% estavam com excesso de peso; 84% foram classificados em risco cardiovascular; 83,3% eram sedentÃrios; 53,7% relataram nÃo comer frutas e/ou verduras diariamente; 12,9% tomavam anti-hipertensivos; 5,3% mencionaram histÃria prÃvia de glicose alta e 47% histÃria familiar de DM2. Segundo observou-se, 5,2% da amostra foram classificados com hipertensÃo e apenas 0,7% com provÃvel diabetes. Quanto ao grau de risco para DM2, 24,6% estavam em baixo risco; 63% em risco moderado e 11,7% em alto risco. Entre os participantes com alto risco, 12,0% eram homens; 30,2% tinham idades ≥ 45 anos; 37,4 estavam com excesso de peso; 21,1% estavam em risco cardiovascular aumentado; 12,9% eram sedentÃrios; 14,7% nÃo comiam frutas/verduras diariamente; 31,5% tomavam anti-hipertensivos; 81,8% relataram histÃria de glicose alta e 23,9% histÃria familiar de DM2. Esse estudo abre portas para uma posterior pesquisa de intervenÃÃo no municÃpio, na qual os indivÃduos com alto risco para DM2 seriam acompanhados pelos profissionais de saÃde da ESF e dos NÃcleos de Apoio à SaÃde da FamÃlia, com orientaÃÃes quanto Ãs mudanÃas no estilo de vida, e com intervenÃÃes nos fatores de risco potenciais encontrados, objetivando reduzir ou retardar o aparecimento da doenÃa.
The type 2 diabetes mellitus is a disease of increasing importance in public health, since its incidence and prevalence have dauntingly advanced, and has been caused by a combination of genetic factors and lifestyle. In this view, public health indicates primary prevention to identify risk factors for T2DM and strategize in order to avoid exposure to risk by delaying or preventing the onset of the disease. The objective was to evaluate the risk for the development of T2DM among adults in Itapipoca town-CearÃ. It is a quantitative research with cross-sectional observational study conducted from January to March 2010, with 419 users of EstratÃgia SaÃde da FamÃlia (ESF) in Itapipoca town-CearÃ, the participants aged between 20 and 59 years. To collect data we applied a form in which demographic and clinical data and Finnish Diabetes Risk Score were registered. The data were stored in Excel, and processed in the Statistical Package for Social Science 18.0. The study was approved by the Ethics Committee of the Federal University of CearÃ, under protocol 346/09. Out of the 419 participating users, 88.1% were female and the average age was 37 years, 60.4% were married or had common law-marriage, 39.4% attended to part of primary school and 58.2% belonged to lower social classes. Regarding risk factors for T2DM, 25.3% were aged ≥ 45 years, 59.7% were overweight, 84% were classified as cardiovascular risk, 83.3% were sedentary, 53.7% reported not eating fruit and / or vegetables daily, 12.9% were taking anti-hypertensive, 5.3% reported a previous history of high glucose and 47% had family history of T2DM. As observed, 5.2% of the sample were classified as having hypertension, and only 0.7% with probable diabetes. As for the risk levels for T2DM, 24.6% were at low risk, 63% in moderate risk and 11.7% at high risk. Amongst participants with high risk, 12.0% were men, 30.2% were aged ≥ 45 years, 37.4% were overweight, 21.1% were at increased cardiovascular risk, 12.9% were sedentary; 14.7% did not eat fruit / vegetables daily, 31.5% took antihypertensive drugs, 81.8% reported a history of high glucose and 23.9% had family history of T2DM. This study opens doors for further intervention research in the town, in which individuals at high risk for T2DM would be accompanied by health professionals from the ESF and the NÃcleos de Apoio à SaÃde da FamÃlia. With the aim to reduce or delay the onset of the disease, the individuals would be given guidance as to changes in lifestyle and interventions on potential risk factors found.
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Barrett, Sheila C. "Risk factors of type 2 diabetes and cardiovascular diseases among Jamaican adolescents." FIU Digital Commons, 2009. http://digitalcommons.fiu.edu/etd/1413.
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Purpose: The purpose of the study was to examine Jamaican adolescents in a school setting, for risk factors of type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVDs).
Methods: A descriptive epidemiological cross-sectional study of 276 Jamaican adolescents (112 males and 164 females) ages 14-19 years (15.6±1.2), randomly selected from grades 9-12 from ten high schools on the island. Thirteen risk factors were examined. Risk factors were compared with BMI levels and demographics. A sub-study validated finger prick testing of fasting blood glucose, total cholesterol, and HbAlc versus venous testing in 59 subjects.
Results: Prevalence of overweight was 33.0% (n=91) with mean BMI of 23.74±7.74. Approximately 66.7% of subjects reported > 3 risk factors. The number of T2DM and CVDs risk factors increased for subjects with BMI above 25. One third of the overweight subjects were classified with the metabolic syndrome. High BMI was associated with high waist circumference (r =.767, p
(r = .180, p.05). Percentage bias for the methods of blood testing met the reference standards for fasting blood glucose but not for total cholesterol and HbAlc. Bland Altman tests of agreement between the two methods indicated good agreement for all three tests.
Conclusion: Jamaican adolescents are at high risk for T2DM and CVDs as seen in other study populations. Effective programs to prevent T2DM and CVDs are needed. Family history of diseases, anthropometric measures, and gender identified more subjects at risk than did the biochemical measures. Comparison between finger prick and venous blood methods suggested that finger prick is an adequate method to screen for risk factors in children and adolescents.
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Bruce, Sharon Gail. "Prevalence, risk factors and impact of diabetes among the western Canadian Metis." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp02/NQ41603.pdf.
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Kappala, Shanthi Sharon. "Risk factors and blood-borne biochemical markers in type 2 diabetes mellitus." Thesis, University of Central Lancashire, 2012. http://clok.uclan.ac.uk/6723/.
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The burden of Diabetes Mellitus (DM) is increasing worldwide and it is estimated to reach indefinite proportions of about 450 million by year 2030. Patients with type 2 diabetes mellitus (T2DM) have a significantly increased risk of developing cardiovascular diseases (CVD). Moreover, CVD is the major cause of mortality and morbidity (75%) in T2DM patients. DM itself has been long recognised as an independent risk factor for several forms of CVD including coronary heart disease (CHD), peripheral arterial disease, cardiomyopathy and congestive heart failure in both men and women. It is well-known that T2DM is associated with several factors including hyperglycaemia, hypertension, dyslipidemia, obesity all of which contribute to CVD. In order to prevent CVD, early intervention on cardiovascular risk factors is vital during clinical assessment of T2DM patients. A major role of inflammation has been well described in the development of CVD in T2DM patients. Inflammatory process and factors which contribute to CVD in T2DM patients have recently become a focus in diabetic research. Elucidation of common patho-physiological mechanisms among T2DM patients might emphasize the role of inflammation in CVD. The main purpose of this study was to investigate any patho-physiological changes in red blood cells (RBC), white blood cells (neutrophils and lymphocytes) and plasma, measuring RBC membrane fragility and proteins, intracellular free calcium concentrations [Ca2+]i and several cations including Na+, Mg2+, Ca2+, Fe2+, Zn2+ and Cu2+, biochemical parameters and inflammatory mediators which normally serve as independent predisposing risk factors for CVD among T2DM patients compared to age-match healthy controls. The results have shown that fura-2 loaded neutrophils and lymphocytes in blood from T2DM patients contain significantly (p<0.05) less [Ca2+]i than neutrophils and lymphocytes from healthy subjects upon stimulation with physiological doses of either fMLP or thapsigargin indicating a derangement in cellular calcium homeostasis during T2DM. Similarly, RBC membranes from T2DM patients contained significantly (p<0.05) more spectrin, ankyrin, band 3, band 4.1, glycophorin etc compared to RBC membranes from age-matched healthy control subjects. The results also show that the RBCs from T2DM patients were more fragile compared to RBC from healthy controls. Measurement of protein glycation in plasma have revealed significantly (p<0.05) more fluorescence in proteins form T2DM patients compared to control. In relation to plasma cations and intracellular markers and mediators, the results show that plasma from T2DM patients contain significantly (p<0.05) more Na+, Mg2+ , Ca2+, Fe2+, Zn2+ and Cu2+ compared to plasma levels from age-match healthy controls. Similarly, the concentrations of kidney and liver function markers such as urea, creatinine, alkaline phosphatase, ALT, AST, GGT, total protein and albumin increased significantly (p<0.05) compared to healthy controls. The same is also true for glucose, total cholesterol, triglycerides, CRP, HBA1C, WBC where the blood from T2DM patients contained elevated concentrations compared to blood from healthy age-matched control patients. Together, the results of this study have clearly demonstrated marked and significant changes in cellular calcium homeostasis in white blood cells, RBC membrane proteins and fragility, plasma protein glycation and in plasma levels of cations, intracellular markers and mediators of T2DM patients compared to healthy controls. Therefore, it is proposed that an early integrated and multi-factorial intervention of risk factors and inflammatory markers must be done in order to reduce the risk of CVD and possible mortality of T2DM patients.
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Feinkohl, Insa. "Risk factors for cognitive decline in older people with type 2 diabetes." Thesis, University of Edinburgh, 2014. http://hdl.handle.net/1842/9612.
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People with type 2 diabetes are at increased risk of age-related cognitive impairment. Previous literature has focused on case-control studies comparing rates of cognitive impairment in patients with and without diabetes. Investigations of potential risk factors for cognitive impairment (including those with increased prevalence in diabetes, such as macrovascular disease, and diabetes-specific factors such as hypoglycaemia) in study populations consisting exclusively of patients with type 2 diabetes have been largely neglected. Moreover, previous studies have failed to take advantage of the extensive characterisation and prospective nature of longitudinal cohort studies to investigate the relative predictive ability of a wider range of potential risk factors for cognitive decline. Using data from the prospective Edinburgh Type 2 Diabetes Study (ET2DS) the present thesis aimed (i) to determine associations of cognitive decline with macrovascular disease and with severe hypoglycaemia, and (ii) to compare a wider range of potential risk factors in their ability to predict cognitive decline. In 2006/2007, 1066 patients with type 2 diabetes (aged 60 to 75 years) attended the baseline ET2DS clinic and 831 returned for the follow-up at year 4. Subjects were extensively characterised for risk factor profiles at baseline, and at year 4 for incidence of severe hypoglycaemia. Socioeconomic status was estimated using postcode data. Scores on seven tests of age-sensitive ‘fluid’ cognitive function, which were administered at baseline and at year 4, were used to derive a general cognitive component (‘g’). A vocabulary-based test, administered at baseline, estimated pre-morbid ability. Findings are reported in three parts. 1.) Macrovascular disease and cognition: Subjects with higher levels of biomarkers indicative of subclinical macrovascular disease, including plasma N-terminal pro-brain natriuretic peptide and carotid intima-media thickness, had significantly steeper four-year cognitive decline, independent of traditional cardiovascular risk factors, stroke, socioeconomic status and estimated pre-morbid cognitive ability. For ankle-brachial pressure index, the association fell just short of statistical significance. Effect sizes were overall modest, with fully adjusted standardised beta coefficients ranging from 0.06 to -0.12. Little evidence was found for associations of the symptomatic markers of macrovascular disease with four-year change in cognitive function that was independent of participants’ pre-morbid ability and socioeconomic status. 2.) Severe hypoglycaemia and cognition: Subjects with lower cognitive ability at baseline were at two-fold increased risk of experiencing their first-ever incident severe hypoglycaemia during follow-up. The rate of four-year cognitive decline was significantly steeper in those exposed to hypoglycaemia compared with hypoglycaemia-free participants, independently of cardiovascular risk factors, microand macrovascular disease and of estimated pre-morbid cognitive ability. Effect sizes again were overall modest (Cohen’s d = 0.2 to 0.3 for statistically significant differences in four-year cognitive decline between subjects with and those without hypoglycaemia, following multivariable adjustment) 3.) Consideration of a wider range of risk factors and cognition: A stepwise linear regression model including a total of 15 metabolic and vascular risk factors identified inflammation, smoking and poorer glycaemic control (in addition to some of the subclinical markers of macrovascular disease) as predictive of a steeper four-year cognitive decline. Other traditional cardiovascular risk factors, diabetic retinopathy, clinical macrovascular disease and a baseline history of severe hypoglycaemia were not included in this model. The interpretation of the latter finding is limited, however, by the fact that the stepwise regression procedure may exclude true predictors from a model when they correlate with already included risk factors. This thesis has demonstrated associations of later-life cognitive decline in people with type 2 diabetes with markers of subclinical macrovascular disease and poor glycaemic control (including hypoglycaemia) as well as other cardiometabolic risk factors (inflammation, smoking). Findings suggest that associations are relatively weak and complex due to inter-relationships amongst risk factors, and indicate a role of pre-morbid ability and socioeconomic status (which as risk factors are difficult to modify) in the relationships of risk factors with cognitive decline. Future research including case-control studies to compare risk factor associations between people with type 2 diabetes and non-diabetic older adults and randomised controlled trials to evaluate potential causal effects of individual modifiable risk factors on cognitive decline, will help to evaluate the mechanisms underlying the observation that people with type 2 diabetes are at risk of cognitive impairment in later life.
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Melander, Emma. "Risk factors to major lower extremity amputation in type 2 diabetes mellitus." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-54443.
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MacGilchrist, Claire. "Lower-limb risk factors for falls in older adults with diabetes mellitus." Thesis, Glasgow Caledonian University, 2012. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.572794.
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Falls are more common in older people with Diabetes Mellitus (DM) than without the condition. Falls cause significant morbidity and mortality among older adults, draining the finite resources of the National Health Service (NHS). Life expectancy of the general population is increasing and a shift in numerous social and environmental factors contribute to ever-increasing recorded cases of DM. As such, identification of risk factors for falls in the DM population is paramount. Previous research has identified intrinsic risk factors for falls in the older population however little research has been conducted specifically in people with DM with regards to primary falls prevention in this 'at risk' group. This study assessed key risk factors for falls in two patient groups; 60 older adults (over the age of 55) with DM and 60 age and gender matched control participants. Logistic regression analysis identified gait velocity, ankle dorsiflexion strength and symptoms of neuropathy (NSS) to be the key predictors of falls in the DM population. Building on the ~ identification of these risk factors, a further study (n=20, 9 males and 11 females, age range 57 - 82) investigated the effect of exercise on these risk factors, comparing the effect of an exercise class, a Nintendo Wii Fit intervention and a control group (no exercise). Interventions were provided x2 p/w for 1 hour duration. This exploratory exercise intervention (pseuso-RCT) demonstrated that individuals allocated to the exercise group achieved the most improvement in risk factors for falls in this study, with significant improvements in Neuropathy Disability Score, right step length and ankle strength for all muscle groups tested. The risk factors for falls in patients with DM are similar to those of the general population; however are more pronounced in those with DM. As such, early identification and strategic intervention such as the implementation of a structured exercise regime are critical to effective falls prevention and management, for people with DM.
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Malek-Ahmadi, Michael. "Cardiovascular risk factors for mild cognitive impairment." [Tampa, Fla] : University of South Florida, 2009. http://purl.fcla.edu/usf/dc/et/SFE0002872.
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Shah, Payal S. "Awareness of Diabetes Risk and Adoption of Diabetes Risk Reduction Behaviors in the Presence of Other Risk Factors in U.S Adults: An Examination of NHANES Data 2007-2008." Digital Archive @ GSU, 2011. http://digitalarchive.gsu.edu/iph_theses/188.
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ABSTRACT
Background: Prediabetes is a precursor condition to type 2 diabetes mellitus. Previous research and clinical trials have shown that the onset of type 2 diabetes could be delayed or prevented through structured life style modifications such as dietary changes, modest weight loss and moderate-intensity exercise. This study examines U.S adults of different ethnicities that include non-Hispanic white, non-Hispanic black and Mexican Americans and whether their awareness of diabetes risk is associated with their participation in diabetes risk reduction behavior, a combination of physical activity, weight control and fat/calories intake.
Methods: The 2007-2008 National Health and Nutrition Examination Survey, NHANES, was used to conduct a cross-sectional study of 4083 U.S. adults who were 20 years old and above and were aware of their diabetes risk. The association between the awareness of one’s diabetes risk and the adoption of diabetes risk reduction behavior were examined in present of other risk factors such as age, gender, ethnicity, education, annual family income, BMI, hypertension, mean systolic blood pressure, mean diastolic blood pressure, total cholesterol, LDL, HDL and triglyceride levels. Males and females were examined separately for all analyses performed. Cross tabulation was conducted and p-values were calculated by the Pearson’s chi-square test for the categorical variables which include gender, ethnicity, education, annual family income, adiposity and hypertension. One Way ANOVA and Tukey post hoc tests were conducted for the continuous variables which include age, mean systolic blood pressure, mean diastolic blood pressure, total cholesterol, LDL, HDL and triglyceride levels. Univariate and multivariate analyses were performed to determine the association between the main independent variable, awareness of one’s diabetes risk, and the dependent variable, adoption of diabetes risk reduction behavior, controlling for other risk factors. A p-value of <0.05 and 95% confidence intervals were used to determine statistical significance throughout all analyses performed.
Results: After controlling for age, gender, race, education, annual family income, BMI, hypertension, mean systolic blood pressure, mean diastolic blood pressure, total cholesterol, LDL, HDL, and triglycerides, results from the multivariate analysis showed that subjects who were aware of their diabetes risk were more likely to adopt diabetes risk reduction behavior (OR= 1,734, 95 % CI=1.217-2.470). Females and non-Hispanic blacks, who were aware of their diabetes risk, were also more likely to adopt diabetes risk reduction behavior compared to males, non-Hispanic whites and Mexican Americans. An increase in the levels of education, annual family income and BMI was also associated with the adoption of diabetes risk reduction behavior. Stratification according to gender and ethnicity, showed that Mexican American males and females were more likely to engage in diabetes risk reduction behavior compared to non-Hispanic whites and non-Hispanic blacks (Mexican American males: OR: 2.496, CI: 0.792-7.868; Mexican American females: OR: 2.830, CI: 0.917-8.736).
Conclusion: This study provides useful insights for health care providers and public health professionals who are developing health promotion and prevention interventions to address pre diabetes before it develops into type 2 diabetes. This study also allows the development of tailored interventions for specific genders and ethnic groups that are at risk. Results of this study indicate that Mexican Americans and females (in general) are more likely to adopt diabetes risk reduction behavior. Therefore, physicians and health care providers should develop culturally, linguistically and gender- specific education materials and programs for this particular gender and ethnic group. This in turn, may reduce the overall increasing prevalence of diabetes, reduce racial and gender disparities and may have a positive impact on the overall health of the U.S. population.
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Charbonneau, Guylaine. "Anthropometric correlates and underlying risk factors for type 2 diabetes mellitus among Inuit." Thesis, McGill University, 2005. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=97924.
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Type 2 diabetes mellitus (DM) is an emerging problem among Inuit of Circumpolar Countries. However, Canadian Inuit health surveillance data are limited. Data from the Nunavik Health Survey were used to evaluate the prevalence of overweight and obesity using the observed body mass index (BMIob) and the standardized BMI adjusted for sitting height (BMIstd). Also, data from Pangnirtung, Nunavut in the Baffin Region pilot health screening were used to evaluate anthropometric correlates of indices of insulin resistance. Obesity among the Nunavik study population (29.8%) is more prevalent than among general Canadians (23.1%), but the prevalence rates are more comparable when using BMIstd (21.5%). In Pangnirtung, anthropometric measures BMIob, BMIstd, waist circumference and percent body fat were associated with indices of insulin resistance/sensitivity (p ≤ 0.05). BMIstd showed similar results to BMIob and does not better predict the indices of insulin resistance/sensitivity.
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Manjoo, Priya Sonya. "Walking volume, abdominal obesity, and selected cardiovascular risk factors in type 2 diabetes." Thesis, McGill University, 2010. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=86913.
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Objectives: To determine whether the associations of walking with selected cardiovascular risk factors [CVRFs: glycemia, dyslipidemia, high blood pressure (BP)] are mediated by abdominal obesity (AO) in patients with type 2 diabetes mellitus (DM2).Methods: 94 women and 106 men with DM2 were assessed (June 2006-June 2008) for walking (2 weeks pedometer); AO (waist to hip ratio, WHR; waist circumference); glycemia (hemoglobin A1C, HbA1C); dyslipidemia therapy; and blood pressure (BP). Associations between walking and CVRFs were examined using multivariate regression, with and without adjustment for AO and potential confounders.
Results: A 1000 daily step increment in women was associated with a 0.13% (95% CI -0.25, -0.01) lower HbA1c, a 0.22 (95% CI: 0.63, 1.00) odds of dyslipidemia therapy, a -2.86 mmHg (95% CI: -4.32, -1.40) difference in systolic and a -1.66 mmHg (95% CI:-2.49, -0.82) difference in diastolic BP. With adjustment for AO, only associations with BP retained significance. The same step increment in men was associated with a 0.10% (95% CI: -0.22, -0.02) lower HbA1c and a -0.77 mm Hg difference in diastolic BP (95% CI: -1.55, 0.00). Adjustment for AO did not impact these associations.
Discussion: Greater understanding of the role of changes in AO may provide insight into sex differences in CVD risk in DM2.
Objectifs: Pour déterminer si les associations de la marche avec des facteurs de risque cardio-vasculaires choisis [CVRFs : glycemia, dyslipidemia, hypertension (BP)] sont atténués par l'obésité abdominale (OA) dans les patients avec DM2.
Méthodes: 94 femmes et 106 hommes avec DM2 ont été évalués (juin 2006-juin 2008) pour marcher (pedometer de 2 semaines); AO (taille à rapport de hanche, WHR ; circonférence de taille) ; glycemia (hémoglobine A1C, HbA1C) ; thérapie de dyslipidemia ; et tension artérielle (BP). Des associations entre marcher et CVRFs ont été examinées utilisant la régression multivariable, avec et sans l'ajustement pour l'ao et les confounders potentiels. fr
Résultats: Un incrément quotidien de l'étape 1000 chez les femmes a été associé à un 0.13% (ci de 95% -0.25, -0.01) HbA1c inférieur, un 0.22 (ci de 95% : 0.63, 1.00) chances de la thérapie de dyslipidemia, -2.86 mmHg (ci de 95% : -4.32,) différence -1.40 dans systolique et -1.66 mmHg (ci de 95% : - 2.49,) différence -0.82 à BP diastolique. Avec l'ajustement pour l'ao, seulement les associations avec BP ont maintenu la signification. Le même incrément d'étape chez les hommes a été associé à un 0.10% (ci de 95% : -0.22, -0.02) HbA1c inférieurs et -0.77 une différence du millimètre hectogrammes à BP diastolique (ci de 95% : -1.55, 0.00). L'ajustement pour l'ao n'a pas effectué ces associations. fr
Discussion: Un plus grand arrangement du rôle des changements de l'ao peut fournir la perspicacité dans des différences de sexe dans le risque de CVD dans DM2. fr
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Khalili, Payam. "Risk factors for cardiovascular events and incident hospital-treated diabetes in the population." Doctoral thesis, Örebro universitet, Institutionen för hälsovetenskap och medicin, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-24173.
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Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. Well-established risk factors for CVD include increasing age, male sex, sedentary lifestyle, obesity, smoking, diabetes, hypertension, dyslipidaemia and low socio-economic status. Traditional risk factors do, however, not fully explain cardiovascular risk in general. In this thesis we focused on two conventional risk factors (smoking, blood pressure), and two unconventional risk markers (adiponectin, an adipocyte derived protein; and sialic acid (SA), a marker of systemic inflammation) for prediction of CVD events. Aims: In Paper I we examined to what degree smoking habits modify the risk of CVD in relation to systolic blood pressure levels in middle-aged men. In Paper II we investigated the predictive role of adiponectin for risk of CVD as well as the cross-sectional associations between adiponectin and markers of glucose metabolism, also in men. In Paper III we examined if increasing pulse pressure (PP) and increasing levels of SA both increase the risk of CVD and whether their effects act in synergism. In Paper IV the association of SA with risk of incident diabetes mellitus and related complications, resulting in hospitalization, was studied. Subjects and Methods: Two large-scale, population-based, screening studies with long follow-up periods have been used. The Malmö Preventive Project (MPP) was used with 22,444 individuals in Paper I and a sub cohort of 3,885 individuals in Paper II. The Värmland Health Survey (VHS) was used in Papers III and IV with 37,843 and 87,035 individuals, respectively. Results: CVD risk increases with increasing systolic blood pressure levels and this risk is almost doubled in smokers. Total adiponectin level is not associated with increased risk of future CVD but it is inversely associated with markers of glucose metabolism. PP and SA both contribute to risk of future CVD. Adjustment for mean arterial pressure reduces the risk induced by PP. Elevated SA contributes to increased risk of incident diabetes and related complications leading to hospitalization.
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McCormack, R. M. "Identification of genetic factors contributing to the development of type 1 (insulin-dependent) diabetes mellitus in the Northern Ireland population." Thesis, Queen's University Belfast, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.246427.
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Schneider, Harald J., Jens Klotsche, Sigmund Silber, Günter K. Stalla, and Hans-Ulrich Wittchen. "Measuring Abdominal Obesity: Effects of Height on Distribution of Cardiometabolic Risk Factors Risk Using Waist Circumference and Waist-to-Height Ratio." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-119990.
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Accumulating evidence suggests that measures of abdominal obesity outperform BMI in predicting diabetes and cardiovascular risk. However, it is debated which measure of obesity should be used. Currently, waist circumference (WC) is most commonly used and codefines the metabolic syndrome.
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Pöykkö, S. (Seppo). "Ghrelin, metabolic risk factors and carotid artery atherosclerosis." Doctoral thesis, University of Oulu, 2005. http://urn.fi/urn:isbn:9514276566.
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Abstract The increasing prevalence of metabolic syndrome and the consequent cardiovascular diseases, including atherosclerotic diseases and type 2 diabetes, are a cause of public concern worldwide. This development has stimulated an active search for novel risk factors and new candidate genes. The hormones regulating energy balance and the polymorphisms associated with them are of special interest as potential risk factors for metabolic syndrome. Ghrelin is a novel peptide hormone from stomach with strong growth hormone releasing activity. It is also able to modify glucose and insulin metabolism, blood pressure levels, cardiac function, adipogenesis and inflammatory processes in experimental conditions. Whether ghrelin and ghrelin gene variations have a role in the development of metabolic syndrome and the associated diseases, is not known. In the present study, the associations between fasting plasma ghrelin concentrations, ghrelin gene mutations (Arg51Gln and Leu72Met), features of metabolic syndrome, type 2 diabetes and carotid artery atherosclerosis were analysed. In addition, the relationship between ghrelin and insulin-like growth factor I (IGF-I) concentrations was studied. The study population consisted of 1045 middle-aged subjects of the hypertensive and the control cohorts of the OPERA project from the City of Oulu, Finland. Low ghrelin concentrations were found to be associated with several components of metabolic syndrome: adiposity, low HDL cholesterol levels, high insulin concentrations and high blood pressure levels. The prevalence of insulin resistance and type 2 diabetes was increased amongst the subjects with low ghrelin concentrations. Out of the individual factors tested, IGF-I concentration was the most significant predictor of ghrelin concentrations. This negative association was strongest in the subjects with insulin resistance and type 2 diabetes, which suggests that changes in ghrelin/IGF-I interactions might be involved in the development of these conditions. The subjects with the Gln51 allele of the ghrelin gene had lower ghrelin concentrations and, consistent with the findings mentioned above, higher prevalence of type 2 diabetes and hypertension compared with the subjects homozygous for the Arg51 allele. No correlation between ghrelin and C-reactive protein concentrations was seen. However, there was a positive association between ghrelin concentrations and carotid artery intima-media thickness. This association was independent of the commonly recognised risk factors of atherosclerosis and was only seen in men, who also had more advanced atherosclerosis than women. These observations call for further studies to clarify the potential causative role of ghrelin in the etiology of metabolic syndrome, type 2 diabetes and atherosclerotic cardiovascular diseasesTiivistelmä Metaboliseen oireyhtymään liittyy kohonnut riski sairastua sydän- ja verisuonisairauksiin kuten tyypin 2 diabetekseen ja sepelvaltimotautiin. Metabolisen oireyhtymän nopea esiintyvyyden kasvu on johtanut aktiiviseen uusien riskitekijöiden etsintään. Erityisen kiinnostuksen kohteena ovat olleet energia-aineenvaihduntaa säätelevät hormonit ja niihin liittyvät polymorfiat. Greliini on ensisijaisesti vatsalaukusta erittyvä hormoni, joka lisää voimakkaasti kasvuhormonin eritystä. Koeolosuhteissa sillä on myös vaikutuksia sokeriaineenvaihduntaan, verenpaineeseen, sydämen toimintaan, rasvakudoksen kehittymiseen ja tulehduksellisiin tapahtumiin, minkä perusteella on syytä epäillä greliinillä olevan osuutta metabolisen oireyhtymän ja siihen liittyvien sairauksien synnyssä. Tässä tutkimuksessa selviteltiin greliinin paastoplasmapitoisuuksien ja greliinipolymorfioiden (Arg51Gln ja Leu72Met) yhteyksiä metabolisen oireyhtymän piirteisiin, tyypin 2 diabetekseen ja kaulavaltimoiden ateroskleroosiin. Lisäksi tutkittiin greliinin ja insuliinin kaltaisen kasvutekijän (IGF-I) pitoisuuksien yhteyksiä. Tutkimusväestö koostui 1045 oululaisesta keski-ikäisestä OPERA tutkimukseen kuuluvasta henkilöstä. Tutkimuksessa matalien greliinipitoisuuksien havaittiin olevan yhteydessä useisiin metabolisen oireyhtymän piirteisiin: lihavuuteen, alhaisiin HDL kolesterolin pitoisuuksiin, korkeisiin insuliinipitoisuuksiin ja kohonneeseen verenpaineeseen. Matala greliinipitoisuus yhdistyi myös tyypin 2 diabeteksen ja verenpainetaudin esiintyvyyteen. Tutkituista tekijöistä IGF-I -pitoisuudet selittivät parhaiten greliinipitoisuuksia. Tämä käänteinen yhteys oli erityisen vahva tyypin 2 diabeetikoilla ja insuliiniresistenteillä henkilöillä viitaten greliinin ja IGF-I:n mahdollisen vuorovaikutukseen liittyvän näiden tilojen kehittymiseen. Lisäksi havaittiin, että greliinigeenin Gln51-alleelia kantavien henkilöiden greliinipitoisuudet olivat alhaiset, ja että he sairastivat enemmän diabetesta ja verenpainetautia kuin henkilöt jotka olivat homotsygootteja Arg51-alleelin suhteen. Greliinipitoisuudet ja C-reaktiivisen proteiinin pitoisuudet eivät korreloineet keskenään. Kaulavaltimon seinämäpaksuus korreloi positiivisesti greliinipitoisuuksien kanssa miehillä riippumatta perinteisistä ateroskleroosin riskitekijöistä. Tutkimustulokset tukevat olettamusta, että greliinillä saattaa olla merkitystä metabolisen oireyhtymän, tyypin 2 diabeteksen ja ateroskleroosin kehittymisessä. Jatkotutkimukset ovat tarpeen tämän yhteyden osoittamiseksi
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Feigl, Andrea B. "Managing Non-Communicable Disease Risk Factors in Developing Countries: Tobacco Control, Cardiovascular Disease Risk Surveillance, and Diabetes Prevention." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:16121160.
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Non-communicable diseases (cardiovascular diseases, cancers, chronic respiratory diseases, diabetes, and mental illnesses) and associated risk factors (unhealthy diets, physical inactivity, harmful use of alcohol, physical inactivity) are on the rise in developing countries, posing a threat to the health and financial systems of emerging economies.
In response, international organizations and Ministries of Health alike have started to tackle chronic diseases and associated risk factors with policies and treatment programs. Yet to this day, the body of evidence for best practices regarding the monitoring, prevention, and control of non-communicable diseases in low- and middle-income countries remains small.
This doctoral thesis adds to this body of evidence. The first paper of my thesis assesses the impact of a national tobacco control program in high schools in Chile. Specifically, it evaluates the effectiveness and makes several policy recommendations based on the findings. My second dissertation paper assesses the modifying effect of a change in anti-retroviral treatment among HIV-positive subjects in KwaZulu-Natal, South Africa on cardiovascular disease risk factors of high body mass index and high blood pressure. The third paper is based on a randomized controlled trial assessing the effectiveness of a social-network-based diabetes and weight management program in Jordan.Global Health and Population
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Gallo, Sina. "The determinants of adiponectin in female adolescents : offspring of gestational diabetes and non-diabetes affected pregnancies." Thesis, McGill University, 2007. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=101125.
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Daughters of gestational diabetes (GDM) affected pregnancies are at greater risk for the development of type 2 diabetes mellitus (DM) later in life. Adiponectin is an early marker of DM risk. Dietary fat quality has been proposed to be involved in the development of insulin resistance. Plasma fatty acids are a marker of recent dietary exposure. The objectives of this research were to determine whether differences in adiponectin exist in daughters of GDM pregnancies, and to describe how dietary fatty acids impact adiponectin concentrations. Fasting adiponectin and plasma fatty acids were examined for 180 adolescent daughters born to mothers with and without GDM. No differences were observed in adiponectin between study groups, however; a significant difference was detected upon comparison of daughters from mothers who were presently diabetic with those from healthy mothers. The association between fatty acids and adiponectin varied by visceral adiposity. Adiponectin was inversely associated with monounsaturated and omega-3 (n-3) fatty acids in the high waist group. Further knowledge on the interactions between fatty acids, desaturase activity and adiponectin would be helpful in planning early interventions for individuals at risk for diabetes.
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Möllsten, Anna. "Factors influencing the risk of diabetic nephropathy : analyses of genes, smoking and diet /." Umeå : Umeå universitet, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-911.
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Robertson, Lynn M. "Maternal and neonatal risk factors for childhood type 1 diabetes a pilot matched case-control study /." Available from the University of Aberdeen Library and Historic Collections Digital Resources, 2009. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?application=DIGITOOL-3&owner=resourcediscovery&custom_att_2=simple_viewer&pid=26211.
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Sukhram, Shiryn D. "Cardiovascular Risk Factors in Turkish Immigrants with Type 2 Diabetes Living in The Netherlands." FIU Digital Commons, 2012. http://digitalcommons.fiu.edu/etd/636.
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The cross sectional study investigated the association of tobacco smoke, vitamin D status, anthropometric parameters, and kidney function in Turkish immigrants with type 2 diabetes (T2D) living in the Netherlands. Study sample included a total of 110 participants aged 30 years and older (males= 46; females= 64). Serum cotinine, a biomarker for smoke exposure, was measured with a solid-phase competitive chemiluminescent immunoassay. Serum 25-hydroxyvitamin D [25(OH)D] was determined by electrochemiluminescence immunoassay (ECLIA). Measures of obesity including: body weight, body mass index (BMI), waist circumference (WC), and hip circumference (HC) were measured. Waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were calculated. Urine albumin was measured by immunoturbidimetric assay. Urine creatinine was determined using the Jaffe method. All statistical analyses were performed using SPSS, version 19.0 (SPSS Inc., Chicago, IL, USA). Independent samples t-test, chi-squared tests, multiple linear regression and logistic regression analysis were used.
Cotinine levels were positively associated with cholesterol to HDL ratio and atherosclerosis-index. Serum 25(OH)D levels were negatively associated with diastolic blood pressure. Gender-specific associations between anthropometric measures and high sensitivity C-reactive protein (hs-CRP) levels were observed. Hs-CRP was positively associated with WC and WHR in males and WHtR in females. Microalbuminuria (MAU), as determined by albumin-to-creatinine ratio, was present in 21% of the Turkish immigrants with T2D. Participants with hypertension were 6.58 times more likely (adjusted odds ratio) to have positive MAU as compared to normotensive participants.
Our findings indicate that serum cotinine, 25(OH)D, hs-CRP, and MAU may be assessed as a standard of care for T2D management in the Turkish immigrant population. Further research should be conducted following cohorts to determine the effects of these biomarkers on CVD morbidity and mortality.
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Schneider, Harald J., Jens Klotsche, Sigmund Silber, Günter K. Stalla, and Hans-Ulrich Wittchen. "Measuring Abdominal Obesity: Effects of Height on Distribution of Cardiometabolic Risk Factors Risk Using Waist Circumference and Waist-to-Height Ratio." Technische Universität Dresden, 2011. https://tud.qucosa.de/id/qucosa%3A27093.
Full textAbstract:
Accumulating evidence suggests that measures of abdominal obesity outperform BMI in predicting diabetes and cardiovascular risk. However, it is debated which measure of obesity should be used. Currently, waist circumference (WC) is most commonly used and codefines the metabolic syndrome.
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Fhärm, Eva. "Treatment of cardiovascular risk factors in type 2 diabetes : time trends and clinical practice." Doctoral thesis, Umeå universitet, Allmänmedicin, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-30686.
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Objectives Patients with type 2 diabetes are at much greater risk of developing cardiovascular diseases (CVD), including coronary heart disease (CHD), compared to non-diabetics. The lowering of glucose, blood pressure, and plasma lipid levels has been shown to reduce CHD risk, and treatment goals for these risk factors are now part of clinical practice guidelines. However, the incidence and outcome of CHD in diabetic patients does not show the same favourable trend as in the general population. Thus, the overall aim of the thesis was to investigate how the treatment goals for CVD risk factors contained in the national guidelines for diabetes care were reflected in clinical practice, and to explore factors that might influence the remaining high incidence of CHD in the type 2 diabetes population. Research designs and results I. The effectiveness of the introduction of treatment goals for dyslipidaemia was evaluated in a retrospective observational population-based cross-sectional study of 971 diabetic patients participating in the Västerbotten Intervention Programme (VIP) 1995–2004. There was a stronger trend of decrease in cholesterol levels among patients with diabetes compared to the non-diabetic population in 2000–2004. Increased use of lipid-lowering agents influenced the trend in diabetic patients, even though only 25.3% received lipid-lowering treatment after the introduction of the new guidelines. II. The experiences of general practitioners relating to treatment practice for type 2 diabetes with specific focus on the prevention of cardiovascular disease were explored in a focus group study. The overall theme was ‘dilemmas’ in GPs’ treatment practice for patients with type 2 diabetes. Five main dilemma categories were identified. First, GPs were hesitant about labelling a person who feels healthy as ill. Second, as regards communicating a diabetes diagnosis and its consequences, GPs were unsure as to whether patients should be frightened or comforted. Third, GPs experienced uncertainty in their role: should they take responsibility for the care or not? Fourth, GPs expressed concern over a conflict between lifestyle changes and drug treatment. Fifth, the GPs described difficulties when attempting to translate science into reality. III. Screening for microvascular and coronary heart disease according to national guidelines was evaluated in a cross-sectional study of 201 screening-detected patients with type 2 diabetes 1.5±0.7 years after diagnosis. A larger proportion of diabetic patients was screened for nephropathy and retinopathy than for CHD. Twenty-three percent of the patients had minor or major ECG abnormalities, but ECG findings seemed to have little or no impact on CHD prevention using lipid-lowering medication and ASA. A clinical history of CHD correlated with a larger proportion of patients receiving secondary prevention. IV. Time trends relating to the achievement of treatment goals and 10-year CHD risk at three years of diabetes duration were studied in 19,382 patients with type 2 diabetes without CHD, who were reported by primary health care sources in the National Diabetes Register in 2003–2008. National treatment goals for glycaemia, blood pressure, total cholesterol, and LDL cholesterol were achieved in 78.4%, 65.5%, 55.6%, and 61.0%, respectively, of the diabetic patients in 2008 following a trend of improved results in 2003–2008. Absolute 10-year risk of CHD increased between year of diagnosis and follow up in a studied subgroup while modifiable risk decreased. Conclusions The introduction of treatment goals for dyslipidemia in Swedish national guidelines in 1999 were reflected in lowered cholesterol levels in people with type 2 diabetes. Since the introduction of the guidelines, an increasing number of diabetic patients are treated in accordance with guidelines. A remaining microvascular focus on the patients together with the revealed dilemmas within the GP’s consultation with diabetic patients might negatively influence the remaining high incidence of CHD in the type 2 diabetes population. Lipid levels, blood pressure and smoking are targets for further improvements.Kappa
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Alzahrani, Saad Hassan S. "Cardiometabolic risk factors, clot structure and the effects of therapies in individuals with diabetes." Thesis, University of Leeds, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.540551.
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Mamudu, Hadii M., Arsham Alamian, Timir Paul, Pooja Subedi, Liang Wang, Antwan Jones, Ali E. Alamin, David Stewart, Gerald Blackwell, and Matthew Budoff. "Diabetes, Subclinical Atherosclerosis and Multiple Cardiovascular Risk Factors in Hard-to-Reach Asymptomatic Patients." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/2778.
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Aim: To examine the association of cardiovascular disease risk factors with and their cumulative effect on coronary artery calcium in hard-to-reach asymptomatic patients with diabetes.
Methods: : A total of 2563 community-dwelling asymptomatic subjects from Central Appalachia participated in coronary artery calcium screening at a heart centre. Binary variable was used to indicate that coronary artery calcium was either present or absent. Independent variables consisted of demographic and modifiable risk factors and medical conditions. Descriptive statistics and multinomial logistic regression analyses were conducted.
Results: : In total, 55.8% and 13.7% of study participants had subclinical atherosclerosis (coronary artery calcium ⩾1) and diabetes, respectively. The presence of coronary artery calcium was higher in subjects with diabetes (68.5%) than those without (53.8%). Compared to subjects without diabetes with coronary artery calcium = 0, obesity, hypertension, hypercholesterolaemia and smoking increased the odds of the presence of coronary artery calcium (coronary artery calcium score ⩾1) regardless of diabetes status; however, with larger odds ratios in subjects with diabetes. Compared to subjects without diabetes with coronary artery calcium score = 0, having 3, 4 and ⩾5 risk factors increased the odds of presence of coronary artery calcium in subjects with diabetes by 14.06 (confidence interval = 3.26–62.69), 32.30 (confidence interval = 7.41–140.82) and 47.12 (confidence interval = 10.35–214.66) times, respectively.
Conclusion: : There is a need for awareness about subclinical atherosclerosis in patients with diabetes and more research about coronary artery calcium in subpopulations of patients.
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Nguyen, Thanh Chung. "A Case-Control Study of Risk Factors for Type 2 Diabetes Mellitus in Vietnam." Thesis, Curtin University, 2016. http://hdl.handle.net/20.500.11937/339.
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A case-control study including 599 type 2 diabetes (T2D) cases and 599 controls was conducted in Northern Vietnam between 2013 and 2015 to investigate the associations between dietary, lifestyle factors and T2D risk. High consumption of green tea, coffee, and moderate intensity of activity were inversely associated with reduced odds of T2D. The present study found that there are inverse associations between habitual tea, coffee consumption, physical activity and risk of T2D among Vietnamese adults.
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Santos, Filipa Alves. "Diabetes Mellitus em cães e gatos : estudo retrospectivo de 35 casos clínicos." Master's thesis, Universidade Técnica de Lisboa. Faculdade de Medicina Veterinária, 2012. http://hdl.handle.net/10400.5/4050.
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Dissertação de Mestrado Integrado em Medicina VeterináriaA Diabetes Mellitus (DM) é uma doença endócrina complexa, de elevada prevalência na clínica de pequenos animais, que se caracteriza por uma hiperglicémia crónica, devido a uma incapacidade absoluta ou relativa das células β do pâncreas produzirem e secretarem insulina e/ou de uma acção insuficiente de insulina nos tecidos, e que vai resultar em importantes alterações no metabolismo dos hidratos de carbono, dos lípidos e das proteínas, que podem ser fatais se não devidamente tratadas. O objectivo deste estudo foi avaliar os aspectos epidemiológicos e clínico-patológicos presentes numa amostra populacional de 23 canídeos e 12 felídeos diabéticos, a fim de identificar eventuais factores predisponentes e as alterações clínicas e laboratoriais mais frequentes. Foi ainda avaliada a evolução da doença e o aparecimento de complicações associadas, desde o momento do diagnóstico. O presente estudo demonstrou que a DM é uma doença que ocorre tipicamente em canídeos e felídeos adultos, de meia-idade a geriátricos, afectando sobretudo os canídeos fêmeas inteiras e os felídeos machos inteiros. As principais alterações clínico-laboratoriais observadas foram hiperglicémia (100% em ambas as espécies), glicosúria (100% em ambas as espécies), cetonúria (56% nos cães e 42% nos gatos), aumento da actividade das enzimas FAS (70,5% nos cães e 37,5% nos gatos), ALT (43% nos cães e 75% nos gatos) e AST (44% nos cães e 33% nos gatos); hipertrigliceridémia (100%) e hipercolesterolémia (43%), na espécie canídea; e hiperbilirrubinémia (60%), na espécie felídea. O conhecimento dos factores de risco e doenças associadas à DM, é de extrema importância, para se poder aplicar um protocolo terapêutico atempado e adequado, de forma a garantir um correcto maneio desta endocrinopatia, bem como prevenir a ocorrência de complicações clínicas. As principais complicações clínicas associadas à DM foram: a cetoacidose diabética (39% nos cães e 50% nos gatos); a catarata diabetogénica (17%) e a ITU (17%), na espécie canídea; e a lipidose hepática (42%), na espécie felídea.
ABSTRACT - Diabetes Mellitus (DM) is a complex endocrine disease, with high prevalence in clinic of small animals, which is characterized by chronic hyperglycaemia due to absolute or relative inability of pancreatic β cells to produce and secrete insulin and/or an impaired insulin action in tissues, and that will result in important changes in the metabolism of carbohydrates, lipids and proteins, which can be fatal if not treated properly. The aim of this study was to evaluate the epidemiological and clinicopathological aspects present in a total of 23 canines and 12 felines diabetics, in order to identify possible predisposing factors and clinical and laboratory changes. It was also assessed the disease progression and the onset of associated complications, from the time of diagnosis. The present study demonstrated that DM is a disease that typically occurs in adult canines and felines, middle-aged to geriatric, mainly affecting the intact female canines and intact male felines. The main clinical and laboratory changes observed were hyperglycemia (100% in both species), glycosuria (100% in both species), ketonuria (56% in dogs and cats 42%), increased activity of enzymes FAS (70, 5% in dogs and 37.5% in cats), ALT (43% in dogs and 75% in cats) and AST (44% in dogs and 33% in cats); hypertriglyceridemia (100%) and hypercholesterolemia (43%) in canine species; and hyperbilirubinemia (60%) in the feline species. Knowledge of risk factors and diseases associated with DM, it is extremely important, in order to implement a timely and appropriate treatment protocol, to ensure the proper management of endocrine disease, as well as prevent the occurrence of clinical complications. The main complications associated with DM were: diabetic ketoacidosis (39% in dogs and 50% in cats), diabetic cataracts (17%) and UTI (17%) in canine species, and hepatic lipidosis (42%) in feline species.
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Wong, Jencia. "Age of diagnosis as a factor in the heterogeneity of type 2 diabetes: a clinical and molecular study." Thesis, The University of Sydney, 2009. https://hdl.handle.net/2123/28210.
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The age range at which type 2 diabetes develops has recently
expanded. Thus chronological age and age of onset are now important
variables in this already heterogeneous disease. The increasing
prevalence of early-onset diabetes in particular raises clinical and
societal concerns. Such individuals have a longer life-time disease
duration and potentially can develop more diabetes related
complications, at a relatively young age, perhaps during the most
productive periods of their lives. The determinants of, and impact on
outcome of age of onset as a clinical variable are unclear. Therefore
studies using both clinical data and molecular techniques are employed
to answer questions in this area.
Whether the factors that impact on the development of type 2 diabetes
are specifically different for those with younger onset as compared to
older onset disease is not clear. By way of three studies, the first part of
this thesis explores the general question of ‘what determines the age
of type 2 diabetes onset?’
The specific impact of the metabolic syndrome, insulin resistance and
body weight on the age of type 2 diabetes onset is examined in two
different ethnic groups. This is in recognition of the paucity of specific
data in this area and the differing prevalence of the metabolic syndrome
in different ethnicities. This is examined in Chapter 2. The ‘accelerators’
of disease onset were quite different, dependent on ethnicity. Weight,
insulin resistance and a high prevalence of the metabolic syndrome are
associated with early-onset disease in Anglo-Celtics, but not so in
Chinese. The mechanistic and public health implications of these
observations are discussed.
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Viali, Satupaitea Public Health & Community Medicine Faculty of Medicine UNSW. "Trends and development of non-communicable diseases and risk factors in Samoa over 24 years." Awarded By:University of New South Wales. Public Health & Community Medicine, 2009. http://handle.unsw.edu.au/1959.4/40404.
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Abstract inserted as part of Final MPH Thesis: Non-Communicable Diseases like diabetes, cardiovascular diseases, cancers and others, have become the major cause of premature death, morbidity and disability in many Pacific countries including Samoa. These are linked by common preventable risk factors like obesity, hypertension, smoking, unhealthy diets and physical inactivity. OBJECTIVES: To determine the trends and development of Non-Communicable diseases and its risk factors in Samoa over the last 24 years using the recently developed diagnostic criteria. RESEARCH DESIGN AND METHODS: This research thesis combines 3 large surveys that were done in 1978, 1991, and 2002, looking at the trends in the prevalence of diabetes, and the prevalence of the NCD risk factors such as blood pressure, obesity, cholesterol and smoking. The 3 survey samples were selected randomly from around similar regions (Urban Upolu, Rural Upolu, and Rural Savaii) of Samoa in 1978, 1991 and 2002, with a total of 5973 individuals (1978 survey = 1467; 1991 survey = 1778; 2002 survey = 2728) available for the thesis analysis. The 1978 and 1991 data sets were secured from Professor P Zimmet, and the 2002 STEPs survey data set was secured from the Samoa Ministry of Health. The 3 surveys methodologies, survey procedures, questionnaires and anthropometric measurements were similar though the diagnostic criteria used to measure obesity slightly differ between the surveys. The blood pressure measurements were similar though the diastolic blood pressure measure in 1978 was higher. The 1978 and 1991 surveys used fasting venous blood sampling to measure fasting plasma glucose, and cholesterol levels at the laboratory. OGTT was also used in 1978 and 1991, but not 2002. The 2002 survey used capillary sampling to measure fasting glucose using a glucometer, and cholesterol level using a cholesterol meter. The combined data was then cleaned, standardized and matched with each survey, to make analysis easier. The recent diagnostic criteria were then applied to all the surveys to diagnose diabetes (1999 WHO Diabetes Criteria), hypertension (WHO 1999, JNC-VII 2003, NHF 1999 Hypertension Criteria), obesity (BMI ≥30 kg/m??), and hypercholesterolaemia. The prevalences using the recent diagnostic criteria were then mapped out. RESULTS: The overall age-standardized prevalence of type 2 diabetes (known or previously unknown) utilizing the current 1999 WHO diagnostic criteria for men and women ≥20 years of age has increased from 5.4% (males 4.8%, females 5.9%) in 1978, to 12.0% (males 10.9%, females 13.5%) in 1991, and to 20.1% (males 17.2%, females 22.2%) in 2002. Among the individuals with diabetes in the 3 surveys, more than 60% had previously undiagnosed diabetes. Compared with the 1978 survey, the diabetes prevalence in 2002 represents a 4-fold increase over the 24 year period. This has occurred along with increasing obesity, urbanization and modernization, aging, cultural changes, and changes in physical activity. There is a high prevalence of non-communicable disease risk factors. The age-standardized prevalence of hypertension defined by the WHO 1999 and JNC-VII 2003 criteria was 47.2% in 1978, 22.5% in 1991, and 24.0% in 2002. The high prevalence of hypertension in 1978 was due to the method used for recording diastolic blood pressure. Hypertension was more common in the urban regions than rural regions in 1978 and 1991 while in 2002, there was no statistical difference between the rates of hypertension between the different regions due to the rise in the prevalence rate of hypertension in rural regions. There is a high prevalence of overweight and obesity in Samoa. Using the WHO classification for BMI, there was an increase in obesity (BMI ≥ 30kg/m??) prevalence in Samoa in the last decade, increasing steeply from 34.9% in 1978 to 51.3% in 1991, and slowing down to an increase to 57.4% in 2002. The prevalence of obesity is significantly higher in females compared with their male counterparts. The overweight prevalence (BMI 25-29.9kg/m??) was 34% in 1978, 31% in 1991 and 29% in 2002. The prevalence of obesity has increased by 65% from 1978 to 2002 with an increase of 47% from 1978 to 1991, and 12% from 1991 to 2002. Prevalence of obesity is increasing with age and is more of a problem in women than men. It is higher in the urban regions but there has been a faster rise in obesity prevalence in rural regions from 1978 to 2002 as the rural regions become urbanized. The prevalence of hypercholesterolaemia (total cholesterol ≥ 5.2 mmol/l) was 30.5% in 1978, and this increased to 51.1% in 1991. There was a marked decline of hypercholesterolaemia in 2002 (14.4%), which may be due to differences in the method of measurement. Although smoking prevalence remains high in Samoa it declined significantly from 42.4% 1978 to 35.3% 1991 but remained essentially steady at 38% in 2002. There was a significant gender difference in smoking with about 60% of men and 20% of women smoking regularly. CONCLUSION: Samoa is experiencing an increasing problem with Non-Communicable diseases like diabetes and some of its risk factors. Diabetes prevalence has dramatically increased by 4-fold in the last 24 years. The prevalence of hypertension has stabilized around 23% though there was a decrease from 1978. The prevalence of obesity has also increased. Smoking prevalence has slightly increased from 1991 to 2002 with a significant number of the population smoking. Hypercholesterolaemia is more common in 1991 with an apparent decrease in 2002. These findings have important implications for public health efforts and policy developments to contain the epidemic of Non-Communicable diseases in Samoa.
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Butt, Modaser Ahmad. "A comparative study of risk factors of coronary heart disease in South Asians and Caucasians." Thesis, University of London, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.243555.
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Rönnemaa, Elina. "Predictors of Dementia : Insulin, Fatty Acids and Vascular Risk Factors." Doctoral thesis, Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-164528.
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Identification of modifiable risk factors for Alzheimer’s disease (AD) is crucial in order to diminish suffering from this devastating disease. The aim of this thesis was to investigate if different aspects of glucose metabolism, insulin, fatty-acid composition or other vascular risk factors predict the future development of AD and dementia. This thesis is based on the Uppsala Longitudinal Study of Adult Men (ULSAM) cohort, which started in 1970. A total of 2322 men at age 50 were examined with focus on vascular risk factors. The cohort was re-examined at ages 60, 71, 77, 82 and 88. Incident diagnoses of AD, vascular dementia, other dementias and cognitive impairment were assessed in 2005–2010. The risk of AD was increased in subjects with lower early insulin response measured with both an intravenous glucose tolerance test at 50 years and an oral glucose tolerance test at 71 years of age. The presence of vascular risk factors such as hypertension, obesity, hypercholesterolemia and smoking increased the risk of future vascular dementia but not of AD. Furthermore, saturated fatty acids at midlife were inversely associated with risk of AD. No evidence of a protective effect of omega-3 fatty acids against dementia was found. The susceptibility allele, APOE ε4, was the strongest individual risk factor. APOE ε4 carriers with vascular risk factors had the greatest risk of developing dementia. Low insulin response was a risk factor for AD mainly in APOE ε4 non-carriers. Disturbances in insulin and glucose metabolism, vascular risk factors and fatty acids are linked differentially to the pathogenesis of AD and vascular dementia. These observations should be considered when future clinical approaches are planned to prevent and postpone the onset of dementia.ULSAM
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Parra-Medina, Deborah M. "The modifying effect of sociocultural status on risk factors for Type 2 Diabetes in older Mexican American women /." Diss., Connect to a 24 p. preview or request complete full text in PDF format. Access restricted to UC campuses, 1998. http://wwwlib.umi.com/cr/ucsd/fullcit?p9907779.
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Robinson, Jacquelyn Patricia Price. "Sociocultural Risk Factors of Non-Insulin Diabetes Mellitus Among Middle Class African Americans in Central Ohio." Columbus, OH : Ohio State University, 2003. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1047487253.
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Thesis (Ph. D.)--Ohio State University, 2003.Title from first page of PDF file. Document formatted into pages; contains xviii, 233 p.: ill. Includes abstract and vita. Advisor: Douglas E. Crews, Dept. of Anthropology. Includes bibliographical references (p. 209-233).
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Williamson, Rachel MacLeod. "Prevalence, risk factors and sequelae of non-alcoholic fatty liver disease in Type 2 diabetes." Thesis, University of Edinburgh, 2013. http://hdl.handle.net/1842/25315.
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Type 2 diabetes is an established risk factor for non-alcoholic fatty liver disease (NAFLD). Despite this, there are few data investigating NAFLD within large populations of people with Type 2 diabetes. In the initial chapters of this thesis NAFLD is defined and the pathological processes linking it to Type 2 diabetes are described. The epidemiological evidence that underpins current understanding of prevalence, risk factors and progression of the condition is reviewed in detail. Subsequent chapters describe research undertaken within the Edinburgh Type 2 Diabetes Study on the epidemiology of NAFLD in this population. The prevalence of NAFLD was determined within 939 subjects, aged 61 - 76 years, with well-characterised Type 2 diabetes. NAFLD was defined by the presence of ultrasounddiagnosed steatosis with detailed exclusion of secondary causes for liver disease. Ultrasound gradings were validated in a subgroup of 58 participants using 1Fi magnetic resonance spectroscopy, the non-invasive gold-standard method for hepatic lipid quantification, and intra- and inter-observer variability in ultrasound grading was calculated. The final prevalence of NAFLD, 42.6%, was higher than in the general population, but lower than in the few studies that have been performed in populations with Type 2 diabetes. It is likely that this was due to comprehensive screening for secondary causes of liver disease and validation of the ultrasound measure which resulted in re-categorisation as "normal" subjects initially graded as having mild steatosis. Independent predictors of NAFLD were diabetes variables or components of the metabolic syndrome. The utility of conventional "liver function tests" in detecting hepatic steatosis and NAFLD was examined. Although liver enzyme levels (alanine aminotransferase, aspartate aminotransferase and gamma-glutamyltransferase) were significantly higher in participants with hepatic steatosis compared with those with normal liver on ultrasound, values remained within the normal range in the majority of cases. The negative predictive values of normal levels were therefore low, calling into question their utility as screening tests for liver disease in the diabetic population. The prevalence of advanced liver disease had not previously been studied in a population with Type 2 diabetes, and was investigated in our population using surrogate markers of hepatic fibrosis. Hyaluronic acid (HA) levels were significantly elevated in 5.7% of subjects and 0.4% had ultrasound-diagnosed cirrhosis. Hepatocellular carcinoma was detected in 0.2% of participants. Liver enzyme markers were poorly predictive of high HA levels. Clinical risk scores identified a large proportion of subjects as potentially having severe fibrosis, but these scores have not previously been validated in populations with Type 2 diabetes and therefore have to be interpreted with caution. NAFLD has previously been shown to be predictive of cardiovascular disease in the context of Type 2 diabetes, but mechanisms underlying this have not been fully elucidated. In the current study the association of hepatic steatosis and NAFLD with non-classical cardiovascular risk factors - clot formation and lysis dynamics, prothrombotic mediators and markers of inflammation - was investigated. NAFLD was significantly associated with a longer clot lysis time and higher levels of complement C3 and plasminogen activator inhibitor type 1. Following adjustment for these prothrombotic compounds, the association of NAFLD and clot lysis time was lost, and it is therefore hypothesised that NAFLD may influence clot lysis time via increased production of these mediators.