Browsing by Subject "Type 2 diabetes"

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    An epidemiologic and genetic exploration of the etiology of Type 2 diabetes in the Atherosclerosis Risk in Communities (ARIC) and Epidemiology of Hearing Loss (EHLS)/Beaver Dam Offspring (BOSS) Studies.
    (2011-10) Raynor, Laura A.
    Type 2 diabetes is a major contributor to mortality and morbidity in the United States. The etiology of this disease is complex and our knowledge of it is incomplete. These analyses sought to increase our understanding of the etiology of type 2 diabetes and to distinguish newly identified risk factors that could someday be useful in clinical risk prediction models. The first paper examined the contributions of novel risk factors to the prediction of type 2 diabetes in the Atherosclerosis Risk in Communities (ARIC) study. There was only modest reclassification of risk with the addition of forced expiratory volume in 1 second (FEV1) to the risk model and a small improvement in the integrated discrimination index (IDI) with the addition of white blood cell count, activated partial thromboplastin time (aPTT), albumin, factor VIII, magnesium, hip circumference, heart rate, and a genetic risk score in the total cohort. In the case-cohort analysis there was no significant reclassification of risk, but the addition of adiponectin, leptin, gamma-glutamyl transpeptidase (GGT), ferritin, inter-cellular adhesion molecule 1 (ICAM-1), and complement C3 to models modestly improved the IDI. A second paper examined the association between sets of genome-wide association (GWA) derived type 2 diabetes score alleles with both incident type 2 diabetes and prostate cancer in the ARIC cohort. We found that these score sets derived from men were not significantly associated with type 2 diabetes in an independent target dataset of women, nor were they associated with prostate cancer in men. Secondarily, we conducted a pathway analysis of our GWA analyses of type 2 diabetes and prostate cancer. We failed to identify pathways significantly associated with both diseases; however, we did identify a pathway statistically significantly associated with type 2 diabetes, the growth hormone signaling pathway. A third paper looked for associations between genetic variants in the Wnt pathway and hemoglobin A1C (HbA1c) levels in the Epidemiology of Hearing Loss (EHLS) and Beaver Dam Offspring Study (BOSS) studies. No Wnt variants were significantly associated with HbA1c. Nor were we able to replicate the associations between three SNPS and HbA1c recently identified in a meta-analysis. This dissertation contributes to our understanding of type 2 diabetes risk prediction by showing that few novel risk factors contribute meaningfully to existing risk prediction and expands our understanding of the etiology of type 2 diabetes by identifying a genetic pathway significantly associated with this disease and its related quantitative traits.
  • Thumbnail Image
    Item
    The lived experience of Type 2 diabetes in urban-based American Indian adolescents.
    (2011-05) Martin, Lisa C.
    This qualitative nursing research study used a hermeneutic phenomenological perspective to discover meaning in urban-based American Indian adolescents' experiences living with Type 2 diabetes. The aim of this study was to understand what it meant for urban-based American Indian adolescents to live with and experience Type 2 diabetes. The study used phenomenologic unstructured interviews to describe and represent the adolescent's voice and experiences of living with the disease in an urban community. The study was guided by Max Van Manen's methodology for phenomenological research. This method entailed turning to the phenomenon of interest, then, inquiring and investigating the experience as it was lived rather than as it was conceptualized. The study reflected and analyzed essential themes that characterized the phenomenon of living with Type 2 diabetes and presented the phenomenon through the art of writing and re-writing. Data collection involved in-depth, in-person interviews with analysis of the resulting transcripts. Adolescents in this study described connections with the American Indian culture, past and present family members, and the pragmatic details of living each day with the disease. Essential themes of the adolescents' experiences were found in the lifeworld areas of relationality and temporality, followed by incidental themes in the areas of corporeality and spatiality. The study findings illuminated the participants' personal meanings and validated the phenomenological research process. A preliminary conceptual model based on the lifeworld categories for understanding adolescents' experiences was proposed and had implications for education, research, and practice, supporting continued inquiry.
  • Thumbnail Image
    Item
    Progressive self-curing: a grounded theory study of exercise behavior maintenance in older adults with Type 2 diabetes.
    (2009-11) Weymiller, Audrey Jane
    Background: Sociocultural shifts have resulted in sedentary, aging population. Type 2 diabetes is reaching epidemic proportions. Older adults with type 2 diabetes generally do not follow an exercise program. Exercise is key therapy for type 2 diabetes. Current heatlh behavior change models lack explanation for behavior maintenance. Thirteen interviews with older adults with type 2 diabetes who had been successful at maintaining an exercise program for at least six months results in the six-stage theory of progressive self-curing.
  • Thumbnail Image
    Item
    Self efficacy, self reliance, adherence to self care, and glycemic control among Cherokee with Type 2 diabetes.
    (2012-07) Mashburn, Diana D.
    Background: Type 2 diabetes is responsible for disability and shortened life span among Native Americans. Adherence to recommendations for diet, exercise and medication is essential to optimizing outcomes. Few studies of self care have included Native American participants. Specific Aims: Among Cherokee adults, aims are to (a) describe self efficacy, Cherokee self reliance, adherence to self care recommendations and glycemic control; (b) explore the relationship between self efficacy and Cherokee self reliance; and (c) predict glycemic control from self efficacy, Cherokee self reliance, adherence to self care recommendations, and personal characteristics. Methods: The design was observational and cross-sectional. A convenience sample of 164 female and 136 male Cherokee adults with type 2 diabetes receiving care at three Cherokee Nation clinics participated. Subjects completed the Diabetes Self Efficacy Scale, Cherokee Self Reliance Questionnaire, and Summary of Diabetes Self Care Activities. Glycemic control was indexed using the most recent A1C value. Results: The average age of participants was 58.29 (SD = 12.07); they had had type 2 diabetes for an average of 9.06 years (SD = 7.85). Using exploratory maximum likelihood factor analysis with orthogonal rotation, items from self efficacy and self reliance measures loaded on separate factors. Self efficacy, years since diagnosis, age and clinic (C compared with B) were significant predictors of A1C. Conclusions: Glycemic control was only partly explained. Diabetes self care is complex. Continued research on psychosocial and educational aspects of self care is needed to better understand diabetes management and outcomes among Cherokee adults.