Browsing by Subject "tyypin 2 diabetes"
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(2009)Diabeetikoiden määrä lisääntyy jatkuvasti. Samalla hoitokulut ovat kasvaneet merkittävästi. Paras tapa hillitä kustannusten kasvua on hoitaa diabetesta mahdollisimman hyvin. Näin voidaan ehkäistä myös diabetekseen liittyvien oheissairauksien syntyä. Diabeteksen hoidossa on tärkeää kiinnittää huomiota hoidon jatkuvuuteen ja potilaan hoitoon sitoutumiseen. Apteekin henkilökunnan asema on noussut yhä keskeisemmäksi diabeetikon hoitoon sitoutumisen edistäjänä. Tämän pro gradu -tutkielman tavoitteena oli selvittää, mikä on apteekin farmaseuttisen henkilökunnan rooli diabetespotilaan hoitoon sitouttamisessa, elämäntapamuutosten toteuttamisessa ja niiden pysyvyyden varmistamisessa. Asiaa tarkasteltiin voimaantumisen teorian näkökulmasta. Tarkoituksena oli selvittää, miten voimaantuminen yksilössä tapahtuu, miten sitä voidaan apteekkineuvonnalla edistää ja mikä on apteekin rooli ulkopuolisena voimaannuttajana. Tämän tutkimuksen aineisto on kerätty Mäntyharjun Havu apteekissa ja se on osa laajempaa tutkimusta, jonka päätavoitteena on kehittää ja testata apteekkeihin soveltuva yksilökeskeinen toimintamalli tyypin 2 diabeteksen hoidon tukemiseen. Toimintamalli perustuu säännöllisiin neuvontatapaamisiin apteekissa. Pro gradu -tutkielmaan analysoitavaksi valittiin tutkimusjoukosta (n=19) ne, joilla tapahtui apteekkiohjelman aikana eniten positiivisia muutoksia yksilötasolla sekä elämäntapamittareilla mitatuissa arvoissa että kliinisissä parametreissa (n=4). Kvaliatiivisessa analyysissä käytettiin sekä deduktiivista että induktiivista lähestymistapaa. Vaikka diabeetikoilla oli tietoa sairaudesta ja elämäntapojen merkityksestä, niin käytännön tasolla jokainen henkilö kaipasi hoitoon ja erityisesti muutosten toteuttamiseen tukea ulkopuoliselta taholta. Apteekin rooli ulkopuolisena voimaannuttajana koettiin erityisen keskeiseksi. Tapaamiset loivat oikeanlaisen ympäristön ja ilmapiirin elämäntapamuutosten toteuttamiseen ja voimaantumisprosessin etenemiseen. Voimaantuminen ruokavaliomuutoksiin oli koko intervention aikana melko nousujohteinen prosessi. Sen sijaan voimaantuminen liikunnalliseen elämäntapaan oli aaltoilevaa. Apteekkitapaamiset sosiaalisena tapahtumana paransivat asiakkaan hoitoon sitoutumista. Asiakas koki, että häntä kohdellaan yksilönä kokonaisvaltaisesti. Voimaantuakseen yksilö tarvitsi aikaa. Vuoden mittaisen intervention aikana voitiin saavuttaa pysyviä muutoksia elämäntapoihin, mikäli yksilöllä itsellään oli halu ja motivaatio sitoutua tukiohjelmaan. Tämä tutkimus osoitti, että tämänkaltaista apteekkiohjelmaa tarvitaan. Nykyisessä kiireyhteiskunnassa ihmiset arvostavat, jos jollakin on aikaa paneutua yksilöön itseensä ja hänen sairautensa hoitoon kokonaisvaltaisesti.
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(2012)The burden of diabetes is increasing globally as the number of people with diabetes reaches over 220 million. Over 90 per cent of these people are suffering from type 2 diabetes. This condition is primarily defined by the chronic increase in blood glucose level or hyperglycemia. Type 2 diabetes is characterized by insulin resistance and is usually associated with abnormal insulin secretion. Insulin resistance is a state where normal amount of blood insulin is inadequate to increase glucose uptake in the most important target tissues of insulin. Numerous reports demonstrate that oversupply of lipids leads to loss of insulin activity and the formation of type 2 diabetes. Protein kinase C (PKC) isozymes comprise a family of serine/threoninekinases, which have a regulatory role in a multiple cellular processes. PKC!-isozyme activity is known to play a role in insulin resistance and therefore in type 2 diabetes. Free fatty acid (FFA) induced insulin gene function inhibition is associated with phosphoinositide dependent kinase1 (PDK1) independent phosphorylation of PKC!-isozyme in the most important insulin target tissues. Phosphorylated PKC!-isozyme causes insulinreceptor gene expression inhibition. Present study is part of a VHH-antibodies related research where the goal is to characterize these antibodies and to find out their effects on protein kinase C. VHH-antibodies are Ilama derived antibodies which contain a single heavy-chain variable domain, that is fully capable of antigen binding. In this work, we studied VHH-antibodies binding to PKC!-isozyme and its functional domains. PKC!-isozyme and its domains were produced in Sf9-insect cells. The binding was studied using Western blot and immunoprecipitation assays. In addition, the binding of 368 VHHantibodies to PKCε-isozyme's domain 2 were studied. With Western blot, it was discovered that E7-VHH-antibody binds to PKCε-isozyme full length and to domain 3. Other VHHantibodies tested in Western blot did not bind to PKCε-isozyme. Seven VHH-antibodies bound to PKCε-isozyme in immunoprecipitation. All of these VHH-antibodies bound to the full length and to domain 3, but not to other domains. In radioligand binding assays none of the VHH-antibodies bound to domain 2 that is the binding site to the endogenous PKCε-isozyme activator diacylglycerol (DAG). The results gathered with these three different methods were in line with each other. As the results gained from Western blot and immunoprecipitation show, all the VHH-antibodies, that bind to PKCε-isozyme, bind to its domain 3. With this study, we succeeded to gather new information about the binding of VHH-antibodies to PKCε-isozyme and its domains. The exact binding site has not been studied with so many VHH-antibodies before this study. Moreover, we also exploited methods that have not been used in this context before.
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(2017)The association of serum branched chain amino acids with insulin resistance, risk of type 2 diabetes and intake of macronutrients Both type 2 diabetes and insulin resistance have been associated with elevated concentrations of blood branched-chain amino acids (BCAA). However, it is not yet known why blood BCAA levels are elevated in people in an insulin-resistant state or how lifestyle and nutrition may affect blood BCAA concentrations. The aim of this study was to determine whether a high serum BCAA concentration is associated with the risk of developing type 2 diabetes and insulin resistance in men and women with impaired glucose tolerance (IGT). The association between macronutrient intake and serum BCAA concentration was also explored in this study. Serum BCAA concentration was analysed at baseline and after 1 year in 128 men and 279 women participating in the Finnish Diabetes Prevention Study (DPS). At baseline, all participants were middle-aged, had been diagnosed with IGT and were classified as overweight. All participants were monitored for T2D onset by oral glucose tolerance testing annually, over an average period of 9 years. Anthropometric measurements, blood samples and 3-day food diaries were collected at baseline and at year 1. Gender-specific quartiles of baseline BCAA were used to categorize the participants (Q1, Q2, Q3, Q4); Cox regression was used to analyse diabetes risk among the BCAA categories. Linear regression analysis was used to test for an association between BCAA concentration and a homeostatic model of insulin resistance (HOMA-IR) and macronutrient intake. In addition, linear regression analysis was used to test for an association between changes in BCAA concentration from baseline to year 1 and changes of HOMA-IR and macronutrient intake. The models were adjusted for age, education, gender and body mass index. In addition, the intakes of macronutrients were adjusted for energy intake. Serum BCAA concentration at baseline was associated with the development of T2D (Q4 vs. Q1 HR=1.72 [1.07–2.75]; Q3 vs. Q1 HR=1.69 [1.05–2.70]; Q2 vs. Q1 HR=1.06 [0.63–1.77]). BCAA concentration correlated with HOMA-IR (β=0.20; p<0.001) but changes in BCAA concentration was not associated with changes in HOMA-IR. In men, there was an inverse correlation between baseline BCAA and baseline energy intake (β=−0.23; p=0.01), while protein intake relative to energy intake was directly correlated with BCAA concentration (β=0.19; p=0.03), although the correlation was attenuated after adjusting (p=0.05). In women, baseline fat intake was correlated with BCAA (β=0.26; p=0.04), although the correlation was attenuated after adjusting (p=0.08). In women, a change in the intake of saturated fat correlated with a change in BCAA (β=0.17; p=0.04). The results of this study support earlier findings that, in people with IGT, elevated blood BCAA concentration is associated with insulin resistance and the risk of developing type 2 diabetes. This study also showed that the intake of macronutrients is differentially associated with blood BCAA concentration in men and women. Additionally, this study suggests that macronutrient intake may be associated with blood BCAA concentration. Futher studies are required to determine whether macronutrient intake modifies the association between blood BCAA concentration and risk of developing type 2 diabetes.
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