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Amalina Nur Fadhilah

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A Metasynthesis of the Self-Management of Type 2 Diabetes

Timothy Gomersall,1 Anna Madill,1 and Lucinda K. M. Summers

Type 2 diabetes is a metabolic disorder characterized by chronically elevated blood

glucose levels and a high risk of cardiovascular disease and other complications affect-ing the
eyes, kidneys, and nervous system (Strine et al., 2005). The maintenance of normal blood
glucose levels depends on the release and functioning of insulin from the pancreas. For people
with type 2 diabetes, the cells targeted by insulin develop resistance to its effects, which results
in greater amounts of glucose in circulation. The development of insulin resistance has been
linked to a number of lifestyle factors including smoking, sedentari-ness, and high dietary fat
intake. Hence, the progression of type 2 diabetes can, in principle, be brought under control if
such factors are moderated by patients themselves. Diabetes is a growing challenge for health
care systems worldwide. Recent estimates predicted that more than 300 million people will have
the condition by the year 2025, increasing from an estimated 150 million in 2000 (King, Aubert,
& Herman, 1998; Zimmet, Alberti, & Shaw, 2001). The rapid increase of diabetes has coincided
with changes in environment and lifestyle associated with advanced industrialization and
globalization , including more sedentary jobs, aging populations, and increased availability of
sugary drinks and foods with high fat and salt content (Kolb & Mandrup-Poulsen, 2010; Zimmet
et al.). Hence, it has been predicted that the greatest increases in type 2 diabetes are likely to
occur in developing countries as they become industrialized and are subjected to the influences
of globalization (Wild, Roglic, Green, Sicree, & King, 2004; Zimmet, 2003). For instance, King
et al. predicted a rise in diabetes cases between 1995 and 2025 of 42% in the developed world
(Europe, North America, Australia, New Zealand, and Japan), and 170% in the rest of the world.
Stroke in Patients With Diabetes The Copenhagen Stroke Study

Henrik Stig J0rgensen, MD; Hirofumi Nakayama, MD;

Hans Otto Raaschou, MD; Tom Skyh0j Olsen, MD, PhD

Although diabetes is a strong risk factor for stroke, it is still unsettled whether stroke is
different in patients with and without diabetes. This is true for stroke type, stroke severity, the
prognosis, and the relation between admission glucose levels and stroke severity/mortality. This
community-based study included 1135 acute stroke patients (233 [20%] had diabetes). All
patients were evaluated until the end of rehabilitation by weekly assessment of neurological
deficits (Scandinavian Stroke Scale) and functional disabilities (Barthel Index). A computed
tomographic scan was performed in 83%. Results The diabetic stroke patient was 3.2 years
younger than the nondiabetic stroke patient (P<.001) and had hypertension more frequently (48%
versus 30%, P<.0001). Intracerebral hemorrhages were six times less frequent in diabetic
patients (P=.OO2). Initial stroke severity, lesion size, and site were comparable between the two
groups. However, mortality was higher in diabetic patients (24% versus 17%, P=.O3), and
diabetes independently increased the relative death risk by 1.8 (95% confidence interval [CI],
1.04 to 3.19). Outcome was comparable in surviving patients with and without diabetes, but
patients with diabetes recovered more slowly. Mortality increased with increasing glucose levels
on admission in nondiabetic patients independent of stroke severity (odds ratio,1.2 per 1
mmol/L; CI, 1.01 to 1.42; P=.O4). This was not the case in diabetic patients. Diabetes influences
stroke in several aspects: in age, in subtype, in speed of recovery, and in mortality. Increased
glucose levels on admission independently increase mortality from stroke in nondiabetic but not
in diabetic patients. The effect of reducing high admission glucose levels in nondiabetic stroke
patients should be examined in future trials. (Stroke. 1994;25:1977-1984.)