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Background: Regular physical activity (PA) attenuates the development of type 2 diabetes mellitus in postpartum women with prior gestational diabetes mellitus (GDM). PA is assessed by calculating the energy expenditure (EE), thus accurate estimation of EE is crucial. International PA Questionnaire (IPAQ) and activity diary are widely used subjective methods while pedometer provides objective evidence of PA and EE. Aims and Objectives: This study aims to compare subjective and objective methods of assessing EE as a measure of PA in postpartum women with a history of GDM. Materials and Methods: Fifty postpartum women who had a history of GDM were advised to maintain activity diaries and pedometer readings for 1 week each month up to 1 year and IPAQ was administered at the end of 6 and 12 months. EE was calculated by all three methods separately and Bland-Altman plots were used to assess the level of agreement between IPAQ and the other tools at 6 and 12 months. Friedman test was performed to compare estimated EE between the three methods. Results: There was a poor agreement between the subjective and objective methods. According to Bland-Altman plot results, the highest mean difference was observed between IPAQ and pedometer at 12 months (mean difference was 75.9). This observation indicated an underestimation of pedometer values at 12 months. EE assessed by two subjective methods were statistically comparable at both time points whereas, EE assessed by pedometer was significantly lower (P<0.017) compared to self-reported tools. Conclusion: Assessment of EE by subjective methods which are based on personal judgment may cause overestimation of PA. In contrast, pedometer readings are likely to underestimate the PA as it only reports kinetics activities. Therefore, a combination of subjective and objective methods is recommended to ameliorate the reliability and validity. [ABSTRACT FROM AUTHOR]

Background: The link between sweet taste perception and carbohydrate intake in diabetics who perform regular combined exercises has not been explored. Aims and Objectives: This study aimed at determining the impact of combined exercises on taste perception for sucrose and carbohydrate intake in patients with type 2 diabetes mellitus. Materials and Methods: A clinical trial was conducted with 225 patients with T2DM, aged 35-60 years assigned randomly into three groups; aerobic, combined, and a control group. Outcomes of the aerobic group were not reported. Combined group performed brisk walking 4-5 days/week and resistance exercises 2-3 days/week for 6 months. Supra-threshold intensity ratings, preference for sucrose, and carbohydrate intake assessed at baseline, at 3 and 6 months were measured using "general Labeled Magnitude Scale," "Monell 2-series-forced choice method," and a 3-day diet diary, respectively. Results: Ratings for the highest (combined vs. control: +3.15±0.57 vs. -7.96±0.40 mol/L, P=0.022) and the second-highest sucrose concentrations (combined vs. control: +7.79±4.49 vs. -8.98±0.99 mol/L, P=0.003) in the combined group were significantly higher with significant time × group interaction (2.02M: P=0.002, 0.64M: P=0.003). Preference for sucrose was lower in the combined group (combined vs. control: -0.08±0.14 vs. +0.01±0.03 mol/L, P=0.002), and the time × group interaction was not significant. Carbohydrate intake (combined vs. control: -46.97±21.60 vs. -6.30±9.36 g, P=0.001) and HbA1c level (combined vs. control: -0.66±1.81 vs. +0.33±1.84%, P=0.008) were reduced in the combined group, and taste sensitivity significantly predicted the carbohydrate intake with combined exercises (R2=0.64, P=0.01). Conclusion: Regular combined exercises increase sweet taste sensitivity for higher concentrations of sucrose. Taste sensitivity, not the preference determines the carbohydrate intake in exercising diabetics. [ABSTRACT FROM AUTHOR]

Women with a history of Gestational diabetes mellitus (GDM) have a high risk of developing Type 2 diabetes mellitus (T2DM) in their future life. Lifestyle interventions are known to reduce this progression. The success of a lifestyle intervention mainly depends on its feasibility. Therefore, this study aimed to evaluate the feasibility of a lifestyle intervention programme aimed to attenuate the development of T2DM in mothers with a history of GDM. This qualitative phenomenological study was carried out in selected Medical offices of Health (MOH) areas in Sri Lanka. Postpartum mothers with a history of GDM who have undergone a comprehensive, supervised lifestyle intervention program for 1 year, their family members, and public health midwives (PHM) were recruited for this study. Focus group discussions (FGD) were carried out with mothers and PHM while In-depth interviews (IDI) were conducted with family members. Framework analysis was used for the analysis of data. A total of 94 participants (45 mothers, 40 healthcare workers, and 9 family members) participated in FGDs and IDIs to provide feedback regarding the lifestyle intervention. Sixteen sub-themes emerged under the following four domains; (1) Feelings and experiences about the lifestyle intervention programme for postpartum mothers with a history of GDM (2) Facilitating factors (3) Barriers to implementation and (4) Suggestions for improvement. Spouse support and continued follow-up were major facilitating factors. The negative influence of healthcare workers was identified as a major barrier to appropriate implementation. All participants suggested introducing continuing education programmes to healthcare workers to update their knowledge. The spouse's support and follow-ups played a pivotal role in terms of the success of the programme. Enhancing awareness of the healthcare workers is also essential to enhance the effectiveness of the programme. It is imperative to introduce a formal intervention programme for the postpartum management of mothers with a history of GDM. It is recommended that the GDM mothers should be followed up in the postpartum period and this should be included in the national postpartum care guidelines. [ABSTRACT FROM AUTHOR]

Objective: To ascertain the possible role of leptin in the resumption of postpartum menstruation in lactating women with differing nutritional statuses. Design: Analysis of data and blood samples collected during a previous prospective study. Setting: Healthy volunteers in an academic research environment. Patient(s): Undernourished (body mass index [BMI]≤19 kg/m2) and well-nourished (BMI≥26 kg/m2) lactating women who resumed regular menstruation before 24 weeks and at or after 24 weeks postpartum. Intervention(s): Venous blood samples at four-weekly intervals and other clinical data collected until resumption of regular menstruation. Main outcome measure(s): Serum leptin concentrations. Result(s): Leptin concentrations were significantly higher in the well-nourished than in the undernourished women, irrespective of the time of resumption of menstruation. Time of resumption of menstruation did not significantly affect leptin levels within well-nourished and undernourished groups. Leptin significantly correlated with BMI (r = 0.78). The BMI (r = −0.53), but not leptin, was significantly and negatively correlated with the duration of lactational amenorrhea. Conclusion(s): Leptin is unlikely to be a major determinant of early resumption of regular menstruation in well-nourished women. [Copyright &y& Elsevier]

Background: A woman with a history of GDM has a high risk of developing type two diabetes (T2DM) in her future life. Lifestyle modifications are known to attenuate the progression of GDM to T2DM. Therefore, the aim of this study was to assess the impact of a simple, cost effective, culturally acceptable lifestyle intervention programme on the trajectory towards T2DM in women with a history of GDM. Methods: This cluster randomized trial was conducted in 100 postpartum women in three selected districts of Sri Lanka. The subjects were divided into intervention (n = 50) and control groups (n = 50) by cluster randomization method. A culturally adapted protocol (comprised of dietary and physical activity modifications) was administered to the intervention group. The glycemic profile was assessed using fasting and 2-hour post-OGTT plasma glucose and HbA1c, and insulin resistance by HOMA-IR at baseline and after one year of intervention. Results: The mean age (SD) of the subjects in the intervention and control groups were 33.0 (5.1) and 34.3 (6.5) years respectively. All glycemic and insulin resistance parameters (i.e. Fasting plasma glucose- FPG, 2-hour post-OGTT plasma glucose, HbA1c and HOMA-ir) were comparable (p > 0.05) between the two groups at baseline. FPG, 2 h post OGTT, HbA1c and HOMA-ir values between intervention vs. control (p) at 12 months were 87.3 vs. 123.2 (< 0.01); 106.5 vs. 156.1 (0.01); 5.3 vs. 6.8 (< 0.01) and 0.9 vs. 2.3 (< 0.01) respectively. All glycemic parameters showed a significant reduction in the intervention group at 12 months compared to baseline. In contrast, the control group showed a significant increase in FPG, 2-hour post-OGTT plasma glucose and HbA1c at 12 months compared to baseline. In multiple linear regression model adjusted for age, parity and family history, the control group showed an approximately 33 times risk of developing insulin resistance compared to the intervention group. Conclusion: The culturally acceptable and individualized lifestyle intervention was able to produce remarkable reductions in glycaemic and insulin resistance parameters among postpartum women with a history of GDM. Trial registration: Ethical clearance was obtained from the Ethics Review Committee of the University of Sri Jayewardenepura, Sri Lanka (ERC 52/14), Sri Lanka Clinical trial registration number Sri Lanka Clinical Trials Registry (SLCTR/2015/021 date 25.09.2015). [ABSTRACT FROM AUTHOR]

Objective:To identify the socio demographic, life style and foot examination related predictors of diabetic foot and leg ulcers with a view to develop a screening tool appropriate for the use in an outpatient setting. Research design and methods:This cross sectional study included type 2 diabetes mellitus (DM) patients; 88 subjects with leg and foot ulcers and 80 non ulcer controls. Socio demographic data and life style factors were documented. Foot was examined for skin changes and structural abnormalities. Distal peripheral neuropathy was assessed by pressure sense, vibration sense and joint position sense. Multivariate analysis by logistic regression was used to determine the significant predictors in screening for foot ulcers. Results:Education of grade 6 and below (OR - 1.41, 95% CI; 1.03 - 4.68), low income (OR - 23.3, 95% CI; 1.5 - 34.0), impaired vibration sense (OR - 24.79, 95% CI; 9.3 - 66.2), abnormal monofilament test on first (OR - 1.69, 95% CI; 1.36 - 16.6), third (OR - 3.4, 95% CI; 1.1 - 10.6) and fifth (OR - 1.8, 95% CI; 1.61- 12.6) toes are found to be predictors of increased risk whereas incidental diagnosis of DM (OR - 0.03, 95% CI; 0.003 - 0.28), wearing covered shoes (OR - 0.003, 95% CI; 0.00 - 0.28), presence of normal skin color (OR - 0.01, 95% CI; 0.001 - 0.14) and normal monofilament test on first metatarsal head (OR - 0.10, 95% CI; 0.00 - 0.67) are protective factors for ulcers. Conclusions:Ten independent risk and protective factors identified in this study are proposed as a simple screening tool to predict the risk of developing leg and foot ulcers in patients with DM. [ABSTRACT FROM AUTHOR]

Aims and objectives To assess nurses' knowledge on diabetic ulcer disease and their attitudes towards patients suffering from it and to identify factors which influence them. Background Diabetic wound care is an evolving specialty with the rising prevalence of diabetes foot complications. As nurses play a key role in wound care, their knowledge and attitudes are important in providing optimum care to patients. Design Descriptive cross-sectional survey design. Methods The study was conducted in three teaching hospitals. Data were collected using a pretested, validated, self-administered questionnaire from purposively recruited, voluntarily participating nurses ( n = 200) who were in diabetic wound care practice for ≥1 year. Results Lack of formal wound care training was reported by 91.2%. Mean knowledge score was 77.9 (range 53.3-100 on a scale from 0-100) with 57.8% of nurses obtaining ≥80%. Nurses demonstrated an overall positive attitude towards caring for diabetic ulcer patients (median = 41, range 23-50 on a scale from 10-50). However, the study identified deficits in core knowledge and some negative attitudes such as insensitivity to pain. Statistically significant associations were seen between nurses' knowledge and duration of nursing, wound care experience and the type of unit they are attached to. In-service education (77.2%) and knowledge sharing with peers (77.9%) were the most popular knowledge-updating sources. Although 98.6% of nurses were interested in wound care, only 8.3% wished to engage in research. No correlation was observed between nurses' knowledge and attitudes. Conclusion Gaps in core knowledge and negative attitudes may be attributed to inadequate training, suboptimal update of knowledge and lack of interest in wound care research. Relevance to clinical practice Wound care training should be made mandatory to improve quality of care given by nurses to patients with diabetic ulcers. Continuous professional development, evidence-based practices and wound care research should be encouraged. [ABSTRACT FROM AUTHOR]

Background: Regular exercise is a key element in the management of type 2 diabetes mellitus (T2DM). Although the importance of regular exercises on glycemic control in people with diabetes is studied extensively, evidence is lacking on its impact on sweet taste perception. Thus, the aim of this study was to determine the impact of aerobic exercises on taste perception for sucrose in people with diabetes. Methods: A sample of 225 people with diabetes aged 35-60 years was assigned randomly into 3 groups; aerobic exercise, combined exercise and a control group. The outcomes of the combined exercise group is not reported. The aerobic exercise group performed brisk walking 30min/day, 4-5days/week for 6 months. The primary outcome measures were supra-threshold intensity ratings and preference for sucrose assessed at baseline, at 3 and 6 months using 'general Labeled Magnitude Scale' and 'Monell 2-series-forced choice method' respectively. Glycated haemoglobin (HbA1c) level was assessed at baseline and at 6 months to determine glycemic control. Results: Aerobic exercise group showed significantly increased ratings (mm) for higher sucrose concentrations at 3 months (mean difference for 2.02M; +6.63±2.50, p=0.048 and for 0.64M; +7.26±2.76, p=0.026) and at 6 months (mean difference for 0.64M; +7.79±4.49, p= 0.044) compared to baseline and also when compared to controls (mean difference for 2.02M between baseline and 3 months; intervention: +6.63±2.50, control: -4.01±1.79, p=0.02 and between baseline and 6 months for 2.02M; intervention: +3.15±0.57, control: -7.96±0.40, p=0.022 and for 0.64M; intervention: +7.79±4.49, control: -8.98±0.99, p=0.003). A significantly reduced preference (mol/L) was seen both at 3 (mean difference; -0.03±0.02, p= 0.037) and at 6 months (mean difference; -0.05±0.12, p=0.011) compared to baseline within the intervention group. Also, a significant reduction was seen in the intervention group compared to controls at 6 months (mean difference; intervention: -0.05±0.12, control: 0.01±0.03, p=0.044). HbA1c was significantly reduced in the intervention group compared to controls at 6 months (mean difference; intervention -0.43±1.6%, control +0.33±1.8%, p=0.018). Conclusion: Regular aerobic exercises increase the sweet taste sensitivity, especially for higher concentrations of sucrose and decrease sweet taste preference in people with diabetes. These alterations in sweet taste perception, are likely to contribute to a better glycemic control in people with diabetes. Trial registration: This trial was registered at the Sri Lanka Clinical Trial registry on 16/12/2015. (Trial registration number- SLCTR/2015/029, https://slctr.lk/trials/slctr-2015-029). [ABSTRACT FROM AUTHOR]

Background: Regular exercise is a key element in the management of type 2 diabetes mellitus (T2DM). Although the importance of regular exercises on glycemic control in people with diabetes is studied extensively, evidence is lacking on its impact on sweet taste perception. Thus, the aim of this study was to determine the impact of aerobic exercises on taste perception for sucrose in people with diabetes. Methods: A sample of 225 people with diabetes aged 35-60 years was assigned randomly into 3 groups; aerobic exercise, combined exercise and a control group. The outcomes of the combined exercise group is not reported. The aerobic exercise group performed brisk walking 30min/day, 4-5days/week for 6 months. The primary outcome measures were supra-threshold intensity ratings and preference for sucrose assessed at baseline, at 3 and 6 months using 'general Labeled Magnitude Scale' and 'Monell 2-series-forced choice method' respectively. Glycated haemoglobin (HbA1c) level was assessed at baseline and at 6 months to determine glycemic control. Results: Aerobic exercise group showed significantly increased ratings (mm) for higher sucrose concentrations at 3 months (mean difference for 2.02M; +6.63±2.50, p=0.048 and for 0.64M; +7.26±2.76, p=0.026) and at 6 months (mean difference for 0.64M; +7.79±4.49, p= 0.044) compared to baseline and also when compared to controls (mean difference for 2.02M between baseline and 3 months; intervention: +6.63±2.50, control: -4.01±1.79, p=0.02 and between baseline and 6 months for 2.02M; intervention: +3.15±0.57, control: -7.96±0.40, p=0.022 and for 0.64M; intervention: +7.79±4.49, control: -8.98±0.99, p=0.003). A significantly reduced preference (mol/L) was seen both at 3 (mean difference; -0.03±0.02, p= 0.037) and at 6 months (mean difference; -0.05±0.12, p=0.011) compared to baseline within the intervention group. Also, a significant reduction was seen in the intervention group compared to controls at 6 months (mean difference; intervention: -0.05±0.12, control: 0.01±0.03, p=0.044). HbA1c was significantly reduced in the intervention group compared to controls at 6 months (mean difference; intervention -0.43±1.6%, control +0.33±1.8%, p=0.018). Conclusion: Regular aerobic exercises increase the sweet taste sensitivity, especially for higher concentrations of sucrose and decrease sweet taste preference in people with diabetes. These alterations in sweet taste perception, are likely to contribute to a better glycemic control in people with diabetes. Trial registration: This trial was registered at the Sri Lanka Clinical Trial registry on 16/12/2015. (Trial registration number- SLCTR/2015/029, https://slctr.lk/trials/slctr-2015-029). [ABSTRACT FROM AUTHOR]

Background: Obesity and its' comorbidities in young adults are emerging health concerns. Obesity is a well-known risk factor for developing cardiovascular diseases, type -2 diabetes, carcinomas, gallbladder disease, sleep apnea, osteoarthritis, and gynecological complications. Young adulthood is considered the best time period to introduce weight control interventions as the established lifestyle behaviors may persist throughout life. Aims and Objectives: The present study assessed self-perception of body weight, knowledge and practices on obesity and weight reduction and their associated factors in a sample of treatment seeking obese young adults. Materials and Methods: Two-hundred and sixty-one obese (BMI ≥ 25 kg m-2) young (18-35 years) adults attending an out-patient nutrition clinic of a teaching hospital in Sri Lanka were studied. An interviewer administered questionnaire was used to collect demographic data and information on body weight perception and, knowledge and practices on obesity and weight reduction. Weight, height and waist circumference were measured. Results: The mean (±SD) BMI of the participants was 29.0 (±3.6) kg m-2. Only 16.1% precisely perceived themselves as 'obese' and increased BMI was only significant predictor of accurate body weight perception (OR=1.23; 95% CI = 1.07-1.47; p = 0.003). Only 49.0% reported obesity as a disease and 46.0 % and 27.2% that it predisposes to stroke and carcinoma respectively. Although 86.2% have attempted weight reduction, only 33.8% sought professional advice. Diet control was the most common weight reduction strategy (73.1%) and among them 33.3% combined with exercises. One fourth (n = 56) relied on green tea for weight reduction and meal skipping was reported in 52.9%. Conclusion: Significant body weight misperception was reported in lower BMI categories. The overall knowledge regarding obesity and weight reduction was satisfactory though not optimum. Diet control with or without physical exercises was the most popular method of weight reduction. [ABSTRACT FROM AUTHOR]

Objectives: Gestational diabetes mellitus (GDM) is a world health concern. Women with a history of GDM have a high prevalence of developing type two diabetes mellitus, recurrence of GDM, and impaired glucose intolerance in their future life. Physical activity (PA) is a key component to attenuate the development of these complications. Therefore, the aim of this study was to evaluate the PA patterns of GDM women at 6 weeks postpartum. Material and Methods: This descriptive cross-sectional component of a large quasi-experimental study was conducted in three selected districts of Sri Lanka in 100 postpartum mothers. Anthropometric and glycemic parameters were assessed at 6 weeks postpartum. Pre-tested International PA Questionnaire (short-version) was used to assess PA. The PA level and intensity were calculated in metabolic equivalent task minutes per week (METminutes/week). Data were analyzed by SPSS 21 version. Both continuous and categorical data were analyzed. Ethical clearance was obtained from the University of Sri Jayewardenepura. Results: Mean HbA1c value was 6.64 ± 1.95. Median truncated PA was 3250 MET-minutes/week. The main contributors to energy expenditure in the study sample were moderate intensity household activities and walking with 58% of mothers walking more than 150 min/week. Although in the categorical analysis, 52% of mothers reported high level of PA, only 10% participated in at least one vigorous intensity activity continuously for more than 10 min to achieve reduced metabolic risks. Average sitting time of mothers was about 3 h/day which is in par with the breast-feeding recommendation. None of the PA MET values significantly correlated with the glycemic parameter, HbA1c. Conclusion: Although it appears that majority of mothers are physically active, these activities are not optimum in terms of reducing the metabolic risk. We suggest designing exercise protocols incorporating day-to-day moderate intensity activities and walking in a structured and scientific manner to achieve maximum benefits for this special group of women. [ABSTRACT FROM AUTHOR]

Background. Gestational diabetes mellitus (GDM) is a global concern. GDM mothers have a 7-fold relative risk of developing type 2 diabetes mellitus (T2DM) in their later life. User-friendly and culturally acceptable dietary interventions can minimize this risk. Therefore, this study aims at exploring the perceptions of GDM mothers and health care workers regarding factors that influence postpartum dietary practices aimed at attenuating the trajectory from GDM to DM. Methods. The study was conducted in selected MOH areas in three districts of Sri Lanka. Six focus group discussions were conducted with thirty mothers with a history of GDM and six in-depth interviews with six health care workers. The phenomenon of interest was to obtain inputs of two stakeholder groups on healthy food habits of GDM mothers during the postpartum period. Framework analysis was used to analyse the data. Data were coded using the analytical framework, abstracted from transcripts, and summarized verbatim in Microsoft Excel in a matrix comprised of one row per participant and one column per code. Finally, the matrix was reviewed intensely and themes were generated. Results. Overall, seven themes emerged from both cases: (1) myths and traditions specific to the postpartum period, (2) lack of motivation, (3) time pressure, (4) financial barriers, (5) negligence of mothers and families, (6) lack of awareness regarding GDM and its postpartum dietary recommendations, and (7) cultural barriers. Conclusions. This study provides an insight into the existing knowledge, common practices, and attitudes regarding food habits among postpartum mothers with a history of GDM. Since the postpartum period is unique, identifying barriers is crucial when introducing dietary modification protocols in order to prevent or attenuate the progression of GDM to T2DM in these mothers. The knowledge gained will be used to introduce feasible, scientifically sound, and culturally acceptable postpartum dietary recommendations for GDM mothers. [ABSTRACT FROM AUTHOR]