An in vitro investigation of novel quinolone derivatives on selected pharmacological targets for diabetes mellitus and associated complications
- Authors: Ayodele, Omobolanle Opeyemi
- Date: 2023-03-29
- Subjects: Diabetes , Hyperglycemia , Quinolone antibacterial agents , Cardiovascular system Diseases , Diabetes Alternative treatment , In vitro experiment
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/409813 , vital:70632
- Description: Diabetes mellitus (DM) is a group of endocrine and metabolic disorders characterised and identified by the presence of hyperglycaemia over a long period and, to an extent, accompanied by hyperlipidaemia. CVD has been reported to be the leading cause of mortality in patients with DM. Several antidiabetic agents are available for managing DM, but these agents are not for curative therapy and present with undesirable side effects. In addition, these agents become less effective as the patient's condition progresses to complete beta-cell failure. Therefore, developing newer antidiabetic agents with minimal undesirable side effects, prolonged efficacy and protection against the development of DM complications are necessary. This study was conducted to identify potential novel antidiabetic agents with cardiovascular-protective activity. The compounds of interest for the study were quinolone derivatives since quinolones have been reported to have an antihyperglycaemic effect. , Thesis (MSc) -- Faculty of Pharmacy, 2023
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- Date Issued: 2023-03-29
Assessing Diabetes distress amongst type 2 Diabetic patients at the Mhlontlo sub-district healthcare clinics in the OR Tambo health District
- Authors: Mboniso, Veronica
- Date: 2022-12
- Subjects: Diabetes , Medical care , Primary health care -- OR Tambo Health District
- Language: English
- Type: Master's theses , Thesis
- Identifier: http://hdl.handle.net/10948/60111 , vital:63096
- Description: Diabetes mellitus is a chronic endocrine condition that requires lifestyle changes and a commitment to its management to ensure patient well-being, although this can be challenging for various reasons. In addition, diabetes is a behavioural and emotionally demanding condition that could affect the psychosocial well-being of a patient. Diabetes distress is quite common in people living with diabetes, as they lose hope easily, especially when their diabetes is uncontrolled. The research study identified and described factors contributing to diabetes distress amongst type 2 diabetic patients at Mhlontlo Sub-District healthcare clinics in the OR Tambo Health District. Probability sampling was used to select patients who were 18 years and older after approval from Nelson Mandela University (NMU) and relevant authorisation was obtained. The study was conducted between August and October 2021, using a quantitative, exploratory and descriptive research design. The data were collected using a self-administered questionnaire, which had been adapted from the Diabetes Distress Scale-17 (DDS-17) created by Polonsky et al. (2005). A total of 136 diabetic patients completed the questionnaire, which comprised three sections: demographic information (Section A); the DDS-17 (Section B); and contributing factors to diabetes distress in diabetic patients at Mhlontlo Sub-District healthcare clinics (Section C). The researcher conducted a pilot study in one of the clinics to check the feasibility of the questionnaire. After the data were collected, it was statistically analysed with the assistance of a statistician to generate descriptive and inferential statistics. The analysed data revealed that most of the diabetic patients indicated that they found travelling far to fetch medication and standing in long queues at the clinic distressing. Therefore, they wanted the Central Chronic Medicine Dispensing and Distribution (CCMDD) programme to be rolled out to bring medication to them. The results also revealed that the patients' diabetes distress was exacerbated by them having to travel to clinics in search of medication when their usual clinic had no adequate v stocks of medication. Another factor contributing to the patients’ diabetes distress was the lack of a doctor on site. The patients indicated that doctors should be available at the clinics, even periodically, to address problems that cannot be solved by nurses. The absence of haemoglucotest (HGT machines at clinics was another contributing factor to diabetes distress. Most of the patients in the study felt that they would manage their diabetes better if the government supplied these machines. The results informed various recommendations that might help the management of OR Tambo Health District to make changes and thus minimise the diabetes distress reported by its patients. However, the study had limitations, although it observed the principles of reliability and validity. Moreover, ethical considerations were guided by the Belmont Report, and the study adhered to the principles of informed consent, respect for persons, anonymity, confidentiality, beneficence, nonmaleficence and distributive justice. , Thesis (MNur) -- Faculty of Health Sciences, School of Lifestyle Sciences, 2022
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- Date Issued: 2022-12
In vitro investigation of the anti-hyperglycemic and chemical composition of Heteromorpha arborescens (Spreng.) Cham leaf extracts used in the management of diabetes mellitus
- Authors: Abifarin, Taiwo Oluwafunmilola https://orcid.org/00000003-4994-4638
- Date: 2021-09
- Subjects: Diabetes
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/10353/22798 , vital:52760
- Description: Diabetes mellitus is currently a major threat all over the world. It is a chronic disorder characterized by elevated blood glucose levels and disturbance in carbohydrate, fat and protein metabolism which often times leads to several complications such as, atherosclerosis, diabetic nephropathy, retinopathy and neuropathy. Due to the side effects associated with synthetic oral hypoglycemic drugs, herbal remedies have become the alternative in the management of diabetes mellitus. Heteromorpha arborescens is one of the many plants used as herbal remedies for the management of diabetes mellitus in South Africa. In addition, the roots, barks and leaves are used in other parts of Southern Africa for the treatment of mental problems, asthma, cough, dysentery and tuberculosis. The roots are fed to malnourished children in Botswana and Swaziland. However, despite the high medicinal importance, there is little or no scientificinformation to prove this claim. Therefore, the basis of this study is to determine the chemical composition as well as perform and invitro investigation of the antihyperglycemic potential of H. arborescens leaf extracts to provide information that could validate the ethno-medicinal claims for the use of this plant in the management of diabetes mellitus. Phytochemical contents and antioxidant activity of the leaf extracts were determined. Phytochemical analysis of the acetone, ethanol, aqueous and blanched extracts of H. arborescens leaves indicated that the total phenol content of the extracts ranged between 15.10 mg GAE/g- 42.50 mg QAE/g, proanthocyanidin, 459-8402.1 mg QE/g and the flavonoid content, 109.24- 235.79 mg QE/g. In addition, alkaloids (7.65percent) and saponin (25.33percent) were present in significantamounts. Based on the IC50 values, the ethanol extract exhibited the highest total antioxidant activity (0.0125 mg/mL) with highest inhibition against DPPH and ABTS radicals (0.06 and 0.049 mg/mL respectively). Relatively high antioxidant activity may be attributed to the polyphenolic contents which possess hypoglycemic potentials. Minimum Inhibitory Concentrations (MIC) of H. arborescens leaf extracts against Bacillus pumilus, Staphylococcus epidermidis, Staphylococcus aureus, Escherichia coli and Klebselia pneumoniae was also determined and results indicated considerable antibacterial activity in the acetone, ethanol and blanched extracts with MIC values ranging from 1.563-12.5 mg/mL; however, the aqueous extract was inactive against all the bacteria strains. The antibacterial activity of the leaf extracts could be advantageous against diabetic related infections. The cytotoxicity, anti-obesity and antidiabetic potentials of blanched, aqueous and ethanol extracts of Heteromorpha arborescens (Spreng.) Cham leaves were also investigated. The results revealed that both ethanol and aqueous extracts indicated considerable inhibition against α-glucosidase (IC50 of 627.29 ± 4.33 μg/mL and 576.46 ± 3.21 μg/mL respectively) while the blanched extract showed weak α- glucosidase inhibition (IC50; 855.38 ± 4.29 μg/mL). The aqueous extract showed the best α- amylase inhibition (IC50; 583.74 ± 5.87 μg/mL) among the assessed extracts. However, weak α- amylase inhibition was observed in the ethanol (IC50; 724.60 ± 4.33 μg/mL) and blanched extracts (IC50; 791.63 ± 3.76 μg/mL) of H. arborescens leaves. Some level of glucose utilization in both C3A and L6 cells was also observed for the aqueous and ethanol extracts which may be attributed to the relatively lower toxicity levels present in them, however, glucose utilization was very weak for the blanched extract, which may be due to higher level of cytotoxicity it possessed. Relatively weak lipase inhibition was observed for the ethanol (IC50; 699.3 ± 1.33 μg/mL), aqueous (IC50; 811.52 ± 3.52 μg/mL) and blanched extract (IC50; 1152.7 ± 4.61 μg/mL) as compared to orlistat (IC50; 56.88 ± 0.11 μg/mL). However, there was no reasonable reduction in lipid accumulation observed in all the extract treated cells. The results obtained suggest that H.arborescens leaf extracts can serve as a potential tool for the development of new strategies for the treatment of diabetes and obesity. However, further analysis is required to ascertain its anti- obesity potential. Also, caution should be taken in the use of the plant at high concentrations in order to ensure safety and efficacy. Analyses were also carried out to determine the nutritional and antinutritional constituents of the plant for possible inclusion in the diet of diabetic patients. Proximate analysis revealed the presence of 8.5 percent total ash, 4.92 percent crude fat, 8.41 percent moisture, 15.74 percent crude protein, 21.48 percent crude fiber, 40.95 percent carbohydrates and 271.04 kcal/100g energy value. Mineral analysis showed that H. arborescens leaves are very rich in K, Ca, and Fe. Considerable amounts of Mg, Mn, Na, P, Cu and Zn were also present. Vitamin analysis showed that the plant has a high content of vitamins A, C and E. The anti-nutrients evaluated were phytate, oxalate, saponin, and alkaloids, all of which were below toxic levels except for saponin which was observed in moderately high level. This study revealed that H. arborescens leaves are a good source of nutrients and mineral elements, (with low anti-nutrient content) that are highly beneficial to human health especially in diabetic individuals, therefore, encouraging its possible inclusion as a vegetable. Essential oil composition of fresh Heteromorphaarborescens leaves were also determined by Solvent-Free-Microwave-Extraction (SFME) and Hydrodistillation (HD) methods and the compositions of both mehods were compared in terms of their chemical compositions, yield, CO2 emission and energy consumption. Solvent Free Microwave extraction method indicated higher oil yield of 0.7 mL/200 g (0.35 percent) as compared to 0.59 mL/200 g (0.295 percent), lower energy consumption and CO2 emission as compared to the hydrodistillation method. In conclusion, H. arborescens leaves indicated considerable potential efficacy in the management for diabetes mellitus and may require further structural elucidation and characterization in order to identify the bioactive constituents. , Thesis (PhD) -- Faculty of Science and Agriculture, 2021
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- Date Issued: 2021-09
Efficacy, acceptability and feasibility of mhealth technology in promoting adherence to anti-diabetic therapy and glycaemic control among diabetic patients in Eastern Cape, South Africa”
- Authors: Owolabi, Eyitayo Omolara
- Date: 2019
- Subjects: Diabetes
- Language: English
- Type: Thesis , Doctoral , PhD (Nursing)
- Identifier: http://hdl.handle.net/10353/16792 , vital:40774
- Description: Background: Diabetes mellitus is a disease of a significant public health concern and a leading cause of death and disability worldwide. In Africa, South Africa ranks second among countries with the highest burden of diabetes, and with a poor level of glycaemic control. mHealth technology is an innovative and cost-effective measure of promoting health and the use of text messaging for fostering health is evolving. In South Africa, there is hardly any study involving the use of mobile health technology, including text messaging for promoting health among diabetic patients. Purpose: The aim of this study was to determine the efficacy, feasibility and acceptability of mHealth in promoting adherence and glycaemic control among diabetic patients in resource-poor settings of the Eastern Cape Province of South Africa. Also, the study assessed the impact of text messaging on knowledge, selfmanagement behaviour, self-efficacy and health-related quality of life. Methodology: The study adopted a multi-centre, two-arm, parallel, randomised controlled trial design. Participants were randomly assigned to the intervention (n=108) and control arm (n=108). Participants’ socio-demographic information was obtained using the widely validated WHO STEPwise questionnaire, and a selfdeveloped questionnaire, including previously validated measurement scales were used to obtain information on adherence, self-management behaviour, self-efficacy and health-related quality of life. Participants in the intervention arm received daily text messages related to diabetes management and care for six months. Data were collected at baseline and six months post-intervention. Blood glucose, blood pressure and anthropometric measurements followed standard procedure. Mixed-model analysis was used to assess the impact of the SMS on random blood glucose while xi | P a g e linear and bivariate logistic regression were used to assess for effect on other clinical outcomes. Results: The mean age of the participants was 60.64 (SD± 11.58) years. The majority of the study participants had secondary level of education (95.3%) and earned 1500 to 14200 Rand per month (67.7%). For both the intervention and the control group, majority never used tobacco (98.10% vs 94.40%) or alcohol (88.00% vs 87.00%). Both arms of the study showed improvement in the primary outcome (blood glucose level), with no significant difference, the mean adjusted difference in blood glucose from baseline to six months post-intervention was 0.26 (-0.81 to 1.32), p=0.634. Also, the intervention did not have a significant effect on the secondary outcomes (knowledge, medication adherence, dietary adherence, adherence to physical activity, healthrelated quality of life, self-management behaviour and diabetes distress). Similarly, the intervention did not have any significant effect on secondary clinical outcomes such as weight (p=0.654), body mass index (p=0.439), systolic (p=0.610) and diastolic blood pressure (p=0.535). An overwhelming majority of the participants (90.74%) were pleased with the intervention and felt it was helpful. Of those who took part in the intervention, 91% completed the follow-up study after six months. Conclusion: The use of SMS is a highly acceptable and feasible adjunct to standard clinical care in the promotion of health among diabetic patients in this study setting. Although there was a little improvement, the efficacy of a unidirectional text messaging in promoting health outcomes in this study setting is still doubt
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- Date Issued: 2019
Biospeciation and antidiabetic effects of oxidovanadium(IV) complexes
- Authors: Ugirinema, Vital
- Date: 2014
- Subjects: Vanadium compounds , Diabetes
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: vital:10442 , http://hdl.handle.net/10948/d1020973
- Description: The syntheses of bis(1R-imidazole-2/4-carboxylato)oxidovanadium(IV) complexes was successfully carried out and the complexes were isolated in the solid state. The coordinated water was confirmed by elemental analyses, and single crystal XRD. The complexes were therefore distorted octahedral rather than square planar due to the coordination of water at the sixth position. The reaction of the vanadyl ion (VO2+) with imidazole-4-carboxylic acid (Im4COOH), imidazole-2-carboxylic acid (Im2COOH) and methylimidazole-2-carboxylic acid (MeIm2COOH), respectively, in the presence of small bioligands (bL) [oxalate (Ox), lactate (Lact), and phosphate (Phos)] and high molecular weight (HMM) human serum proteins [albumin (HSA) and transferrin (hTf)] were studied in aqueous solution using potentiometric acid base titrations under oxygen and carbon dioxide–free conditions. The data obtained from these titrations was used to calculate the binary and ternary stability constants using the programme HYPERQUAD. The overall stability constants for VO2+-L-Ox system (log β1111 = 18.9, 18.79 and 19.86), VO2+-L-Lact system (log β1111 = 21.83, 20.98 and 22.86), and VO2+-L-Phos system (log β1111 = 27.35, 24.16 and 27.42) (for L= Im4COOH, Im2COOH and MeIm2COOH, respectively) were obtained. The species distribution diagrams showed that under physiological pH the following ternary and quaternary species; [(VO)L(bL)], and [VO(L)(bL)(OH)], would dominate provided that the competition with serum proteins is not too strong. These species were also confirmed by HPLC, LC-MS and EPR. The overall stability constants for the VO2+-L-HSA system (log β2,1,1,0 = 24.3, 23.7 and 24.7), and for the VO2+-L-hTf system (log β2,2,1,0 = 31.1, 30.8, 36.4 for L = Im4COOH, Im2COOH and MeIm2COOH, respectively), suggesting stronger binding of transferrin. The formation constants for the formation of binary (VO(IV) and the proteins) were 9.1 and 13 for log β11, and 20.9 and 25.2 for β12, for human serum albumin and human serum transferrin respectively. The species distribution diagrams for the proteins (HMM) with oxidovanadium(IV) under physiological pH was dominated by VO(HMM)2, VOL(HMM) for unsubstituted Im4COOH and Im2COOH, however, for the N-substituted MeIm2COOH, the species distribution diagrams under physiological pH, were dominated by VOL2, VO(HMM)2 and VO2L2(HMM). These species were further confirmed by HPLC, MALDI-TOF-MS and EPR. The glucose stimulated insulin secretion (GSIS) action of the complexes was investigated using INS-1E cells at 1μM concentration which was established through cytotoxicity studies via the MTT assay. The vanadium salt (VOSO4), cationic vanadium(IV) complex ([VO(MeImCH2OH)2]2+) were also included in the GSIS study in addition to the three neutral complexes [VO(Im4COO)2, VO(Im2COO)2 and VO(MeIm2COO)2] for comparison. The neutral complexes, especially VO(MeIm2COO)2, showed promising results in the stimulation of insulin secretion than the cationic complex and the vanadium salt.
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- Date Issued: 2014
The effects of three carbohydrate supplementation protocols on the blood glucose levels in type I diabetic subjects during a 60 minute bout on the treadmill
- Authors: Venter, Teneille
- Date: 2014
- Subjects: Glucose tolerance tests , Diabetes
- Language: English
- Type: Thesis , Masters , MA
- Identifier: http://hdl.handle.net/10948/4157 , vital:20561
- Description: Diabetes associated complications make management during exercise complex (Brugnara, Vinaixa, Murillo, Samino, Rodriguez, Beltran, Lerin, Davison, Correig & Novials, 2012). Research on the prevention of such challenges is of paramount importance. The aim of this study was to determine the effects of three different carbohydrate supplementation protocols on blood glucose levels after every 10 minutes of a 60 minute exercise bout at 65 to 75 % HRR on the treadmill as well as every half hour during a two hour post exercise recovery period. The three protocols implemented after a standardized pre-exercise meal were: control protocol (no carbohydrate supplementation), protocol 1 (one carbohydrate supplementation of 15 grams given at 30 minutes) and protocol 2 (two carbohydrate supplementation of 15 grams given at 30 minutes and 45 minutes). A total of 32 participants took part in the study (Mean age: 32.84 ±12.12). All participants were submitted to all three protocols. Statistical and practical significant differences were found between blood glucose levels of protocol 0 and protocol 1 (MDIF = 2.62 ± 3.99 mmol.L--‐1) at 20 minutes of the exercise duration (p=.024;d=0.42). Statistical and practical significant differences in blood glucose levels with protocol 0 rendering the higher glucose values were also found between protocols 0 and 2 at 10 minutes (MDIF = 3.44 ± 5.54 mmol.L--‐1; p=.001;d=0.62), 20 minutes (MDIF = 3.32 ± 5.23 mmol.L--‐1; p=.001;d=0.63) and 30 minutes of exercise (MDIF = 2.81 ± 5.40 mmol.L--‐1; p=.006;d=0.52) as well as between the mean minimum (M0 = 9.49 ± 4.51 mmol.L--‐1 and M2 = 7.28 ± 4.07 mmol.L--‐1; p=.013;d=0.46), mean maximum (M0 = 12.73 ± 5.51 mmol.L--‐1 and M2 = 10.07 ± 4.63 mmol.L--‐1; p=.015;d=0.46) and overall mean (M0 = 9.07 ± 4.88 mmol.L--‐1 and M2 = 8.53 ± 4.25 mmol.L--‐1; p=.011;d=0.48) with protocol 0 rendering the higher glucose values in all these comparisons. It was concluded that carbohydrate supplementation during exercise affects blood glucose levels positively particularly considering the significant difference found between protocol 0 and 2. Whilst protocol 2 also resulted in less fluctuations in the blood glucose levels during exercise and minimum, overall mean and maximum blood glucose values were closer to “normal/safe” range, there was no conclusive evidence that protocol 2 was better than protocol 1.
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Investigation of antidiabetic properties, mechanisms of action and toxicology of Strychnos Henningsii (GILG) bark
- Authors: Oyewole, Oyedemi Sunday
- Date: 2011
- Subjects: Medicinal plants -- South Africa -- Eastern Cape , Traditional medicine -- South Africa -- Eastern Cape , Diabetics -- Alternative treatment -- South Africa , Loganiaceae , Lamiaceae , Diabetes , Proteins
- Language: English
- Type: Thesis , Doctoral , PhD (Biochemistry)
- Identifier: vital:11254 , http://hdl.handle.net/10353/d1001070 , Medicinal plants -- South Africa -- Eastern Cape , Traditional medicine -- South Africa -- Eastern Cape , Diabetics -- Alternative treatment -- South Africa , Loganiaceae , Lamiaceae , Diabetes , Proteins
- Description: The apparent reversal of trend from modern drugs to herbal medicine is partly due to the fact that synthetic drugs have always shown adverse reactions and other undesirable side effects. Hence, the use of medicinal plants for the treatment of diseases such as diabetes is very common especially in the rural areas. Majority of these plants are used based on the experience and indigenous knowledge without identification of the therapeutic agents. There is enormous wealth of medicinal plants in the world yet many of them have not been discovered or studied scientifically to substantiate their ethno-medicinal usages. Ethnobotanical study has been the method often used to search for locally important plant species for the discovery of crude drugs with low side effects. An ethnobotanical survey was conducted on the medicinal plants commonly used for the management of diabetes mellitus in Nkonkobe Municipality, Eastern Cape of South Africa. Information was obtained through structured questionnaire administered to traditional healers and herbalists in the region. The study revealed 15 species of plants belonging to 13 families. Strychnos henningsii and Leonotis leonorus among others were repeatedly mentioned by the traditional healers as the two mostly used plants for the management of diabetes mellitus. The infusion and decoction of the roots, leaves and barks of these plants are the methods of preparation. The antioxidant potential of aqueous bark extract of S. henningsii was investigated both in vivo and in vitro using spectroscopic method. The antioxidant activity of the extract against hydrogen peroxide (H2O2), 2,2′-azinobis[3-ethylbenzothiazoline6-sulfonic acid] diammonium salt (ABTS), as well as reducing power was concentration dependent. The extract exhibited lower and average scavenging activities against 1,1diphenyl2picrylhydrazyl (DPPH) and nitric oxide (NO) radicals with IC50 value of 0.739 and 0.49 mg/ml respectively. The administration of the plant extract at 250, 500 and 1000 mg/kg significantly increased the activities of the antioxidant enzymes in the hepatotoxic rats induced with carbon tetrachloride. On the other hand, the stem bark extract had lower effect on lipid peroxidation level except at the dose of 250 mg/kg. The effect of oral administration of S. henningsii extract was evaluated in normal Wistar rats for 28 days. The observed result indicated non- toxic effect of sub-acute administration of plant extract to the animals except at certain doses. This is because, there was no apparent damage to some haematological and biochemical parameters used in assessing organ specific toxicity. However, the alterations observed on platelet, white blood cells and its differentials imply parameter and dose selective toxicity when repeatedly consumed on daily basis at the doses investigated. This study also investigated the antidiabetic activities of the extract at the doses of 125, 250 and 500 mg/kg body weight in diabetic rats induced with streptozotocin -nicotinamide for 15 days. The extract appreciably (P <0.05) reduced the blood glucose level, feed and water intake while the best result was obtained at 250 mg/kg. Similarly, the level of triacylglycerol at the three doses investigated was significantly decreased. In addition, the glucose tolerance was reduced to near normal level after 90 min at certain doses. The clinical significance of the extract on some biochemical and haematological parameters lessen both hepatic and renal damages. Anaemic condition in diabetic animals was also improved after plant extract administration. However, no significant effect was observed in white blood cells and some of its differentials. The extract demonstrated strong glucose utilization in 3T3-L1 cells with a response of 278.63 percent of the control at 12.5μg/ml while that of Chang liver cells was 103.54 percent. The cytotoxicity result revealed non toxic effects of the extract to both cell lines. Treatment of 3T3 L1 cells with the extract did not reduce lipid accumulation. The extract inhibited the activity of α- glucosidase and α- amylase in a concentration dependent manner with IC50 values of 38 μg/ml and 60.9 μg/ml respectively. The percentage protein antiglycation of S. henningsii was 18.4, 38.2 and 61.2 perceent for 0.25, 0.5 and 1 mg/ml respectively while aminoguanidine a known inhibitor of protein glycation was 87.2 percent at 1 mg/ml. The FRAP assay values of the extract was 357.05 μmol Fe (II)/g. The findings from this study support the folkloric usage of this plant for the management of diabetes mellitus in the region.
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- Date Issued: 2011
Management of type 2 diabetes mellitus : a pharmacoepidemiological review
- Authors: Saugur, Anusooya
- Date: 2011
- Subjects: Diabetes , Diabetes -- Management , Diabetes -- Diet therapy , Diabetes -- Prevention , Insulin -- Therapeutic use , Hypoglycemia
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10129 , http://hdl.handle.net/10948/1635 , Diabetes , Diabetes -- Management , Diabetes -- Diet therapy , Diabetes -- Prevention , Insulin -- Therapeutic use , Hypoglycemia
- Description: Type 2 diabetes mellitus (DM) is a progressive disease characterised by hyperglycaemia caused by defects in insulin secretion and insulin action. In early stages of type 2 DM, dietary and lifestyle changes are often sufficient to control blood glucose levels. However, over time, many patients experience β cell dysfunction and require insulin therapy, either alone or in combination with oral agents. There are guidelines available to structure the management of this disease state, including both the use of oral hypoglycaemic agents and or insulin. Besides health complications, there are economic burdens associated with the management of type 2 diabetes mellitus. The aim of this study was to determine the management of type 2 DM in a South African sample group of patients drawn from a large medical aid database. The objectives of the study were: to establish the prevalence of type 2 DM relative to age, examine the nature of chronic comorbid disease states, establish trends in the prescribing of insulin relative to other oral hypoglycaemic agents, investigate cost implications, and determine trends in the use of blood and urine monitoring materials by patients. The study was quantitative and retrospective and descriptive statistics were used in the analysis. DM was found to be most prevalent amongst patients between 50 and 59 years old. Results also demonstrated that 83% of DM patients also suffered from other chronic comorbid diseases, with cardiovascular diseases, especially hypertension and hypercholesterolaemia being the most prominent. This study also revealed that DM is predominantly managed with oral hypoglycaemic agents. Changes in drug prescribing, for chronic disease states such as DM may have medical, social and economic implications both for individual patients and for society and it is envisaged that the results of this study can be used to influence future management of DM. Keywords: Pharmacoepidemiology, management, type 2 diabetes mellitus
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- Date Issued: 2011
Optimisation of pharmacological management of diabetes mellitus in a primary health care setting
- Authors: Dickason, Beverley Janine
- Date: 2007
- Subjects: Diabetes , Diabetes -- Treatment
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10161 , http://hdl.handle.net/10948/846 , http://hdl.handle.net/10948/d1012902 , Diabetes , Diabetes -- Treatment
- Description: Levels of diabetic care in primary health care settings in South Africa have been found to be sub-optimal. Knowledge deficits and inadequate practices have been implicated in the poor quality of local diabetes care. Type 2 diabetes and hypertension are commonly associated chronic conditions hence to optimise diabetic care, tight control of blood pressure is essential. Although guidelines for the overall management of diabetes in a primary health care setting have been published (Working Group of the National Diabetes Advisory Board, 1997; Society for Endocrinology, Metabolism and Diabetes of South Africa, 2002a), adherence to these guidelines has not yet been optimised in the primary health care setting. The objectives of the study were: to design and implement an educational intervention aimed at nursing staff, based on the South African guidelines for type 2 diabetes and hypertension, at a public sector primary health care clinic; to determine the impact of the educational intervention on the level of knowledge and attitudes of the nursing staff, and on the level of diabetic and blood pressure control achieved in the patient population, and to determine the impact of the educational intervention on pharmacological management of patients. A questionnaire was used to quantitatively assess the nursing staffs’ knowledge of the management of type 2 diabetes and hypertension at a primary health care level. A qualitative evaluation of the nursing staff attitudes was obtained using focus group interviews. The educational intervention, in the form of lectures and based on national diabetes and hypertension guidelines (Working Group of the National Diabetes Advisory Board, 1997; Society for Endocrinology, Metabolism and Diabetes of South Africa, 2002a; Milne et al., 2003), was then implemented and directed at the nursing staff at a primary health care clinic. A post-intervention evaluation was performed after four months by repeating the questionnaire and focus group interviews. Comparisons between the pre- and post-intervention questionnaire and focus group interviews evaluated the impact of the educational intervention on the knowledge and attitudes of nursing staff towards the management of type 2 diabetes. Pre- and post-intervention patient data was collected from patient medical files and compared to determine if the management of diabetes and hypertension improved in the patient population after the implementation of the educational intervention. The patient population consisted of 103 patients. The educational intervention resulted in an extremely significant improvement in the level of knowledge of the nursing staff [93 correct responses (28.3 percent; n = 329 (pre-intervention)) vs 223 correct responses (67.8 percent; n = 329 (post-intervention)); p < 0.0001, Fisher’s Exact test]. The educational intervention resulted in improved attitudes of nursing staff towards the management of diabetes. Ideal random blood glucose concentrations improved significantly [16 percent; n = 100 (pre-intervention) vs 22 percent; n = 100 (post-intervention); p = 0.0003; Student t test]. The number of patients with a compromised HbA1c level (> 8 percent) decreased by 2 [51; 49.5 percent, n = 103 (pre-intervention) vs 49, 47.5 percent, n = 103 (post-intervention)] which was not a significant improvement. Ideal blood pressure control improved by one from 38 patients [36.9 percent; n = 103 (pre-intervention)] to 39 patients [37.9 percent; n = 103 (post-intervention)] which was not significant. Optimal change of pharmacological management following the referral of an uncontrolled diabetic patient was only noted for 18 patients (20.2 percent, n = 89) referred in the post-intervention phase. Clinical inertia was identified as a major limitation to the optimisation of diabetes care. Implementation of an educational intervention based on the South African diabetes and hypertension guidelines at a public sector primary health care clinic was successful in improving the knowledge levels and attitudes of nursing staff
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- Date Issued: 2007