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
- Full Text:
- Date Issued: 2022-12
- 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
- Full Text:
- Date Issued: 2022-12
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
- Full Text:
- Date Issued: 2011
- 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
- Full Text:
- 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
- Full Text:
- Date Issued: 2007
- 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
- Full Text:
- Date Issued: 2007
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.
- Full Text:
- 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.
- Full Text:
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