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Dissertation submitted in partial compliance with the requirements for the Master's Diploma: Chiropractic, Technikon Natal, 1995. / Subjects who were previously diagnosed as having insulin dependent diabetes mellitus (i.d.d.m.) were treated in a single blind, randomised, placebo controlled trial. The objective of this study was to evaluate the efficacy of chiropractic treatment in the management of i.d.d.m. The sample of 21 subjects was randomly divided into an experimental group of Il subjects and a control group of 10 subjects. At the initial consultation, a case history and physical examination was performed on each subject and an informed consent form, screening questionnaire and subjective health status questionnaire (S.H.S.Q.) were completed by each subject. Each subject was required to be in possession of a glucometer. The subjects were treated once a week for a period of four months. Glycosylated haemoglobin readings were taken before the commencement of treatment, after two months and at the' end of the study. Venous glucose readings were taken before treatment was started and for every two weeks thereafter. (i i) Subjects in the experimental group received chiropractic manipulation of anysubluxations detected within the vertebral levels of CO - e3 and T7 - Tl2. Subjects in the control group received vacotron suction pads from an interferential unit over the transpyloric plane with the milliamperage set at zero. / M

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La Diabetes constituye uno de los problemas de salud más importantes en el mundo por la carga de enfermedad en términos de discapacidad y mortalidad prematura.; “la prevalencia en el Perú está en un 5,5 %; de esta, la Diabetes tipo II representa el 90% de los casos; y su magnitud está en aumento, debido al incremento de factores riesgo como la obesidad, el sedentarismo entre otros”1. Es por ello que el presente estudio titulado “Actitudes de los adultos hacia la Prevención de Diabetes tipo II en un Centro de Salud en Lima Metropolitana, en el 2014” tuvo como objetivo Determinar las actitudes de los adultos hacia la prevención de diabetes tipo II en el Centro de Salud “Villa San Luis”. El enfoque fue cuantitativo, de nivel aplicativo, de método descriptivo y corte transversal. La población estuvo conformada por 101 adultos de 50 a 59 años de edad pertenecientes a la estrategia de Prevención y control de daños no transmisibles que respondieron a criterios de inclusión y exclusión. El instrumento que se utilizó fue la escala tipo Likert modificada y dentro de los resultados que se obtuvieron fueron: que de un total de 50 (100%) adultos encuestados; 14 (28%) presentaron actitud medianamente desfavorable, 13 (26%) presentaron actitud desfavorable, 12 (24%) presentaron actitud favorable y 11 (22%) presentaron actitud medianamente favorable hacia la prevención de Diabetes tipo II. Concluyéndose que Las actitudes que tienen los adultos del Centro de Salud Villa San Luis hacia la prevención de diabetes tipo II en la mayoría es desfavorable, por lo cual se estaría incrementando el riesgo de padecer la Diabetes tipo II con sus complicaciones. Palabras claves: Diabetes mellitus tipo II, actitudes, prevención. / --- Diabetes is one of the most important health problems in the world for the burden of disease in terms of disability and premature mortality; “its prevalence in Peru is 5.5%; This, Type II Diabetes accounts for 90% of cases; and its magnitude is increasing, due to increased risk factors such as obesity, a sedentary lifestyle among others” That is why this study entitled "Attitudes of adults towards the Prevention of Type II Diabetes in a health center in Lima, in 2014," aimed to determine the attitudes of adults towards the prevention of type II diabetes Health Center "Villa San Luis". The approach was quantitative level application, descriptive method and cross section. The population consisted of 101 adults aged 50-59 years of age belonging to the strategy of prevention and control of noncommunicable damage respondents inclusion and exclusion criteria. The instrument used was the modified Likert scale and within the results obtained were that a total of 50 (100%) adults surveyed; 14 (28%) had fairly unfavorable attitude, 13 (26%) had unfavorable attitude, 12 (24%) had positive attitude and 11 (22%) had fairly favorable towards the prevention of Type II Diabetes attitude. Concluding that attitudes that adults Health Center Villa San Luis towards preventing type II diabetes in most unfavorable, so we would be increasing the risk of developing Type II Diabetes with its complications. Keywords: Type II Diabetes Mellitus, attitudes, prevention.

Objetivo: Determinar los factores clínicos de riesgo de amputación en pacientes diabéticos hospitalizados en el Servicio de Medicina del Hospital Nacional Arzobispo Loayza en el año 2015. Métodos: El tipo de estudio fue retrospectivo de casos, no experimental, conformado por 208 historias clínicas de pacientes diabéticos con diagnóstico de pie diabético hospitalizados en el servicio de medicina del Hospital Nacional Arzobispo Loayza en el año 2015. Para el análisis de datos se usó el paquete estadístico SPSS v. 22.0. Resultados: La media de la edad de los pacientes del sexo masculino fue de 62.8+/-11.5 años, y la media de la edad de las mujeres fue de 65.5+/-11.5 años, siendo la media global de 63.6+/-11.5 años, con una mínima edad de 44 años y una máxima de 89 años. El 74% de los pacientes diabéticos, recibió tratamiento con insulina. El 58.7% de los pacientes diabéticos eran hipertensos. El 28.8% de los pacientes fumaban. El 59.6% de los pacientes tenían sobrepeso. Encontramos una mayor frecuencia de grado IV según la clasificación de Wagner en el 52.9% de los casos. Los pacientes que tuvieron escala de Wagner IV se caracterizaron por ser del sexo masculino (72.7%), recibir como tratamiento insulina (72.7%), ser hipertensos (52.7%), y tener sobrepeso (52.7%). Conclusiones: Los factores de riesgo de amputación estadísticamente significativos fueron la edad, el estado nutricional (sobrepeso) y la hiperglicemia. Palabras Claves: factores clínicos, amputación, diabetes. / --- Objective: To determine the clinical risk factors for amputation in diabetic patients hospitalized in the Department of Medicine of the National Archbishop Loayza Hospital in 2015. Methods: The type of study was retrospective cases, cross consisting of 208 clinical records diabetic patients diagnosed with diabetic foot hospitalized in the health service Archbishop Loayza National Hospital in 2015. For data analysis package was used statistical SPSS v. 22.0. Results: The mean age of male patients was 62.8 +/- 11.5 years and the mean age of women was 65.5 +/- 11.5 years, with an overall mean of 63.6 +/- 11.5 years, with a minimum age of 44 years and a maximum of 89 years. 74% of diabetic patients received treatment with insulin. 58.7% of diabetic patients were hypertensive. 28.8% of patients smoked. 59.6% of patients were overweight. We found a higher frequency of grade IV according to the classification of Wagner in 52.9% of cases. Patients who had Wagner IV scale were characterized as male (72.7%), receiving as insulin (72.7%) treatment, be hypertensive (52.7%) and overweight (52.7). Conclusion: Risk factors amputation was statistically significant, age, nutritional status and hyperglycemia (P <0.05). Keywords: clinical factors, amputation, diabetic.

Introduction Diabetes (especially type 2) is a common and growing health problem with significant mortality and morbidity including foot problems (neuropathy, ulceration, infection and amputation) These micro vascular/macro vascular complications can be decreased with certain treatments including good diabetic foot self-care. With this in mind, I set out to measure self-reported knowledge/awareness and performance of appropriate foot self-care among diabetic patients attending Dr. Yusuf Dadoo Hospital-a level one urban hospital. My premise which was borne by my result was that foot self-care and awareness thereof was poor among sampled diabetic patients. This can be attributed to both scant education and infrequent foot examination by clinicians and poor adherence to appropriate foot care by majority of the patients surveyed. Objectives: To determine the awareness and performance of appropriate foot self-care practices among diabetic patients attending the out-patient unit of Dr. Yusuf Dadoo Hospital. Study design and methods: This was a descriptive cross sectional study. Participants were consecutively recruited until the sample size of 120 was reached. A questionnaire was used to collect data. Data was analysed using STATA version 10.0. Main outcome measures: foot self-care practices, the level of awareness of foot self-care and foot abnormalities found in diabetics Results: There were more females (60%) than males (40%) and the mean age was 56.3 years. About 30.8% of patients had not inspected their feet for one week, while 21.7% had done it poorly. 92.5% did not use talcum powder to dry their feet, 45.8% did not inspect their shoe before wearing and 94.2% did not make use of a podiatrist at all. However, 53.3% did not soak their feet in water and only 25% walked bare foot while 75% did not. Only about 37.5% has had their feet examined by either a doctor or a nurse while 67.5% had not. Hypertension was found to be the commonest co-morbidity occurring in 60% of the patients studied Athlete‟s foot was the most frequently occurring foot problem found in 16.2% of these patients. Conclusion: Majority of the patients had poor awareness and poor foot self-care practices or inadequate foot self-care practices .Appropriate foot care education should be given to diabetic patients by health care professional to enable them carry out adequate foot self-care practices.

ABSTRACT The Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) estimates the prevalence of Type 2 Diabetes Mellitus in South Africa to be approximately 13% in the Indian, 3% in the European and 4.8-8% in the African population group. Morbidity from diabetes is a consequence of both macrovascular and microvascular disease. Over the last decade, a fundamental transformation of the principles of management of type 2 diabetes has occurred. This was driven by a large number of multicentre randomized clinical trials documenting improved outcomes associated not only with glycaemic control, but also with use of antihypertensive, lipid lowering and anti-platelet therapy. The objective of this research report was to ‘revisit’ our diabetes clinics to ascertain how many diabetic patients are reaching the lipid, blood pressure, body mass index, waist circumference and glucose targets as recommended by the SEMDSA guidelines and to ascertain if there has been any improvement since a previous study conducted a decade ago. Study design included a sample of 150 patients. Body mass indices (BMI), fasting lipograms, glycated haemoglobin (HbA1c), waist measurements and blood pressure were determined in patients with type 2 diabetes mellitus who were on oral agents or insulin (Protaphane), or a combination thereof, and who were age 35 years or older. Results showed that, out of the 150 patients, 98 were females and 52 were males. Black patients constituted 68%, White 12,7%, Indian 10,7% and Coloured 8,7%. The mean age was 59 years. The mean HbA1c was 8,7% with HbA1c being more than 8% in 83 patients (55%). Obesity was present in 37,3% of the patients; it was class I (BMI 30-34,9 kg/m2) in 22%, class II (BMI 35-39,9) in 10% and class III (BMI >40) in 5,3%. Hypercholesterolaemia (total cholesterol > 5,0 mmol/l) was present in 29,3%, hypertriglyceridaemia (total triglycerides > 1,5 mmol/l) in 45,3% of the patients. Waist circumference was greater or equal than 80cm in 98% of the females and greater or equal than 94cm in 69% of males. In the whole cohort of 150 patients, 127 were hypertensive (84,67%). 78,74% of patients with hypertension had systolic blood pressure above or equal to 130 mmHg and 59,84% had diastolic blood pressure above or equal to 80 mmHg. Out of the 150 patients, 43% did not engage in regular exercise, 6% smoked cigarettes and 51% were on aspirin. In conclusion these findings are similar to those from a previous study conducted in 1996 and show little improvement in the holistic care of patients with type 2 diabetes.

SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF THE DEGREE OF MASTER OF FAMILY MEDICINE, FACULTY OF HEALTH SCIENCES, UNIVERSITY OF THE WITWATERSRAND. / BACKGROUND: Diabetes Mellitus is a chronic metabolic disease that is a global problem. The increasing incidence and prevalence globally is of great concern. This condition is a long-term challenge, which requires behavioural change and adherence to management to maintain glycaemic control. Good knowledge of diabetes influences adequate self-care practices, glycaemic control, and overall diabetes management. Incorrect self-care practices impair the achievement of the desired treatment targets. AIMS AND OBJECTIVES: This study aimed to determine patient-reported knowledge, perceptions and practice regarding diabetes self-management skills and behaviour through assessing knowledge, reported practice, and perceptions of diabetic self-management among adult patients with diabetes attending the diabetic clinic at Mokopane provincial hospital, and determining the strength of associations between knowledge, reported practice, perception of self-care and glycaemic control. DESIGN AND METHODS: This was a descriptive cross sectional study using a questionnaire on knowledge, perception and self-management practices. Participants were recruited consecutively until the sample size of 76 was reached. Data was analysed using the statistical software SPSS version 17.0. RESULTS: There were more females (71%) and most of the participants (39%) were above 60 years of age. The majority of participants (87%) had a HbA1c of >7%, with a mean HbA1c of 10.2%. Diabetic knowledge was poor. A majority of the participants answered less than 50% of the knowledge questions correctly. More than half of the respondents could not answer the diabetes knowledge questions correctly. The proportion of participants, who responded positively to 3 of the 4 questions to assess knowledge and perception of self-care, was in the range of 70-90%. 86% of participants indicated that they had adjusted their diet since being diagnosed with diabetes. 48% of participants reported that they always adhered well to medication. Most of the participants (81%) indicated that they do not smoke. Responses to other questions to assess practice of self-care showed that only 29% of the participants always practiced the self-care activities stated. There was no statistically significant association between knowledge of diabetes, practice, perception of self-care and glycae. CONCLUSION: General knowledge of diabetes and practice of self-care were inadequate, but perception about diabetes self-care was good. Although many participants had altered their diet, their diabetic control was poor. Poor general knowledge of diabetes, not practicing self-care and poor diabetic control were found in the majority of participants although there was no statistically significant association among these measures.mic control (HbA1c).

Diabetes Mellitus is a chronic disease characterized by uncontrollable chronic high blood glucose (hyperglycemia) and complications, leading to serious damage to different tissues. In clinical studies, diabetic patients are found to have a higher risk of developing neurodegeneration and osteoporosis, and hyperglycemia-induced formation of advanced glycation endproducts (AGEs) may contribute towards the pathogenesis of diabetes-induced neurodegeneration and osteoporosis. Therefore the aim of this project is to investigate the role of hyperglycemia-induced methylglyoxal (MG) on neurodegeneration, neuroinflammation and osteoporosis.;Firstly, the role of MG on neurodegeneration of neuronal astrocytes, a kind of major glia in the brain, was studied. Astrocyte plays roles in the structural and functional support of the brain neurons and maintains normal brain physiology. In the present study, MG disturbed insulin signaling and led to apoptosis in rat primary astrocytes. Furthermore, the protective effects of ginsenosides were studied. From the results, impairment of insulin signaling was found in astrocyte culture under MG treatment. Moreover, cleavage of caspase and Poly ADP ribose polymerase (PARP) was observed together with insulin signaling disruption, showing the neurotoxic effects of MG towards astrocytes. The effects of ginsenosides in MG-treated astrocytes were also investigated. The ginsenosides Rd and R-Rh2 were shown to ameliorate the cell viability of MG-treated astrocytes and improve insulin signaling and inhibit apoptosis, indicating that Rd, R-Rh2, and related compounds may have therapeutic potential in treating diabetes-induced neurodegeneration.;Secondly, the role of MG on neuroinflammation was studied. The effects of MG in astrocytic cultures and hippocampi of experimental animals were compared. The astrocyte DITNC1 and C57BL/6 mice were treated with MG solution and hippocampi were harvested. MG induced astrogliosis in DITNC1 astrocytic cultures and C57BL/6 mice. Also, activation of the proinflammatory JNK signaling pathway was observed. Furthermore, increased gene expression of pro-inflammatory cytokines and astrocytic markers were observed. In addition, inhibition of JNK activities resulted in down-regulation of TNF- in MG-treated astrocytes. Our results suggest that MG may contribute to the progression of diabetes-related neurodegeneration through JNK pathway activation in astrocytes and the subsequent neuroinflammatory responses in the central nervous system.;Thirdly, the role of MG on osteoporosis and osteoclasts were studied. The osteoclasts are bone cells having catabolic action in the bone remodeling cycle. The effects of MG on osteoporosis in both animal and cell models were investigated. SD rats were treated with either MG or streptozotocin and the macrophage RAW264.7 was treated with MG. MG was shown to induce osteoclastogenesis by increased gene expression of osteoclast bone biomarkers CTSK, OSCAR and TRACP5. The results of MG-treated rats were similar to type 1 diabetic model. Furthermore, in MG-treated macrophages activation of the JNK was observed, and inhibition of JNK activities resulted in down-regulation of osteoclast biomarkers. Our results, suggested that MG may contribute to the progression of diabetes-related osteoporosis and the imbalanced bone remodeling through the JNK pathway in osteoclasts.;To conclude, MG causes different diabetic complications in multiple organs. It may be a potential therapeutic target to reduce and delay the development of neurodegeneration, neuroinflammation, and osteoporosis in diabetes.

No description available.