Diabetes in Indigenous Australians occurs at a younger age and at almost four times the rate of non-Indigenous Australians. While the cause for this health disparity is multi-factorial, recent studies suggest that nutrition, and particularly magnesium intake, may play a role in onset of diabetes and related pathologies. No study has ever examined whether there is any relationship between diabetes and magnesium intake in Indigenous Australians, and the present study therefore sought to establish whether any such interrelationship existed. As part of this study, dietary magnesium intake was estimated in an urban cohort of Aboriginal and Torres Strait Islander subjects and compared to the average Australian dietary intake. An ecological study then explored environmental correlates, and specifically the magnesium level in drinking water, to diabetes mortality. Finally, total and free serum magnesium concentrations were determined to identify any differences in magnesium status between diabetic and non-diabetic Indigenous and non-Indigenous Australians, and also to compare which of the two parameters was a more sensitive measure of magnesium status and diabetic risk. All Aboriginal and Torres Strait Islander people that were recruited for this study were patients of the Townsville Aboriginal and Islander Health Services, Townsville, North Queensland, who presented for health monitoring and subsequently required fasting blood tests as part of that routine care. Additional non-Indigenous people were recruited from five GP practices in the Townsville area. Inclusion criteria included persons over the age of 15 (Tanner Stage 5) who had lived in the Townsville area for at least ten days. Exclusion criteria included chronic diarrhoea, alcoholism or binge drinking in the past two weeks, use of diuretics, consumption of magnesium supplements, reduced renal function (urinary albumin to creatinine ratio exceeding > 2.5 mg/mmol in men and > 3.5 mg/mmol in women), severe mental illness, pregnancy, or breastfeeding. Our results indicated that 60% of the Indigenous people assessed in this study had a dietary intake of magnesium that was below the estimated average magnesium requirement for half the national population. Additionally, the average magnesium intake in Indigenous Australians was significantly less than the intake of non-Indigenous Australians (p<0 .001). A significant negative correlation was found between the incidence of diabetes related mortality and the concentration of magnesium in drinking water in Queensland, confirming previous reports from the USA that drinking water magnesium may be an important factor in development of diabetes. The needs assessment study confirmed that diabetes in both Indigenous and non-Indigenous Australians was associated with reduced levels of total serum magnesium, and more importantly, that total serum magnesium was lower in Indigenous Australians who did not have diabetes compared with their non-Indigenous counterparts (p=<0.001). In the absence of diabetes, the prevalence of hypomagnesaemia was 17.2% for the non-Indigenous but 36.9% for the Indigenous subjects. Finally, the ionic serum magnesium analysis confirmed the results of the total serum magnesium study, and demonstrated that ionic magnesium was strongly correlated to the total magnesium concentration (r: 0.75. p < 0.001), with the relationship being apparent irrespective of either diabetic (r: 0.66 to 0.81. p<0.001) or ethnicity (r = 0.71 to 0.81. p<0.001)." We conclude that although not causal, the evidence suggests that magnesium may be a significant contributing factor to diabetes in Australia, especially for Aboriginal and Torres Strait Islander peoples, and that further investigation of the potential relationship between magnesium and diabetes in the Australian Indigenous populations, and possible corrective interventions, is highly warranted. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1348469 / Thesis (Ph.D.) - University of Adelaide, School of Medical Sciences, 2008

Master of Public Health / OBJECTIVES: In Australia, diabetes causes significant morbidity and mortality. Whilst the need to prevent diabetes and its complications has been widely recognised, the capacity of health care systems - which organise diabetes care - to facilitate prevention has not been fully established. METHODS: A series of seven population-based case-control studies were used to examine the effectiveness of the Australian health care system and its capacity to manage diabetes. Six of the studies compared the patterns of care of patients who had developed advanced diabetes complications in 2000 (cases), to similar patients who remained free of the condition (controls) across Australia and for various risk groups. A secondary study investigated the role of treating GPs in the development of the outcome. RESULTS: A strong relationship between the patterns of care and the development of advanced diabetes complications was found and is described in Chapter 4. In Chapter 5, this same relationship was investigated for each Australian state and territory, and similar findings were made. The study in Chapter 6 investigated whether late diagnosis or the patterns of care was the stronger risk factor for advanced diabetes complications, finding that the greatest risk was associated with the latter. In Chapter 7 the influence of medical care during the pre-diagnosis period was explored, and a strong relationship between care obtained in this period and the development of advanced complications was found. In Chapter 8, which investigated the role of socio-economic status in the development of advanced complications, found that the risk of advanced diabetes complications was higher in low socio-economic groups. Chapter 9 investigated geographic isolation and the development of advanced diabetes complications and found that the risk of advanced complications was higher in geographically isolated populations. Finally, Chapter 10, which utilised a provider database, found that some GP characteristics were associated with the development of advanced diabetes complications in patients. CONCLUSION: A number of major risk factors for the development of advanced complications in Australia was found. These related to poorer diabetes management, later diagnosis, low socioeconomic status and geographic isolation. Strategies must be devised to promote effective diabetes management and the early diagnosis of diabetes across the Australian population.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2009. / Thesis presented in partial fulfillment of the requirements for the degree of Master of Nutrition at Stellenbosch University. / ENGLISH ABSTRACT: The glycemic index (GI) has proven to be a valuable nutritional tool in the management and prevention of diabetes and other chronic diseases of lifestyle 1,3,4,5,6,79,12,14,15. In this quantitative, cross-sectional, observational and descriptive study, the aim was to determine the knowledge and level of comprehension of South African registered dietitians with regard to GI and glycemic load (GL) as well as to determine their ability to use/implement the GI in the treatment of diabetes / insulin resistance. A questionnaire was emailed to 388 registered dietitians for completion. The questionnaire was based on relevant scientific literature and divided into three parts. The first part gathered demographical information about the participants, with special emphasis on where they had acquired their knowledge of GI principles. The second and third parts contained closed-end questions to which the participants were required to answer ‘true’ or ‘false’ or were presented with a multiple choice. Twenty-five questions specifically focused on the GI and the other 12 focused on GL. One hundred and fourteen subjects took part in the study. The results showed that most dietitians (54 %) did not learn GI principles at university and that the year that they qualified did not affect test results. The University attended did not seem to affect test results either, with the exception of Medunsa (Medical University of South Africa), where graduates scored on average significantly lower than the rest of the group). The test scores varied between 43% and 97%. The average test score for the group was 71% with those dieticians in private practice scoring the highest average (76%) compared to those working in other practice areas. Although 84% percent of participants reportedly used GI principles in their daily practice with patients, compared to only 33% who reportedly used GL principles, results showed no significant difference between knowledge or comprehension levels of GI and GL or the ability to implement GI or GL principles. To conclude, South African dietitians seem to have a good general knowledge of GI, but there is still room for improvement in order to ensure that dietitians can become experts in the field. It is recommended that curricula be revised to give this subject more attention during formal university training. / AFRIKAANSE OPSOMMING: Navorsing het bewys dat die Glukemiese Indeks (GI) ‘n waardevolle wetenskaplike hulpmiddel is in die voorkoming en bestuur van diabetes en ander chroniese siektes van lewenstyl 1,3,4,5,6,79,12,14,15 . Die doelwit in hierdie kwantitatiewe, dwars-snit, beskrywende studie was om die kennis- en begripsvlak van Suid-Afrikaanse dieetkundiges te toets rakende die GI en glukemiese lading (GL) asook hul vermoëns om hierdie beginsels toe te pas en te gebruik in die behandeling van diabetes en insulienweerstandigheid. ‘n Vraelys is aan 388 dieetkundiges gepos. Die vraelys was gebasseer op relevante wetenskaplike literatuur en het uit drie afdelings beslaan. Die eerste afdeling was ten doel om demografiese inligting oor deelnemers te bekom met spesifieke belang by die afkoms van hul kennis oor die GI. Die tweede en derde afdelings het bestaan uit vrae waarop ‘waar’ of ‘vals’ gemerk moes word of uit veelvuldige keuse vrae. Vyfen-twintig vrae het gefokus op die GI en twaalf vrae het gefokus op die GL. Eenhonderd-en-veertien persone het deelgeneem aan die studie. Die resultate het getoon dat meerderheid van die deelnemers (54%) nie die beginsels aangaande die GI op universiteit geleer het nie. Die jaar waarop graduasie plaasgevind het, het blykbaar nie ‘n invloed op uitkoms gehad nie, en die universiteit waar graduasie plaasgevind het, het ook nie die uitslag beïnvloed nie, uitsluitend Medunsa (waar gegradueerdes aansienlik swakker gevaar het as die res van die groep). Toets uitslae het gewissel tussen 43% en 97%. Die gemiddelde toetspunt was 71%. Dieetkundiges werkend in privaat praktyk het die hoogste gemiddelde toetspunt van 76% behaal in vergelyking met dieetkundiges wat in ander velde praktiseer. Ten spyte daarvan dat 84% deelnemers aangetoon het dat hulle GI beginsels in hulle werksomstandighede toepas, in vergelyking met slegs 33% wat GL beginsels toepas, was daar geen noemenswaardige verskil in uitkomste rakende deelnemers se kennis of begripsvlak van GI of GL, of hul vermoë om verwante beginsels toe te pas nie. Ter opsomming wil dit voorkom of Suid- Afrikaanse dieetkundiges oor ‘n goeie vlak van algemene kennis betrekkende die GI beskik. Daar is wel steeds ruimte vir verbetering om te verseker dat dieetkundiges as ware kenners op die gebied kan optree. Dit word aanbeveel dat universiteite se kurrikulums aangepas word om sodoende voorsiening te maak vir verbeterde voor-graadse opleiding oor die onderwerp.

Thesis (MNutr)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Objective: The objective of the study was to assess and compare the level of knowledge of South African health professionals) treating patients with Type 1 and Type 2 Diabetes Mellitus (T1 and T2 DM) with regard to nutrition and Diabetes Self-management (DSM). To achieve this objective, two questionnaires (one for T1 DM and one for T2 DM) was developed and validated. In addition the study identifies the areas in need for further education as well as to assess if socio-demographic factors influence the level of knowledge. Methods: The questionnaires were developed by: i) planning and developing constructs on nutrition and DSM by experts (n = 2) in the field of nutrition and diabetes care, ii) compilation and evaluation of a pool of 60 questions for face and content validity by an expert panel comprising six Registered Nurses / Diabetes Educators (RN / DE) and registered dieticians (RD) and iii) testing the questionnaires for criterion validity and reliability by a pilot group (n = 34 RN / DE and RD). Chronbach’s alpha values were calculated to determine validity and questions were disregarded or changed depending on this outcome. These questionnaires were then sent via electronic and hard mail to a randomised sample of RD (n = 1200) and RN / DE (n = 498). Data of 70 questionnaires on T1 DM and 105 on T2 DM was coded and analysed. The cut off value of 70% was considered as adequate knowledge. Results: With regard to questionnaire development, constructs were eliminated by the expert panel and this resulted in the acceptance of 60 constructs for the final questionnaires. Five constructs were replaced to improve content validity and an additional three constructs were adjusted to improve face validity. Recommended amendments were made to improve the criterion validity of the questionnaires. Internal consistency was shown with an overall Cronbach’s alpha value of 0.73 for the T1 DM questionnaire and 0.71 for the T2 DM questionnaire. In terms of the assessment of knowledge for T1 DM, the RD (75.4%) but not the RN/DE (67.2%) had adequate knowledge of nutrition. This was not statistically significant different from the RN / DE (p = 0.07). Both groups scored equally with regard to their knowledge of DSM with scores indicating inadequate knowledge (64.7% and 64.9% respectively) (p = 0.27). For T2 DM, the RD (74.6%) but not the RN / DE (61.6%) showed their knowledge of nutrition to be adequate, and statistically significantly better than the RN / DE (p = 0.0005). Both groups showed inadequate knowledge of DSM (56.0% and 61.9% respectively) (p = 0.31). The main areas of knowledge for diabetes mellitus (DM) identified in need for further education were the glycaemic index (GI) values of food, carbohydrate counting, the use of sugars / sweeteners, timing of meals and snacks with regard to activity, medication used, treatment of hypo- and hyperglycaemia and the use of alcohol. Age affected knowledge (for both nutrition and DSM) with regard to T1 DM, as the age group 30 - 49 years scored significantly better than the rest (nutrition p = 0.005, DSM p = 0.006 respectively). Health professionals in the private sector achieved higher scores compared to those working in the public sector (nutrition p = 0.011, DSM p = 0.016 respectively). Conclusion: Two valid and reliable quantitative questionnaires comprising 4 sections and 30 questions were developed to assess the level of knowledge of health professionals (RN / DE and RD) on nutrition and DSM treating patients with T1 and T2 DM in South Africa. RN / DE required further education towards key nutrition concepts and RN / DE and RD required further education on key concepts regarding DSM for both T1 and T2 DM. / AFRIKAANSE OPSOMMING: Doel: Die doel van die studie was om die hoeveelheid van kennis van verpleeg en dieetkunde personeel wat persone met Tipe 1 en Tipe 2 Diabetes Mellitus (T1DM en T2DM) in Suid – Afrika behandel, te bepaal en te vergelyk. Die studie het gefokus op kennis t.o.v. voeding en diabetiese self-sorg. Om die doel te bereik was twee vrae lyste, een vir T1 DM en een vir T 2 DM ontwikkel. Die verskillende aspekte van kennis wat verdere opleiding benodig is geidentifiseer asook of enige demografiese faktore wat kennis kon beinvloed. Metode: Die volgende stappe was geneem om voldoende geldigheid en betroubaarhied te bereik: 1. Twee kenners het verskeie belangrike aspekte van voeding en diabetiese self-sorg geidentifiseer en ontwikkel. 2. ‘n Paneel van 34 geregistreerde dieetkundiges en verpleeg personeel wat in Diabetes Mellitus spesialiseer , het die inhoud van ‘n totaal van 60 vrae ge- evalueer vir geldigheid en toepaslikheid. 3. Die paneel het die vraelyste verder ge- evalueer vir ‘n aanvaarbare standard van betroubaarheid. Chronbach-alfa waardes was gebruik vir die aanvaarbaarheid van alle vrae. 4. Die finale weergawe van 30 aanvaarbare vrae in elke vraelys was gestuur via elektroniese en normale pos na 1200 RD en 489 verpleegpersoneel wat spesialiseer in T1 en T2 DM. 5. Inligting van onderskeidelik 70 T1DM en 105 T2 DM vraelyste was gekodeer en ge-analiseer. Resultate: Tydens die ontwikkeling van die vraelyste, was sekere aspekte van kennis deur die twee kenners ge-elimineer. Die evaluering van die groep van dieetkundiges en verpleeg personeel het verder bygedra tot die vervanging en aanpassing van sekere aspekte van kennis. Dit het bygedra tot die vlak van voldoende geldigheid en toepaslikheid. Vir voldoende betroubaarheid was die Chronbach- alfa waardes van 0.73 vir T1DM and 0.71 vir T2 DM onderskeidelik aanvaar. Die studie het getoon dat die dieetkundiges voldoende kennis besit t.o.v. voeding vir T1 DM (75.4%). Dit was egter nie statisties betekenisvol meer in vergelyking met die kennis soos behaal deur die verpleegpersoneel (62.2%) (p = 0.07). Beide groepe se kennis t.o.v diabetiese self sorg was bepaal as onvoldoende met onderskeidelik 64.7% en 64.9%. In terme van T2 DM, het die dieetkundiges statisties betekenisvol beter kennis getoon vir voeding (74.6%) in vergelyking met die vlak van kennis soos behaal deur die verpleeg personeel (61.6%) (p = 0.0005). Soos in die geval van T1 DM het beide groepe onvoldoede kennis getoon vir diabetiese self sorg met onderskeidelike waardes van 56.0% en 61.9%. (p = 0.31). Die areas van kennis wat geidentifiseer was vir verdere opleidig, was die glisemiese indeks van voedsel, bepaling van die hoeveelheid koolhidrate in voedsel, die gebruik van suiker en versoeters, die neem van maaltye en versnapperinge, oefening, medikasie, voorkoming van lae en hoe blood glukose vlakke asook die gebruik vam alkoholiese drankies. Die ouderdoms groep tussen 30-49 jaar het statisties ‘n hoer vlak van kennis getoon vir beide voeding (p = 0.005) en diabetiese self sorg (p = 0.006) vir T 1 DM in vergelyking met die ander ouderdoms groepe. Personeel wat in die private sektor werk het ‘n beter vlak van kennis getoon in vergelyking met personeel wat in die openbare sektor werk (p = 0.011 en p = 0.016 vir voeding en diabetiese self sorg onderskeidelik. Samevatting: Twee geldige en betroubare vrae lyste met 30 vrae in totaal was ontwikkel om die vlak van kennis van dieetkundiges en verpleeg personeel te bepaal in terme van voeding en diabetiese self sorg vir beide T1 en T2 DM. Die verpleegpersoneel benodig verder opleiding t.o.v sekere aspekte van voeding en diabetiese self -sorg en die dieetkundiges t.o.v. diabetiese self -sorg vir beide T1 en T2 DM.

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Thesis (MTech (Biomedical Technology))--Cape Peninsula University of Technology, 2015. / Diabetes mellitus (DM) is an endocrine disorder that is characterised not only by severe hyperglycemia but also altered metabolism of glucose and lipids. It is a major health problem worldwide and its impact is greatly noticed in developing countries due to the lack of adequate medical facilities. Oxidative stress remains the principal factor that actively plays major roles in the onset and progression of diabetes mellitus and its complications. The use of medicinal plants in the treatment of DM has undisputedly gained the attention and interest of researchers throughout the globe mainly because plants have established promising outcomes in the treatment of diabetes. It is evident that the plants’ constituents possess therapeutically potent metabolites that have beneficial effects such as antioxidant, antidiabetic, anticancer, anti-inflammatory and antibacterial activities. Hypoxis hemerocallidea is a native plant that grows in the Southern African regions. H. hemerocallidea is well known for its beneficial medicinal values. In South Africa it is known as the African potato. The main aim of this study was to investigate both the beneficial and also the possible toxic effects of H. hemerocallidea in the kidney and liver tissues of streptozotocin-induced diabetic male Wistar rats by assessing the antioxidant status and selected biochemical parameters in the two studied organs. Diabetes was induced in overnight fasted rats by administration of a single intraperitoneal injection of STZ at a dosage of 50mg/kg in citrate buffer (0.1 M at 4.5 pH). Hyperglycemia was confirmed 72 hours after induction of diabetes using STZ in rats with glucose levels > 15 mmol/l. Treatment with the plants extract commenced on the fourth day after STZ administration via gastric gavage that was done once a day over a 6 week period. The effects of H. hemerocallidea on glucose, body weight, liver and kidney weights, liver function, kidney function and the oxidative status were evaluated after the feeding period.

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Orientador: Valeria Helena Alves Cagnon Quitete / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-06T00:54:48Z (GMT). No. of bitstreams: 1 Caldeira_EduardoJose_D.pdf: 18400558 bytes, checksum: 7e8b4eb768cbda17d8707f0e18392f62 (MD5) Previous issue date: 2006 / Resumo: O Diabetes Mellitus compromete as glândulas salivares, alterando a morfologia e os mecanismos de salivação, os quais são fundamentais para a saúde bucal. ssim, o objetivo do presente estudo foi analisar os efeitos do tratamento insulínico prolongado sobre as células responsáveis pelo processo secretor das glândulas salivares parótidas e submandibulares de camundongos diabéticos autoimunes, além da expressão dos receptores de insulina (INS-R) e dos receptores dos fatores de crescimento homólogos a insulina (IGFIR). Um total de 45 camundongos fêmeas foram divididos em três grupos: 18 Nod diabéticos positivos (grupo I), 18 Nod diabéticos tratados com insulina (grupo II) e 9 controles BALB/C (grupo III). O grupo II foi dividido em dois subgrupos com 9 animais que receberam insulina após 10 dias e 20 dias da expressão do diabetes. Da mesma forma os camundongos dos grupos I e III receberam diariamente solução fisiológica. Amostras das glândulas salivares foram analisadas em microscopias de luz, eletrônicas de transmissão e varredura e imunohistoquímica. Os resultados demonstraram que após tratamento insulínico prolongado os níveis glicêmicos dos animais retornaram a padrões de normalidade, contudo ainda observou-se alterações celulares como atipia celular, desorganização das biomembranas, aumento dos componentes fibrilares e alterações na expressão dos receptores de INS e de IGF-IR. Assim, a partir dos resultados pôde-se concluir que o diabetes provocou importantes mudanças tanto nas glândulas parótidas como nas submandibulares mesmo quando controlado com tratamento insulínico, o que pode levar a deficiências nos processos de manutenção e renovação tecidual, além de comprometer os mecanismos funcionais / Abstract: Not informed. / Doutorado / Anatomia / Doutor em Biologia Celular e Estrutural

The need for alternative strategies for the prevention and treatment of diabetes is growing rapidly as type II diabetes is reaching epidemic status in our society. This need was the basis for the creation of this study, as it was necessary to start looking towards medicinal plants as potential antidiabetic treatment and no comprehensive in vitro model existed. In creating a model for determining the effects of alternative traditional medicines as antidiabetic potentiates, it was necessary that two metabolic pathways, namely glucose uptake and insulin secretion, which play a significant role in glucose homeostasis, be at the centre of our investigations. The objective of this project was to optimize the methodology required to screen and ultimately determine the effectiveness of the plant extracts Kankerbos and MRC2003, as antidiabetic potentiates, through observing their effects on glucose utilisation and insulin secretion. If these medicinal plants are going to make a positive contribution to the health of type II diabetic South Africans, then the determination of their efficacy is essential. The cell lines used in this study included 3T3-L1 preadipocytes, Chang liver, C2C12 muscle and INS-1 rat pancreatic cells. Each cell line represents a different in vivo organ that is known to have an influence on glucose homeostasis in our bodies, each with its own unique metabolic pathways and mechanisms of activity, thereby making each one a vital component in the study. The positive controls for the two models were insulin and metformin (glucose utilisation) and glibenclamide (insulin secretion). Insulin was shown to provide a significant increase in the amount of glucose taken up in C2C12 muscle and Chang liver cells for acute conditions. Chronic treatments with metformin provided a significant increase in glucose utilised by Chang liver cells. Glibenclamide was an effective positive control for stimulating insulin secretion by INS-1 cells under acute conditions as there was a significant increase in the amount of insulin secreted. MRC2003 did not show any significant antidiabetic activity. Sutherlandia frutescens (Kankerbos) showed biological activities comparable to some of the more recognized antidiabetic compounds throughout the study. With regards to the glucose utilisation model, Kankerbos was seen to have both acute and chronic effects in different cell lines. In the C2C12 muscle cell line, Kankerbos significantly increased glucose uptake when they were exposed to acute conditions. Kankerbos also had a significant effect on the Chang liver cells as it was observed that under both acute and chronic conditions, this plant extract induced the uptake of glucose into these cells. With respect to the insulin secretion model involving INS-1 cells, no significant effect was seen during acute exposure with Kankerbos treatment. However during chronic exposure, an increase in insulin secretion was initiated by this plant extract. Overall, the results of this study suggest that Kankerbos has a twofold mechanism of action for its glucose-lowering effects. Given that Kankerbos is widely available in South Africa, this study was valuable as it provided an indication that Kankerbos has antidiabetic activities and could possibly be used as an alternative antidiabetic medication.

This study will be focussing on the experiences of Xhosa-speaking patients with DM utilising the NMMM public hospitals complex. In the OPD patients are assessed and treated for all chronic conditions including DM, and patients are seen at monthly intervals or when necessary. The OPD serves the neighbouring black population from the surrounding townships as well as the informal settlements. The effects of urbanisation have resulted in this area having a semi–rural, semi-urban population that is mostly Xhosa speaking. The bulk of the population is unemployed, while others are living on a minimal income. Unemployment in the Eastern Cape ranges from 40% in rural areas, rising to 50 - 60% in the urban areas (Proposed aluminium Pechiney smelter within the Coega IDZ, 2002:4-8). In some homes there is no or little money to buy food, and even less to make use of a health service. Some people live on either a social grant for the elderly, a grant for young children or a disability grant and most people in this area have an income below the level at which payment of taxes for contribution to the economy is possible.