Thesis (MPH.) -- University of Limpopo, 2021 / Background: Diabetes mellitus (DM) is a major public health problem, and it remains one of the global epidemics of non-communicable diseases. Diabetic retinopathy (DR) is a micro-vascular complication of DM due to a prolonged hyperglycaemia, and it is the most common cause of a visual loss in people living with DM. The global increase in the prevalence of DM has led to an increase in prevalence of diabetic complications, such as DR. The primary aim of this study was to investigate the prevalence and determinants of DR among the DM patients receiving treatment from Maruleng public healthcare facilities, Mopani District in the Limpopo Province. Methodology: A quantitative cross-sectional survey was used as a primary source data from the DM patients who were readily available at the selected public healthcare facilities to collect a chronic treatment during the time of the study. Selection of eligible DM patients was done through a convenient sampling technique for those who were readily available or willing to take part of the study after receiving all information about the study for them to consent freely without any form of coercion by researcher or any other person. All selected respondents had undergone face-to-face interviews and basic clinical screening for DR to collect a primary source data using piloted structured researcher-administered questionnaire to record data collected from respondents, and calibrated medical equipment were used to measure a clinical variables during clinical screening. Data analysis was carried out using Statistics and Data Analysis (STATA) version 15 software for windows. The characteristics of DM patients were summarised and analysed using a descriptive statistics. Inferential statistics were performed on dependent variable and independent variables using a logistic regression analysis to determine the strength of association between variables, where a potential predictors of DR among DM patients were identified at significant level of less than 0.05 (p<0.05). Results: Out of the 416 DM patients who participated in the study, the majority were females (n=315; 76%) and all DM patients were above the age of 18 years, with a mean age of 61 years (standard deviation [SD] =11.5). The overall prevalence of DR was 35.4% comprising 32% mild non-proliferative DR (NPDR) and 3.4% moderate NPDR. DR was found to be slightly more prevalent in females, at 35.9%, than in males, at 34.6%; particularly in those females with type 2 DM, at 35.1%, comprising 32.1% mild NPDR and 3% moderate NPDR. DR was more prevalent in older females, at 77.8%, comprising 55.6% mild NPDR and 22.2% moderate NPDR. The DM patients aged 55 years and above were found to be 2.7 times more likely to develop DR, at p<0.001, and DM patients with higher systolic blood pressure of 140 mmHg or more were found to be 1.4 times more likely to develop DR as compared to DM patients with a systolic blood pressure of 139 mmHg or less (≤139 mmHg), at p<0.05. Employed DM patients were 1.4 times more likely to develop DR as compared to unemployed DM patients, at p<0.001. Age of the DM patients, high systolic blood pressure (SBP) or a hypertension of 140 mmHg or more (≥ 140 mmHg), and employment status were significantly associated with higher risk of developing DR among DM patients. Gender, hyperglycaemic state, poor glycaemic control, smoking and high BMI were found to be associated with DR but this association was not statistically significant. Conclusion and recommendations: Slightly more than one third of the DM patients receiving treatment during the study period from the public healthcare facilities in the Maruleng sub-district had some form of DR, which means that nearly four in ten DM patients had some form of DR. Diabetic retinopathy was more prevalent in females, and in older DM patients. Age of the DM patient, employment status, and high systolic blood pressure were significantly associated with an increased risk of developing DR among the DM patients. There is an urgent need to implement a health promotional programmes to educate people about the complications of a diabetes mellitus such as DR, and also to establish a coordinated screening programme for DR among DM patients receiving a chronic treatment, which must be supported by the Department of Health in all public healthcare facilities. Keywords: Diabetes Mellitus, Diabetic Retinopathy, Prevalence, Determinants / Health and Welfare Sector Education and Training Authority (HWSETA)

This study examined Neuro-Reflex Therapy, a type of reflexology, and effleurage massage for the treatment of diabetic neuropathy in men and women 40-73 years old with Type II diabetes. Participants were physician-referred to an alternative medicine clinic and were randomly assigned to Neuro-Reflex Therapy, effleurage massage, or a wait-list control group. The treatment groups received 12 individual 30 min sessions scheduled once a week for 12 weeks, and the control group received treatment after the study was completed. Scores on the Neuropathic Pain Scale, Section III of the Multidimensional Pain Inventory, the Profile of Mood States, the Short-Form McGill Pain Questionnaire, changes in foot temperature, and changes in scores on a Visual Analogue Scale (VAS) were analyzed. As hypothesized, pain for both treatment groups significantly decreased from the control group; however, mood states, participation in daily activities, and temperature for the treatment groups did not significantly increase, compared to the control group, as expected.

No description available.

Aldose reductase inhibitors (ARI's) have been shown to attenuate or prevent several complications of diabetes in animals. Tolrestat is a potent and unique ARI from Ayerst Laboratories, New York, NY. The efficacy and toxicology of tolrestat via topical ocular administration was examined. Tolrestat effectively enhanced corneal reepithelialization and was efficacious in the prevention of cataracts in the streptozotocin-diabetic rat. Ocular tissues were examined by slit lamp biomicroscopy, scanning and transmission electron microscopy, and light microscopy. Liver and kidney tissue was also examined. The presence of tolrestat was confirmed in urine, feces, and eye specimens, and quantitated in serum. There was no evidence of local or systemic tolrestat induced toxicity. Tolrestat prevented cataract formation at less than one-third the reported oral dose and at approximately one-fiftieth the associated serum concentration in rats. ED-50 and TD-50 calculations indicate that tolrestat is a relatively safe drug by topical ocular administration.

Complex diseases often arise from intricate interactions between genetic predispositions and environmental factors, leading to cellular dysfunctions that manifest across a range of pathological conditions. Addressing these multifactorial challenges necessitates innovative therapeutic strategies capable of simultaneously targeting multiple disease pathways. This thesis explores the development and optimization of versatile nanosystems designed for protein delivery and scavenging of pro-inflammatory factors, aimed at treating diverse and complex conditions. The research introduces three distinct approaches: (1) the development of a polymeric nanosystem for oral delivery of the pegfilgrastim protein as a radiation countermeasure for hematopoietic acute radiation syndrome (H-ARS); (2) the adaptation of this polymeric nanosystem for glucose-responsive, antibacterial, and antioxidant treatment of diabetic wounds; and (3) the creation of a 2D nanosheet for scavenging small extracellular vesicles (sEVs), aimed at mitigating metastasis in triple-negative breast cancer post-radiotherapy. These studies utilized a combination of material synthesis, advanced characterization techniques, and delivery strategies to enhance the therapeutic functionality of the delivered cargos. For H-ARS, the polymeric nanosystem was engineered to improve bioavailability and enable controlled release, ensuring effective oral delivery of the PF protein. The glucose-responsive polymeric nanosystem, encapsulated within a P(NIPAm-co-AAc) hydrogel, facilitated responsive release under high glucose conditions, scavenging cell-free DNA and reactive oxygen species, while inhibiting bacterial growth to accelerate wound healing in mouse models. Additionally, the 2D cationic nanosheet was designed to capture and neutralize tumor-derived small extracellular vesicles (sEVs), reducing their role in metastasis and enhancing therapeutic outcomes following radiotherapy in breast cancer models. The findings from these investigations demonstrate the significant therapeutic potential of the engineered nanosystems across three distinct disease models. The rational design of these nanocarriers addresses several key challenges in contemporary medicine, including the highly challenging oral delivery of proteins, the intricate process of diabetic wound healing, and the suppression of radiotherapy-induced metastasis. This dissertation not only bridges a critical knowledge gap regarding the strategic deployment of nanomaterials to overcome these complex pathological conditions but also contributes to the development of advanced tools for the next generation of precision medicine. By elucidating how nanosystems can be systematically optimized for specific therapeutic applications, this work provides a foundation for innovative approaches that could enhance treatment modalities across a spectrum of diseases.

Objectives. To investigate diabetes prevalence, incidence, mortality trends, the effects of hyperglycaemia and blood pressure, diabetes and hypertension treatment, and the effect of screening detection on total and cardiovascular disease (CVD), myocardial infarction (MI) and stroke incidence. Study population and methods. Between 1972 and 2001 all patients with diabetes, some detected clinically and some by case-finding procedures (screening), were entered in a diabetes register at Laxå Primary Health Care Center in Sweden. The register included information on medical treatment and laboratory data as well as information on mortality and morbidity from National Registers. The register was supplemented with five non-diabetic subjects, matched to each diabetes patients by age, sex, and year of detection. Results. During the study period 776 new diabetes cases was found, 36 type 1 diabetes mellitus and 740 type 2 diabetes mellitus. Age standardised incidence and prevalence rates for type 1 and type 2 diabetes did not increase over time. Diabetic patients had 17% higher mortality rate than non-diabetic persons, 22% in women and 13% in men. The corresponding over-mortality in CVD was 33%, 41% in women and 27% in men. CVD mortality decreased across time in non-diabetic subjects and in diabetic men but not in diabetic women. Results regarding coronary heart disease (CHD) were similar. CVD incidence increased with fasting blood glucose (FBG), body mass index (BMI), mean arterial blood pressure (MABP), and decreased with metformin treatment and sulfonylurea. Myocardial infarction incidence increased with FBG, BMI and MABP, and decreased with metformin treatment. Stroke incidence increased with MABP. There was no difference in prognoses between those detected by screening or clinically. Conclusions. Diabetes prevalence and incidence did not change over time. The over-mortality according to diabetes was moderate. CVD and MI during follow up were negatively affected by hypertension and hyperglycaemia, and positively by pharmacological diabetic treatment. For stroke no pharmacological protective effect was seen. Screening did not improve prognosis.

Chan, Yuet Wa. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 217-232). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese.

Basing on the traditional TCM interpretation, experience of recent research studies and our experimental findings, a few component herbs in Formulae 1 & 2 would be tentatively selected for a new formula. They were Radix Rehmanniae, Radix Astragali, Rhizoma Atractylodis Macrocephalae, Rhizoma Alismatis, Cortex Moutan and Rhizoma Smilacis Chinensis. Whether the new formula could give better efficacy would need to be tested in new clinical trials and experimental models. (Abstract shortened by UMI.) / Diabetes mellitus has long been a clinical problem for hundreds of years. More than 194 million people in the world now suffer from the disorder. About 15% of all diabetic patients would develop unhealing foot ulcers which compile significant proportion of nontraumatic lower-extremity amputations. Basing on the clinical experience of Prof. Xi Jiu Yi in Shanghai, literature review and an innovative interpretation of traditional Chinese medicine, two formulae (F1 & F2) derived from a well known herbal formula: the "Pills of Six Drugs with Rehmannia" were created for clinical trials. With the early successful limb salvage rate of over 80% observed in a clinical series studied at the Prince of Wales Hospital, Hong Kong, multi-directional studies on the two formulae were carried out. The aim was to find out the clinical efficacy of Formulae 1 & 2, and their component herbs, and the biological mechanism of action. A series of in-vitro, ex-vivo and in-vivo experimental models were completed for the latter purposes. / Granulation formation is an important issue essential for ulcer healing. Therefore a CRL-7522 fibroblast cell line and primary fibrobass from eight diabetic foot ulcer patients (ex-vivo) were used to detect the granulation enhancing activities of the Formulae 1 & 2 and component herbs. The two formulae and some of their component herbs viz, Radix Astragali (HQ), Radix Rehmanniae (SD) and Rhizoma Atractylodis Macrocephalae (BZ) showed significant enhancement effects on the cell viability and apparently facilitated granulation formation. Hence the Formulae 1 & 2, and the three component herbs were selected for further studies. The other nine component herbs of the formulae were found to have no significant enhancing effects on cell viability. With an established diabetic rat model (n0 STZ and n5 STZ), a piece of full-thickness skin was removed from the foot of the rat to develop a diabetic rat foot ulcer model. The ulcer area was measured by a specially designed area measuring programme, namely the Image Analytical Programme. The ulcer areas and their percentage reductions over time were recorded and analysed using statistical multilevel models with adjustments for weight, blood glucose level and the presence of extra ulcers. Results revealed that the ulcer area was significantly reduced by the Formulae 1 & 2, and one of their component herbs, Radix Rehmanniae (SD). / Lau Tai-Wai. / "February 2005." / Adviser: Ping Chung Leung. / Source: Dissertation Abstracts International, Volume: 67-01, Section: B, page: 0197. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 292-310). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Self-monitoring of blood glucose (SMBG) can be effective in preventing poor outcomes associated with diabetes mellitus but previous research has identified that SMBG is not being undertaken in line with current recommendations. Guidance informs health professionals to educate patients on how they should self-monitor but very little is know about how patients self-monitor in the real world. In this thesis, a quantitative scoping study is first presented. This study used routine data sources to examine the levels and patterns of self-montoring in different population groups and then proceeded to a larger qualitative study to explore and question what patients are doing in practice in relation to self-monitoring, and why. This involved a qualitative multi-case study of patients, their support people, health care practitioners (HCPs) and patient diaries. Ten individuals and their nominated support people and HCPs formed ten cases among whom 21 in-depth semi-structured interviews were carried out and six patient diaries analysed. The exploratory work was framed around Stones’ version of structuration theory and uncovered a complex linkage of individual motives for monitoring, associated responses and behaviours in relation to the motive, and the underpinning attitudes and beliefs behind the motive. The following key points emerged from the analysis. People have differing relationships with their diabetes and this links with the level of engagement they have with their condition. Resistance to support people and health services was commonly observed. Experiences of diabetes reviews were important, with an identified need for them to feel more like collaboration and less like surveillance. A significant factor was the gaps and limitations in knowledge and understanding around diabetes for patients, relatives, support people and HCPs; and, finally, there was a noted maintenance of blood glucose levels higher than recommended through SMBG in several participants, which stemmed from a fear of hypoglycemic episode. The analysis concluded that although self-monitoring of blood glucose, in theory, and when considered in isolation, is a simple process to undertake, its application in the wider context of self-management and the individual is much more complicated. The process is influenced by many complex factors and generates a variety of responses and behaviours, some not in keeping with good diabetes self-management. There was a significant lack of person-centered approaches to managing diabetes which was, in part, due to existing health systems and processes. Therefore, there is a need to raise awareness of the gaps that exist in terms of such approaches as well as the gaps in knowledge and understanding of individuals with diabetes and those caring for and supporting them. In more specific terms, it is essential to develop and evaluate individual approaches to patients in relation to their self-monitoring and associated self-management in the context of their own lives, which involves the assessment of engagement and understanding around self-monitoring.

Factors such as poverty, ethnicity, socio-economic status, poor infrastructure and governance, etc., are some of the reasons that effective and proven prevention and treatment interventions for most of the major causes of mortality and morbidity in the developing world continue to fail. Chronic diseases require complex interventions that these countries simply cannot maintain. Diabetes mellitus (DM) is a chronic disease that is on the rise worldwide. This disease is a lifestyle disease, which means, that it is brought on by poor health habits. Statistics show that 285 million (6.4%) people aged between 20 and 79 years will be affected by Diabetes in 2010 and a staggering 439 million (7.7%) by 2030. This is a projected growth of 69% in developing countries and 20% in developed countries. The findings from studies conducted from 1993 to 2003 in Sub-Saharan Africa, particularly in South Africa, around the health care services for diabetes highlights many challenges. Sadly, the challenges 10 years after that study, are very similar. The conditions of people with Diabetes can be improved through regular monitoring of patients, improvement and monitoring of health care provided, education on healthy lifestyle, as well as education on the importance of adherence to treatment plans for the successful management of the condition. The diabetes endemic in South Africa is exacerbated by the manual functions that are performed in all aspects of monitoring and management of the disease. With the advancements that have been made in ICT and the many apps that already exist for healthcare, it is sensible to state that ICT can assist in the monitoring and management of diabetes. Another factor that is considered is that of patient-centred care. The huge number of people who need acute care and treatment in hospitals and clinics have forced a previously caring environment, to turn into a cold, almost production line affair. The sick wait in long queues and are ushered in and out of the consulting rooms as fast as possible without even as much as a “hallo”. This has left a void in the healthcare delivery to South Africans which should never have been removed in the first place, namely patient-centred care. This means that the patient is at the centre of the treatment and fully involved in the decisions about his/her health. Every patient deserves to be recognised as a human-being and treated with dignity and respect. Treatment plans for long term chronic care patients such as diabetics, should be thoroughly discussed with the patient and they should believe and comit themselves to the treatment plan. These plans are life-long and require dedication and as it is vital that patients are part of decision making and understand fully what they are expected to do. Bearing this in mind, this study has investigated the needs and care plans for people with diabetes. Specialist in the field of diabetes were interviewed and recognised care plans for diabetes such as those from WHO, IDF and SEMSDA were studied. This study also established, that by practising a patient-centred approach the adherence to a treatment plan is likely to be higher. The strategy developed involves the person with diabetes, the healthcare worker and the support structure in the care plan of the diabetic. The use of ICT as part of the solution must consider the patient-centred requirements for using IT so that the people using the strategy are comfortable and not intimidated by the technology. The need to incorporate e-health into governments’ healthcare plans has been growing over the last decade. The GSMA conducted research into mobile health opportunities in South Africa and found that SA now has a penetration of 98% and that this is the ideal medium to address the inaccessibility and inequality of healthcare in SA. The causes identified as playing a major role in the rise in diabetes were identified and it was determined that through the implementation of an ICT strategy for diabetes care, many of these can be addressed. These include the use of technology for, improved monitoring and management, increased diabetes awareness and education, and promotion of healthy lifestyle. The study focuses on the self-management aspect of diabetes and produces a strategy that incorporates various ICT solutions that would assist in the daily aspects of diabetes care, as well as follow a patient-centred approach to diabetes care. This strategy developed in this study does not need any intervention from government as it is driven by the people who have diabetes and their healthcare workers, with the aid of the technology that they currently have on hand.