In our current environment virtually any information, including health-related data, can be readily accessible due to the ubiquity of smart devices and health monitoring smart device accessories, such as activity, sleep, heart rate, pulse, and blood pressure tracking devices. However, currently available self-monitoring devices are restricted to extra-corporeal data, leaving many important physiological parameters such as glucose, hormone, and electrolyte level changes uncharted. Of notable interest in the area of self-monitoring is that of blood glucose levels in the pre-diabetic population. Continuous glucose monitoring (CGM) devices utilised by diabetics are invasive and cost prohibitive for general consumers and therefore uncommonly used pre-diagnosis. These devices are thus unlikely to enable the lifestyle changes and administration of the appropriate adjustments in a timely manner to pre-diabetics, which may prevent the progression to diabetes. This dissertation discusses and demonstrates the development of a minimally invasive wearable device for the continuous sensing of glucose, with Bluetooth wireless connectivity to enable data transfer to a smart device. Three major components of this device are: 1) microneedles, which serve to penetrate the skin to access the underlying dermal interstitial fluid, and to immobilise the glucose sensor; 2) fluorescent glucose sensor, which senses glucose in the dermal interstitial fluid whilst being immobilised to the microneedles; and 3) wearable fluorescence detection system, which interrogates and evaluates the light signal generated by the microneedle sensing platform. The microneedles are unique compared to the previous microneedle sensing devices, in that the sensing moiety can be chemically integrated into the microneedles to allow for continuous fluid sampling and analyte monitoring to take place simultaneously in situ. Glucose sensing is enabled by modular fluorescent sensors, consisting of glucose receptors, a reporting fluorophore, and an immobilisation site. The wearable fluorometer is 5.1 x 3.2 x 1.9 cm in dimension, is battery-powered, has an adjustable dynamic range, and exhibits fluorescence detection capability comparable to that of the gold standard microplate reader device. In vitro and in vivo assessments demonstrate that the microneedle sensing platform and the detector are able to perform their intended functions, and more importantly, can be integrated compatibly into the final envisioned system. Beyond the intended overall application of continuous glucose monitoring, each component and their fabrication methods have the potential to be utilised for the continuous monitoring of other health metrics. When these components are assembled, the end product is a wearable continuous sensing system that is easy to use, almost painless, minimally invasive, and overall, accessible in terms of convenience and cost to the general consumer.

Thesis (MSc(Biomedical Technology))--Cape Peninsula University of Technology, 2019 / Background: Maturity Onset Diabetes of the Young (MODY) is a monogenic type of diabetes caused by a single gene mutation. Up to date 14 different MODY subtypes have been identified. Mutations in the glucokinase (MODY 3) and hepatic nuclear factor 1 alpha (HNF1A) (MODY 2) are the most frequent causes of MODY in all populations studied. Patients with MODY are misdiagnosed with type 1 or type 2 diabetes. Identifying patients with MODY is important as it affects treatment, for example, MODY 2 patients need no treatment, whereas those diagnosed with MODY 3 are very sensitive to low doses of sulphonylureas. To date, no data is available on the prevalence of MODY in populations from Africa. Thus, we aimed to investigate and report on the incidence of MODY, specifically mutations in the HNF1A gene in a population from the Western Cape. Methods: In this study, we screened for HNF1A MODY (MODY 3) mutations (rs115080759, rs140491072 rs137853245, and rs142318174) in 1639 (males = 406) individuals using real-time PCR. Positive MODY samples were confirmed by subsequent sequencing. All individuals underwent an oral glucose tolerance test. Results: The mean age of participants was 47.1±15.6 in males and 49.9±15.1 females. We identified 12 (0.73%) individuals with HNF1A gene polymorphisms; 12/1642 of rs115080759. Seven participants with a SNP in rs115080759 presented with normoglycemia, one with prediabetes, and four with diabetes. No polymorphism was detected in three SNPs; rs140491072, rs137853245 and rs142318174. Discussion and conclusion: To our knowledge, this is the first African study on MODY, and the incidence is similar to that reported in other studies. The results suggest that MODY is misdiagnosed with other types of diabetes in Africa; therefore, our findings support the introduction of diagnostic genetic testing for MODY in South Africa.

Thesis (MSc)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Context: There are serious deficiencies in the current tests and criteria available for the diagnosis of diabetes. A novel screening method for the earlier and more efficient detection of type 2 diabetes would be a significant clinical advance. Objective: The hexosamine biosynthetic pathway (HBP) usually acts as a fuel sensor and its activation leads to O-GlcNAcylation of target proteins in a glucose-responsive manner. O-GlcNAc transferase (OGT) and O-GlcNAcase (OGA) are responsible for O-GlcNAc addition and removal, respectively. As higher HBP flux is linked to insulin resistance/type 2 diabetes, we hypothesized that increased O-GlcNAcylation of leukocyte proteins can detect the onset of pre- and overt diabetes. Materials and methods: 74 participants from Bellville and Stellenbosch (Western Cape, South Africa) were recruited and characterized as normal, pre-diabetic or diabetic. Leukocytes (granulocytes and lymphocytes) isolated from study subjects were evaluated for O-GlcNAcylation, OGA and OGT expression by flow cytometry, immunofluorescence microscopy and Western blotting. Results: Leukocyte O-GlcNAcylation increased in both pre-diabetic and diabetic individuals, with leukocyte sub-population data showing the greatest sensitivity. OGA expression and O-GlcNAc/OGA ratios elevated in parallel with increasing glucose concentrations. OGT expression did not significantly change for any of the study subjects investigated. Conclusions: The initial and significant increases in leukocyte O-GlcNAcylation demonstrate great potential for the earlier detection of pre-diabetic and diabetic individuals. OGA expression and O-GlcNAc/OGA ratios may also have diagnostic value. Together our data show strong promise for eventual diagnostic utility and the more efficient detection of type 2 diabetes. / AFRIKAANSE OPSOMMING: Die konteks: Daar is ernstige tekortkominge in die huidige toetsing en kriteria vir die diagnose van diabetes. ʼn Nuwe metode vir die vroeë en meer effektiewe opsporing van tipe 2 diabetes sal beduidende kliniese voordeel inhou. Doelstelling: Onder normale omstandighede tree die heksosamienbiosintetiese pad (HBP) as energie sensor op, en die aktivering daarvan gee aanleiding tot O-GlcNAsetilering van proteïene in ʼn glukose-afhanglike wyse. O-GlcNAs transferase (OGT) en O-GlcNAse (OGA) is onderskeidelik verantwoordelik vir O-GlcNAs toevoeging en verwydering. Aangesien hoër HBP fluks verband hou met insulienweerstandigheid /tipe 2 diabetes, stel ons ʼn hipotese voor dat opsporing van verhoogde O-GlcNAsilasie van leukosietproteïene, die aanvang van pre-diabetes en diabetes kan voorspel. Materiale en metodes: 74 vrywillige deelnemers van Bellville en Stellenbosch (Wes Kaap Provinsie, Suid Afrika) is gewerf en gekarakteriseer as normaal, pre-diabeties of diabeties. Leukosiete (granulosiete en limfosiete), uit bloed van deelnemers geïsoleer, is vir O-GlcNAsilasie, OGA en OGT uitdrukking deur vloeisitometrie, immunofluoressensie-mikroskopie en Western blotting, ondersoek. Resultate: Leukosiet O-GlcNAsetilering is verhoog in beide pre-diabetiese en diabetiese individue, met leukosiet sub-populasie wat die mees sensitiewe data gelewer het. OGA uitdrukking en O-GlcNAs/OGA verhoudings in parallel verhoog tot ʼn toename in glukose konsentrasies. OGT uitdrukking het nie betekenisvol verander in enige van die individue wat ondersoek is nie. Gevolgtrekkings: Die vroeë en betekenisvolle toename in leukosiet O-GlcNAsetilering toon groot potensiaal vir die vroeë opsporing van pre-diabetiese en diabetiese individue. OGA uitdrukking en O-GlcNAs/OGA verhoudings het ook moontlik diagnostiese waarde. Ons data toon belowende resultate vir die gevolglike diagnostiese waarde en ʼn meer effektiewe opsporing van tipe 2 diabetes.

Thesis (M.Cur.) --University of Limpopo, 2010 / In this study, a qualitative, descriptive and contextual research methodology was applied to describe the problems faced by newly diagnosed diabetes mellitus patients at the primary healthcare facilities of the Mopani district in the greater Giyani municipality, Limpopo Province, South Africa. Purposive sampling was used and phenomenological interviews were held with newly diagnosed diabetes mellitus patients after investigations within the first six months. The data were analyzed using Tesch’s open coding method of data analysis for qualitative research. The findings indicated that newly diagnosed diabetes mellitus patients faced a number of problems, such as emotional disturbance, fear, anger, denial, frustration, depression, uncertainty, and poor interpersonal relationships with nurses. This study found that lack of support and proper health education for newly diagnosed diabetes mellitus patients demand government intervention, and thus proposes guidelines and recommendations for more effective healthcare practices and education for implementation at primary healthcare facilities.

No description available.

The aim of this study was to explore and describe the experiences of diabetes mellitus patients at the Piggs Peak Hospital in Swaziland, from the time of diabetes diagnosis to living with diabetes, adherence to treatment and implementing diabetes self-care. A descriptive, exploratory, contextual qualitative research was conducted. Data was gathered through semi-structured interviews with 26 participants purposively selected on diabetes days at the hospital. Data was analysed qualitatively. Results revealed that patients present late for diagnosis. Being diagnosed causes psychological distress of varying intensity and duration. Hospital visits are burdensome due to financial and transport challenges, as well as service shortcomings. Self-care activities are difficult due to financial challenges and nonconducive social circumstances at home. Social support is lacking. Diabetes patients fear insulin use and prefer oral tablets. It is concluded that diabetes self-care is burdensome for most patients of the PPH in Swaziland. The service providers, stakeholders, and government need to explore strategies for mitigating effects of various barriers to self-care as revealed in this study. / Health Studies / M.A. (Public Health)

The aim of this study was to explore and describe the experiences of diabetes mellitus patients at the Piggs Peak Hospital in Swaziland, from the time of diabetes diagnosis to living with diabetes, adherence to treatment and implementing diabetes self-care. A descriptive, exploratory, contextual qualitative research was conducted. Data was gathered through semi-structured interviews with 26 participants purposively selected on diabetes days at the hospital. Data was analysed qualitatively. Results revealed that patients present late for diagnosis. Being diagnosed causes psychological distress of varying intensity and duration. Hospital visits are burdensome due to financial and transport challenges, as well as service shortcomings. Self-care activities are difficult due to financial challenges and nonconducive social circumstances at home. Social support is lacking. Diabetes patients fear insulin use and prefer oral tablets. It is concluded that diabetes self-care is burdensome for most patients of the PPH in Swaziland. The service providers, stakeholders, and government need to explore strategies for mitigating effects of various barriers to self-care as revealed in this study. / Health Studies / M.A. (Public Health)

Thesis (M. A. Medicine (Family Medicine)) -- University of Limpopo, 2021 / Diabetes is a rising problem globally. The World Health Organization (WHO) has classified diabetes as an epidemic. The major impact of the disease is felt in low- and middle-income countries. The literature has emphasised the fact that most patients living with diabetes are undiagnosed, and those who are diagnosed are poorly controlled. The complications associated with diabetes usually occur over a long period of time and are mainly influenced by poor glycaemic control. In South Africa, diabetes is a major cause of morbidity and mortality and a burden to the already overstretched health system in the country. In this study, factors that impair a patient’s ability to achieve good glycaemic control are investigated. ' Methods In this cross-sectional, descriptive study was conducted at the general outpatients department (GOPD) of the Mankweng hospital in the Capricorn District of the Limpopo Province. A total number of 97 participants formed part of the study. An HbA1c test was used to classify patients into a well-controlled glycaemic group (HbA1c ≤ 7%) or a poorly controlled group (HbA1c > 7%). Factors for poor glycaemic control were investigated. The following factors were investigated to identify characteristics of poorly controlled diabetes patients: demographic data; adherence to treatment; and, clinical measurements characteristics. Frequency tables, univariate logistic regression models and chi-square tests were used to determine factors influencing glycaemic control. Results Of the 97 patients, only 63 (64.9%) had an HbA1C measurement done (measurable outcome). Of these patients, only 13 (15.7%) had well controlled diabetes, while diabetes in 50 patients was poorly controlled. Patients on oral treatment only comprised the bulk of the patients who were well controlled. Following multivariate analysis, being male was found to be a significant predictor of good glycaemic control. Conclusions Most patients who had an HbA1C done were poorly controlled. As a secondary observation, management of diabetes was suboptimal. Male patients treated with oral medication alone were more likely to have good glycaemic control. Key concepts Diabetes mellitus, HbA1C, glycaemic, hospital, general out-patient department, Limpopo

Indiana University-Purdue University Indianapolis (IUPUI) / Heat shock protein (HSP) 90 is a molecular chaperone that regulates diverse cellular processes by facilitating activities of various protein clients. Recent studies have shown serum levels of the alpha cytoplasmic HSP90 isoform are elevated in newly diagnosed type I diabetic patients, thus distinguishing this protein as a potential biomarker for pre-clinical type I diabetes mellitus (TIDM). This phase of disease is known to be associated with various forms of beta cell stress, including endoplasmic reticulum stress, insulitis, and hyperglycemia. Therefore, to test the hypothesis that HSP90 is released by these cells in response to stress, human pancreatic beta cells were subjected to various forms of stress in vitro. Beta cells released HSP90 in response to stimulation with a combination of cytokines that included IL-1β, TNF-α, and IFN-γ, as well as an agonist of toll-like receptor 3. HSP90 release was not found to result from cellular increases in HSP90AA1 gene or HSP90 protein expression levels. Rather, cell stress and ensuing cytotoxicity mediated by c-Jun N-terminal kinase (JNK) appeared to play a role in HSP90 release. Beta cell HSP90 release was attenuated by pre-treatment with tauroursodeoxycholic acid (TUDCA), which has been shown previously to protect beta cells against JNK-mediated, cytokine-induced apoptosis. Experiments here confirmed TUDCA reduced beta cell JNK phosphorylation in response to cytokine stress. Furthermore pharmacological inhibition and siRNA-mediated knockdown of JNK in beta cells also attenuated HSP90 release in response to cytokine stress. Pharmacological inhibition of HSP90 chaperone function exacerbated islet cell stress during the development of TIDM in vivo; however, it did not affect the overall incidence of disease. Together, these data suggest extracellular HSP90 could serve as a biomarker for preclinical TIDM. This knowledge may be clinically relevant in optimizing treatments aimed at restoring beta cell mass. The goal of such treatments would be to halt the progression of at-risk patients to insulin dependence and lifelong TIDM.

Os glicosímetros permitem que a medição da glicemia seja realizada pelo próprio usuário sem alterar a sua rotina de vida. Dois princípios são utilizados para mensurar o nível de glicemia no sangue: o fotométrico e o amperométrico. No princípio fotométrico, após reações bioquímicas com a amostra de sangue venoso capilar, a glicemia é avaliada pela mudança de comprimento de onda de um feixe de luz padrão. No princípio amperométrico, após reações bioquímicas com a amostra de sangue venoso capilar, é avaliada a intensidade de corrente elétrica que circula pela amostra, sendo proporcional a glicemia. Os glicosímetros disponíveis no mercado utilizam um dos dois princípios. O equipamento utilizado pelos laboratórios de análises bioquímicas utiliza o princípio fotométrico com amostras de sangue venoso coletadas do antebraço do paciente. Este trabalho foi aprovado pelo comitê de ética e avalia de forma pareada um conjunto de medidas de glicemia realizadas com vários glicosímetros disponíveis no mercado e um equipamento laboratorial. Os resultados apresentaram forte correlação entre as medições dos glicosímetros e o equipamento laboratorial, mas com erros sistemáticos e aleatórios elevados. Com os resultados obtidos confirma-se que o glicosímetro pode ser utilizado para monitoramento individual de glicemia, mas não pode ser utilizado para fins de diagnóstico / The glucometer allows the measurement of glycemia to be performed by the user without hindering his daily routine. Two principles are used to measure the level of blood glycemia: photometric and amperometric. On the photometric principle, after biochemical reactions with the sample obtained from capillary venous blood, the glycemia is measured by changing the wavelength of a light beam pattern. On the amperometric principle, after the biochemical reactions with the capillary venous blood sample, intensity of eletric current flowing through the sample can be measured and evaluated, where the intensity of the electric current is proportional to the blood glycemia level. The glucometers available on the market use one of the mentioned principles. Equipment used by biochemical analysis laboratories do make use of the photometric principle with venous blood samples collected from the patient's forearm. This work, approved by the ethics committee, evaluates a set of glycemia measures made by multiple glucometers and laboratory measuring equipment used by clinical laboratories. Presented results demonstrated a strong correlation between glycemia measures obtained from glucometer and equipment used on biochemical analysis laboratories, but with a high rate of systematic and random errors. With the results, the usage of glucometers can be assured for personal and individual measurement of glycemia, whereas this kind of device cannot be used for diagnosis.