A report on a study submitted to the Department of Speech Pathology, Faculty of Arts. University of The Witwatersrand, Johannesburg in Partial fulfilment of the requirements for the Degree of Masters of Arts in Speech Pathology, Johannesburg, 1998. / This study was designed to examine the incidence of dysphagia in a group of fifty diabetic patients. The interrelationship between dysphagia and other complications of diabetes was examined. These included neuropathy, orthostatic dysfunction, renal dysfunction and respiratory disorders. Issues such as type of diabetes, patient age and age of onset were addressed. The utility and sensitivity of an interview schedule devised by the researcher was critically evaluated. Data were obtained through the administration of a standardized open-ended interview schedule coupled with an examination of the patients' hospital files. Results were interpreted and tabulated by the researcher. Results revealed that a significant proportion of diabetic patients are experiencing swallowing difficulties within all three phases of the swallow process. It is postulated that the cause of the dysphagia may be due to severe autonomic neuropathy and consequent vagal denervation. The highest incidence of dysphagia appeared to be amongst Type I diabetics who developed diabetes before the age of forty. The interview schedule was thus able to detect those patients experiencing dysphagia. However it was found to be unsuccessful in determining the severity of the problem. Clinical implications for both the Speech Therapist and the Medical team are discussed. Suggestions for future research are put forward.

Background: Adherence to diabetes care is an issue of concern at Bishop Lavis Community Health Centre (BLCHC) as it results in so many diabetes patients ending up with complications that could have been avoided. Aim: To explore the reasons for people with diabetes in the Bishop Lavis area being non-adherent to diabetes care. Method: A qualitative study was undertaken. Three focus groups were held and seven in-depth interviews were conducted. The framework method was used to analyze the data. Findings: The main findings in this study was consistent with many of previous studies done on adherence, i.e. patient barriers, disease and drug regime barriers and doctor-patient relationship barriers.11 However, in this poverty-stricken area these participants also face other constraints that influence their compliance behaviour. These include 1.over-burdened public healthcare facilities, 2.insufficient education, 3.poor support structures, 4.infrastructure which is not wheelchair-friendly, 5.unsafe communities, 6.low income and unemployment. Conclusion: Non-adherence is a topic that has been widely researched over the last couple of years and it appears that the reasons are mostly consistent. However, in poverty-stricken areas it seems as if over-burdened public health services and social problems are the main reasons that need to be addressed. It is thus with great anticipation that we await the NHI plan of the government that will be rolled out as from 2012 to see whether it will better the health care services to the poor.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Thesis (MSc.(Med.)(Pharmacy))--University of Limpopo, 2010. / Diabetes Mellitus (DM) is a self -managed condition and it is essential for patients to have the relevant knowledge, skills and attitudes needed for successful diabetes management. Follow-up and proper counselling are major components in diabetes management as these will improve adherence and optimise diabetes management. The aim of this study was to compare the knowledge, understanding and outcome of the disease management in four health institutions ; a dedicated institution, a semi-dedicated institution and two non-dedicated institution. The study objectives were: To describe the level of knowledge and understanding of diabetic patients in the management of their condition at the different institutions , to describe the outcome of diabetes management at the different institutions , to describe consulting and dispensing times for diabetic patients at the different institutions , and to obtain patients’ perceptions on the quality of the health care services pertaining to the treatment of their diabetes. A total of 120 patients were interviewed, 30 per institution. A questionnaire was used to collect data for the different objectives. Prospective and retrospective data were collected. Knowledge of DM was assessed in ten patients from each institution. Patients were asked to explain their understanding on five aspects of the condition. Median scores for patients from the two non-dedicated institutions were compared using Wilcoxon two-sample test, and were found not to differ significantly for any of the questions or the overall score. The groups did not differ significantly in their understanding of whether there was a cure for diabetes mellitus and in their understanding of hypoglycaemia and its management. Patients at the dedicated clinic were significantly more knowledgeable of the condition, it’s causes and their overall understanding of the questions asked. Hyperglycaemia and its management were understood significantly better by the patients at the dedicated iv institution than those at the non-dedicated institutions , with patients at the semi-dedicated institution not differing significantly from either group. The outcome of diabetes management was recorded from the patients file for a six month period. The proportions of elevated blood pressure results recorded at the three institution types differed significantly. The semi-dedicated institution had a significantly higher proportion of uncontrolled blood pressure results (33 of 55 results recorded, or 60%) than the non-dedicated institutions (32 of 91, 35%) or the dedicated institution (9 of 36, 25%,). None of the ten patients at the semi-dedicated institution had all their values within the controlled range, as compared to six of 20 at the non-dedicated and six of ten at the dedicated institution. The glucose control was least achieved in patients at the semidedicated institution, where only one of ten (10%) of patients had no recorded value outside the controlled range, as opposed to four of ten (40%) at the dedicated institution and nine of eighteen (50%) at the non-dedicated institutions. Median visit times differed between all types of institutions. Time spent on consulting and dispensing was the shortest at the non-dedicated (median=7min), it took longer at the semi-dedicated (median=9), and longest at the dedicated institution (median=18min). The patient’s perception on the quality of care was recorded for patients. They were asked whether they were satisfied with the amount of time that they spent with the healthcare worker. Patient satisfaction with visit time was not linked to the duration of the visit. Actual visit time did appear to be linked to patients’ perception of whether they got enough time to ask questions. As for perceived quality of service, fewer patients were informed about their progress at the non-dedicated institution than at the others. Family members of fewer patients were educated at the dedicated than at the other institutions. More patients at the dedicated institution than at the other institutions were informed of treatment changes. Suggestions for improvement of patient care were made by 18% of v patients attending non-dedicated institutions , 23% of patients at the semi-dedicated institution and 63% at the dedicated institution. The conclusion based on the results is that the more dedicated a service is, the better the diabetic care of patients. Patients at the dedicated clinic had more time with the health worker during consultation and dispensing of treatment. They were informed about treatment changes more than the patients at other institutions. Patients at the dedicated clinic also showed a better knowledge and understanding of their condition than patients in other institutions. They also had higher affirmative responses in terms of lifestyle modification as compared to the other institutions.

Thesis submitted in fulfillment of the requirements for the degree of Masters in Technology: Biomedical Sciences in the Faculty of Health and Wellness Sciences at the Cape Peninsula University of Technology 2015 / Background: The Mixed Ancestry population of South Africa has recently been reported to have a higher prevalence of type 2 diabetes (T2DM). However, the genetic risk factors that may contribute to the development of T2DM are currently unknown. We investigated the association of fat mass and obesity-associated gene (FTO), ectonucleotide pyrophosphatase/phosphodiesterase gene (ENPP1) and transcription factor 7-like 2 gene (TCF7L2) with T2DM risk in a community residing in Bellville South, Cape Town. Methods: Five hundred and sixty six participants (11.7% males) who consented to genetic analyses were genotyped for six single nucleotide polymorphisms (SNPs): ENPP1-rs997509 and -rs1044498, FTO-9941349 and -rs3751812, TCF7L2-rs12255372 and -rs7903146. The SNPs were genotyped using their corresponding Taqman genotyping assays, and validated by automated sequencing. Allele and genotype frequencies were determined and regression analyses was conducted to assess the association of the polymorphisms with T2DM and its related,traits. Results: Overall and in subgroups defined by diabetes and obesity statuses, there were present no significant differences in the distribution of alleles and genotypes, except for the polymorphisms observed in the FTO and ENPP1 genes. In logistic regression models adjusted for age, sex, body mass index (BMI) and insulin resistance, minor alleles of ENPP1-rs997509 and ENPP1-rs1044498 were associated with risk for T2DM respectively, 4.55 (1.06-19.49) (p=0.041) and 1.81 (1.09-2.98) (p=0.021) assuming a recessive genetic model. Furthermore, the FTO rs9941349 minor allele was associated with the prevalent T2DM under the log-additive model: 1.40 (1.00 to 1.96) (0.049). The TCF7L2 polymorphisms showed no evidence of association with T2DM and/or insulin sensitivity/resistance indicators. Conclusion: Our results demonstrate that ENPP1 and FTO polymorphisms may contribute to T2DM susceptibility in this population, confirming previous findings that insulin resistance may mediate the development of the disease in the Mixed Ancestry population group of South Africa.

published_or_final_version / Social Work / Master / Master of Social Work

Two hundred non-insulin dependent diabetic patients, predominantly from three health facilities in Lahore, Pakistan were assessed for metabolic control, weight status, diabetes knowledge, and six areas of diabetes self-care activities as well as dietary intake. A questionnaire was administered in an interview format followed by a 24-hour recall of dietary intake. Glycosylated haemoglobin status were determined on ninety subjects. The care levels appear to be inadequate for satisfactory diabetes control. Only 5 subjects had HbA1c levels within the normal range, while 21 showed extremely high levels. Complications and associated medical conditions were present in more than half of the sample. Diabetes knowledge averaged 4 correct responses out of a total of 11. Considerable variation was noted in the reported care regimens including the dietary regimen. Analysis revealed a number of areas of concern including high fat intake and a low intake of leafy vegetables, pulses and fruit which along with nutrient analysis results suggests a low fibre intake. The data points towards the need for improved diabetes education at all levels and identifies several areas of concern to be address / Master of Science (Hons)

Individuals with NIDDM and low insulin sensitivity (Si) have altered fuel use, which may appear in NIDDM relatives. Adolescent males, six with NIDDM relatives (POS) and six controls (CON), matched for fitness and fatness, participated. Peak oxygen uptake (V02pea), ventilatory threshold (VT) and body composition were measured. Insulin and glucose values were used for Si estimates. Oxygen consumption (V02) and respiratory exchange ratio (RER) measurements were made at rest and during exercise at 80,100 and 120% of VT for substrate use. No group differences were found in anthropometric data, V02pea, VT or blood measurements, although fat free mass (FFM) tended to be greater in CON. CON tended to use a higher percentage carbohydrate and a lower percentage of fat than POS, but differences were no longer present after normalization to FFM. Trends towards fuel use differences may suggest metabolic abnormalities are present in POS, but further investigation is necessary. / School of Physical Education, Sport, and Exercise Science

Background: Diabetes is an increasing problem in Hong Kong. Physical activity is an integral part of diabetes care but received surprisingly few attention locally. This study is the first study with focus on physical activity in Type 2 diabetes in Hong Kong. / Conclusion: There is a need to implement physical activity programs for the diabetes patients in Hong Kong. Stage-matched intervention for increasing physical activity level should be introduced into the current diabetes management routine. / Methods: For this cross-sectional study, 576 patients were recruited from two specialized diabetes clinics in Hong Kong for telephone interview. The interview included measures of physical activity (by IPAQ), mental distress (by DASS21), diabetes self-care (by SDSCA), self-care self-efficacy (by DES), exercise efficacy, attitude and subjective norm towards exercise, time-spent on exercise, instrumental social support, and various indicators of diabetes control (HbA1c, blood pressure, LDL-cholesterol). Regression models were fitted to identify determinants of physical activity, mental distress, and diabetes self-care. Structural equation modeling was used to model the inter-relationships between the variables. / Results: About half of the patients did not meet international guidelines of physical activity for diabetes patients. Exercise efficacy and attitudes towards exercise are the two dominant factors that predict physical activity level and exhibit significant difference between key stages of change. Level of mental distress was very low and did not correlate with physical activity or diabetes self-care. / Mui, Wai Ho. / Adviser: Joseph T.F. Lau. / Source: Dissertation Abstracts International, Volume: 73-02, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 167-191). / 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, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice