Department of Advance Nursing Science / MCur

Thesis (M. Pharm) -- University of Limpopo, 2019 / Diabetes mellitus (DM) is a major public health problem, challenging patients, healthcare professionals, health planners and policy makers worldwide. Its prevalence has been on the rise for the past four decades, with this trend expected to continue. With this challenge, the management of DM should be done following evidence-based guidelines to prevent or slow down the development of DM-related complications. According to the Society of Endocrinology Metabolism and Diabetes South Africa (SEMDSA) guidelines, it has been shown that strict glycaemic control and proper clinical monitoring can help with prevention and slowing down development of complications. If left untreated or poorly controlled, DM progresses into an array of complications which may increase morbidity and mortality. The prevalence and management of DM complications was investigated. Objectives: • To determine the prevalence of DM complications at Mankweng Hospital. • To evaluate the management of patients with DM complications at Mankweng Hospital. • To determine the factors contributing to the development of complications. • To determine preventive measures taken on non-complicated patients to prevent them from complicating. Method: A retrospective longitudinal review of 134 randomly selected patient records was conducted for a five-year period spanning from June 2012 to May 2017. A pretested DM complications checklist was used to collect data from the patient records. A cross-sectional study was conducted amongst healthcare professionals caring for patients with DM. A total of 41 healthcare professionals were included in the study where a self-administered questionnaire was used to obtain the data. Both sets of data obtained were analysed using IBM SPSS version 25. xiii Results: Retrospective study The study sample population was entirely consisted of African patients with 70.1% (n=94) females and 29.9% (n=44) males. In the sample, 17.2% were suffering from T1DM while 82.8% were suffering from T2DM. The complications with the highest prevalence were diabetic nephropathy, peripheral neuropathy and diabetic retinopathy with prevalence of 35.8%, 32.1% and 22.4% respectively. Vascular diseases, autonomic neuropathy and diabetic foot ulcer had prevalence of 9.7%, 9% and 6% respectively. The overall prevalence of complications in general was 67.2% which was very high. Cross-sectional study A self-administered questionnaire was distributed amongst 41 healthcare professionals (14 males and 27 females). This sample consisted of 9.8% doctors, 41.5% pharmacists, 17.1% professional nurses, 17.1% physiotherapists, 2.4% podiatrists and 12.2% optometrists. It was discovered that only 92.6% and 84.6% of the participants were compliant with the guidelines in terms of random blood glucose tests and blood pressure (BP) per every visit. Only 50% of the HCPs revealed that HbA1c tests should be done according to the guidelines. Merely 5.6%, 8.3%, 5.3% and 22.7% of the HCPs correctly indicated the frequency of foot examinations, eye examinations, renal function tests and lipogram tests respectively, as per the guidelines. Patient related factors were rated as the most contributory factors (56.4%) to the development of complications. Socio-economic and medication related factors had most of the HCPs (36.1% and 29% respectively) rating them as moderate in terms of how much they contribute to the development of complications. The factors rated the least were healthcare team (32.4%) and health system (33.3%) related factors. Conclusion: There was a high prevalence of overall complications in general, with diabetic nephropathy, peripheral neuropathy and diabetic retinopathy being the three highest individual complications. There was poor monitoring of patients with complications as the compliance with the SEMDSA guidelines was very low. Patient related factors xiv were rated the most contributory factors to the development of complications in patients with DM. Recommendations: There is need to implement patient-centred DM care which makes sure that the patient is involved in decision making so that they take responsibility of their own health. There is need for the development and implementation of institutional quality improvement programs where regular audits of the processes of DM care and outcomes are monitored. Limitations: • The limitations of the study are that the researcher completely relied on patient records. • The sample size for HCPs was very small and therefore the study results cannot be generalised. / HWSETA

MSc (Botany) / Department of Botany / Diabetes and arthritis are the most common chronic diseases. Arthritis is the leading cause of global disability and diabetes has become a major health problem which is increasing rapidly. The purpose of the study was to document medicinal plants that are used to treat and manage diabetes and arthritis by traditional medicinal practitioners around the Vhembe District Municipality as well as to evaluate their in vitro efficacy. Traditional practitioners were interviewed using semi-structured questionnaires. Seventeen plant species belonging to fourteen different families were found to be used in the treatment of diabetes as well as arthritis. Fabaceae family was dominating. Antioxidant, anti-inflammatory, cytotoxicity, alphaamylase and alpha-glucosidase) of five plant species, (Bridellia mollis, Elephantorrihiza burkei, Elaeodendron transvaalense, Senna petersiana and Searsia lancea) used traditionally to manage diabetes were investigated using the standard in vitro procedures. All extracts showed a good nitric oxide inhibition, with highest percentage inhibition found in the highest concentration of 100 μg/ml. They all had good percentage cell viability at lowest concentration which was comparable to quercetin. Only two plant extracts B. mollis (T2) and E. transvaalense (T3) had lower than inhibition of quercetin at 25 μg/ml than at 12.5 μg/ml. In vero cells low toxicity effect was observed at lowest concentration tested, and toxicity increased with the increase in concentration. In bovine dermis cell line all plant extracts had more cell viability at lower concentration than doxorubicin. Ethanol extracts of B. mollis and S. petersiana, and ethyl extract of E. transvaalense had a good alpha-amylase inhibitory activity with IC50 values 58.6, 81.9 and 131.5 mg/ml respectively. Hydro-ethanol, ethyl acetate and ethanol extracts of E. burkei exhibited a significant alpha-glucosidase inhibitory activity with IC50 values 56.9, 52.2 and 129.7 mg/ml respectively. Kinetic analysis revealed non-competitive and un-competitive inhibitions of the plant extracts on alpha-amylase and alpha-glucosidase enzymes respectively. The information obtained showed that people in Vhembe District Municipality still rely on medicinal plants to treat and manage diabetes and arthritis. All plant extracts were toxic to both bovine dermis and vero cell lines. S. lancea (T5) was found to be the most toxic plant extract. The observed good inhibitions of both alpha-amylase and alpha-glucosidase enzymes by plant extracts of B. mollis, S. petersiana, E. transvaalense and E. burkei validate their use in the traditional treatment of diabetes in the region to some extent. Aqueous extracts of these medicinal plants should also be investigated because water is the main solvent which is used by traditional practitioners in the preparation of their herbal medicines.

MCur / Department of Advanced Nursing Science / Diabetes mellitus is a global health issue affecting people of all ages. It is defined as a non-communicable chronic disease caused by abnormal insulin production, impaired insulin utilization or both. Its prevalence and complications is increasing rapidly. The aim of this study was to assess knowledge of Diabetes mellitus chronic complications among diabetic patients in the Vhembe district of the Limpopo Province, South Africa. The study objectives were: to assess the knowledge of Diabetes mellitus chronic complications amongst diabetic patients; to determine the knowledge of diabetic patients regarding self-care practice, control and management of diabetes in the Vhembe District, and to identify challenges faced by diabetic patients regarding chronic complications of Diabetes mellitus in the Vhembe District A quantitative descriptive design was used. The study population was diabetic patients who were visiting the selected 4 hospitals, 2 health centers and 2 clinics were in Thulamela Municipality. Convenient sampling was used to sample 259 respondents (184(71%) females and 75(29%) males) and to select the 8 health care services. A structured, closed-ended selfadministered questionnaire in Tshivenda was used to collect data on the day that diabetic patients were coming for follow-up treatment, and after they had been attended to by the health care providers. Data were analyzed using the / NRF