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

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

Magister Economicae - MEcon / The provision of health care in South Africa is undergoing major restructuring. The aim is to achieve substantial, visible and sustainable improvements to the efficiency and accessibility of primary healthcare (PHC) services for all South Africans. One of the country's most critical problems is the weak and fragmented public sector PHC system. The most critical problems contributing to this are the maldistribution of resources (financial, physical and human) between hospitals and the primary care system, and between rural and urban areas. The health sector, therefore, faces the challenge of a complete restructuring and transformation of the national health care delivery system and related institutions. Choices need to be made about which services to cut, which to streamline and where savings can be made. Ways need to be found to use ALL of South Africa's resources optimally. This process of restructuring would be facilitated by the availability of accurate information on resource utilisation in the health sector. This study estimates the difference in the cost of primary diabetes treatment at dayhospitals and a provincial hospital in the Western Cape in 1992/93. Health economics is in its infancy in South Africa and serious data limitations exist. This study is therefore a pioneering effort in many ways. An appropriate methodological framework in which to conduct the costing had to be developed. The South African health sector, health spending arid the cost of primary diabetes treatment at day-hospitals and the provincial hospital are reviewed. Theoretical perspectives of the health care market and the methodologies of cost analysis are discussed. The cost analysis method of study is chosen, and arguments are advanced for its suitability in the South African context. A simple method of calculating the direct costs to obtain the average cost is proposed for the purpose of the study. Direct costs consist of staff costs and other related costs, such as medical supplies, non-medical supplies, building operations, equipment etc. These costs are then used to calculate the average costs per diabetic patient at the day-hospitals and the provincial hospital. The average cost per diabetic patient at day-hospitals amounted to R18.76, while at the provincial hospital the cost was R59.60.

Diabetes mellitus is a chronic disease affecting millions of people worldwide. The degenerative changes caused by diabetes can, however, be controlled through the correct treatment. The outcome of diabetes mellitus depends mainly on the patient's self-management. Health professionals therefore have a major responsibility to assist patients to acquire the essential knowledge, skills and attitudes for self-management. The purpose of this study was to identify diabetic patients and family members' knowledge and views about diabetes mellitus and its treatment regimen. A quantitative descriptive survey design was used. Questionnaires were used to collect data from a convenient sample of diabetic patients and family members. Data was analysed by a computer program called Statistical Package for Social Sciences. Findings revealed that patients and family members lack adequate knowledge on diabetes mellitus and its treatment. Recommendations regarding the required information and assistance to be given to diabetic patients and their family members were formulated. / Health Studies / (MA (Health Studies))

The purpose of the study was to evaluate the health education for clients diagnosed with diabetes mellitus by nurses working in the diabetes clinic of the specific hospital. The quantitative descriptive cross sectional design used two questionnaires to collect data from all 20 nurses working in the diabetes clinic and from a convenient sample of 132 clients diagnosed with diabetes mellitus, making use of the health services at the diabetes clinic of the hospital. Data was analysed by a computer program, statistical package for social science (SPSS). Measures were taken to ensure acceptable ethical practice, validity and reliability of the study. Findings revealed the absence of official documents to guide the health education and other factors, such as not knowing the learning needs of the clients, not utilising teaching methods optimally. Recommendations address the development of standard procedures, lesson plans, recording of health education sessions and education skills development for the nurses. / Health Studies / M. A. (Nursing Science)

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-12-11T11:58:00Z No. of bitstreams: 1 Liliane Bobato Licciardi.pdf: 2577430 bytes, checksum: d53f9c693da0ce838f15bc014541ad12 (MD5) / Made available in DSpace on 2018-12-11T11:58:00Z (GMT). No. of bitstreams: 1 Liliane Bobato Licciardi.pdf: 2577430 bytes, checksum: d53f9c693da0ce838f15bc014541ad12 (MD5) Previous issue date: 2018-10-25 / Introduction: Diabetes mellitus (DM) is a highly prevalent disease with several repercussions for patients and public health. Diabetic patient care shared between the endocrinologist and primary care health professionals in the form of continuing education is highly desirable. Objectives: To implement a treatment protocol for DM based on national guidelines, adapted to the reality of unified health system, as part of the diabetic patient care process. To perform support by an endocrinologist with the health professionals, with emphasis on permanent and transformative education. To promote the education of diabetic patients with the use of conversation maps, analyzing self-care as well as their attitudes towards the disease. To analyze the indicators related to the control of diabetes after the intervention of the specialist and application of treatment protocol. Material and Method: Prospective, quantitative, analytical and educational study on health, in type 2 diabetes, in a basic health unit chosen by the municipal manager. The project was based on the implementation of a protocol of care by an endocrinologist in partnership with health care professionals and in educational records with the help of a health team, using talk programs, during three months of follow-up. Laboratory data on glycemic control and questionnaire responses were compared statistically before and after the clinical and educational motivation and were submitted to the normality test and the Wilcoxon test, being considered significant when p <0.05. Results: Increased knowledge about the disease and improvement of glycated hemoglobin (from 9.6 to 8.0%), both significants. Conclusions: The educational intervention shows effectiveness to control Diabetes type 2 in a short period of time / Introdução: O diabetes mellitus (DM) é doença altamente prevalente com diversas repercussões para os portadores e para a saúde pública. O cuidado ao paciente diabético compartilhado entre o endocrinologista e os profissionais da atenção primária por educação permanente é bastante desejável. Objetivos: Implantar protocolo de tratamento para DM baseado em diretrizes nacionais, adaptadas para o Sistema Único de Saúde (SUS), como parte da linha de cuidado da doença. Realizar matriciamento junto à equipe de profissionais de saúde, com foco na educação permanente e transformadora. Promover educação dos pacientes diabéticos com o uso de mapas de conversação, analisando o autocuidado, a atitude do paciente frente a doença e os indicadores relacionados ao controle do DM2 após intervenção do especialista, aplicação de protocolo de tratamento e avaliar a percepção dos profissionais de saúde à intervenção clínico-educacional proposta. Materiais e Métodos: Estudo prospectivo, quantitativo, analítico e de intervenção educacional em saúde em diabetes tipo 2, na atenção primária por três meses. Houve implantação de um protocolo de atendimento por um endocrinologista em parceria com os profissionais de saúde e a realização de reuniões semanais educacionais com pacientes e a equipe de saúde, utilizando mapas de conversação. Os dados laboratoriais do controle glicêmico e as respostas a questionários que avaliaram atitudes e adesão (ATT-19 e QAD) conhecimento (DKN-19), capacidade institucional (ACIC) e questionário retrospectivo pré e pós intervenção foram comparados antes e depois da intervenção clínica e educacional (teste de normalidade e o teste t ou de Wilcoxon, considerando-se significante quando p<0,05). Resultados: Houve aumento de conhecimento, do autocuidado da doença e melhora da hemoglobina glicada (de 9,6 para 8,0%), ambos significantes. A atitude do paciente frente à doença não se modificou. A percepção dos profissionais de saúde quanto a intervenção realizada foi positiva. Conclusões: A intervenção educativa mostrou-se efetiva para o controle do DM2 mesmo em um curto período e recebeu avaliação positiva dos profissionais de saúde, que também apontaram incremento de seu conhecimento. Encontrar novas formas que possam melhorar o controle do diabetes é essencial e a educação compartilhada do profissional de saúde e do paciente representam um caminho para essas conquistas

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-12-12T09:30:29Z No. of bitstreams: 1 Silvia Cordenonsi Michelin Machado.pdf: 6823054 bytes, checksum: 33e42eaac2f165c494424902ad99ad02 (MD5) / Made available in DSpace on 2018-12-12T09:30:30Z (GMT). No. of bitstreams: 1 Silvia Cordenonsi Michelin Machado.pdf: 6823054 bytes, checksum: 33e42eaac2f165c494424902ad99ad02 (MD5) Previous issue date: 2018-11-13 / Introduction: Diabetes Mellitus (DM), a chronic disease with a possible outcome with several complications, is considered a public health problem. Brazil ranks fourth in the prevalence of diabetic patients in the world (14.3 million people), and 76% of these patients have been shown to have glycated hemoglobin greater than 7%, that is, they were not controlled. In 1988, with the creation of the Unified Health System (SUS) and 20 years later, with the creation of the Family Health Care Center (NASF), the specialized care for the population can be improved through population through reference teams and matrix support. However, little was achieved regarding care for the diabetic patient, maintaining a high rate of patients not adequately controlled and, consequently, the high mortality rate. The justification for this failure may be related to the inaccessibility of the diabetic patient to the information, either by limitation in the number of professionals, lack of training of the health professionals or by low educational level, once it has been demonstrated a prevalence of DM twice higher in patients with low schooling. Objectives: To implant and evaluate, in a Family Health Strategy unit, educational intervention applied to diabetic patients, together with the health team, as well as a protocol for the treatment of diabetic patients, supported by the guidelines of the Brazilian Diabetes Society and adapted to SUS, with the logic of in-service training and continuing education. Materials and methods: A quantitative, prospective and analytical study consisted in the implementation of a protocol of care by an endocrinologist in partnership with health professionals and in educational meetings with 28 patients and the health team using conversation maps. Laboratory data on glycemic control and questionnaire responses (Diabetes Self - Care Activity Questionnaire - QAD, Attitude - Diabetes Questionnaire - ATT - 19, Diabetes Knowledge Scale - DKN - A, Institutional Capacity Assessment Questionnaire for Attention Chronic diseases - ACIC and pre- and post-intervention retrospective questionnaire for professionals) were compared statistically (Wilcoxon, p <0.05) before and three months after protocol implantation. Results: There was a significant improvement in the knowledge scale (with 100% of the patients with a score better than 8 after the intervention, indicating a good knowledge of the disease), self-care (with significant improvement in foot and feeding care), attitude improvement in the attitude towards the disease in 53% of the patients) and in the glycemic control (HbA1c from 8.1% to 7.5%) of the participants, besides the improvement of the perception of the health team regarding the importance of the educational intervention. Conclusion: It has been concluded that diabetes education programs are important in educating, informing and motivating patients to adopt healthier lifestyles. For the health team, it stimulates reflection on the work process that has been conducted for these patients / Introdução: Diabetes Mellitus (DM), doença de evolução crônica com possível desfecho com diversas complicações, é considerada um problema de saúde pública. O Brasil ocupa o quarto lugar na prevalência de pacientes diabéticos no mundo (14,3 milhões de pessoas) e já se demonstrou que 76% destes pacientes apresentavam hemoglobina glicada superior a 7%, ou seja, não estavam controlados. Em 1988, com o surgimento do Sistema Único de Saúde (SUS) e 20 anos após, com a criação do Núcleo de Atenção à Saúde da Família (NASF), podese aprimorar o atendimento especializado à população através das equipes de referência e apoio matricial. Porém, pouco se conquistou a respeito do atendimento ao paciente diabético, mantendo uma alta taxa de pacientes não adequadamente controlados e, consequentemente, a alta taxa de mortalidade. A justificativa para esta falha pode estar relacionada à inacessibilidade do paciente diabético à informação, seja por limitação no número de profissionais, falta de treinamento dos profissionais da saúde ou por baixo nível educacional, uma vez que já foi demonstrada prevalência de DM duas vezes maior em pacientes com baixa escolaridade. Objetivos: Implantar e avaliar, em uma unidade de Estratégia de Saúde da Família, intervenção educacional aplicada a pacientes diabéticos, conjuntamente com a equipe de saúde, além de protocolo de tratamento ao paciente diabético, amparado nas diretrizes da Sociedade Brasileira de Diabetes e adaptado ao SUS, com a lógica do treinamento em serviço e da educação continuada. Materiais e métodos: Estudo quantitativo, prospectivo e analítico, consistiu na implantação de um protocolo de atendimento por um endocrinologista em parceria com profissionais de saúde e na realização de reuniões educacionais com 28 pacientes e a equipe de saúde, utilizando mapas de conversação. Dados laboratoriais do controle glicêmico e respostas a questionários (Questionário de Atividades de Autocuidado com o Diabetes - QAD, Questionário de Atitude em Diabetes - ATT-19, Escala de Conhecimento em Diabetes - DKN – A, Questionário de Avaliação da Capacidade Institucional para a atenção às doenças Crônicas – ACIC e questionário retrospectivo pré e pós intervenção para os profissionais), foram comparados estatisticamente (Wilcoxon, p<0,05) antes e três meses após a implantação do protocolo. Resultados: Houve melhora significante na escala de conhecimentos (com 100% dos pacientes com escore melhor que 8 após a intervenção, indicando bom conhecimento da doença), no autocuidado (com melhora significante dos cuidados com os pés e alimentação), na atitude (com melhora na atitude frente à doença em 53% dos pacientes) e nos controles glicêmicos (HbA1c de 8,1% para 7,5%) dos participantes além na melhora da percepção da equipe de saúde quanto a importância da intervenção educacional. Conclusão: Concluiu-se que programas de educação em diabetes são importantes para educar, informar e motivar os pacientes a adotar estilos de vida mais saudáveis. Para a equipe de saúde, estimula a reflexão sobre o processo de trabalho que vem sendo conduzido a esses pacientes

Thesis (M. Nursing Science) --University of Limpopo, 2018 / Introduction: Diabetes mellitus has become a worldwide problem that is continuing to rise resulting in morbidity and mortality in developing countries.Finland developed the FINDRISC tool. Canada uses the Finnish Diabetes Risk Score (FINDRISC) tool and the Canadian Diabetes Risk Questionnaire (CANRISC), Germany has developed the German Diabetes Risk Score (GDRS). These risk scores are all self-assessment tools meant for assessing the risk of diabetes. They cover variables such as age, waist circumference, height, history of hypertension, physical activity, consumption of alcohol, coffee, whole grains and red meat (Buijsse, Simmons, Griffin & Schulze, 2010). Aim: To determine the feasibility of Home-Based Carers (HBCs) on the use of the FINDRISC tool to assess diabetes mellitus (DM) patients at Ga-Dikgale Village, South Africa. Methodology: A quantitative, descriptive cross–sectional design has been used to describe knowledge and practices of HBCs in using FINDRISC tool to assess the Diabetes Mellitus patient at the Dikgale village. Fifty two (52) HBCs have been assessed and homogeneous purposive convenience sampling has been used. A modified (tool) has been used by the HBCs to assess the risk status of people to determine diabetes risk status while the researcher scored the HBCs on the utilisation of modified FINDRISC tool after they have demonstrated all sections of the risk assessment tool. Data analysis has been done using (Statistical Package for Social Sciences) IBM ABSTRACT vii SPSS version 24 software and Microsoft excel sheet. Results: This study has found that HBCs can play in important role in the assessment of patients at risk of developing diabetes in the communities by using the assessment tool. The knowledge and skills of the HBCs that have been acquired throughout the years can be augmented by strengthening the primary health care re-engineering programme and in-service training that can be tailored for proper functioning of the HBCs within the health care team. Conclusion and recommendation: The burden of DM can be alleviated through the use of FINDRISC tool by determining diabetes risk status and employ necessary precautions to assist people who are at risk. This study recommend that the FINDRISC tool be modified in order to be relevant to the African perspective by validating of the tool through taking blood samples from people who are at risk . Keywords: diabetes mellitus, home-based carers, Finnish diabetes risk score tool, feasibility, assessment of patients at risk.

Diabetes mellitus is a chronic disease affecting millions of people worldwide. The degenerative changes caused by diabetes can, however, be controlled through the correct treatment. The outcome of diabetes mellitus depends mainly on the patient's self-management. Health professionals therefore have a major responsibility to assist patients to acquire the essential knowledge, skills and attitudes for self-management. The purpose of this study was to identify diabetic patients and family members' knowledge and views about diabetes mellitus and its treatment regimen. A quantitative descriptive survey design was used. Questionnaires were used to collect data from a convenient sample of diabetic patients and family members. Data was analysed by a computer program called Statistical Package for Social Sciences. Findings revealed that patients and family members lack adequate knowledge on diabetes mellitus and its treatment. Recommendations regarding the required information and assistance to be given to diabetic patients and their family members were formulated. / Health Studies / (MA (Health Studies))

Type 2 diabetes mellitus is a chronic disease of pandemic magnitude, increasingly contributing to the disease burden of countries in the developing world, largely because of the effects of unhealthy lifestyles fuelled by unbridled urbanisation. In certain settings, patients with diabetes are more likely to have a healthcare encounter with a pharmacist than with any other healthcare provider. The overall aim of the study was to investigate the potential of South African community pharmacists to positively influence patient adherence and metabolic control in Type 2 diabetes. The designated primary endpoint was glycated haemoglobin, with the intermediate health outcomes of blood lipids, serum creatinine, blood pressure and body mass index serving as secondary endpoints. Community pharmacists and their associated Type 2 diabetes patients were recruited from areas throughout South Africa using the communication media of various nonstatutory pharmacy organisations. Although 156 pharmacists initially indicated interest in participating in the study, only 28 pharmacists and 153 patients were enrolled prior to baseline data collection. Of these, 16 pharmacists and 57 patients participated in the study for the full twelve months. Baseline clinical and psychosocial data were collected, after which pharmacists and their patients were randomised, nine pharmacists and 34 patients to the intervention group and 8 pharmacists and 27 patients to the control group. The sample size calculation revealed that each group required the participation of a minimum of 35 patients. Control pharmacists were requested to offer standard pharmaceutical care, while the intervention pharmacists were provided with a scope of practice diabetes care plan to guide the diabetes care they were to provide. Data were again collected 12-months postbaseline. At baseline, proportionally more intervention patients (82.4%) than control patients (59.3%) were using only oral anti-diabetes agents (i.e. not in combination with insulin), while insulin usage, either alone or in combination with oral agents was conversely greater in the control group (40.7%) than in the intervention group (17.6%) (Chi-squared test, p=0.013). Approximately half of the patients (53.8% control and 47.1% intervention) reported having their HbA1c levels measured in terms of accepted guidelines. There was no significant difference in HbA1c between the groups at the end of the study (Independent t-test, p=0.514). In the control group, the mean HbA1c increased from 7.3±1.2% to 7.6±1.5%, while for the intervention patients the variable remained almost constant (8.2±2.0% at baseline and 8.2±1.8% at post-baseline). Similarly, there were no significant differences between the groups with regard to any of the designated secondary clinical endpoints. Adherence to medication and self-management recommendations was similarly good for both groups. There were no significant differences between the two groups for any of the other psychosocial variables measured. In conclusion, intervention pharmacists were not able to significantly influence glycaemic control or therapeutic adherence compared to the control pharmacists.