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Thesis (MFamMed)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Introduction: Diabetes is the most prevalent endocrinology problem encountered in primary care practice. If recent trends showing a dramatic increase in prevalence (believed to be a consequence of a decline in physical activity and excessive caloric intake) continue, then the condition will soon affect nearly 20 million people in the U.S a reflection of the global trend. Effective management requires care that is thoughtful and meticulous, incorporating intensive patient education. Euglycemic control, with the level of glycosylated haemoglobin (HbA1c) kept below 7.0mmol/L, has emerged as a major treatment objective because of its association with a marked reduction in the risk for micro vascular complications. The primary physician is in the unique position to provide comprehensive care to the diabetic patient. Setting: The aim of this study is to evaluate the profile of complications arising due to diabetes mellitus among adult diabetics attending internal medicine outpatient department and family medicine/primary care outpatient department in the Dora Nginza hospital, PE hospital complex. Method: The study is a descriptive retrospective study in which names of patients were collated from clinic records of both clinics, files sought at the records department covering the period between Jan 2007 and Jan 2008 inclusive. Prevalence of statistical variables was generated using frequency tables, bar graphs, cross tabulations and chi square test. Results: Hyperglycemia was the major complication which predominantly was associated with high haemoglobin A1c (HbA1c) levels. However, some hyperglycaemic cases were also found to be associated with normal HbA1c. Complications were found to be more in type 2 diabetics. Patients with hypertension, obesity, smoking and alcohol use were observed to have a higher risk of developing diabetic complications. The findings on retinopathy in this study was inconclusive in view of the fact that patients sent for fundoscopy did not return with documented results from the sister hospital PE provincial hospital. Family Medicine outpatient department overall did better in patient care compared to the Internal Medicine outpatient department. Conclusion: The challenge for the primary care physician is to design a therapeutic program that is safe practical and acceptable to the patient. The ultimate goal of therapy is the prevention of micro vascular and macro vascular complications, consequence of diabetes that makes the condition a major risk factor for cardiovascular disease, stroke, visual impairment, renal failure, impotence, peripheral neuropathy, limb loss and ultimately death. These can be averted through appropriate education of both hospital staff, patients and their care givers. The recommendations made are based on the findings of the study. / AFRIKAANSE OPSOMMING: Nie beskikbaar.

Class of 2006 Abstract / Objectives: To examine the manner in which the DTSQ was used with a variety diabetic populations in different countries. The DTSQ is an 8 item questionnaire assessing satisfaction with diabetes treatment (6 items) and 2 items on glycemic control. Methods: Intensive search of published scientific literature was conducted to identify studies in which the DTSQ has been used in different countries. Data was extracted from each study on the following variables: country, ethnicitiy, DTSQ scores, Hg A1cgender, treatment, type of diabetes, and education level. Results: A total of twenty-four studies reporting the use of the DTSQ were identified. The majority studies (14/24) were treatment comparisons. The other studies were various other questions investigated. T he DTSQ was used for studies ranging in size from 15 to 1918 (mean 436.3 (SD=541.4) The DTSQ was used with patients who had thye 1, type 2, and gestational diabetes. Average HgA1c level was 7.6, and average DTSQ score was 29.9. Most studies did not describe the educational or ethnic background of their study participants. Most of the studies (18) were done in Europe with ten in the United Kingdom, two were in the USA, one in New Zealand, one in Nigeria, one in Canada, and one in Israel and Slovenia combined. Conclusions: The DTSQ appears useful with a variety of patient populations, although little information was presented on population characteristics.

Magister Artium - MA / In South Africa 3.5 million people (estimated 6% of the total population) are diagnosed and living with diabetes. The majority of the diagnosed group suffer from Type 2 diabetes respectively. Described as a metabolic disorder, diabetes is also understood as an illness and disease and is usually handled through the intervention of biomedical perspectives, especially in the manner in which it is treated and managed. However, few ethnographies have interrogated how individuals living with diabetes in South Africa in negotiate between various medical/healing knowledge systems- both ‘alternative’ and biomedical. The study explores the area of Genadendal as a case study, using an ethnographic approach and a material semiotic approach (Mol, 2002) in relation to medical sense-making and treatments. I investigate the partial connections as discussed by Strathern (2004), between medical/healing knowledge systems, i.e. biomedical and herbal management through plant medicines, which inform diabetic realities. Ultimately, this study considers the various notions and understandings of diabetes, local knowledge, experiences of individuals with diabetes and the interfaces of different ways of knowing with each other.

Objectives: To investigate the impact of electronic health record (EHR) on diabetes management through examination of the effectiveness of implementation of EHR and to improve the quality of care and the cost-effectiveness on the use of EHR. Methods: Three databases, PubMed, Ovid Medline and Google Scholar, were searched with specific combination keywords including electronic medical record and electronic health record, and diabetes. Quality appraisal and extraction of data were conducted on literature that met with the inclusion criteria. Results: 10 literature studies, a total of 204,251 participants with diabetes, were included in this study. All subjects, with similar demographic and clinical characteristics, were from clinic and primary care setting with the use of EHR. Different outcome measures were compared and to evaluate the effectiveness of EHR on quality of care and cost-effectiveness. Discussion: The impact of EHR on effectiveness of diabetes management, potential factors of barrier for adoption and the limitation for implementation of EHR were discussed. These suggested that further research is needed to have stronger evidence to widespread the use of EHR in Hong Kong as a future direction on public health issue. Conclusion: In this systematic review, EHR showed potential benefit in improving the quality of care and reduce the health care expenditure for long term running. Patient safety and efficiency are yet to be covered in the studies. Further research is needed on the acceptability and applicability of the use of EHR in Hong Kong. / published_or_final_version / Public Health / Master / Master of Public Health

Consumer health information technologies (CHITs) are emerging as promising tools for delivering healthcare services and facilitating patient self-management of chronic diseases; however, the use of the CHITs is largely constrained by usability problems and unclear evidence on the effectiveness of the technologies. The ergonomics research team of The University of Hong Kong developed a patient-centered computerized self-monitoring system that appeared to be useful and easy to use; with the system, this thesis focuses on the examination of the short-term impacts of the technology on patient outcomes for diabetic and hypertensive patients. The self-monitoring technology was designed using user-centered approaches and relevant human factors principles. Iterative usability evaluations were conducted to assess and improve the usability of the technology with 97 chronically ill patients. Also, using data from a larger randomized controlled trial (RCT) of technology-based disease self-management to improve patients’ outcomes, this thesis compared the short-term effects of the use of a computerized self-monitoring system to usual care using 63 patients with type 2 diabetes and hypertension for four weeks. Thirty-three patients were randomized into intervention group, whose disease care was supported by the self-monitoring system, while 30 patients into control group, who continued with their usual care. A pretest-posttest repeated measures design was employed to determine the effects of the technology on clinical, psychosocial, behavioral, usage, and technology perception outcomes over time. Measurements were obtained at baseline, and after 2 and 4 weeks. The iterative usability studies improved and verified the usability of the self-monitoring system for chronically ill patients. Results from the RCT showed that after four weeks, there were significant decreases in systolic blood pressure (p < 0.001) and diastolic blood pressure (p < 0.001), self-efficacy for managing chronic disease (p = 0.001), and adherence to treatment (p = 0.001) in the intervention group compared with the control group. Significant differences in favor of intervention group after four weeks were also documented for changes of several quality of life subscales (i.e., general health (p = 0.010), role physical (p = 0.001), role emotional (p = 0.002), bodily pain (p = 0.050), and physical component summary score (p = 0.005)), and perceived ease of use (p = 0.007). No significant difference was found between groups for fasting blood glucose (p = 0.687), perceived usefulness (p = 0.661), frequency of self-monitoring of blood pressure (p = 0.230) and self-monitoring of blood glucose (p = 0.993), and several other quality of life subscales over time. The usability evaluation presented in this thesis report demonstrated that the method was effective and efficient in identifying potential usability problems at the early stage of system development for CHITs. The findings from the RCT indicated that the use of the human factored-engineered self-monitoring technology had short-term effectiveness in improving blood pressure control, self-efficacy for managing chronic disease, adherence to treatment, and quality of life for patients with type 2 diabetes and hypertension. A human factored-engineered self-management technology appears to be an effective tool in patient self-management of chronic diseases. / published_or_final_version / Industrial and Manufacturing Systems Engineering / Doctoral / Doctor of Philosophy

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Nursing has its own unique contribution to make to diabetes care, but that impact is rarely quantified, measured or conceptualised. The thesis makes this contribution in the form of three published research projects and proposes an adaptation to Abbott’s conceptual framework on the division of expert labour. The first research project demonstrates the value of the hospital based diabetes specialist nurse using a randomised controlled trial; the second delineates the competences of different levels of nurses in diabetes care using a nominal group technique and the third project provides a baseline of the state of nursing in relation to the initiation of insulin therapy using a survey approach. Each project is followed by a personal reflection and discussion of the implications in the light of Abbott’s framework. Abbott’s thesis is that the development of professions is determined by a series of jurisdictional disputes rather than by a grand plan of the professions themselves. While this assertion does not always hold true in diabetes care the studies do concur with Abbott in other ways, particularly that the profession can be taken forward by taking responsibility for appropriate educational preparation, extending the boundaries of knowledge and the nursing role where appropriate. The discussion cautions against setting up professional edifices that become self-serving and stifle development, either by rigid enforcement of competences or by fossilising the nursing contribution to diabetes care. In terms of the care of the person with diabetes, nursing remains most effective within the umbrella of a multi-disciplinary team while demonstrating its own contribution. Nursing should show professionalism by continually striving for excellence, developing new knowledge and pushing role boundaries when it is in the best interests of the patient. The original contribution to knowledge is shown in the research projects’ contribution to the evolution of diabetes nursing in the United Kingdom and the proposal that Abbott’s framework be modified to put more emphasis on the task of work to achieve optimum patient outcomes than on the jostling of professions; acknowledging the growth in multi-disciplinary team-working and rise in the power of organisations at the expense of the power of individual professions since his work was first published.

Diabetes mellitus (DM) is a life changing disease which affects a large portion of the population and the economy through high medical costs and loss of productivity. Marrubiin (MAR), a diterpenoid isolated from Leonotis leonurus, a plant indigenous to Southern Africa, is used by traditional healers to alleviate DM symptoms. This study aims to screen the inhibitory potential of MAR and MAR derivatives on PTP1β and glucose uptake properties of Chang liver, C2C12 and 3T3-L1 cells. Marrubiin and 19 of its derivatives were tested to determine the inhibition constants for PTP1β. A Ki of 21 μM and 0.047 μM was detected for oleanolic acid in silico and in vitro, respectively. All other diterpene derivatives did not display substantial levels of inhibition of PTP1β. Treatment of Chang liver cells with the various MAR derivatives (10 μM) did not significantly increase glucose uptake beyond metformin, a known antidiabetic drug. The various treatments showed a protective/proliferative effect on the C2C12 muscle cells with two MAR treatments (DC16 and DC18) significantly increasing glucose uptake as compared to metformin in C2C12 muscle cells. It was noted that DC17, DC18 and MAR significantly increased glucose uptake in 3T3-L1 adipocytes, relative to the control. Contrary to cytotoxicity studies with Chang liver and C2C12 muscle cells, adipocytes displayed no cytotoxicity to treatments while a significant increase in cell viability was seen for DC9 and DC15. To unravel the mechanism of action, Western blotting analysis was completed and an increased expression of PTP1β was observed for treatments with DC17 and DC6 was seen in adipocytes, while DC18 and metformin decreased expression significantly. This correlated with a significant decrease of Ser 612 phosphorylation of insulin receptor substrate (IRS1) for DC17. Real time qPCR of IRS1 and GLUT4 highlighted that DC17 and MAR were able to significantly increase expression of IRS1 and GLUT4, respectively. The results show that MAR and the selected derivatives (DC6, DC17, DC18) have been found to increase glucose uptake in peripheral tissue types with IRS1, GLUT4 and PTP1β being associated with the mechanism of action. However, a complete understanding of the mechanisms is yet to be established.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences