THESIS SUBMITED IN FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF THE DEGREE OF MASTER OF TECHNOLOGY OF PRIMARY HEALTH CARE IN THE FACULTY OF HEALTH AND WELLNESS SCIENCES AT THE CAPE PENINSULA UNIVERSITY OF TECHNOLOGY 2009 / Numerous sources including the World Health Organization (WHO) and International Diabetes Federation (IDF) reported that a diabetes epidemic, with a parallel rise in obesity and insulin resistance is presently enveloping the world. Type 2 diabetes mellitus accounts for over 80% of all diabetics in most countries and has been recognized as a global epidemic, with its prevalence increasing at a rapid rate in both developed and developing countries. Up to 80% of type 2 diabetic cases can be preventable by changing diet, increasing physical activity and improving the living environment. The prevalence of diabetes in South Africa varies from one province to another and within different population groups. The highest rates have been reported among Asian Indians and the mixed ancestry populations, however, data is limited. Urbanization and industrialization which come along with westernized lifestyles such as sedentarism, consumption of high fat diets consequently resulting into obesity are some of the factors implicated in the development of type 2 diabetes. With type 2 diabetes prevalence rate increasing at an alarming rate, both in industrialized and also in developing countries, every factor associated with the development of diabetes needs to be explored and addressed. Before progression to diabetes, the diabetic state is preceded by a glucose regulation disorder commonly referred to as impaired glucose tolerance which may last for several years. Another form of glucose metabolism disorder other than diabetes is impaired fasting blood glucose level. While some cases of diabetes are often undiagnosed, it has also been noted that for every one diagnosed diabetic, there could be another that is undiagnosed. As has been shown in this study, many people could be walking with diabetes which is undiagnosed. The aims of this study were to determine: The prevalence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), diabetes mellitus and the risk factors for developing diabetes amongst the 35 – 65 year old population of Bellville South, Cape Town South Africa. In a cross-sectional survey, 600 subjects within the age group of 35-65 years selected through stratified random sampling within the Bellville South area of Cape Town underwent an oral glucose tolerance test. Diabetes, IGT and IFG were determined using both the American Diabetes Association (ADA) and the revised WHO criteria. Subjects also underwent several anthropometric measurements. Personal demographic, family, health and lifestyle data were extrapolated by use of a questionnaire. The prevalence of diabetes did vary between the two criterion used. The prevalence of newly diagnosed diabetes was 77 (12.8%) using the WHO criteria and 62 (10.3%) using the ADA criteria. Overall, the prevalence of diabetes was 25.6 % of which 12.8 % were newly diagnosed. IGT was present in 24 (4.0%) whilst IFG was in 179 (29.8%) using the WHO and ADA criterion respectively. Females were more affected than males and the prevalence of diabetes increased with age. Although overweight did not differ significantly between males and females, the latter were significantly more obese across all age groups (p < 0.05). Presence of a first degree relative with diabetes mellitus, particularly the father was significantly associated with development of diabetes, (odds ratio = 2.092, 95% CI 1.109 – 3.949, p = 0.023). Though more than 40% of the population studied was shown to engage in heavy drinking (30g of alcohol per day), it was not associated with diabetes. There has been a 10.4% increase in the prevalence of diabetes in this population group compared to what was reported more than a decade ago. Of great concern is the number of individuals with undiagnosed diabetes.

A thesis submitted for the degree of Doctor of Philosophy in the Faculty of Humanities, University of the Witwatersrand, 2017 / This study explores the role of the doctor-patient relationship in the management of diabetes in South Africa. The originality of this study lies in the unique manner in which the topic is approached from an explicit theoretical perspective as well as the context in which it is studied. It takes into account the biomedical aims of diabetes management as well as the socio-cultural context of the environment in which communication occurs. Diabetes Mellitus is a chronic disease of lifestyle (CDL) and one of the most prevalent chronic diseases, both globally and within South Africa. In South Africa, although statistics vary across provinces and within different demographic and socio-economic groups, it is estimated that about 5.5% of the population over the age of 30 years, has diabetes. The disease has a significant impact on morbidity and mortality in the country, as well as on socio-economic development. The need to improve diabetes education and awareness, in addition to the need to address patient adherence to management plans and the prevention of complications, are vital in order to effectively manage this rising epidemic. Current management of diabetes favours an individualised approach to risk reduction. This involves patient adherence to a negotiated (between doctor and patient) management plan, as well as modifications in the patient’s lifestyle behaviours. International literature on adherence to the management plans of all CDLs suggests that there are many challenges. Furthermore, most studies have shown that there are shared common barriers inherent to all chronic diseases, where the complexity and chronicity of treatment are major factors in adherence. Despite the large number of studies and the identification of many influencing factors, few direct and replicable causal links to adherence have been found. Models of adherence from other chronic diseases in South Africa have highlighted the importance of patient motivation to change behaviour as being linked to their perceptions and beliefs, formed by the attitudes of those with whom they interact. A review of the literature on health communication in various fields of medicine identifies the need for a firm perspective and justification of the methodology employed in the study. Various theoretical stances are examined but it is ultimately the interaction between doctor and patient within the sociocultural context of the consultation that is seen to be most relevant. A social constructionist perspective is justified as the basis from which a disease such as diabetes, which requires complex therapeutic manipulation and lifestyle adaptations, can be studied. A brief overview of medical education is also discussed as it pertains particularly to the teaching of communication skills and behaviours. This becomes relevant as it is medical training that ultimately informs clinical practice. In recent years, medical education has been called upon to be more socially relevant and incorporate a multitude of supporting competencies into training. These models are described and interrogated with relevance to the study aims. The research was conducted in the province of KwaZulu-Natal (KZN) in South Africa within the diabetes clinics of two district level public health care institutions; one was located in the eThekwini metropolitan area (Durban) and the second at a rural site in northern KZN. These hospitals were purposively selected because of their contrasting locations, reflecting diverse socio-economic, ethnic, racial and language groups, thus providing a rich set of data. In keeping with the social constructionist perspective of the study, natural consultations at both sites were the primary source of data aimed to focus on the communication between doctor and patient. A total of 24 routine diabetes follow-up consultations provided the data source. Consultations between patients and doctors were audio- and video-recorded and ethnographic observations were made by the researcher, who was an observer in all consultations. All consultations were transcribed, translated into English if necessary, and analysed using elements of conversational analysis transcription conventions. In order to understand the contextual environment of the study, ethnographic observations made by the researcher during the consultations and other site visits are also included in the data set. These observations are presented and contrasted with the experiences of doctors and patients as explored in interviews and focus group discussions at each site. Participants were asked to comment on their experience of their clinical care as well as the interaction with their doctor and their ability to manage their diabetes. By using multiple data sources and contrasting the findings, the study provides a robust framework from where communication in diabetes can be examined. By analysing the data from a socio-constructionist viewpoint it became evident that the relationship between doctor and patient was a strong influential factor on disease management. Furthermore, the manner in which various communication behaviours were interpreted was seen to be able to transcend the superficial socio-cultural environment should other interpersonal factors mitigate the relationship. Not only was the process by which communication content delivered important, but also the underlying attitudes, past experiences and broader context of the consultation. If patients and doctors found themselves in the position to internalise the behaviours experienced in the consultation, their feelings, ideas and beliefs towards one another and diabetes was seen to change. Over time, it was suggested that these new attitudes would feedback either positively or negatively on future interactions. This study also showed how cultural norms cannot be part of a checklist but that they are dynamic over time and are influenced by a multitude of factors, including past experiences and mutual respect, which need to be understood from an interactional and relational perspective. A new model that incorporates existing knowledge coupled with integration of clinical, scientific diabetes management and the art of communication is also described. The findings from this study should be used to guide and inform clinical practice in order to improve health outcomes for those living with diabetes. By extension, they should also be used to inform medical education models where communication is being incorporated into clinical skills training. As was found by observing and analysing clinical practice behaviours for the purpose of this study, the author believes that by internalising experiences, students may be able to forms new ideas and attitudes towards communication which will enhance their clinical practice. The methods utilised in this study have also highlighted the fact that previous methods have not been sensitive enough to the human dynamics that occur in health communication in diabetes and future research should be developed with a strong theoretical perspective that guides an appropriate methodological approach. This study depicts the pivotal role communication plays within each unique consultation and how the manner in which the interaction is perceived and interpreted will have a strong influence on behavioural decisions. However, it is not merely the words that are spoken or the language in which they are spoken but rather the internalisation and adaptation to the context that will ultimately will guide behavioural change. / XL2018

One of the earliest recorded references to polyuria is found in the Papyrus Ebers (1500 BC) and much later the occurrence of "honey urine" was noted by an ancient Hindu physician, Sushrutha, in old Indian Sanskrit (400 BC). However, the first good clinical description of the disease is ascribed to Celsus, although the name "diabetes" was introduced by Aretaeus of Cappadocia. The body of knowledge which has accumulated since these early recordings to the present state of the art reflects a most impressive sojourn, punctuated by many milestones, each adding impetus to future attempts in a relentless endeavour to unravel the aetiopathogenesis of this common malady. However, this "sweet evil" (diabetes) remains an enigma in many ways. There is little doubt today that there are 2 major types of diabetes: juvenile onset diabetes, presently known as insulin-dependent diabetes mellitus (IDDM) and maturity onset diabetes, referred to as non-insulin dependent diabetes mellitus (NIDDM). In NIDDM aggregation of HLA types, evidence of cell mediated immunity and the presence of circulating islet cell antibodies, which are characteristically associated with IDDM, are not found. There is also a vast difference in concordance of diabetes in the co-twins between the two types of diabetes suggesting that a different mixture of genetic and environmental factors is operative in the pathogenesis of these two types of diabetes. In I960, Fajans and Conn drew attention to the existence of a form of diabetes with an onset before the age of 35 years. Their patients showed a substantial improvement in glucose tolerance when treated with an oral hypoglycaemic agent, tolbutamide. Subsequent to this report numerous studies from various parts of the world confirmed this entity of non-insulin dependent diabetes in the young (NIDDY) in White Caucasians. There are, however, several different syndromes presenting as mild carbohydrate intolerance in the first two to three decades of life. The classical form of NIDDY is a mild non-insulin requiring form of diabetes in which the disorder is inherited as a dominant trait; there is little progression of glucose intolerance, if any, with time, and the diabetes is rarely accompanied by vascular complications. This subtype of diabetes is referred to as MODY (maturity onset diabetes in the young) and thus constitutes a subset under the broad umbrella of NIDDY. However, recently compelling evidence for heterogeneity within MODY has been presented. This evidence is based on the prevalence of certain HLA antigens, insulin responses to oral glucose, occurrence of vascular complications, progression of hyperglycaemia to the stage of insulin requirement and failure to demonstrate autosomal dominant inheritance in some families studied. In the South African Indian population which has a high prevalence of diabetes, Campbell was the first to draw attention to NIDDY in Indians more than two decades ago. Since this initial report, nobody has really studied NIDDY in any depth in South Africa and certainly not in the Indian population. NIDDY in the local Indian population is of particular interest for the obvious reason that diagnostic and management problems arise daily in a population with a high prevalence of non-insulin dependent diabetes. It is vital that the clinical features, endocrine and associated biochemical aberrations be known in detail if this condition is to be managed appropriately and adequately. A study of these aspects therefore became the primary task of this thesis. To pre-empt any challenge that patients were not really diabetic, the strict criteria of the W.H.O. for the diagnosis of diabetes were chosen. It should therefore be borne in mind throughout this study that a group of rather severe diabetics were selected by design. The patients studied represent the rather extreme end of the spectrum. But, in the event, this selection proved advantageous in that it covered an unstudied part of the spectrum and some light could be shed on the natural history of the disorder. In the long term the purpose was to prepare the ground for what must become the thrust of future studies, namely the biochemical pathogenesis of NIDDM. If it is true that some forms of NIDDY are inherited dominantly, existing techniques should make it possible to identify a gene(s) locus and if this is done the biochemical basis of this disorder must be identifiable. In the present study direct examination of these aspects were not undertaken, but an attempt was certainly made to pinpoint those biochemical abnormalities which are perhaps primary or central to the whole disorder. / Thesis (M.D.)- University of Natal, Durban. 1982.

Treatment of diabetes mellitus is mainly focused on glycaemic control regulated by insulin and takes place in insulin sensitive tissues like skeletal muscle which accounts for 75% of glucose metabolism. Plant derived compounds that have anti-diabetic potential are currently being investigated for diabetes treatment as they are cheap and non-toxic. Oleanolic acid (OA), a triterpene found in a wide variety of plants has been shown to have anti-diabetic effects but its mechanism of action, especially on the insulin signalling cascade has not been fully elucidated. The aim of the present study was to investigate the effects of OA on the PI3K/Akt insulin signalling cascade in skeletal muscle and skin of streptozotocin induced diabetic male Sprague-Dawley rats. Male Sprague-Dawley rats (non-diabetic and diabetic) were treated with insulin (4IU/ kg bw), OA (80 mg/kg bw) and a combination of OA + insulin in an acute and sub-chronic study. The study showed that OA does not reduce blood glucose levels in type 1 diabetic rats but enhances insulin stimulated hypoglycaemic effects. In the acute study OA was shown to activate Akt and dephosphorylate GS in skeletal muscle of streptozotocin induced diabetic rats. In the sub-chronic study OA and OA + insulin increased expression of GS in skeletal muscle of diabetic rats. GP expression was decreased by OA and OA + insulin treatments in skeletal muscle whilst in skin it was increased by both treatments. OA increased both GS and GP in skeletal muscle whilst in skin they were decreased. OA + insulin treatment increased GS and decreased GP activities in skeletal muscle and increased activity of both enzymes in skin of diabetic rats. OA increased the amount of glycogen in both muscle and skin whilst OA + insulin reduced the amount of glycogen. OA and OA + insulin treatment showed some protective effects against liver and muscle damage as there were reductions in serum LDH, ALT and AST levels. In conclusion, oleanolic acid in synergy with insulin can enhance activation of the insulin signalling pathway and there was evidence of OA activation of insulin signaling enzymes independent of insulin. / Thesis (M.Sc.)-University of KwaZulu-Natal, Durban, 2013.

Diabetes mellitus (DM) is a metabolic disease characterized by chronic hyperglycaemia; this condition is caused by lack of insulin secretion (Type 1) and/or insulin resistance (Type 2). In diabetic patients; carbohydrate, protein and lipid metabolism is disturbed due to the lack of the body’s ability to utilise glucose efficiently. Management of type 1 diabetes involves insulin therapy which may be inconvenient for patients. Therefore alternative methods for management of type 1 diabetes involving medicinal products are being investigated. This study is aimed at investigating the effect of OA on markers of lipid metabolism and on proteins of the insulin signalling pathway in Type 1 diabetic rats as this plant product has anti-hyperglycaemic effects. Male Sprague-Dawley rats were divided into two groups (diabetic and normal). In both groups the rats were further divided into four groups and assigned to treatment as follows: vehicle, insulin, OA and OA plus insulin. Oral glucose tolerance test was performed in fasted and non-fasted diabetic rats for 2 hours. In acute studies the effect OA following treatment of rats was evaluated at 15, 30 and 60 minutes. In sub-chronic studies rats were treated daily for 14 days. OA did not improve glucose tolerance in diabetic rats after 2 hours of administration. However, it enhanced blood glucose lowering effect of insulin and this was statistically significant in fasted rats. In acute studies OA enhanced the effect of insulin in normal and diabetic animals as AKT phosphorylation was increased when insulin was used in combination with OA. OA reduced the expression and activity of HSL in liver tissue after 14 days of treatment in both normal and diabetic rats. In adipose tissue, OA reduced the expression of HSL in diabetic rats. However, OA alone did not reduce the activity of HSL but when it was combined with insulin, a reduction of HSL activity was observed. OA administration had no significant effect on TGA and HDL-c levels but significantly (p < 0.05) reduced total cholesterol and LDL-c in diabetic rats. It had no significant effect on total cholesterol, and increased LDL-c levels in normal rats. Serum AST and ALT levels in diabetic rats were reduced by OA administration but this reduction was not statistically significant. The results of this study suggest that OA enhances the hypoglycaemic effect of insulin, improves lipid profile and possesses hepatoprotective effects. Lastly, OA independently increases AKT phosphorylation and decreases HSL expression and activity. / Thesis (M.Sc.)-University of KwaZulu-Natal, Durban, 2013.

The ability of insulin to stimulate glucose uptake into muscle and adipose tissue is central to the maintenance of whole-body glucose homeostasis. Deregulation of insulin action manifests itself as insulin resistance, a key component of type 2 diabetes. Insulin resistance is also observed in HIV patients receiving protease inhibitors. An agent that can reversibly induce an insulin-resistant state would be a very useful tool in developing model systems that mimic the pathogenesis of type 2 diabetes. Insulin resistance can arise from defects in insulin signal transduction, changes in the expression of proteins or genes that are targets of insulin action, cross talk from other hormonal systems or metabolic abnormalities. Deterioration of the insulin-receptor-signalling pathway at different levels leading to decreased levels of signalling pathway intermediates and/or decreased activation through phosphorylation accounts for the evolution from an insulin-resistant state to type 2 diabetes. In addition, defects in GLUT4 glucose transporter translocation are observed, further fuelling impairments in skeletal muscle glucose uptake. Levels of insulin-induced GLUT4 translocation in the skeletal muscle of type 2 diabetic patients are typically reduced by 90%. Many cellular pathways & their intermediates are in some way or another linked to insulin signalling. This study focused on three of these namely the PI3-kinase/Akt pathway, the Mitogen Activated Protein Kinase (MAPK) cascade and the AMP Kinase pathway, with successful monitoring of the PI3-K pathway. Investigations involved observing and evaluating the effects of various compounds as well as an indigenous medicinal plant, Sutherlandia frutescens on the activities of key insulin signalling pathway intermediates within the three fore mentioned pathways including Akt, AMPK and MEK1/2 as well as membrane surface GLUT4 levels. Scientific research has in the past leant heavily on Western blotting as the method of choice for gaining vital information relating to signal transduction pathways, however for research into cellular mechanisms the negatives of this method outweigh the positives. The drawbacks include a need for large amount of cells, multiple washing steps which may be disadvantageous to any weak and transient interactions as well as lysing of cells which may interfere with the maintenance of the subcellular localisation of a specific signalling event. Based on these, the need for a better method in terms of speed & reliability to monitor phosphorylation states of signal transduction pathway intermediates & GLUT4 translocation was evident and was one VII of the main aims & successes of this study. The method created used the mouse muscle cell line C2C12 in conjunction with the quick, sensitive method of flow cytometry which allowed us to monitor these processes in these cells through immune-labelling. Adherent cell cultures such as the C2C12 cell line pose the problem of possible damage to plasma membrane receptors (including insulin receptors) during harvesting to obtain a cell suspension for flow cytometry. We however used C2C12 mouse myocytes to optimize a method yielding insulin responsive cells in suspension that were successfully used for flow cytometry after immunelabelling of insulin signalling intermediates. Insulin (0.1μM) significantly raised the levels of both P-Akt and GLUT4 above basal levels. This effect was shown to be dose dependent. At a concentration of 50μg/ml, Sutherlandia frutescens was able to act as an insulin-mimetic in terms of its ability to increase P-Akt levels, GLUT4 translocation and glucose utilisation in an acute manner. These increases could be reduced with the addition of wortmannin, a PI3-K inhibitor. Therefore, these results suggest the mechanism of the plant extract’s insulin-like activity may be in part due to the activation of the insulin signalling pathway leading to GLUT4 translocation, which involves the phosphorylation of insulin receptor- and subsequent PI3-K activity, leading to P-Akt activity. These results provide further evidence of this plant extract’s anti-diabetic potential. The effect of Sutherlandia frutescens on insulin secretion, calcium signalling and proliferation in INS-1 rat pancreatic cells was also investigated and it was found to increase the activities of all of these processes. However no change in the levels of GLUT2 glucose transporter was seen. Ritonavir is prescribed by the South African Department of Health in co-formulation with other protease inhibitors within its second regime in the treatment of HIV and AIDS. Using C2C12 cells, ritonavir decreased glucose uptake acutely and had no effect on GLUT4 translocation however surprisingly increased P-Akt levels. In conclusion, it was found that Sutherlandia frutescens has antidiabetic benefits, diverse in nature depending on tissue type as well as length of time administered. The establishment of novel flow cytometry techniques to assess antidiabetic properties using in vitro cell culture was achieved. These methods will be useful in the future for the assessment of insulin sensitivity and in the identification of novel compounds that stimulate the insulin signalling pathways.

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

Social Work / MA(SS)(MENTAL HEALTH)

Thesis (MNutr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Introduction: Intensive lifestyle intervention in people with Type 2 Diabetes Mellitus (T2DM) is associated with weight loss, significant reductions in HbA1c% and a reduction in cardiovascular disease risk factors. Small towns unfortunately experience a deficit of dieticians, thus limiting access to lifestyle intervention. Furthermore, a limited number of South African studies have evaluated the effect of dietary habits, anthropometric status, activity level (AL) and dietician-led medical nutrition therapy (MNT) on glycaemic control in patients with T2DM. This study thus aimed to identify the association between glycaemic control and lifestyle habits in adults with T2DM living in Thabazimbi. The role of the dietician with regard to optimal glycaemic control was also investigated with great interest. Methods: Individuals (>18 years) with T2DM who had a recent HbA1c test result and no acute infection/illness were included in the study over a 7 month recruitment period. Weight, height and waist circumference were measured, AL and dietetic contact evaluated, and dietary habits assessed by means of a structured questionnaire. Six home-measured post-prandial glucose (PPG) measurements and HbA1c% were used to evaluate glycaemic control. Results: A total of 62 (59.7% males) patients were included. The mean age was 60.13 ±10.85 years and mean T2DM disease duration was 121 ±96.56 months. Only 6.45% of participants had a normal Body Mass Index classification. Most (90.32%) participants had a substantially increased waist circumference (WC). Half of the participants had a sedentary/low AL, whilst 48.39% had an active/moderately active AL. Almost all (95%) participants indicated it was necessary for persons with DM to consult a dietician for MNT, however only 63% of participants actually consulted one. Mean dietary compliance was 74.53 ±10.93%. The average HbA1c% and PPG of participants were respectively 7.50 ±1.62% and 8.90 ±3.21mmol/l. A significant negative association (r=-0.31; p=0.02) was found between HbA1c% and percentage dietary compliance. The number of dietetic sessions completed and average PPG were also significantly [(r=0.40; p=0.001), (r=-0.34; p=0.01)] associated with percentage dietary compliance. In turn PPG had a significant positive (r=0.30; p=0.02) association with DM disease duration. Both the good HbA1c and good PPG control groups had significantly (p=0.01, p=0.04) better dietary habits than the poor HbA1c and PPG control groups. When compared to the poor PPG group, the good PPG group made significantly (p=0.04) better dietary decisions with regard to the main meal’s carbohydrate quality and quantity. Body Mass Index, WC, AL and extent of dietetic contact didn’t play a significant role in the glycaemic classification (good vs. poor) of participants. Conclusion: The longer T2DM is present, the worse PPG control becomes. Optimal dietary habits play a significant positive role in both the long- and short term glycaemic control of people with T2DM in Thabazimbi. The choice and portion size of the main meal’s carbohydrates has been identified to be the most important dietary role-player in the glycaemic control of this study population. This study also shows that if individuals with DM spend enough time with a dietician, it could potentially contribute to better dietary compliance and subsequent better glycaemic control. / AFRIKAANSE OPSOMMING: Inleiding: Intensiewe leefstyl intervensie onder diegene met Tipe 2 Diabetes Mellitus (T2DM) word geassosieer met gewigsverlies, beduidende verlaging in HbA1c% asook ’n vermindering in verskeie kardiovaskulêre-siekte risiko faktore. Plattelandse dorpies beleef egter ’n tekort aan dieetkundiges, wat gevolglik toegang tot leefstyl intervensie beperk. Daar is ook ’n beperkte hoeveelheid Suid-Afrikaanse studies wat die impak van eetgewoontes, antropometriese status, aktiwiteitsvlak en dieetkundige-begeleide dieetterapie op glisemiese beheer in T2DM pasiënte evalueer. Die doel van die studie was dus om die verband tussen glisemiese beheer en leefstyl gewoontes in volwassenes met T2DM in Thabazimbi te bepaal. Die rol van die dieetkundige met betrekking tot optimale glisemiese beheer was ook met groot belangstelling nagevors. Metodes: Diegene (>18 jaar) met T2DM wat oor ’n onlangse HbA1c toets uitslag beskik het en nie enige akute siektes/infeksie gehad het nie, is oor ’n 7 maande werwingsperiode ingesluit. Gewig, lengte en middel-omtrek was gemeet, aktiwiteitsvlak en dieetkundig-kontak bepaal, en eetgewoontes geassesseer m.b.v. ’n gestruktueerde vraelys. Ses tuis-bepaalde na-ete bloedsuiker lesings en HbA1c% was gebruik om glisemiese beheer te evalueer. Resultate: Twee-en-sestig (59.7% mans) pasiënte het aan die studie deelgeneem. Die gemiddelde ouderdom was 60.13 ±10.85 jaar en die gemiddelde T2DM duurte 121 ±96.56 maande. Slegs 6.45% van die deelnemers het ’n gesonde Liggaam-Massa-Indeks gehad. Meeste (90.32%) deelnemers se middel-omtrek was ook ruimskoots verhoog. Die helfte van die deelnemers het ’n passiewe/lae aktiwiteitsvlak gehad, terwyl 48.39% ’n aktief/matig-aktiewe aktiwiteitsvlak gerapporteer het. Amper al (95%) die deelnemers het aangedui dat mense met T2DM ’n dieetkundige moet raadpleeg vir dieetterapie. Slegs 63% van die deelnemers het egter werklik ’n dieetkundige vir diabetes dieetterapie geraadpleeg. Gemiddelde dieet-gehoorsaamheid was 74.53 ±10.93% en die gemiddelde HbA1c % en na-ete bloedsuiker vlakke van deelnemers was onderskeidelik 7.50 ±1.62% en 8.90 ±3.21mmol/l. Daar was ’n beduidende negatiewe verband (r=-0.31; p=0.02) tussen HbA1c % en persentasie dieet-gehoorsaamheid. ’n Beduidende verband was ook tussen persentasie dieet-gehoorsaamheid en die hoeveelheid voltooide dieetterapie sessies (r=0.40; p=0.001) asook die gemiddelde na-ete bloedglukose vlak (r=-0.34; p=0.01) geïdentifiseer. Na-ete bloedglukose het ook ’n beduidende positiewe (r=0.30; p=0.02) verband met die duurte van diabetes getoon. Beide die goeie HbA1c en goeie na-ete glukose groepe het beduidend (p=0.01, p=0.04) beter eetgewoontes as die swak HbA1c en swak na-ete glukose groepe gehad. Die goeie na-ete glukose groep het veral beduidend (p=0.04) beter dieet keuses m.b.t die hoofmaal se koolhidraat kwaliteit en kwantiteit gemaak. Lengte-Massa-Indeks, middel-omtrek, aktiwiteitsvlak en die mate van dieetkundige kontak het nie ’n beduidende rol in die glisemiese klassifikasie (goed teenoor swak) van deelnemers gespeel nie. Gevolgtrekking: Na-ete bloedsuiker beheer word al hoe slegter hoe langer T2DM teenwoordig is. Optimale eetgewoontes speel ’n beduidende positiewe rol in beide die lang- en kort-termyn glisemiese beheer van mense met T2DM in Thabazimbi. Die keuse en porsie grootte van die hoofmaal se koolhidrate blyk die belangrikste dieet rolspeler in die glisemiese beheer van die studie populasie te wees. Die studie dui ook aan dat as mense met T2DM genoeg tyd saam met ’n dieetkundige deurbring, dit moontlik kan bydra tot beter dieet-gehoorsaamheid en gevolglik beter glisemiese beheer.