Thesis (MFamMed)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Background: The number of adults affected by diabetes mellitus in developing countries, such as South Africa, is projected to grow by 170%, from 84 to 228 million people between 1995 and 2025 .This high and increasing prevalence of diabetes worldwide, and the economic burden of diabetes on developing countries like South Africa emphasizes the importance of ensuring good glycemic control so as to slow down the rate of disease progression and prevent complications. The district health care facilities are the foundation of the health care system of South Africa. The current practice is that diabetics have a point of care random blood glucose (RBG) done on the morning of their clinic appointment and this is used as a form of assessment of glycemic control during the consultation. For further clinical decision making a HbA1c is done once a year as a benchmark of glycemic control. The practical clinical question that arises is whether the assumptions underlying local clinical decision making using the RBG are valid and to what extent RBG can be used to guide clinical management. Aim and Objectives: The aim of this study was to assess the strength of the correlation between RBG and HbA1c and to make recommendations for the interpretation of RBG results in adult patients with Type 2 Diabetes taken at Karl Bremer District Hospital out-patient department. The objectives were: To determine glycaemic control in the study population and compare differences between age, sex and racial groups , and determine the RBG cut-off with the best sensitivity and specificity for predicting poor glycaemic control (HbA1c>7.0% ) as well as the predictive value, likelihood ratio and pre/post-test odds and probability at this cut off. Methods: A retrospective analysis of existing hospital data and the HbA1c tests requested from the NHLS by Karl Bremer Hospital over the 2011 year period. The data was analysed by means of a receiver operating characteristic (ROC) curve analysis to determine the value of RBG with the best combination of sensitivity and specificity to predict poor control of diabetes. A p-value of < 0.05 was assumed to represent statistical significance and 95% confidence intervals were used to describe the estimation of unknown parameters. HbA1c level of < = 7% was taken as representing good control and > 7% poor control. Results: Data was obtained on 349 diabetic patients of whom 203 (58.2%) were female and 146 (41.8%) male. This study population had a mean age of 54.7 years, mean RBG of 13.0mmol/l and mean HBA1c of 9.4%. The total number of black patients was 79 (23%), coloured patients 147 (42%) and white patients 122 (35) % and their mean RBG were 15.4 mmol/l, 12.8 mmol/l and 11.9 mol/l respectively. There was a statistically significant correlation between increasing RBG and increasing HbA1c (p< 0.01). The best value obtained on the ROC curve was an RBG of 9.8 mmol/l, which had a sensitivity of 77% and a specificity of 75%, positive predictive value of 0.88, positive likelihood ratio 3.08 and post-test probability of 88.2% for predicting an HbA1c above 7%. Conclusion: It was concluded that a moderate correlation exists between RBG and HbA1c in this population of diabetic patients. .The best RBG for determining poor control, defined as a HbA1c>7.0%, was found to be 9.8mmol/l and this RBG had a sensitivity of 77% , specificity of 75% and positive predictive value of 88%. Significant differences were found in pre- and post -test probability for different racial groups. Point of care testing using this level of RBG for clinical decision making will inappropriately categorise 23% of patients in this population and therefore introducing point of care testing for HbA1c is recommended.

Background:  Diabetes mellitus is a common disease and people with diabetes have doubled the last 20 years. Individual’s experiences in living with diabetes is useful to increase the understanding of persons with diabetes ability to manage, accept and possibilities to reconcile with a life with diabetes. Aim: The aim of this study was to describe person’s experiences of living with insulin dependent diabetes. Method: The study is a qualitative descriptive study with an inductive approach. Nineteen persons with insulin dependent diabetes mellitus was recruited from diabetic clinics at two hospitals in the middle of Sweden. The analysis was made with a qualitative content analysis. Findings: Time around the diagnosis living with diabetes was losing control of self and life. By flexible strategies they could regain control of self and life. By living in the present they found a way to live with illness as a part of life.  Conclusions: Persons with insulin dependent diabetes needed to develop flexible strategies for daily life. With the help of strategies and a positive attitude they could continuously re-evaluate their planning for outer form of reconciliation. The threat of future complications constitutes an obstacle to inner form of reconciliation.

CONTEXTO: as mulheres na pós-menopausa com diabetes mellitus não insulino-dependente (DMNID) constituem um grupo com maior risco de doença cardiovascular, visto serem muitas delas obesas, hipertensas e hiperlipidêmicas. A tibolona pode se constituir opção viável para a terapêutica de reposição hormonal nessas pacientes, no entanto são necessários estudos que avaliem as implicações clínicas, modificações metabólicas e resultados terapêuticos da tibolona nesse grupo de pacientes. OBJETIVO: determinar o perfil de segurança clínico-laboratorial da terapia com tibolona em pacientes na pós-menopausa portadoras de DMNID. TIPO DE ESTUDO: prospectivo, longitudinal, aberto e não controlado. LOCAL: Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. PARTICIPANTES: 24 pacientes na pós-menopausa portadoras de DMNID, tratadas com 2,5 mg/dia de tibolona, pelo período de 6 meses. VARIÁVEIS: avaliação clínica, medidas antropométricas (IMC, RCQ e % Gordura), dosagens hormonais (FSH, LH, T4 livre, TSH), bioquímica sangüínea (uréia, creatinina, bilirrubinas, TGO, TGP, glicose e hemoglobina glicosilada) e ultra-sonografia transvaginal (espessura endometrial e volume uterino). ANÁLISE ESTATÍSTICA: teste não-paramétrico de Kolmogorov-Smirnov, análise de variância para medidas repetidas e teste “t” pareado para dois períodos, sendo adotado nível de significância de 5%. RESULTADOS: após 6 meses, todas as pacientes permaneceram em uso da medicação. Como efeitos colaterais, 8,3% apresentaram cefaléia, 8,3% mastalgia e 16,6% sangramento genital. Houve melhora na % de gordura corporal (43,15 ? 6,39 vs 41,76 ? 5,20; p=0,01) e na pressão arterial diastólica (87,29 ? 7,36 vs 78,33 ? 11,67; p=0,0005). Não houve variações significativas na pressão arterial sistólica, freqüência cardíaca, IMC e RCQ, bem como nos parâmetros bioquímicos. Houve diminuição dos sintomas climatéricos (22,17 ? 7,15 vs 3,08 ? 3,33; p=0,0001). A avaliação ultra-sonográfica não revelou variações do volume uterino e espessura endometrial. CONCLUSÃO: a utilização de tibolona durante um período de 6 meses, mostrou bom perfil de segurança clínico-laboratorial em pacientes na pós-menopausa portadoras de DMNID. / CONTEXT: Postmenopausal women with non-insulin-dependent diabetes mellitus (NIDDM) represent a high risk group since many of them are obese, hypertensive and hyperlipidemic, with a higher risk for cardiovascular disease. Tibolone may represent a viable option for the hormonal replacement therapy of these patients. There is the need for studies assessing the clinical implications, metabolic modifications and therapeutic results of tibolone in this group of patients. OBJECTIVE: To determine the clinical-laboratory safety profile of tibolone treatment in postmenopausal women with NIDDM over a period of 180 days. TYPE OF STUDY: Prospective, longitudinal, open and uncontrolled. PLACE: University Hospital, Faculty of Medicine of Ribeirão Preto. PARTICIPANTS: 24 postmenopausal women with NIDDM treated with 2.5 mg/day tibolone. VARIABLES: Clinical evaluation, anthropometric measurements (BMI, WHR and % body fat), blood determinations (FSH, LH, free T4, TSH, urea, creatinine, bilirubins, GOT and GPT, glucose, and glycosylated hemoglobin), and transvaginal ultrasonography (endometrial thickness and uterine volume). STATISTICAL ANALYSIS: Non-parametric Kolmogorov-Smirnov test, repeated measures analysis of variance and paired t-test for two periods, with the level of significance set at 5 %. RESULTS: After 6 months, all patients continued to use the medication. Side effects were headache in 8.3% of patients, mastalgia in 8.3%, and genital bleeding in 16.6%. There was an improvement in % body fat (43.15 ? 6.39 vs 41.76 ? 5.20; p=0.01) and diastolic arterial pressure (87.29 ? 7.36 vs 78.33 ? 11.67; p=0.0005). There were no significant variations in systolic arterial pressure, heart rate, BMI or WHR in the biochemical parameters. There was a reduction in the climacteric symptoms (22.17 ? 7.15 vs 3.08 ? 3.33; p=0.0001) and ultrasonography showed no changes in uterine volume or endometrial thickness. CONCLUSION: Treatment with tibolone for 180 days showed a good clinical-laboratory safety profile in postmenopausal women with NIDDM.

Studies show that vasomotor and sudomotor activity is compromised in individuals with Type 1 Diabetes (T1DM) which could lead to altered thermoregulatory function. However, recent work suggests that the impairments may only be evidenced beyond a certain level of heat stress. We therefore examined T1DM-related differences in heat loss responses of sweating and skin blood flow (SkBF) during exercise performed at progressive increases in the requirement for heat loss. Participants were matched for age, sex, body surface area and fitness cycled at fixed rates of metabolic heat production of 200, 250, and 300 W•m-2 of body surface area, each rate being performed sequentially for 30 min. Local sweat rate (LSR), sweat gland activation (SGA), and sweat gland output (SGO) were measured on the upper back, chest and forearm while SkBF (laser-Doppler) was measured on the forearm and upper back only. We found that despite a similar requirement for heat loss, LSR was lower in T1DM on the chest and forearm only, relative to Control and only different at the end of the second and third exercise periods. Differences in chest LSR were due to reduced SGA whereas the decreased forearm LSR was the result of a decrease in SGO. SkBF did not differ between groups. The reduction in the sweating response in the T1DM group was paralleled by a greater increase in core temperature. We show that T1DM impairs heat dissipation as evidenced by reductions in LSR and not SkBF. A compromised thermoregulatory response during and following physical exertion is of considerable concern due to the associated increased risk of post-exertion heat-related injury.

No description available.

The purpose of this study was to examine the levels of depression in adolescent with diabetes (type 1), non-insulin dependent diabetics (type 2) and the general adolescent population.

Background and Purpose: Children diagnosed with Type 1 Diabetes face significant challenges in the day to day management of their disease. Parents play an important role in supporting children at every stage of their lives and helping them transition to independence in the management of T1D. The purpose of this study was to learn from parents who have raised their children with T1D to adulthood and identify strategies for parents who are currently raising a child with T1D. Methods: Using a biographical method, a qualitative design, two in-depth interviews with open-ended prompts were completed with purposively selected parents of children with Type 1 Diabetes (T1D) who have grown into adulthood (18 parents, 36 interviews). The first interview invited participants to share their experience raising a child with T1D. The second interview asked specific questions about challenges, things that went well, things that didn't go well and advice for parents currently raising a child with T1D. Qualitative content analysis was used. Results: Analysis of the data identified recommendations for parents currently raising children with T1D. Advice for the parents included, 1) Parental attitude toward diabetes will be reflected in the child – Keep it positive, 2) Learn as much as you can about diabetes, 3) Find a good diabetes provider – Make your endocrinologist your best friend, 4) Don't make diabetes the definition of the child – treat them as normal, 5) Empower self-management – Teach them along the way then step back and let them take over, 6) Be your child's advocate, 7) Find support – Formal or informal, 8) Listen to your child – Don't judge. Conclusions and Implications: Nurses and nurse practitioners can share strategies identified by parents that were helpful in raising their child with Type 1 Diabetes.

Background The Chinese famine of 1959–61 has been widely interpreted as an important driver of current and future epidemics of type 2 diabetes (T2D). We conducted a systematic review and meta-analysis of prenatal famine exposure and type 2 diabetes (T2D) in China to summarize study characteristics, examine impacts of control selections on study results, and identify whether study results can be related to any characteristics. Methods We searched PubMed, Embase, Wanfang Data, and CNKI databases for studies that examined the relationship between T2D and prenatal exposure to the Chinese famine up to January, 2021. From included studies, we abstracted information on the number of T2D cases and populations at risk among individuals born during the famine (famine births), born before the famine (pre-famine births), and born after the famine (post-famine births). We examined the quality of studies with the modified Newcastle–Ottawa scale. We compared T2D in famine births to different controls: post-famine births, pre-famine and post-famine births combined (age-balanced), and pre-famine births. Fixed-effects models and random-effects models were used to calculate summary estimates. Heterogeneity across studies was assessed, and subgroup analyses were performed using sex, age at the survey, T2D measurements, famine intensity, residence, and publication language as possible effect modifiers. Findings Of 5,363 studies identified, 18 studies met our inclusion criteria. All studies defined famine exposure based on participants' years and/or months of births. Sample sizes ranged between around 300 and over 80,000 across studies. When post-famine births were used as controls, we found an increased risk of T2D (OR 1.48, 95% CI 1.30–1.68) among famine births based on the random-effects model. Using age-balanced controls, we did not find any increased risk of T2D (1.09, 95% CI 0.98–1.22). When pre-famine births were used as controls, famine was associated with a reduction in risk (0.85, 95% CI 0.75–0.97). Large variations and inconsistencies were identified in study design, famine intensity assessment, and covariate adjustment across studies. Conclusion Our analysis shows that it still remains an open question whether the Chinese famine has contributed substantially to the current T2D epidemic in China. Studies with more rigorous methods will need to quantify this relationship. The four-level famine intensity instrument developed in this study is a robust measure to identify a potential dose-response relation between famine exposure and health outcomes. It is likely to improve the reproducibility and generalizability of future studies.

No description available.

No description available.