Background Due to population growth, aging, urbanisation, increasing prevalence of obesity and physical inactivity, diabetes mellitus (DM) has become one of the most important and prevalent chronic diseases. Glycated haemoglobin A1c (HbA1c) assessment is currently being used all over to monitor glycaemic control as a cornerstone of diabetes care. It might also be a useful screening tool for non–insulin dependent DM, also known as type 2 DM (T2DM). Elevated HbA1c can be linked with long–term risk of cardiovascular complications. Aim The aim of the study was to determine whether HbA1c can be used as reliable screening tool for early detection of T2DM in an African population. Methods This study was a cross–sectional study and was part of the South African, North–West Province (SANWP) leg of the 12–year Prospective Urban and Rural Epidemiological (PURE) study. Baseline data was collected from March to December 2005. A total of 2010 volunteers were recruited from randomly selected households. Data was collected on socio–demographic characteristics, physical activity, dietary intakes, blood pressure and anthropometry. HbA1c, fasting plasma glucose (FPG), liver enzymes and HIV status were determined. Ethical approval for the PURE study was obtained in July 2004. Oral glucose tolerance tests (OGTT) were also done for a sub–group of 465 subjects. The Statistical Consultation Services of the North–West University were consulted to analyse data with SPSS 17.0 and STATISTICA 9.0. Results The HbA1c values within the diabetic FPG groups were 7.46% for men and 8.08% for women. HbA1c values increased significantly progressively from the normal FPG groups to the groups with impaired FPG and the diabetic FPG groups for both men and women. No significant increases were found in HbA1c between the OGTT groups (normal 2 hour plasma glucose (PG), impaired 2–hour PG and diabetic 2–hour PG). Total cholesterol, triglycerides, body mass index and FPG increased significantly and high–density lipoprotein cholesterol decreased significantly with an increase in HbA1c values in men and women. In addition, systolic blood pressure increased significantly in women with increased HbA1c. Thus, with an increase in HbA1c, an increase in the number of risk factors was observed. When using HbA1c and FPG in combination, 43 subjects of the whole population were detected with having a risk of developing T2DM. However, when considering the commonality of subjects identified to be diabetic or at risk by the OGTT, FPG and HbA1c individually, only one subject was identified by all the methods as having diabetes or being at risk to develop diabetes. Discussion and conclusions An increase in HbA1c and FPG was associated with an increase in risk factors and therefore with metabolic syndrome (MS). MS is associated with an increased risk of developing T2DM and therefore it can be concluded that HbA1c was useful for detecting in this population individuals at increased risk of developing T2DM. The use of FPG and HbA1c in combination was considered a better screening tool when compared to HbA1c alone. Factors other than what were measured in this study might be the cause of the unexpected results obtained in the participants with impaired OGTT. / Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2011.

Background Due to population growth, aging, urbanisation, increasing prevalence of obesity and physical inactivity, diabetes mellitus (DM) has become one of the most important and prevalent chronic diseases. Glycated haemoglobin A1c (HbA1c) assessment is currently being used all over to monitor glycaemic control as a cornerstone of diabetes care. It might also be a useful screening tool for non–insulin dependent DM, also known as type 2 DM (T2DM). Elevated HbA1c can be linked with long–term risk of cardiovascular complications. Aim The aim of the study was to determine whether HbA1c can be used as reliable screening tool for early detection of T2DM in an African population. Methods This study was a cross–sectional study and was part of the South African, North–West Province (SANWP) leg of the 12–year Prospective Urban and Rural Epidemiological (PURE) study. Baseline data was collected from March to December 2005. A total of 2010 volunteers were recruited from randomly selected households. Data was collected on socio–demographic characteristics, physical activity, dietary intakes, blood pressure and anthropometry. HbA1c, fasting plasma glucose (FPG), liver enzymes and HIV status were determined. Ethical approval for the PURE study was obtained in July 2004. Oral glucose tolerance tests (OGTT) were also done for a sub–group of 465 subjects. The Statistical Consultation Services of the North–West University were consulted to analyse data with SPSS 17.0 and STATISTICA 9.0. Results The HbA1c values within the diabetic FPG groups were 7.46% for men and 8.08% for women. HbA1c values increased significantly progressively from the normal FPG groups to the groups with impaired FPG and the diabetic FPG groups for both men and women. No significant increases were found in HbA1c between the OGTT groups (normal 2 hour plasma glucose (PG), impaired 2–hour PG and diabetic 2–hour PG). Total cholesterol, triglycerides, body mass index and FPG increased significantly and high–density lipoprotein cholesterol decreased significantly with an increase in HbA1c values in men and women. In addition, systolic blood pressure increased significantly in women with increased HbA1c. Thus, with an increase in HbA1c, an increase in the number of risk factors was observed. When using HbA1c and FPG in combination, 43 subjects of the whole population were detected with having a risk of developing T2DM. However, when considering the commonality of subjects identified to be diabetic or at risk by the OGTT, FPG and HbA1c individually, only one subject was identified by all the methods as having diabetes or being at risk to develop diabetes. Discussion and conclusions An increase in HbA1c and FPG was associated with an increase in risk factors and therefore with metabolic syndrome (MS). MS is associated with an increased risk of developing T2DM and therefore it can be concluded that HbA1c was useful for detecting in this population individuals at increased risk of developing T2DM. The use of FPG and HbA1c in combination was considered a better screening tool when compared to HbA1c alone. Factors other than what were measured in this study might be the cause of the unexpected results obtained in the participants with impaired OGTT. / Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2011.

The aim of the study was to evaluate type 2 diabetes mellitus (DM) medicine management in Government Clinics in Maseru, Lesotho. A two-dimensional research method was employed, consisting of a literature review and an empirical investigation. The objective of the literature review was to provide information on the pathophysiology, signs and symptoms, diagnosis, treatment and clinical management of DM. The empirical investigation consisted of a descriptive pharmacoepidemiological study, in which data for analysis was collected retrospectively from patients‘ medical records (―bukanas‖) at dispensing points, a using data collection tool. The selected study sites were Domiciliary Health Center, Mabote, Likotsi, and Qoaling filter clinics in Maseru district of Lesotho. Data on costs of antidiabetic agents was collected from purchase invoices provided by the pharmacy department of Domiciliary Health Center. Results showed that the overall ratio of males to females was 1.3. There were no statistical difference in DM prevalence between males and females in the different clinics (p = 0.48). The mean age of males and females was 57.5 ± 14.2 years and 58.6 ± 11.3 years, respectively (Cohen‘s d = 0.07). DM was more prevalent in patients 59 to 69 years for both males and females, with the exception of Mabote and Qoaling filter clinics, where DM was more prevalent in patients 49 to 59 years. These differences in prevalence were not statically significant. Overall, 20% (n = 69) of the study sample had DM alone, while 80.0% of patients had DM concurrently with hypertension. The odds ratio implicated that women were 1.7 times more likely to have hypertension concurrently with Type 2 Diabetes Mellitus. The mean blood glucose level at 95% confidence interval for females and males were 10.1 ± 5.9 mmol/L (95% CI: 10.1–11.7) and 10.9 ± 6.2 mmol/L (95% CI: 11.0–14.0) respectively. The difference in the mean blood glucose levels of males vs. females was not statistically significant (p = 0.07). In both males and females there were outliers as high as 33.3 mmol/L. Metformin 850 mg given three times, metformin 500 mg three times a day, glibenclamide 10 mg daily and glibenclamide 5 mg twice daily are oral hypoglycaemic agents that were first, second, third and fourth choice treatment of DM at all four study sites at a frequency of 54.2% (n = 160), 27.7% (n = 82), 4% (n = 12) and 2.7% (n = 27), respectively. Actraphane® 20 units in the morning and 10 units in the evening was prescribed at a frequency of 11.6% (n = 432) in comparison to other Actraphane®-containing regimens. The frequencies of prescribing metformin and Actraphane® as combination therapies represented 10.6% (n = 40), 7.1% (n = 27), and 6.6% (n = 25), respectively, for Actraphane® 20 units in the morning and 10 units in the evening, plus metformin 500 mg three times per day; Actraphane® 20 units in the morning and 10 units in the evening plus metformin 850 mg three times per day; and Actraphane® 30 units in the morning and 15 units in the evening plus metformin 850 mg three times per day. The combination therapy of metformin and glibenclamide were prescribed at frequencies of 24.6% (n = 172), 22.9% (n = 160), and 13.4% (n = 94) respectively for glibenclamide 10 mg daily plus metformin 850 mg three times per day, glibenclamide 5 mg daily plus metformin 850 mg three times per day, and glibenclamide 5 mg once a day plus metformin 500 mg three times per day as first, second and third choice treatments at all study sites. The total cost incurred for all the oral drugs prescribed alone within different regimens was M75.6 with the weighted average cost per patient of M0.81 ± 2.06 per day compared to the cost of Actraphane® which was M40 660.52 per month at a weighted average daily cost of M21.43 ± 6.23 per patient. The overall cost of Actraphane® and metformin combination therapy amounted to M50 676.50, at an average cost per patient of M21.77 ± 6.80 per day. The cost of combination therapy consisting of metformin and glibenclamide amounted to M377.10, at a weighted average cost amounting to M0.49 ± 0.16 per patient, per day. Based on the results of this study some conclusions were reached on the prevalence of DM, prescribing patterns and the cost of antidiabetic agents. Recommendations pertaining to the clinics and further research were made. / MPham (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014

The aim of the study was to evaluate type 2 diabetes mellitus (DM) medicine management in Government Clinics in Maseru, Lesotho. A two-dimensional research method was employed, consisting of a literature review and an empirical investigation. The objective of the literature review was to provide information on the pathophysiology, signs and symptoms, diagnosis, treatment and clinical management of DM. The empirical investigation consisted of a descriptive pharmacoepidemiological study, in which data for analysis was collected retrospectively from patients‘ medical records (―bukanas‖) at dispensing points, a using data collection tool. The selected study sites were Domiciliary Health Center, Mabote, Likotsi, and Qoaling filter clinics in Maseru district of Lesotho. Data on costs of antidiabetic agents was collected from purchase invoices provided by the pharmacy department of Domiciliary Health Center. Results showed that the overall ratio of males to females was 1.3. There were no statistical difference in DM prevalence between males and females in the different clinics (p = 0.48). The mean age of males and females was 57.5 ± 14.2 years and 58.6 ± 11.3 years, respectively (Cohen‘s d = 0.07). DM was more prevalent in patients 59 to 69 years for both males and females, with the exception of Mabote and Qoaling filter clinics, where DM was more prevalent in patients 49 to 59 years. These differences in prevalence were not statically significant. Overall, 20% (n = 69) of the study sample had DM alone, while 80.0% of patients had DM concurrently with hypertension. The odds ratio implicated that women were 1.7 times more likely to have hypertension concurrently with Type 2 Diabetes Mellitus. The mean blood glucose level at 95% confidence interval for females and males were 10.1 ± 5.9 mmol/L (95% CI: 10.1–11.7) and 10.9 ± 6.2 mmol/L (95% CI: 11.0–14.0) respectively. The difference in the mean blood glucose levels of males vs. females was not statistically significant (p = 0.07). In both males and females there were outliers as high as 33.3 mmol/L. Metformin 850 mg given three times, metformin 500 mg three times a day, glibenclamide 10 mg daily and glibenclamide 5 mg twice daily are oral hypoglycaemic agents that were first, second, third and fourth choice treatment of DM at all four study sites at a frequency of 54.2% (n = 160), 27.7% (n = 82), 4% (n = 12) and 2.7% (n = 27), respectively. Actraphane® 20 units in the morning and 10 units in the evening was prescribed at a frequency of 11.6% (n = 432) in comparison to other Actraphane®-containing regimens. The frequencies of prescribing metformin and Actraphane® as combination therapies represented 10.6% (n = 40), 7.1% (n = 27), and 6.6% (n = 25), respectively, for Actraphane® 20 units in the morning and 10 units in the evening, plus metformin 500 mg three times per day; Actraphane® 20 units in the morning and 10 units in the evening plus metformin 850 mg three times per day; and Actraphane® 30 units in the morning and 15 units in the evening plus metformin 850 mg three times per day. The combination therapy of metformin and glibenclamide were prescribed at frequencies of 24.6% (n = 172), 22.9% (n = 160), and 13.4% (n = 94) respectively for glibenclamide 10 mg daily plus metformin 850 mg three times per day, glibenclamide 5 mg daily plus metformin 850 mg three times per day, and glibenclamide 5 mg once a day plus metformin 500 mg three times per day as first, second and third choice treatments at all study sites. The total cost incurred for all the oral drugs prescribed alone within different regimens was M75.6 with the weighted average cost per patient of M0.81 ± 2.06 per day compared to the cost of Actraphane® which was M40 660.52 per month at a weighted average daily cost of M21.43 ± 6.23 per patient. The overall cost of Actraphane® and metformin combination therapy amounted to M50 676.50, at an average cost per patient of M21.77 ± 6.80 per day. The cost of combination therapy consisting of metformin and glibenclamide amounted to M377.10, at a weighted average cost amounting to M0.49 ± 0.16 per patient, per day. Based on the results of this study some conclusions were reached on the prevalence of DM, prescribing patterns and the cost of antidiabetic agents. Recommendations pertaining to the clinics and further research were made. / MPham (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014