El objetivo de la presente investigación fue describir la realidad sanitaria de la diabetes en el departamento de Lambayeque, analizar el rol de la enfermera frente a la realidad sanitaria de dicha enfermedad y discutir las implicancias de esta realidad en el rol preventivo de enfermería. El marco teórico desarrolla los conceptos de realidad sanitaria con aportes de OMS (2009), y rol de la enfermera fundamentado por Kérouac (1996) y Torres (2005). El abordaje fue el estudio de caso, argumentado en Menga Ludke (1986). Minsa y Essalud de Lambayeque fueron los escenarios de la investigación. La muestra fue de 10 enfermeras que trabajaron con la estrategia de daño no transmisible y con la cartera del adulto. La información se recogió con la entrevista semiestructurada y cuestionario socio demográfico. Se aplicó análisis de contenido de Bardin (2006), emergiendo tres categorías: (a) la diabetes un problema social emergente, donde enfoca el impacto que la diabetes genera hoy en día en la sociedad dando origen a un nuevo rol de la enfermera salubrista (b) los obstáculos presentes en la prevención de la diabetes, donde se enfatiza cómo las políticas de salud perpetúan un enfoque biomédico y asistencialista, y se demuestra que las estrategias no responden a la realidad, a esto se añade un presupuesto deficiente y escasez de profesionales de enfermería. Y (c) multiplicidad de roles de la enfermera en la prevención de la diabetes, donde emergen los siguientes roles: asistencial, gestora, educadora y ausente el rol de investigadora. / Tesis

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / CoordenaÃÃo de AperfeÃoamento de Pessoal de NÃvel Superior / The bisphosphonate tiludronic acid (TIL) presents anti-resorptive and anti-inflammatory properties and it has not been evaluated in the association periodontitis-diabetes mellitus (DM) to date. The purpose of this study was to evaluate the effects of local administration of TIL on experimental periodontitis (EP) in rats with streptozotocin (STZ)-induced DM. On day 1, thirty two rats received STZ injection. The animals were divided into groups (n=8): DM/C (Control), DM/EP, DM/EP/TIL1 and DM/EP/TIL3. In groups EP, a ligature was placed around the cervical area of mandibular first molars at day 8. In groups DM/EP/TIL1 and DM/EP/TIL3, TIL solutions of 1 and 3 mg/kg body weight, respectively, were injected into the buccal gingival margin of mandibular first molars every other day. Animals were euthanized at day 18. Histomorphometric analyses were performed. Data were statistically analyzed (p<0.05). Group DM/EP/TIL3 presented reduced alveolar bone loss and attachment loss when compared with group DM/EP (p<0.05). Within the limits of this study, it can be concluded that i) the local administration of TIL solutions presented a protective effect on tissue destruction in EP in diabetic rats and ii) the dosage of TIL may influence its effects. / O bisfosfonato Ãcido tiludrÃnico (TIL) apresenta propriedades antirreabsortivas e anti-inflamatÃrias e ainda nÃo foi estudado na associaÃÃo periodontite-diabetes mellitus (DM). O objetivo deste estudo foi avaliar os efeitos da administraÃÃo local do TIL na periodontite experimental (PE) em ratos com DM induzido por streptozotocina (STZ). No 1 dia, trinta e dois ratos receberam injeÃÃo de STZ. Os animais foram divididos nos grupos (n = 8): DM/C (Controle), DM/PE, DM/PE/TIL1 e DM/PE/TIL3. Nos grupos PE, uma ligadura foi colocada na Ãrea cervical dos primeiros molares inferiores no 8 dia. Nos grupos DM/PE/TIL1 e DM/PE/TIL3, soluÃÃes de TIL (1 e 3 mg/kg de peso corporal, respectivamente) foram injetadas na margem gengival vestibular dos primeiros molares inferiores em dias alternados. Os animais foram submetidos à eutanÃsia no 18 dia. AnÃlises histomorfomÃtricas foram realizadas. Os dados foram estatisticamente analisados (p<0,05). O grupo DM/PE/TIL3 apresentou perda Ãssea alveolar e perda de inserÃÃo reduzidas quando comparado com o grupo DM/PE (p<0,05). Dentro dos limites deste estudo, pode-se concluir que i) a administraÃÃo local de soluÃÃes de TIL apresentou um efeito protetor na destruiÃÃo tecidual na PE em ratos diabÃticos e ii) a dosagem de TIL pode influenciar seus efeitos.

CoordenaÃÃo de AperfeÃoamento de Pessoal de NÃvel Superior / The diabetes and dyslipidemia are important in cardiovascular risk factors. When associated with oxidative stress may accelerate coronary artery disease and progression of atherosclerotic lesions. There are several natural products that stand out as potential therapeutic agents for treatment of such diseases, including caffeic acid, a phenolic compound that has a variety of biological and pharmacological activities described in the literature. Thus, the aim of this study was to evaluate the therapeutic potential of caffeic acid in experimental protocols of diabetes and dyslipidemia, as well as examine their modulating activity under oxidative stress. Hyperlipidemia was induced in male mice using two protocols by means of a single intraperitoneal administration of 400mg/kg Triton WR-1339 and 400mg/kg Poloxamer-407 in all animals, except for the normal control. The treated groups received doses caffeic acid 25 (CA25), 50 (CA50) and 100 mg/kg (CA100). The serum of these animals was analyzed on two different time intervals for total cholesterol, triglycerides and glucose. Liver tissue was analyzed after both protocols dyslipidemia for products of lipid peroxidation, the non-protein sulfhydryl groups (NP-SH) and the antioxidant enzyme superoxide dismutase (SOD). The hypoglycemic activity of caffeic acid was checked by the protocol of diabetes induced by alloxan. Treatment with three doses of caffeic acid and 200mg/Kg fenofibrate significantly reduced total cholesterol and triglyceride levels 24 and 48 hours after induction of dyslipidemia in both protocols dslipidemia. There was also reduced blood glucose at all doses used to induce dyslipidemia with Poloxamer -407. Furthermore, the treatment caused a reduction in the CA and an increase in lipid peroxidation levels of NP -SH in two models of dyslipidemia and in addition, increased levels of SOD-induced hyperlipidemia in Poloxamer-407. Regarding the induction protocol with alloxan diabetes, there was reduction in blood glucose and total cholesterol levels in the three groups treated with caffeic acid. Triglyceride levels were significantly reduced in animals in groups CA25 and CA100. The results suggest that caffeic acid has a beneficial effect in the treatment of dyslipidemia and diabetes, as well as an important antioxidant activity without the presence of adverse effects. However, most studies of chronic so they can ensure the safety and efficacy of its use are needed. / O diabetes e as dislipidemias constituem-se em importantes fatores de risco cardiovascular. Quando associados ao estresse oxidativo podem acelerar a doenÃa arterial coronariana e a progressÃo das lesÃes aterosclerÃticas. Existem vÃrios produtos de origem natural que despontam como potenciais agentes terapÃuticos para tratamentos de tais doenÃas, dentre eles o Ãcido cafeico, um composto fenÃlico que apresenta uma variedade de atividades biolÃgicas e farmacolÃgicas descritas na literatura. Desse modo, o objetivo do presente trabalho foi avaliar o potencial terapÃutico do Ãcido cafeico em protocolos experimentais de diabetes e dislipidemia, bem como analisar sua atividade moduladora sob o estresse oxidativo. A hiperlipidemia foi induzida em camundongos machos atravÃs de dois protocolos, sendo mediante uma Ãnica administraÃÃo intraperitoneal de 400mg/Kg de Triton WR-1339 e 400mg/Kg de Poloxamer-407 em todos os animais, exceto no controle normal.Os grupos tratados com Ãcido cafeico receberam as doses de 25 (AC25), 50 (AC50) e 100 mg/Kg (AC100). O soro desses animais foi analisado em dois intervalos de tempos diferentes para colesterol total, triglicerÃdeos e glicose. JÃ o tecido hepÃtico foi analisado apÃs ambos os protocolos de dislipidemia para os produtos de peroxidaÃÃo lipÃdica, os grupos sulfidrÃlicos nÃo-proteÃcos (NP-SH) e a enzima antioxidante superÃxido dismutase (SOD). A atividade hipoglicÃmica do Ãcido cafeico foi verificada atravÃs do protocolo de diabetes induzida por aloxano. O tratamento com as trÃs doses de Ãcido cafeico e fenofibrato 200mg/Kg reduziram significativamente os nÃveis de colesterol total e triglicerÃdeos 24 e 48 horas apÃs a induÃÃo da dislipidemia em ambos os protocolos de dslipidemia. Houve tambÃm reduÃÃo da glicose sanguÃnea em todas as doses utilizadas ao se induzir a dislipidemia com o Poloxamer-407. AlÃm disso, o tratamento com AC promoveu diminuiÃÃo da peroxidaÃÃo lipÃdica e aumento nos nÃveis de NP-SH nos dois modelos de dislipidemia e, adicionalmente, aumento nos nÃveis de SOD na hiperlipidemia induzida por Poloxamer-407. Em relaÃÃo ao protocolo de induÃÃo de diabetes com aloxano, verificou-se reduÃÃo da glicemia e do colesterol total nos trÃs grupos tratados com Ãcido cafeico. JÃ os nÃveis de triglicerÃdeos foram reduzidos significativamente nos animais dos grupos AC25 e AC100. Os resultados obtidos sugerem que o Ãcido cafeico possui um efeito benÃfico no tratamento das dislipidemias e do diabetes, alÃm de uma importante atividade antioxidante, sem a presenÃa de efeitos adversos durante o estudo. No entanto, sÃo necessÃrios mais estudos de forma crÃnica que possam garantir a seguranÃa e eficÃcia de sua utilizaÃÃo.

Objetivos: Avaliar a variabilidade glicêmica, respostas metabólicas e cardiovasculares após uma sessão de exercício aeróbico em pacientes com diabetes em tratamento com vildagliptina ou glibenclamida. Métodos: Foi realizado ensaio clínico aberto e paralelo que incluiu 13 pacientes com diabetes tipo 2 tratados com vildagliptina (50mg bid) ou glibenclamida (5mg bid) por 12 semanas. Antes e após a intervenção, a variabilidade glicêmica (glicose média, variância da glicose, coeficiente de variação e média da amplitude das oscilações glicêmicas), respostas metabólicas (HbA1c, glicose, insulina e 8-iso prostaglandina F2α) e cardiovasculares (débito cardíaco, variabilidade da frequência cardíaca e componentes do controle autonômico) foram avaliadas no repouso, durante e após uma sessão de exercício aeróbico de 30 minutos. A variabilidade da pressão arterial foi aferida nas 24 horas após o exercício. Resultados: Doze semanas de tratamento resultou em redução da glicemia de 18% com vildagliptina e 35% com glibenclamida (p grupo=0.007). A HbA1c reduziu significativamente (1.24 % e 1.52%) nos grupos vildagliptina e glibenclamida, respectivamente.A variabilidade glicêmica não se alterou após o tratamento com glibenclamida ou vildagliptina (MAGE=55.8 ±5.3 mg/dL e 69.9 ± 13.3 mg/dL, respectivamente; p grupo=0.091; p tempo=0.234). Foi encontrada uma diminuição da glicose avaliada por monitoramento contínuo durante as 3 horas de recuperação do exercício, com AUC (de 6h) menor no grupo glibenclamida vs vildagliptina (p=0.04). A glibenclamida induziu maiores concentrações de insulina na recuperação do exercício. O grupo tratado com vildagliptina obteve 6.3mmHg de redução da pressão arterial sistólica, enquanto a glibenclamide reduziu 3.6mmHg, sem diferença entre os grupos. Os pacientes tratados com vildagliptina apresentaram menor variabilidade da pressão arterial sistólica (0.0445 ±0.05 mm/Hg), medida por time rate, comparados aos tratados com glibenclamida (0.601 ±0.12 mm/Hg), p=0.012. Conclusão: Este é o primeiro estudo conduzido em pacientes com DM2 que fornece dados sobre a influência da terapia medicamentosa padrão (metformina e glibenclamida) vs outra classe disponível (metformina e vildagliptina) em respostas a uma sessão de exercício aeróbico, um dos tratamentos recomendados para pacientes com DM2. Além de melhora no controle glicêmico e redução da pressão arterial sistólica obtidas por ambos tratamentos, foi observada menor variabilidade da pressão arterial nos 9 pacientes submetidos ao tratamento com vildagliptina. Não foi encontrada menor variabilidade da glicemia após o exercício nos pacientes tratados com vildagliptina comparados aos tratados com glibenclamida, refutando a hipótese de estudo.

A inflamação subclínica é caracterizada pelo aumento da concentração de marcadores inflamatórios na circulação, como, por exemplo, proteína-C-reativa (PCr) e leucócitos, e está envolvida na patogênese das doenças crônicas, dentre elas o diabetes (DM). A dieta tem um papel central na regulação dessa inflamação, e já foi desenvolvido um índice de inflamação da dieta (IID) para avaliar o potencial inflamatório alimentar. Estudos apontam que o IID está associado às doenças crônicas não transmissíveis (DCNT), como câncer, doenças cardiovasculares (DCV), obesidade e resistência à insulina. O IID foi reproduzido para o ELSA-Brasil, sendo que metade dos participantes avaliados teve uma alimentação pró-inflamatória. Indivíduos mais velhos e do sexo feminino apresentaram um padrão alimentar mais anti-inflamatório. O IID se associou de forma positiva com proteína-C-reativa (níveis de PCr ≥ 3 mg/L; quarto quartil versus primeiro quartil; OR=1,20, IC95% 1,04-1,39) e resistência à insulina (níveis de insulina > 9,4 μU/mL; quarto quartil versus primeiro quartil; OR=1,20, IC95% 1,03-1,38). Nos últimos anos, tem-se dado atenção ao estudo de padrões alimentares. O uso de análises que avaliam esses padrões tem vantagem sobre a análise dos nutrientes isoladamente, uma vez que o consumo alimentar é caracterizado pelo efeito sinérgico ou antagônico de nutrientes Com essa hipótese, utilizou-se a metodologia do Reduced Rank Regression (RRR), para desenvolver um padrão alimentar inflamatório para o ELSA-Brasil. Esse padrão foi composto por 18 grupos alimentares, merecendo destaque para associação positiva dos marcadores de inflamação com cachorro quente, carne processada, carne vermelha, carne de porco, outros frutos do mar, refrigerante com e 14 sem açúcar, sucos artificiais com e sem açúcar, cerveja; e associação negativa com manteiga, oleaginosas, frutas, vinho e pizza. O Índice de Inflamação dos Alimentos (IIA) derivado a partir desse padrão esteve associado aos marcadores de inflamação, grande ganho de peso (ganho ≥ 1,73 kg/ano; quartil 4 versus quartil 1: OR=1,42; IC95% 1,15-1,76), ao aumento de um marcador inflamatório [GlycA; aumento de um desvio padrão do IIA (140) esteve associado com um incremento de 6 μmol/L (4,0-8,2)] e o risco de desenvolver diabetes (quartil 4 versus quartil 1: HR=1,29; IC95% 1,01-1,65). As associações encontradas para o IID e o padrão inflamatório da dieta com marcadores de inflamação e incidência de diabetes, respectivamente, apontam que o aumento da inflamação subclínica pode ser um dos caminhos pelo qual a dieta interfere na fisiopatologia das doenças crônicas. / Subclinical inflammation is characterized by an increased concentration of inflammatory markers in the circulation, such as c-reactive protein and leukocytes. It is also involved in the pathogenesis of chronic diseases, among them diabetes mellitus. The diet has a central role in the regulation of this inflammation, and an index of dietary inflammation has already been developed to evaluate the dietary inflammatory potential. Studies indicate that DII is associated with non-communicable chronic diseases, such as cancer, cardiovascular diseases, obesity and insulin resistance. DII was reproduced for ELSA-Brazil, with half of the study participants having a pro-inflammatory diet. Older and female subjects had a more anti-inflammatory food pattern. DII was positively associated with markers of inflammation (c-reactive protein PCr ≥ 3 mg/L; fourth quartile versus first quartile; OR=1,20, 95%CI 1,04-1,39) and insulin resistance (insulin levels > 9,4 μU/mL; fourth quartile versus first quartile; OR=1,20, 95%CI 1,03-1,38). In recent years, attention has been paid to the study of dietary patterns. The use of tests that evaluate these patterns has the advantage over nutrient analysis alone, since we do not consume isolated nutrients, and since food consumption is characterized by synergistic or antagonistic effect of nutrients together. With this hypothesis, the Reduced Rank Regression (RRR) methodology was used to develop an inflammatory food pattern for ELSA-Brazil. This pattern was composed of 18 food groups, with emphasis on the positive association of inflammation markers with hot dogs, processed meat, read meat other seafood, pork, artificial juice, soda; and negative association with butter, oilseeds, fruits, wine and pizza. The Food Inflammation Index (FII) derived from this pattern is 16 associated with large weight gain (gain ≥ 1,73 kg/year; fourth quartile versus first quartile; OR=1,42; 95%CI 1,15-1,76), increased inflammatory markers [GlycA; one standart deviation FII (140) is associated with increased of 6 μmol/L (4,0-8,2)] and the risk of developing diabetes (fourth quartile versus first quartile; HR=1,29; 95%CI 1,01-1,65). The associations found between the dietary inflammatory pattern and the markers of inflammation and diabetes incidence indicate that the increase in subclinical inflammation could be one of the reasons why diet interferes with the pathophysiology of chronic diseases.

Orientador: Ana Cláudia Okamoto / Banca: Suzely Adas Saliba Moimaz / Banca: Aylton Valsecki Júnior / Resumo: A utilização da saliva na avaliação de condições fisiológicas e patológicas em seres humanos tem muitas vantagens como coleta simples, fácil, não invasiva e de baixo custo de armazenamento. Tem sido muito empregada no diagnóstico da doença periodontal, bem como de sua evolução e monitoramento. Durante a gestação, algumas mulheres podem desenvolver a diabete gestacional, sendo este um fator modulador da doença periodontal. A colonização e implantação do complexo vermelho de Socransky e de P. intermedia estão intimamente associados a diversas modalidades de doença periodontal podendo variar da gengivite até a doença periodontal crônica. Objetivou-se avaliar a pressão arterial e glicemia capilar em gestantes com e sem doença periodontal, relacionar alterações de pressão arterial e glicemia com as condições periodontais, bem como verificar a presença de bactérias do complexo vermelho de Socransky e de P. intermedia em gestantes com e sem doença periodontal, por meio da PCR. Participaram deste estudo caso-controle 86 gestantes com idade gestacional entre o 4º e o 7º mês, submetidas ao atendimento pré-natal em UBS. Foi avaliada a condição periodontal utilizando-se o índice IPC, proposto pela Organização Mundial da Saúde (OMS) para levantamentos epidemiológicos de saúde bucal; para o exame de verificação dos níveis glicêmicos no sangue foi utilizado um monitor de glicemia (Accu-Chek Advantage II, Roche, USA), para a aferição da pressão arterial utilizou-se esfigmomanômetroe para a coleta de saliva foram utilizados cones de papel absorventes esterilizados (No. 30, Endopoints Ind. Com. Ltda, RJ.).A extração de DNA foi realizada pelo o kit Easy-DNA (Invitrogen, SP) e a presença das bactérias foi detectada por PCR com primers e sondas específicas para cada microrganismo. O teste Exato de Fisher foi utilizado para verificar... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Saliva has been an important resource for the evaluation of physiological and pathological conditions in humans. Its utilization has several advantages, including simple and easy collection, besides being non invasive and having a low storage cost. Saliva utilization as a diagnosis mean for periodontal disease, as well as its evolution and management, has become more studied. During pregnancy, some women can develop gestational diabetes, which is a modulating factor of periodontal disease. The colonization and implantation of the Socransky red complex and Prevotella intermedia are intimately associated to several modalities of periodontal disease, varying from gingivitis to chronic periodontal disease. This study aimed to evaluate the arterial pressure and capillary glycemia of pregnant women with and without periodontal disease, and to relate arterial pressure and glycemia alterations with periodontal conditions, as well as to verify the presence of bacteria from the Socransky red complex and P. intermedia in pregnant women with and without periodontal disease, by PCR. This case-control study included 86 pregnant women with gestational age between the 4th and the 7th months, submitted to pre-natal attendance in Health Basic Units (HBU). Periodontal condition was assessed through the CPI (Community Periodontal Index), proposed by the World Health Organization (WHO) for epidemiologic analysis of oral health; for the verification of blood glycemic levels it was used a glycemia monitor (Accu-Chek Advantage II, Roche, USA); a sphygmomanometer was used to check the arterial pressure; and, for the saliva gathering, sterilized absorbent paper cones were used (No. 30, Endopoints Ind. Com. Ltda., RJ., Brazil). DNA extraction was accomplished through the Easy-DNA Kit test (Invitrogen, SP, Brazil) and the presence of bacteria was detected by PCR with primers and specific probes... (Complete abstract click electronic access below) / Mestre

Thesis (MSc.(Med.)(Pharmacy))--University of Limpopo, 2010. / Diabetes Mellitus (DM) is a self -managed condition and it is essential for patients to have the relevant knowledge, skills and attitudes needed for successful diabetes management. Follow-up and proper counselling are major components in diabetes management as these will improve adherence and optimise diabetes management. The aim of this study was to compare the knowledge, understanding and outcome of the disease management in four health institutions ; a dedicated institution, a semi-dedicated institution and two non-dedicated institution. The study objectives were: To describe the level of knowledge and understanding of diabetic patients in the management of their condition at the different institutions , to describe the outcome of diabetes management at the different institutions , to describe consulting and dispensing times for diabetic patients at the different institutions , and to obtain patients’ perceptions on the quality of the health care services pertaining to the treatment of their diabetes. A total of 120 patients were interviewed, 30 per institution. A questionnaire was used to collect data for the different objectives. Prospective and retrospective data were collected. Knowledge of DM was assessed in ten patients from each institution. Patients were asked to explain their understanding on five aspects of the condition. Median scores for patients from the two non-dedicated institutions were compared using Wilcoxon two-sample test, and were found not to differ significantly for any of the questions or the overall score. The groups did not differ significantly in their understanding of whether there was a cure for diabetes mellitus and in their understanding of hypoglycaemia and its management. Patients at the dedicated clinic were significantly more knowledgeable of the condition, it’s causes and their overall understanding of the questions asked. Hyperglycaemia and its management were understood significantly better by the patients at the dedicated iv institution than those at the non-dedicated institutions , with patients at the semi-dedicated institution not differing significantly from either group. The outcome of diabetes management was recorded from the patients file for a six month period. The proportions of elevated blood pressure results recorded at the three institution types differed significantly. The semi-dedicated institution had a significantly higher proportion of uncontrolled blood pressure results (33 of 55 results recorded, or 60%) than the non-dedicated institutions (32 of 91, 35%) or the dedicated institution (9 of 36, 25%,). None of the ten patients at the semi-dedicated institution had all their values within the controlled range, as compared to six of 20 at the non-dedicated and six of ten at the dedicated institution. The glucose control was least achieved in patients at the semidedicated institution, where only one of ten (10%) of patients had no recorded value outside the controlled range, as opposed to four of ten (40%) at the dedicated institution and nine of eighteen (50%) at the non-dedicated institutions. Median visit times differed between all types of institutions. Time spent on consulting and dispensing was the shortest at the non-dedicated (median=7min), it took longer at the semi-dedicated (median=9), and longest at the dedicated institution (median=18min). The patient’s perception on the quality of care was recorded for patients. They were asked whether they were satisfied with the amount of time that they spent with the healthcare worker. Patient satisfaction with visit time was not linked to the duration of the visit. Actual visit time did appear to be linked to patients’ perception of whether they got enough time to ask questions. As for perceived quality of service, fewer patients were informed about their progress at the non-dedicated institution than at the others. Family members of fewer patients were educated at the dedicated than at the other institutions. More patients at the dedicated institution than at the other institutions were informed of treatment changes. Suggestions for improvement of patient care were made by 18% of v patients attending non-dedicated institutions , 23% of patients at the semi-dedicated institution and 63% at the dedicated institution. The conclusion based on the results is that the more dedicated a service is, the better the diabetic care of patients. Patients at the dedicated clinic had more time with the health worker during consultation and dispensing of treatment. They were informed about treatment changes more than the patients at other institutions. Patients at the dedicated clinic also showed a better knowledge and understanding of their condition than patients in other institutions. They also had higher affirmative responses in terms of lifestyle modification as compared to the other institutions.

Thesis (M Med (Family Medicine))--University of Limpopo (Medunsa Campus), 2010. / Introduction: Diabetes Mellitus still remains an important non- communicable disease globally. The burden of the disease continues to rise even in the sub-Saharan Africa. Aim: The study aimed to assess and describe the dietary practices and the prevalence of obesity among type 2 diabetic patients seen at Scott Hospital. Methods: A descriptive cross- sectional study was conducted among type 2 diabetic patients at Scott Hospital, Morija, Lesotho. A simple random sample of 50 participants was selected and each completed an interviewer administered questionnaire. The administration of the questionnaire was done by the researcher and a research assistant. Socio- demographic characteristics of the participants were obtained, anthropometric measurements were height and weight of each participant with subsequent determination of the BMI. Dietary intake was assessed using questions from a modified food frequency questionnaire of 16 food groups that reflect the commonest food items available. Results: The results showed that 86% (43/50) of the participants were females and 14% (7/50) were males with a female: male ratio of 6:1. The majority (72%) were above age 50 years and with regards to educational status, 62% had primary school education as the highest level attained. Four percent (4%) had no formal education. Fifty percent (50%) of the participants were unemployed. The mean weight of the participants was 84.22 ± 13.51 kg and the mean height was 157.76 ± 6.10 cm. The mean BMI was 33.97 ± 4.99 kg/m². Seventy-eight percent (38/50) of the participants were obese, and 14% (7/50) of the participants who were females, were morbidly obese with BMIs ≥ 40kg/m². The prevalence of obesity when stratified by gender showed that 57% (4/7) of male participants and 81% (35/43) of female participants were obese. According to the dietary assessments, food groups with the highest reported consumption per unit per month were; maize meals, breakfast-cereals and bread respectively. Conclusion: The study showed a predominantly female and elderly population of type 2 diabetics at Scott Hospital, Morija, Lesotho. The prevalence of obesity was high (78%) among the participants and this further supports the view that obesity is a major risk factor for type 2 diabetes. Reported dietary intake showed a higher consumption of carbohydrates and a very low intake of dietary fibre as represented by legumes. Keywords: Type 2 diabetes mellitus, dietary habits and obesity.

Thesis (MSc (Biochemistry))--University of Limpopo (Medunsa Campus), 2010. / Background: Clausena anisata (C. anisata) (Willd) Hook [Family: Rutaceae] is one of the South African indigenous medicinal plant whose blood glucose lowering effect has been demonstrated in animal models of diabetes mellitus. However, the mechanism(s) by which extracts of these plants exert their blood glucose lowering effect have not been investigated Objectives of the study: The objectives of the current study were to investigate in vitro inhibitory effects of different C. anisata leaf extracts on the activities of human urinary α-amylase, Bacillus stearothermophilus α-glucosidase and rat hepatic glucose 6-phosphatase and to characterize the enzyme inhibitory effect of the extracts on these enzymes with respect to the mode of inhibition (type of inhibition) and IC50 values (measure of inhibition potency). Another objective of the study was to confirm the enzyme inhibitory effects of C. anisata in vivo by measuring postprandial glucose levels in alloxan induced diabetic rats after oral administration of sucrose. Results: Aqueous and methanolic extracts of C. anisata leaves inhibited human urinary α-amylase with IC50 values of 1947 ± 50 and 2436 ± 62 µg/ml respectively. Inhibitions of α-amylase by these extracts were however, significantly less than that of the reference drug acarbose (84 ± 11 µg/ml) (P < 0.001). The mode of inhibition of these extracts on human urinary α-amylase appears to be a reversible non-competitive one. Acetone and hexane extracts of C. anisata inhibited Bacillus stearothermophilus α-glucosidase with IC50 values of 1020 ± 32 and 2068 ± 59 µg/ml respectively. Inhibition of Bacillus stearothermophilus α-glucosidase by these two extracts was also significantly less than that produced by acarbose (36 ± 11 µg/ml) (P < 0.001). The mode of inhibition of Bacillus stearothermophilus α-glucosidase by the acetone extract was found to be reversible competitive in this case. Aqueous and methanolic extracts of C. anisata leaves also inhibited hepatic glucose 6-phosphatase with IC50 values of 493.6 ± 12 and 1012 ± 58 µg/ml respectively. In this case the effect of the aqueous extract was significantly less than that of the reference inhibitor of glucose 6-phosphatase, sodium vanadate (1651 ± 46 µg/ml) (P < 0.05). The mode of inhibition of glucose 6-phosphatase by C. anisata aqueous leaf extract was found to be irreversible. Furthermore, oral administration of C. anisata acetone leaf extract to normal and alloxan induced diabetic rats, 30 minutes before sucrose loading failed to prevent the rise in postprandial glucose levels in these animals. Conclusions: Although both C. anisata aqueous and hexane leaf extract inhibited human urinary α-amylase and Bacillus stearothermophilus α-glucosidase in vitro, this does not appear to be the case in vivo. C. anisata aqueous leaf extract appeared to be a more potent inhibitor of rat hepatic glucose 6-phosphatase than the known inhibitor of the catalytic subunit of this multi-component enzyme system.

Thesis (M Med (Family Medicine))--University of Limpopo, 2010. / The number of diabetic patients will continue to rise even in rural settings and the burden of this disease will continue to take its effect on the limited resources of these communities. The effect of such burden will be more pronounced if we are to add the various complications associated with substandard management of diabetes mellitus. The first step in assessing the level of care we give to this category of patients is to measure their level of adherence, in an effort to expose the pitfalls on both the side of the patients and on the side of the health care provider. The aim of the study is to assess the level of adherence to treatment among type2 diabetic patients in Matlala district hospital; Limpopo Province. This cross-sectional study used the convenience method of sampling with the aid of a tested, structured questionnaire, to obtain data from respondents between December 2009 and March 2010, a period of 4 months. The excel computer program was used for data capturing. Percentages and numbers were used for interpretation and cross tabulation was used to determine association. The result of the study indicated that 137 {70%} of the respondents adhere to diabetes treatment. There were two demographical characteristics that are significantly associated with non adherence: age {p=0.028} and employment status {p=0.018}. Of those respondents that keep their appointments, 98% are adherent to treatment. When considering reasons for poor adherence; 29% of respondents stated that the clinic did not have their pills, 16% stated that they forgot to take their medication and 14% stated that they travelled to visit ix and did not take enough pills with them. On the reasons for poor adherence to lifestyle: 29% of the respondents said that they were too old, 22% stated no specific reason, 13% struggled to motivate themselves and 10% simply forgot what to do. Most, 68%, of the respondents that adhere to the recommended use of medication agreed that they take it at meal time, 14% set a reminder, 8% employed the assistance of a treatment supporter and other respondents used other means to remember. The study revealed an above average level of adherence in my setting and it will be logical to assess whether this corresponds to the metabolic control expected of good adherence. More is needed to be done on the reasons why our patients do not adhere to both medication and lifestyle changes and each stake holder needs to address their short comings.