In severely ill hospitalised patients with diabetes mellitus (type 1 and type 2) there is an increase in metabolic rate. Insulin requirements are increased and glycaemic control becomes more difficult to achieve. The insulin sliding-scale is a form of „top up‟ therapy used to supplement the patients existing hypoglycaemic medication. In 2002, research at Livingstone Hospital found that 14 different sliding scales were used in 38 patients (Du Plessis, 2002: 79). In 2006 the nurses and doctors working in the general medical wards at Livingstone Hospital indicated that they were willing to use a standardised insulin sliding scale protocol (Smith, 2006: 56). Thus the aim of this study was to assess whether a standardised insulin protocol can be effectively implemented. The objectives of the study were to: 1) assess insulin usage via insulin sliding scales prior to the implementation of the standardised insulin protocol; 2) implement the standardised insulin protocol; and 3) reassess insulin usage after the implementation of the standardised insulin protocol. As the study involved evaluating the use of insulin via the insulin sliding scale and the implemented insulin protocol, it occurred in four phases. The preliminary phase entailed obtaining ethical approval. The pre-intervention phase included data collection in the form of a nursing questionnaire and the auditing of patient medical records using a data collection tool. The intervention phase involved education sessions on the new insulin protocol for the nursing staff, and the implementation of a standardised insulin protocol, while the post-intervention phase comprised of post-intervention data collection, which included a nursing questionnaire, a prescribers questionnaire and the auditing of patient medical records using a data collection tool. The overall impression obtained from the comparison between the pre- and post-intervention nursing questionnaire was conflicting; in some aspects the educational intervention was successful in others not. Regardless the indication obtained was that the nursing staff require more in-service training on a more regular basis as a lack of knowledge regarding diabetes mellitus as a disease state may negatively affect patient outcomes. The overall response from the nursing staff towards the insulin protocol was positive. The prescribers‟ response to the insulin protocol was conflicted. The number of correct insulin sliding scale doses administered in the pre-intervention and post intervention phase improved by 5.25 percent. The number of incorrect insulin sliding scale doses administered during the pre- and post -intervention phase decreased by 5.25 percent. These results are positive and may be due to fewer sliding scales being prescribed in the post-intervention phase and the implemented insulin protocol. Only three (5.55%; n=54) inpatients with Type 1 diabetes mellitus were placed on the implemented protocol that is, the basal bolus regime, and rarely were dose adjustments to their insulin made rendering the effectives of the protocol undesirable. Only four (7.40%; n=54) inpatients with Type 2 diabetes mellitus were placed on the implemented protocol that is, an intermediate- to long-acting insulin (Protophane®). However all four patients experienced immediate improvements in their fasting blood glucose levels. These results indicated that by adding an intermediate- to long-acting insulin (Protophane®) to the therapy of a patient with Type 2 diabetes mellitus fasting blood glucose levels decrease. This would improve patient outcomes and decrease the risk of related diabetic complications. These limited results may indicate a clinical inertia on the part of the prescribers. Unfortunately overall the educational intervention was not successful and the implementation of the protocol was not successful and did not yield the desired results.

About 8.3% of individuals diagnosed with diabetes mellitus (DM) are diagnosed with comorbid depression, a higher rate than the general adult population. This project examined the differences of depression symptoms experienced between diabetic and matched non-diabetic individuals and the relationship of daily activity and nutrition behaviors with depression between these groups. The 2005-2006 National Health and Nutrition Examination Survey (NHANES) was utilized to assess: depression symptoms, diabetic glycemic control as measured by glycoginated hemoglobin (HbA1c), amount of physical activity, percentage of macronutrients, daily frequencies of foods consumed, and the use of nutritional food labels to make food choices. A sample of diabetic (n = 451) and non-diabetic individuals (n = 451) were matched to on age, gender, ethnicity, and education. The diabetic individuals experienced greater depression on both continuous and ordinal diagnostic variables. Counter to expectation, there was no relationship observed between depression and HbA1c in diabetic individuals, r = .04, p > .05.

published_or_final_version / Social Work and Social Administration / Master / Master of Social Sciences

Submitted in fulfillment of the requirements of the degree of Master in Technology, Department of Biomedical Technology and Clinical Technology, Durban University of Technology, Durban, South Africa, 2016. / Introduction In Africa, use of phytotherapy for treatment of diabetes mellitus is a common form of practice. Considering the increasing burden of non-communicable diseases in South Africa efforts are directed at simple, cost effective, non-hazardous and efficient methods to treat cancer, cardiovascular diseases and diabetes. The role of phytonanotherapy is an attractive proposition for advancing new therapies. Metal nanoparticles are a possible means for delivery of such therapies. However, this requires investigation on interactions, mechanisms and therapeutic efficacy upon co-administering ethnobotanicals with metal nanoparticles and existing drug therapy in human beings. Aim The primary aim of the study was to test the in vitro antidiabetic and antibacterial activity of Ocimum sanctum (leaf extracts and flower extracts), Ocimum basilicum (leaf extracts and flower extracts), and a combination of the leaf extracts of both, and to observe whether any antidiabetic and antibacterial activity was enhanced in due to phyto-synthesised bimetallic gold-silver (Au-Ag) nanoparticles and silver nanoparticles. Methods Aqueous and ethanol extracts of O. sanctum and O. basilicum leaf and flowers alone and combined (leaf + flower) were prepared using hot vs cold water extraction techniques and 60% and 70% ethanol as polar solvents. A simple, rapid, cost effective and reproducible green chemistry method synthesised alloyed bimetallic (Au-Ag) nanoparticles using O. basilicum leaf and flower aqueous extracts and prepared silver nanoparticles (AgNps) using O. basilicum and O. sanctum leaf aqueous extracts singly and in combination (O. sanctum + O. basilicum). The size, shape and elemental analysis of the nanoparticles was carried out using UV-Visible spectroscopy, transmission electron microscopy (TEM), scanning electron microscopy coupled with energy-dispersive X-ray (SEM-EDX), dynamic light scattering (DLS) and zeta potential. Fourier transform infrared spectroscopy (FT-IR) supported by gas chromatography mass spectroscopy (GC-MS) identified the bio-capping agents. Antidiabetic carbohydrate metabolising enzymes, α-amylase (porcine) and Bacillus stearothermophilus α-glucosidase as models tested the in vitro inhibitory potential of the aqueous and ethanol plant extracts and the phyto-synthesised (Au-Ag) bimetallic and AgNps. In addition, the study investigated the antibacterial potential for the aqueous plant preparations and their respective phyto-synthesised bimetallic and AgNps against the bacterial species Staphylococcus aureus, Escherichia coli, Bacillus subtilis, Salmonella species and Pseudomonas aeruginosa compared to gentamycin and vancomycin. Results Bimetallic nanoparticles (synthesised from leaf and flower aqueous extracts) displayed inhibitory activity that showed uncompetitive inhibition (leaf extract), and non-competitive inhibition (flower extract) of α-amylase and competitive (leaf extract) and uncompetitive inhibition (flower extract) of α-glucosidase. Bimetallic nanoparticles were higher in inhibitory activity than acarbose and the crude O. basilicum ethanol and aqueous leaf and flower extracts. In the antibacterial analysis, bimetallic nanoparticles derived from O. basilicum leaf showed inhibition against Staphylococcus aureus, Escherichia coli, Bacillus subtilis and Pseudomonas aeruginosa and were greater in activity compared to the crude aqueous leaf extract from O. basilicum. The in vitro inhibitory effect of AgNps derived from O. sanctum and AgNps derived from O. basilicum on both enzymes was higher in activity than acarbose and their respective crude extracts. However, in combination (O. sanctum + O. basilicum), the derived AgNps appeared to be a less potent inhibitor of α-amylase and α-glucosidase enzyme and was lower than acarbose. AgNps synthesised from the combination of O. sanctum and O. basilicum showed the highest percentage inhibition against Bacillus stearothermophilus α-glucosidase, and AgNps derived from O. sanctum and AgNps derived from O. basilicum displayed competitive type of inhibition. In the antibacterial analysis, AgNps derived from the various extracts showed zones of inhibition against the Gram negative and Gram positive bacterial test strains. However, AgNps synthesised from the O. sanctum leaf extract showed higher inhibition against Escherichia coli than the positive control gentamycin and higher inhibition against Staphylococcus aureus compared to vancomycin. In addition, AgNps from O. sanctum leaf extract displayed inhibition against Bacillus subtilis, Pseudomonas aeruginosa and Salmonella species, thus representing the highest antibacterial potential. Conclusion The results demonstrate the possibility of synthesis of stable silver and bimetallic nanoparticles of Ocimum sp. The synthesised silver nanoparticles and first time synthesis of bimetallic (Au-Ag) nanoparticles displayed enhanced antihyperglycaemic properties compared to their respective crude extracts and, therefore, show promising effects in lowering postprandial hyperglycaemia in diabetic patients with dual potential for antibacterial treatment. However, the antidiabetic and antibacterial effect will need to be further affirmed in a clinical context. Medicinal plants with therapeutic value may create a new platform for further research to explore the potential for herbal medicine and nanoscience as effective biomedical and industrial applications, and for improving existing drug delivery systems in diabetic patients. Investigations into the cytotoxicity of these extracts and phytosynthesised nanoparticles is recommended. / M

published_or_final_version / Dentistry / Master / Master of Dental Surgery

published_or_final_version / Nursing Studies / Master / Master of Nursing

The objective of this study was to compare the effects on eating behavior, lipids, lipoproteins, lipid peroxidation, and glycemic control in women with type 2 diabetes of a high-monounsaturated fat diet (HM) compared to a high-carbohydrate diet (HC). In an outpatient feeding study, ten hypertriglyceridemic postmenopausal type 2 diabetic women alternately for six weeks consumed the HM and HC diets. On the HM diet, 45% of total calories were consumed as carbohydrate and 40% as fat (27% monounsaturated) compared to 55% carbohydrate and 30% fat (10% monounsaturated) in the HC diet. At the beginning and end of each diet phase, total lipids, lipoproteins, lipid peroxidation, and glycemic variables were measured. For 8 days in each diet phase eating pattern frequency, palatability of foods, hunger and fullness were assessed. At the end of each diet phase, taste testing to determine preference for fat was conducted. Total cholesterol was significantly decreased on the HC diet. Serum triglyceride, very low density lipoprotein (VLDL) triglyceride and cholesterol, and apolipoproteins A-1 and B were not significantly different on the two diets. When comparing initial to final values, both diets lowered LDL-C; however, the change was greater on the HM diet. Lipid peroxidation variables improved when the HM diet was consumed. Glycemic variables improved on both diets. No significant differences between total number of eating episodes on the HM and HC diet phases were found. Both diets were rated as highly palatable. Hunger and fullness ratings varied within and between subjects. However, fullness was more commonly experienced than hunger on both HM and the HC diet. Preference for fat was not found at the end ofHM or HC diets. However, subjects differed significantly in ratings for liking of foods that were salty, sour, and bitter when compared to nondiabetic women. Consumption of the HM and HC diets did not result in deterioration of lipid status. The HM diet by virtue of less oxidation of the LDL particle and improvement of glycemic control provides an important advantage over the HC diet. A description of eating behavior of women with type 2 diabetes emerged. / Graduation date: 2000

The purpose of this research study was to determine the acceptability of complementary and alternative medicine use in a pediatric population with diabetes. Subjects included 76 patients who attend or have previously attended a diabetes clinic at Riley Hospital for Children in Indianapolis, Indiana.Once patient and parent approval had been granted, the researcher conducted a telephone interview to gather information. Using SPSS statistical software, frequencies and Chi-squared analysis were performed on the data collected. It was revealed that although subjects had a wide variety of concerns with the use of CAM and were unsure about whether it "could heal diabetes or other health problems," a majority were willing to try CAM. Results also indicated that willingness to try CAM was not affected by the age of the child, the type of diabetes present, use of insulin or special diet, or current use of a vitamin or supplement. / Department of Family and Consumer Sciences

Submitted in fulfillment of the requirements for the degree of Master of Clinical Technology (Nephrology), Durban University of Technology, Durban, South Africa, 2013. / Diabetic nephropathy is a serious complication of diabetes that can lead to end stage renal failure (ESRF). It is now the most common cause of ESRF in patients accepted onto renal replacement therapy (RRT) programmes. Kidney disease is common in South Africa. 60-65% is due to inherited hypertension and 20-25% due to Type 2 diabetes (National Kidney Foundation of South Africa, 2002). The renal replacement therapies include haemodialysis, peritoneal dialysis and transplantation. Successful long-term haemodialysis in patients with end stage renal disease (ESRD) depends to a large extent upon a trouble- free vascular access. Achieving a successful vascular access remains a challenge especially in the diabetic population. Current Kidney Dialysis Outcome Quality Initiative (KDOQI) guidelines encourage placing Arterio-Venous Fistula (AVF) in more haemodialysis patients. While the upper limb is the preferred site for AVF creation, researchers are undecided on which is the ideal location (distal or proximal arm) in the diabetic population. Many new fistulae fail to mature sufficiently to be usable for haemodialysis. Pre-insertion work-up with regard to haemodialysis access is important in maintaining the most appropriate access in the growing diabetic population requiring haemodialysis. Pre-operative vascular mapping to identify suitable vessels has been reported to improve vascular access outcomes . In South Africa, duplex scanning is not routinely done, and a clinical judgement by the surgeon remains in most instances the deciding factor on the site of the AVF. Whilst conducting this research, it has been found that while diabetic patients may have AVF created, the maturation time is of a much extended period, and a challenge to achieve the desired dose of dialysis. This is a prospective, quantitative and qualitative study of 21 diabetic patients. These included patients that were starting on the chronic haemodialysis program and limited to patients that were having first attempt of AVF creation and aims to establish if sonogram testing provides a more accurate measure of the ideal location for the AVF, or if a clinical evaluation alone by the surgeon is sufficient. Surgical techniques are different amongst surgeons and clinical evaluation is more a subjective decision. By limiting the surgeons performing the AVF, a standardized surgical procedure was established. If an ideal AVF access for the patient is created, haemodialysis efficiency is increased and ultimately patient outcome improved. The AVF was created according to the clinical evaluation as is the current process, and the surgeons were not aware of the duplex sonogram results. Failure and success of AVF were analysed according to primary patency and functional success. A primary patency success of the AVF does not guarantee functional success. If an AVF is not able to complete an entire haemodialysis session trouble free at the prescribed dialysis dose, the AVF is considered a failure irrespective of primary patency success. This was evident with 10% of patients who had primary patency but functional success was not achieved. With a 55% functional success in this study with AVF created on clinical evaluation, there was no significance difference (p=0.795) if AVFs were based on duplex sonogram findings. However, there was evidence of increased AVF success in 33% of the failed AVFs when the new AVFs were created at the duplex sonogram site. 95% of patients in this study had commenced haemodialysis with a Central Venous Catheter (CVC). AVF success could be increased if early referral of diabetic patients for permanent access to the surgeon occurred. Maturation rate of AVF differed from KDOQI guidelines with AVF first cannulation only after 17 weeks, and not after the recommended time of 6 weeks. Blood flow rates on dialysis also varied with international standards, with only maximum of 400mls/min reached after one year. With distal arm AVF, diameter of radial artery of less than 2mm and cephalic vein less than 3mm was associated with AVF failure. This research study represents the first of its kind in Kwazulu Natal looking at vascular access sites in diabetic patients with End Stage Renal Disease on haemodialysis. / PDF Full-text unavailable. Please refer to hard copy for Full-text / M

This online study evaluated the efficacy of an e-health avatar/cartoon video with women of color living with type 2 diabetes for a minimum of 2 years. After considerable dropout, the sample size declined from n=149, as 50.3% (n=75, 50.33%) did not complete the survey. After eliminating those who did not watch “all” or “most” of the video, the sample declined further. The final sample (n=64) was 31.3% (n=20) U.S.-born, 100% (n=64) female, 79.7% (n=51) Black, and 12.5% (n=8) Asian—with mean age of 49.28 (Min=22, Max=79, SD=13.24). Using backwards stepwise regression, higher post-video global self-efficacy to perform AADE7 Self-Care Behaviors™ was significantly predicted by: higher level of coping self-efficacy—stopping unpleasant emotions and thoughts (B=0.131, p =.001); and higher age (B=0.026, p=.002) with the R2=.331 (Adjusted R2 =.298; 29.8% of the variance was explained). However, less emphasis should be placed on findings from this controversial regression with small sample size. Instead, as this is an online evaluation of a brief online video intervention, what are important are results of pre- versus post-video paired t-test results. These suggested that engagement in the brief online intervention of watching the new video was associated with: a significant increase in type 2 diabetes self-management knowledge for performing the AADE7™ Self-Care Behaviors; and, a significant increase for stages of change, self-efficacy, and motivation to perform the 7 diabetes self-management behaviors. Finally, the mixed methods data were important for underscoring the value of the study’s quantitative findings. Some 89.1% (n=57) would recommend the video to other women of color living with type 2 diabetes. Reflecting how the video intervention was a true innovation in integrating a brief form of motivational interviewing with relapse prevention, consider sample emergent themes: video was motivational; and video covered relapse prevention and problem solving, using a menu of options. There is value in ensuring exposure to an e-health avatar video on the AADE7 Self-Care Behaviors™ that also integrates the evidence-based approaches of motivational interviewing and relapse prevention, in order to meet the health education needs of those diagnosed with type 2 diabetes.