3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Food insecurity and its relationship to glycaemic control in diabetic patients attending Jabulani Dumani Community Health Centre(2018) Nsimbo, Kayumba Bin AssumaniBackground: Food insecurity can predispose diabetic patients to poor glycaemic control. The study aimed to assess the prevalence of food insecurity and its relationship with glycaemic control and other demographic characteristics among diabetic patients attending Jabulani Dumani Community Health Centre. Method: A cross-sectional descriptive study using an administered questionnaire, analysed using nQuery software, Release 7.0. Descriptive statistics were used to analyse independent variables. Chi-square test and logistic regression were used to test associations between variables. Results: Among the 250 participants, 63.6% reported being food insecure and 69.9% had poor glycaemic control. There were statistically significant associations between food insecurity and immigration status (p=0.049), household size (p=0.045), employment status (p=0.033), and glycaemic control (0.000). Conclusion: Overall there is higher prevalence of food insecurity in diabetic populations at the primary healthcare level; hence there is a need for regular screening for food insecurity in all diabetic patients for better glycaemic control.Item Prevalence and factors associated with self-reported diabetes mellitus in Gauteng Province in South Africa(2018) Chiwanda Banda, JonathanIntroduction Diabetes mellitus is a global public health challenge because of its increasing prevalence particularly in low and middle income countries. The prevalence of diabetes varies between countries because of differences in environmental factors and genetic susceptibility. The aim of this study was to estimate the prevalence and determine factors associated with self-reported diabetes mellitus in Gauteng province in South Africa. Methods This was a cross sectional study that used secondary data from a household survey done in 2015 by Gauteng City-Region Observatory. The study had 30,002 participants aged 18 years and above who were selected through multistage sampling technique in which enumeration areas (EAs) as primary sampling unit were drawn using probability proportional to size. Random eligible participants per household were sampled. Prevalence was estimated as a proportion of total diabetes cases from the study sample. Logistic regression was used to analyse the association between diabetes status as an outcome and certain socio-demographic and comorbidity characteristics. Results The estimated prevalence of self-reported diabetes was 11.23% (95% CI: 10.87-11.59) overall, 12.19% (95% CI: 11.69-12.69) in women and 10.13% (95% CI: 9.63-10.63) in men. Factors significantly associated with diabetes were being migrants who had lived in the province for less than ten years [adjusted Odds Ratio (aOR): 0.57, 95% CI: 0.47-0.69], advanced age (aOR: 1.01, 95% CI: 1.01-1.02), socioeconomic status (p<0.0001), Indian race (aOR: 1.52, 95% CI: 1.19-1.94). In addition, a number of comorbidities were associated with diabetes, namely hypertension, heart disease/stroke, HIV/AIDS, tuberculosis, cancer, asthma and mental illness Conclusion The study findings reported higher prevalence of self-reported diabetes mellitus among adult population in Gauteng province compared to national prevalence (8.4%). Migrants who had stayed less than ten years and participants with low socioeconomic status were protected against diabetes. We recommend scaling up public health interventions that would reduce further growth of the disease particularly targeting higher risk population sub-groups. Keywords: Diabetes mellitus, prevalence, Gauteng province.Item Genome-wide gene expression analysis in black South African women who develop gestational diabetes mellitus(2017) Hobbs, Angela Wendy; Hobbs, Angela WendyGestational diabetes mellitus (GDM) is characterized by high blood glucose levels that first develop during pregnancy. GDM has been linked with many adverse short and long term health outcomes for the developing foetus as well as for the mother. The Developmental Origins of Health and Disease (DOHaD) concept suggests that in the presence of adverse stimuli, the foetus will adapt, through epigenetic mechanisms, to ensure its immediate survival. For this reason, epigenetic modifications are emerging as mediators linking early environmental exposures during pregnancy with programmed changes in gene expression that alter offspring growth and development. The objective of this research study was to explore the role of altered gene expression and methylation in the development of GDM and determine whether these alterations are inherited by the exposed foetus. Transcriptome sequencing was performed on mRNA extracted from blood samples collected from six women with GDM and from six controls; as well as from exposed (N=6) and unexposed placenta (N=6). Genes that displayed significant (p<0.005) differential expression (log2 fold change >2 and <-2) between cases and controls were identified from the blood (N=60) and placenta (N=56) datasets. Gene ontology and enrichment was performed using DAVID and PANTHER with the aim to narrow down the candidate gene lists. The ten most likely candidate genes for differential gene expression from the blood dataset were G6PD, DCXR, TKT, ALDOA, PGLS, KCNQ1, C14orf80, KCNQ1, SLC25A22 and GSK3A. Gene enrichment revealed that five of these significantly under-expressed genes (G6PD, DCXR, TKT, ALDOA and PGLS) encode enzymes in the pentose phosphate pathway (PPP). In the placental dataset the top ten candidate genes were CXCR1, CXCR2, G6PD, TKT, IGFBP-1, IGFBP-2, IGFBP-6, GGT3P, MMP12 and GLT1D1. The direction and fold change of differential expression of all twenty genes were validated using TaqMan qPCR probes. Of these twenty genes, the five most promising biological candidates (G6PD, TKT, IGFBP-1, IGFBP-2 and IGFBP-6) were identified and the level of promoter region methylation was assessed using EpiTech Methyl II PCR Assays. The level of methylation in the promoter region of G6PD in both blood and placenta tissue was found to be significantly higher (p=1.90 x 10-5 and p=1.2 x 10-11 respectively) in the case groups, correlating with decreased mRNA expression levels. There was a significant negative correlation between G6PD mRNA expression in the blood and placenta with the level of maternal glucose at fasting (p=0.006 and p=0.001, respectively), 1-hr (p=0.016 and p=0.007, respectively) and 2-hr post OG (p=0.045 in placenta). We observed a significant positive correlation between G6PD promoter region methylation in both blood and placental tissues with maternal glucose levels at fasting (p=0.023 and p=0.001, respectively) and at 1-hr post OG (p=0.001 and p=0.004, respectively). IGFBP-1 was found to be significantly under-expressed in exposed placental tissue and hypermethylated (p=1.1 x 10-6) at the promoter region when compared to unexposed samples. There was a significant negative correlation between the expression of IGFBP-1 mRNA in the blood and placenta with foetal birth weight (p=0.005 and p=0.017, respectively). Our results suggest that high glucose levels, an important characteristic of GDM, result in the disturbance of the pentose phosphate pathway, a pathway linked closely to glycolysis, and the IGF-axis, which is important in foetal growth and development. In GDM there is suppression of G6PD mRNA expression in both the blood and placental tissue which influences the pentose phosphate pathway. We hypothesize that this is mediated through an epigenetic mechanism since it is correlated with increased methylation of the G6PD promoter region. Down regulation of G6PD would suppress the PPP and reduce the levels of NADPH production, which may in turn lead to an increase in oxidative stress and an adverse outcome in the mother and foetus. With regard to the IGF-axis, our results demonstrated that IGFBP-1 and IGFBP-2 mRNA expression in the placenta may be inhibited due to the presence of high glucose and insulin levels and this decrease in mRNA expression is likely implicated in the abnormal foetal growth which is often associated with GDM. This study has provided novel insights into gene expression and DNA methylation changes in the blood of women with GDM and the placenta of their female offspring that involve genes in the PPP and the IGF-axis.Item Assessing fear of hypoglycaemia among parents of children with Type 1 Diabetes Mellitus(2017) Madumetse, Kitsiso OneIntroduction: Hypoglycaemia is the most widespread acute side effect of insulin therapy in individuals with type 1 diabetes mellitus. Severe hypoglycaemia can cause loss of consciousness, seizures, accidents or physical injuries, and even death. Given these severe consequences, it is almost inevitable for patients or their caregivers not to develop fear of hypoglycaemia. Fear of hypoglycaemia in children and their parents has not, thus far, been measured at diabetic clinics in South Africa. Fear of hypoglycaemia among paediatric type 1 diabetes mellitus patients and their parents affects quality of life and adherence to diabetes management strategies. However, behavioural workshops can address and decrease such fears and therefore increase compliance with T1DM management programmes. An improved understanding of fear of hypoglycaemia should assist nurses running clinics to develop appropriate programmes to offer support. Aim of the study: To assess fear of hypoglycaemia among parents whose children have type 1 diabetes mellitus. Study objectives: The objectives of the study were: 1. To identify aspects suggestive of worry about hypoglycaemia among parents whose children have type 1 diabetes mellitus, and 2. To determine the behaviours adopted by parents to prevent hypoglycaemia among children with type 1 diabetes mellitus. Method: A descriptive and cross-sectional survey design was used to identify factors suggesting fear of hypoglycaemia among parents and the actions parents take to prevent hypoglycaemia. In this study the population comprises parents of type 1 diabetes mellitus children attending a specific diabetic outpatient’s clinic (N=140). The total population was used as a sample over a period of three months due to the limited population size. Fifteen (15) patients are pre-booked for clinic services every Monday from 08h00–13h00. vi Only parents or guardians of children aged 3 to 18 years, diagnosed with type 1 diabetes mellitus and on insulin therapy, were considered eligible for the study. Data collection: A self-administered Hypoglycaemia Fear Survey – Parent version (HFS-P) was used to collect data. Besides demographic data, the HFS-P’s data collection tool focuses on worry and avoidant behaviours, with a total of 25 questions scored using Likert Scales ranging from 0 (“never”) to 4 (“always”). The Worry subscale HFS-P (W) measures different anxiety-provoking aspects of hypoglycaemia. The Behaviour subscale HFS-P (B) measures behaviours used to avoid hypoglycaemia and its consequences. The demographic data collected concerned parents’ ages, genders, marital status, employment status and levels of education. Data analysis: Data was analysed using STATA version 13.1. Data analysis was divided into descriptive and inferential statistics. Results: Parents of type 1 diabetes mellitus children are more likely to experience fear of hypoglycaemia and to practise negative behaviours to avoid hypoglycaemia, which eventually impact negatively on glycaemic control. Nurses should be able to intervene and teach such parents how to manage type 1 diabetes mellitus correctly.Item A study of some aspects of the metabolism of fatty acids by the human red blood cell in health and disease, with special reference to diabetes mellitus(1962-11) Mendelsohn, DennisThe awakening of an appreciation of the importance of biochemistry to medical science in recent years has prompted the clinical chemist to study and explain disease mechanisms in terms of fundamental cellular metabolism. However these efforts have been considerably hampered by obvious difficulties involved in obtaining suitable tissues for experimental purposes. Most of our rather meagre understanding of the underlying mechanisms causing metabolic diseases in the human subject has been obtained by absolute chemical analysis of the body fluids of which it is probably true to say that the blood ( either whole blood or serum ) has been the most extensively studied. It is becoming increasingly apparent however, that this type of approach does not offer a satisfactory explanation for the disturbed metabolic reactions in certain diseasesItem Infants of diabetic mothers: maternal and infant characteristics and incidence of hypoglcemia(2016) Magadla, YoliswaBackground: Diabetes mellitus is the most common metabolic disease affecting women during pregnancy and is associated with adverse outcomes during the neonatal period, common one being hypoglycemia. The characteristics and incidence of hypoglycemia in infants of diabetic mothers (IDM) are not well reported in South Africa. Objectives: To describe the characteristics of IDM with or without hypoglycemia and to determine prevalence of hypoglycemia in IDM. Methods: Medical records of mothers, and their infants admitted with a diagnosis of IDM at gestational age ≥34 weeks and/ or birth weight ≥2000 grams and admitted at CHBAH from January 2012 to December 2013, were retrieved. Maternal characteristics, type and treatment of diabetes, infant characteristics and glucose measurements were captured for analysis. Results: A total of 234 IDM were admitted over this 2-year period and 207 met inclusion criteria. Median maternal age was 33 years. Seven percent of mothers had stillbirths and 14% had miscarriages in previous pregnancies. A total of 56% of mothers had gestational diabetes. Among infants, 54% were born preterm, 19% were large for gestational age (LGA) and 10% were macrosomic. Pre-gestational diabetic mothers had higher preterm births than gestational diabetic mothers (64% vs 48%, p=0.037). Hypoglycemia occurred in 39% of IDM, occurring within the first 3 hours of life in 85% of infants. There were no statistically significant differences in types of maternal diabetes and its treatment between hypoglycaemic and normoglycaemic infants, but hypoglycaemic infants were more likely to be LGA (28.2% vs 12.8%, p=0.009). Conclusion: Hypoglycemia is a common finding in IDM, presenting early in postnatal age. Only just over a quarter of hypoglycaemic infants are LGA. All IDM should be monitored for hypoglycemia, especially within the first 3 hours of life.Item Patient-reported knowledge, perception and practice, regarding diabetic self-management skills and behaviours, in Mokopane Provincial Hospital(2013-11) Etukudo, Inyang OdiongBACKGROUND: Diabetes Mellitus is a chronic metabolic disease that is a global problem. The increasing incidence and prevalence globally is of great concern. This condition is a long-term challenge, which requires behavioural change and adherence to management to maintain glycaemic control. Good knowledge of diabetes influences adequate self-care practices, glycaemic control, and overall diabetes management. Incorrect self-care practices impair the achievement of the desired treatment targets. AIMS AND OBJECTIVES: This study aimed to determine patient-reported knowledge, perceptions and practice regarding diabetes self-management skills and behaviour through assessing knowledge, reported practice, and perceptions of diabetic self-management among adult patients with diabetes attending the diabetic clinic at Mokopane provincial hospital, and determining the strength of associations between knowledge, reported practice, perception of self-care and glycaemic control. DESIGN AND METHODS: This was a descriptive cross sectional study using a questionnaire on knowledge, perception and self-management practices. Participants were recruited consecutively until the sample size of 76 was reached. Data was analysed using the statistical software SPSS version 17.0. RESULTS: There were more females (71%) and most of the participants (39%) were above 60 years of age. The majority of participants (87%) had a HbA1c of >7%, with a mean HbA1c of 10.2%. Diabetic knowledge was poor. A majority of the participants answered less than 50% of the knowledge questions correctly. More than half of the respondents could not answer the diabetes knowledge questions correctly. The proportion of participants, who responded positively to 3 of the 4 questions to assess knowledge and perception of self-care, was in the range of 70-90%. 86% of participants indicated that they had adjusted their diet since being diagnosed with diabetes. 48% of participants reported that they always adhered well to medication. Most of the participants (81%) indicated that they do not smoke. Responses to other questions to assess practice of self-care showed that only 29% of the participants always practiced the self-care activities stated. There was no statistically significant association between knowledge of diabetes, practice, perception of self-care and glycae. CONCLUSION: General knowledge of diabetes and practice of self-care were inadequate, but perception about diabetes self-care was good. Although many participants had altered their diet, their diabetic control was poor. Poor general knowledge of diabetes, not practicing self-care and poor diabetic control were found in the majority of participants although there was no statistically significant association among these measures.mic control (HbA1c).Item The awareness and performance of appropriate foot self-care practices among diabetic patients attending Dr. Yusuf Dadoo Hospital, Gauteng Province, South Africa.(2012-01-19) Dikeukwu, Robert AIntroduction Diabetes (especially type 2) is a common and growing health problem with significant mortality and morbidity including foot problems (neuropathy, ulceration, infection and amputation) These micro vascular/macro vascular complications can be decreased with certain treatments including good diabetic foot self-care. With this in mind, I set out to measure self-reported knowledge/awareness and performance of appropriate foot self-care among diabetic patients attending Dr. Yusuf Dadoo Hospital-a level one urban hospital. My premise which was borne by my result was that foot self-care and awareness thereof was poor among sampled diabetic patients. This can be attributed to both scant education and infrequent foot examination by clinicians and poor adherence to appropriate foot care by majority of the patients surveyed. Objectives: To determine the awareness and performance of appropriate foot self-care practices among diabetic patients attending the out-patient unit of Dr. Yusuf Dadoo Hospital. Study design and methods: This was a descriptive cross sectional study. Participants were consecutively recruited until the sample size of 120 was reached. A questionnaire was used to collect data. Data was analysed using STATA version 10.0. Main outcome measures: foot self-care practices, the level of awareness of foot self-care and foot abnormalities found in diabetics Results: There were more females (60%) than males (40%) and the mean age was 56.3 years. About 30.8% of patients had not inspected their feet for one week, while 21.7% had done it poorly. 92.5% did not use talcum powder to dry their feet, 45.8% did not inspect their shoe before wearing and 94.2% did not make use of a podiatrist at all. However, 53.3% did not soak their feet in water and only 25% walked bare foot while 75% did not. Only about 37.5% has had their feet examined by either a doctor or a nurse while 67.5% had not. Hypertension was found to be the commonest co-morbidity occurring in 60% of the patients studied Athlete‟s foot was the most frequently occurring foot problem found in 16.2% of these patients. Conclusion: Majority of the patients had poor awareness and poor foot self-care practices or inadequate foot self-care practices .Appropriate foot care education should be given to diabetic patients by health care professional to enable them carry out adequate foot self-care practices.Item Scintigraphic assessment of cardiovascular diseases in asymptomatic diabetic black patients(2012-01-10) Vangu, Mboyo Di Tamba Heb'En WillyThe association between diabetes and coronary artery disease (CAD) has been recognized as a major public health problem in the developed world. While there is an increased prevalence of silent myocardial ischaemia among asymptomatic individuals with diabetes, diabetic individuals with CAD in their larger number are usually asymptomatic, and when they present with signs of disease, there is extensive and severe CAD. It should be noted that amongst black South African, ischemic heart disease (IHD) remains rare, and there is little data linking diabetes mellitus with IHD. However, contrary to early reports that have suggested a low prevalence of CAD in black population in Africa, many studies have indicated a rapid change on the spectrum of CAD in numerous parts of the African continent. Despite the emerging report of high prevalence of risk factors there are only limited data investigating prevalence of CAD in black African with diabetes. The purpose of this thesis was to use myocardial perfusion imaging (MPI) at rest and after stress testing to detect CAD in a group of asymptomatic black patients suffering from diabetes and therefore assess the prevalence of CAD; to assess the changes in myocardial perfusion in asymptomatic diabetic black individuals and compare the differences seen in myocardial perfusion changes between the asymptomatic diabetic black and, the asymptomatic diabetic white and Indian individuals; to include data from symptomatic diabetic patients who were referred for MPI as part of their routine clinical management for possible comparison Consecutive 94 asymptomatic diabetic black patients and 50 asymptomatic diabetic white and Indian patients were recruited from the outpatient diabetic clinic of the Johannesburg hospital. Data from 90 subjects forming a group of symptomatic diabetic patients, 45 blacks and 45 whites and Indians referred for MPI as part of their clinical management were also analyzed. A two-day protocol for SPECT MPI was used in all participants: on the first day the stress testing MPI while the rest MPI was consistently done on the second day. Both exercise and pharmacologic stress testing were used. Technetium-99m methoxy-isobutylisonitrile (MIBI) was used as the myocardial perfusion radiopharmaceutical. Myocardial perfusion was assessed by means of semi-quantitative scoring system to measure the extent and severity of perfusion abnormality. Visual inspection of the reconstructed SPECT MPI images was carried out to assess perfusion deficit where there was a doubt on the extent and severity of perfusion abnormality. The QPS/QGS software allows obtaining resting and post stress left ventricular ejection fraction (LVEF). The means and percentages on study variables were obtained. The Spearmen correlation coefficient was used to calculate correlations between variables. The Kruskal-Wallis test was used to assess differences between black diabetic and white or Indian diabetic patients and Wilcoxon scores (rank sum) two-sided were used to measure differences within these racial groups. There were 123 females (52.6%) and 111 males (47.4%) in total. From the recruited participants, 53 (56.4%) asymptomatic females and 41 (43.6%) asymptomatic males were blacks whereas 24 (48%) asymptomatic females and 26 (52%) asymptomatic males were whites or Indians. The symptomatic group was comprised of 26 (57.8%) female and 19 (42.2%) male black patients and 20 (44.5%) female and 25 (55.5%) male white or Indian patients. Asymptomatic diabetic black participants were younger than the participants from the asymptomatic diabetic white and Indian group with a mean age of 60 (SD±7.2) years Vs 64 (SD±7.7) [p=0.003]. Fourteen percent of asymptomatic black participants had evidence of ischaemia by showing improvement of perfusion on stress testing versus twenty eight percent of white and Indian asymptomatic participants (p=0.62). Perfusion defects that did not change from rest to post stress testing MPI (fixed defects) were also noted in 20% of asymptomatic black and 26% of asymptomatic white and Indian diabetic participants. These fixed perfusion defects are indicative of previous myocardial infarctions and therefore suggestive of CAD. No significant difference was noted on the changes of perfusion that could account either for ischaemia or infract between asymptomatic diabetic black participants and their white and Indian counterparts (p=0.47). The difference on the improvement of perfusion from rest to post-stress MPIs or reversibility of perfusion to suggest only the presence of ischaemia did not also show a significant difference between these two racial groups (p=0.62). Our data demonstrated a high prevalence of CAD in asymptomatic diabetic black participants similar to other racial groups. Our study has demonstrated evidence to recommend screening of asymptomatic diabetic black individuals in equal manner than other races for the detection of CAD. More importantly, stress MPI should be routinely used as a noninvasive investigation in our environment and be utilized more actively in the management of all asymptomatic diabetic patients.