Experiences of young adults living with type 1 diabetes mellitus regarding self-management and lifestyle adaptation in the Nelson Mandela Bay Health District
- Fayindlala, Meliswa Theodora
- Authors: Fayindlala, Meliswa Theodora
- Date: 2019
- Subjects: Diabetes -- Treatment , Diabetes Lifestyles -- Health aspects
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: http://hdl.handle.net/10948/39818 , vital:35476
- Description: Living with type1 diabetes mellitus (T1DM), which is a challenging disease, is especially difficult during the young adult stage of development. This developmental stage is characterised as complex; difficult even for healthy individuals. There is an estimated worldwide increase of 415 million young adults living with T1DM, and this number is projected to rise to 642 million by 2040. Recent statistics indicate that this increase holds true for South Africa. T1DM has an early onset and is treated with insulin injections up to four (4) times a day. The management of T1DM is best achieved through self-management of an individual living with the disease as well as support from the health care providers, community, and the family. Young adults living with T1DM experience difficulties maintaining optimal blood glucose levels, ranging between four (4) and seven (7) millimoles, during this stressful transition period from childhood to young adulthood. Transitional actions include moving away from home for the first time to study at a tertiary institution, joining the work-force, or entering new relationships, such as getting married and becoming a parent. This phenomenon motivated the researcher to explore and describe the experiences of young adults living with T1DM regarding self-management and lifestyle-adaptation. The study followed a qualitative, exploratory, descriptive, and contextual design. The research population included young adults living with T1DM between the ages of 18 and 25 years in the Nelson Mandela Bay Health District, attending a diabetic clinic at a public tertiary hospital. Purposive sampling was utilised to select the 11 participants. A pilot study was conducted with one (1) participant before the main study commenced to ensure the trustworthiness of the findings. The researcher obtained data through semi-structured one-on-one interviews. Tesch’s method was used to analyse the research data. Once data were analysed; the findings underwent literature control. Lincoln and Guba’s model of trustworthiness was utilised to ensure that the study was trustworthy and credible which consists of the following four criteria: credibility, transferability, dependability, and conformability. Ethical principles such as autonomy, informed consent, beneficence, and justice were considered throughout the study to ensure that participants do not experience any violations during the research study. The results of the data analysis revealed the following main findings: Participants had negative experiences in relation to T1DM. Participants shared their experiences in relation to achieving self-management of T1DM. Recommendations were made to assist registered nurses to manage young adults living with T1DM adequately. The study achieved its intended objective.
- Full Text:
- Date Issued: 2019
- Authors: Fayindlala, Meliswa Theodora
- Date: 2019
- Subjects: Diabetes -- Treatment , Diabetes Lifestyles -- Health aspects
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: http://hdl.handle.net/10948/39818 , vital:35476
- Description: Living with type1 diabetes mellitus (T1DM), which is a challenging disease, is especially difficult during the young adult stage of development. This developmental stage is characterised as complex; difficult even for healthy individuals. There is an estimated worldwide increase of 415 million young adults living with T1DM, and this number is projected to rise to 642 million by 2040. Recent statistics indicate that this increase holds true for South Africa. T1DM has an early onset and is treated with insulin injections up to four (4) times a day. The management of T1DM is best achieved through self-management of an individual living with the disease as well as support from the health care providers, community, and the family. Young adults living with T1DM experience difficulties maintaining optimal blood glucose levels, ranging between four (4) and seven (7) millimoles, during this stressful transition period from childhood to young adulthood. Transitional actions include moving away from home for the first time to study at a tertiary institution, joining the work-force, or entering new relationships, such as getting married and becoming a parent. This phenomenon motivated the researcher to explore and describe the experiences of young adults living with T1DM regarding self-management and lifestyle-adaptation. The study followed a qualitative, exploratory, descriptive, and contextual design. The research population included young adults living with T1DM between the ages of 18 and 25 years in the Nelson Mandela Bay Health District, attending a diabetic clinic at a public tertiary hospital. Purposive sampling was utilised to select the 11 participants. A pilot study was conducted with one (1) participant before the main study commenced to ensure the trustworthiness of the findings. The researcher obtained data through semi-structured one-on-one interviews. Tesch’s method was used to analyse the research data. Once data were analysed; the findings underwent literature control. Lincoln and Guba’s model of trustworthiness was utilised to ensure that the study was trustworthy and credible which consists of the following four criteria: credibility, transferability, dependability, and conformability. Ethical principles such as autonomy, informed consent, beneficence, and justice were considered throughout the study to ensure that participants do not experience any violations during the research study. The results of the data analysis revealed the following main findings: Participants had negative experiences in relation to T1DM. Participants shared their experiences in relation to achieving self-management of T1DM. Recommendations were made to assist registered nurses to manage young adults living with T1DM adequately. The study achieved its intended objective.
- Full Text:
- Date Issued: 2019
Liver steatosis and insulin-resistance : reversal by Sutherlandia frutescens
- Authors: Clarke, Stephen
- Date: 2014
- Subjects: Insulin resistance , Diabetes -- Treatment
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: vital:10348 , http://hdl.handle.net/10948/d1020788
- Description: Type 2 diabetes mellitus (T2DM) is rapidly emerging as one of the greatest global health issues of the 21st century. Insulin-resistance is a condition associated with T2DM and in the cell it is defined as the inadequate strength of insulin signalling from the insulin receptor downstream to the final substrates of insulin action involved in multiple metabolic, gene expression, and mitogenic aspects of cellular function. To investigate the potential mechanisms involved in the development of insulin-resistance, two in vitro liver cell models were established using palmitate or a combination of insulin and fructose as inducers. The development of insulin-resistance was determined via the capacity of the hepatocytes to maintain normal glucose metabolism functionality by measuring hepatic gluconeogenesis and glycogenolysis. It was established that the treatments induced the development of insulinresistance after 24 hours chronic exposure. Previous studies have investigated the potential of Sutherlandia frutescens extracts as therapeutic agents for insulin-resistance. The aim of this study was thus to investigate the ability of a hot aqueous extract of S. frutescens to reverse the insulin-resistant state, via measuring gluconeogenesis and glycogenolysis, the associated changes in cellular physiology (lipid accumulation, oxidative stress, and acetyl- CoA levels), and changes in mRNA expression. The results showed that S. frutescens had a significant effect on reversing the insulin-resistant state in both models of insulin-resistance. Furthermore, S. frutescens was capable of reducing lipid accumulation in the form of triacylglycerol in the high insulin/fructose model, while this was unaffected in the palmitate model. However, S. frutescens did reduce the accumulation of diacylglycerol in the palmitate model. Oxidative stress, seen to be associated with the insulin-resistant state, was successfully treated using the extract, as indicated by a reduction in reactive oxygen species. However no change was seen in the nitric oxide levels, in either model. Interestingly, although S. frutescens had no effect on the level of acetyl-CoA in the insulin/fructose model, it was found to increase this in the palmitate model. It is suggested that this may be due to increased β-oxidation and metabolic activity induced by the extract. The analysis of mRNA expression gave some insight into possible mechanisms by which insulin-resistance develops, although the results were inconclusive due to high variability in samples and the possibility of the RNA being compromised. Future studies will address this issue. The results of this study reflect different proposed clinical causes of insulin-resistance through the responses seen in the two cell models. These indicate that liver steatosis and insulin-resistance are induced by high palmitate as well as high insulin and fructose levels, and reversed by S. frutescens. Therefore the potential of S. frutescens to be used as a therapeutic agent in the treatment of insulin-resistance is indicated by this study.
- Full Text:
- Date Issued: 2014
- Authors: Clarke, Stephen
- Date: 2014
- Subjects: Insulin resistance , Diabetes -- Treatment
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: vital:10348 , http://hdl.handle.net/10948/d1020788
- Description: Type 2 diabetes mellitus (T2DM) is rapidly emerging as one of the greatest global health issues of the 21st century. Insulin-resistance is a condition associated with T2DM and in the cell it is defined as the inadequate strength of insulin signalling from the insulin receptor downstream to the final substrates of insulin action involved in multiple metabolic, gene expression, and mitogenic aspects of cellular function. To investigate the potential mechanisms involved in the development of insulin-resistance, two in vitro liver cell models were established using palmitate or a combination of insulin and fructose as inducers. The development of insulin-resistance was determined via the capacity of the hepatocytes to maintain normal glucose metabolism functionality by measuring hepatic gluconeogenesis and glycogenolysis. It was established that the treatments induced the development of insulinresistance after 24 hours chronic exposure. Previous studies have investigated the potential of Sutherlandia frutescens extracts as therapeutic agents for insulin-resistance. The aim of this study was thus to investigate the ability of a hot aqueous extract of S. frutescens to reverse the insulin-resistant state, via measuring gluconeogenesis and glycogenolysis, the associated changes in cellular physiology (lipid accumulation, oxidative stress, and acetyl- CoA levels), and changes in mRNA expression. The results showed that S. frutescens had a significant effect on reversing the insulin-resistant state in both models of insulin-resistance. Furthermore, S. frutescens was capable of reducing lipid accumulation in the form of triacylglycerol in the high insulin/fructose model, while this was unaffected in the palmitate model. However, S. frutescens did reduce the accumulation of diacylglycerol in the palmitate model. Oxidative stress, seen to be associated with the insulin-resistant state, was successfully treated using the extract, as indicated by a reduction in reactive oxygen species. However no change was seen in the nitric oxide levels, in either model. Interestingly, although S. frutescens had no effect on the level of acetyl-CoA in the insulin/fructose model, it was found to increase this in the palmitate model. It is suggested that this may be due to increased β-oxidation and metabolic activity induced by the extract. The analysis of mRNA expression gave some insight into possible mechanisms by which insulin-resistance develops, although the results were inconclusive due to high variability in samples and the possibility of the RNA being compromised. Future studies will address this issue. The results of this study reflect different proposed clinical causes of insulin-resistance through the responses seen in the two cell models. These indicate that liver steatosis and insulin-resistance are induced by high palmitate as well as high insulin and fructose levels, and reversed by S. frutescens. Therefore the potential of S. frutescens to be used as a therapeutic agent in the treatment of insulin-resistance is indicated by this study.
- Full Text:
- Date Issued: 2014
Nursing strategies to facilitate self-management in persons living with diabetes mellitus type 2
- Authors: O'Brien Coleen Ann
- Date: 2011
- Subjects: Diabetes -- Treatment , Nurses -- South Africa , Diabetes -- Prevention Popular works
- Language: English
- Type: Thesis , Doctoral , DPhil
- Identifier: vital:10019 , http://hdl.handle.net/10948/1627 , Diabetes -- Treatment , Nurses -- South Africa , Diabetes -- Prevention Popular works
- Description: The growing pandemic of diabetes mellitus (DM) is continuing to spread around the world with developing countries being most vulnerable. Diabetes mellitus is the direct cause of 5 percent of deaths worldwide at present, with an expected increase of 50percent in the next 10 years. Diabetes mellitus was virtually unknown in Africa at the start of the 20th century but the incidence is expected to increase by 80 percent by 2025. South African estimates indicate that at present there are up to four million people living with DM in South Africa, with an expected rise of 25 percent by 2020. If DM is not adequately controlled, life-threatening complications ensue, resulting in financial, physical and emotional costs both for people living with the condition and for their families. There is also a great financial burden on the state, both directly due to the cost of providing health care and indirectly due to loss of productivity and a reduced tax base. Global initiatives against DM include the Diabetes Strategy for Africa compiled by the International Diabetes Federation and World Health Organization. There are several forms of DM with Type 2 being the most common with an estimated 95% of cases. Optimal glycaemic control is essential for the management of DM, potentially allowing the course of the disease to be slowed or halted. The previous medical model of management of chronic disease has changed to an empowerment approach where the person living with the condition is a partner in the management process. This is particularly true of DM where all aspects of life are affected by the condition. During Phase One of this study, a qualitative, exploratory, descriptive, contextual approach was utilized to explore and describe the experiences of persons living with DM and of diabetes nurse educators who assist them in Nelson Mandela Bay. During Phase Two, a conceptual framework was created and utilized to develop strategies which professional nurses may use in facilitating self-management by persons living with DM. Persons living with DM experience a definite initial experience on diagnosis of DM but gradually gain an acceptance and acknowledgment of their condition. They have definite views on the concept of self-management and experience both positive and negative factors influencing self-management. They also have definite ideas on how professional nurses may assist them in achieving self-management. These findings were confirmed ii by the experiences of the diabetes nurse educators who formed the second group of participants in this study. The ACE approach to self-management of DM consists of an Action Strategy, a Coordination Strategy and an Education Strategy. The ACE approach makes use of grand and functional strategies implemented on the macro (national), meso (provincial) and micro (local) levels to enable the professional nurse to assist persons living with DM to achieve self-management of their condition. Grand strategies need to be implemented on a macro or meso level to enable the professional nurse to function effectively on a micro level. Assisting the patient has to go beyond merely improving knowledge about the condition but has to include individual goal setting as well as problem solving skills and coping strategies as part of a therapeutic relationship between the professional nurse and the person living with DM. The level of personal responsibility achieved by persons living with DM is affected by the memes which they hold regarding their level of health and their ability to address any barriers to self-management which they may experience. Making use of the process of the therapeutic relationship, the professional nurse is able to positively influence the memes held by persons living with DM and assist them in achieving a greater level of personal responsibility. The therapeutic relationship is potentially influenced by all three of the strategies described above. This study provides insight into the experiences of persons living with DM and of the diabetes nurse educators who assist them in Nelson Mandela Bay. Recommendations regarding the implementation of a National Diabetes Policy on a macro level are made, as well as recommendations for nursing practice, education and research. The strategies which were evaluated by an Expert Panel provide a tool for the professional nurse to use while assisting persons living with DM by facilitating the growth of personal responsibility leading to self-management.
- Full Text:
- Date Issued: 2011
- Authors: O'Brien Coleen Ann
- Date: 2011
- Subjects: Diabetes -- Treatment , Nurses -- South Africa , Diabetes -- Prevention Popular works
- Language: English
- Type: Thesis , Doctoral , DPhil
- Identifier: vital:10019 , http://hdl.handle.net/10948/1627 , Diabetes -- Treatment , Nurses -- South Africa , Diabetes -- Prevention Popular works
- Description: The growing pandemic of diabetes mellitus (DM) is continuing to spread around the world with developing countries being most vulnerable. Diabetes mellitus is the direct cause of 5 percent of deaths worldwide at present, with an expected increase of 50percent in the next 10 years. Diabetes mellitus was virtually unknown in Africa at the start of the 20th century but the incidence is expected to increase by 80 percent by 2025. South African estimates indicate that at present there are up to four million people living with DM in South Africa, with an expected rise of 25 percent by 2020. If DM is not adequately controlled, life-threatening complications ensue, resulting in financial, physical and emotional costs both for people living with the condition and for their families. There is also a great financial burden on the state, both directly due to the cost of providing health care and indirectly due to loss of productivity and a reduced tax base. Global initiatives against DM include the Diabetes Strategy for Africa compiled by the International Diabetes Federation and World Health Organization. There are several forms of DM with Type 2 being the most common with an estimated 95% of cases. Optimal glycaemic control is essential for the management of DM, potentially allowing the course of the disease to be slowed or halted. The previous medical model of management of chronic disease has changed to an empowerment approach where the person living with the condition is a partner in the management process. This is particularly true of DM where all aspects of life are affected by the condition. During Phase One of this study, a qualitative, exploratory, descriptive, contextual approach was utilized to explore and describe the experiences of persons living with DM and of diabetes nurse educators who assist them in Nelson Mandela Bay. During Phase Two, a conceptual framework was created and utilized to develop strategies which professional nurses may use in facilitating self-management by persons living with DM. Persons living with DM experience a definite initial experience on diagnosis of DM but gradually gain an acceptance and acknowledgment of their condition. They have definite views on the concept of self-management and experience both positive and negative factors influencing self-management. They also have definite ideas on how professional nurses may assist them in achieving self-management. These findings were confirmed ii by the experiences of the diabetes nurse educators who formed the second group of participants in this study. The ACE approach to self-management of DM consists of an Action Strategy, a Coordination Strategy and an Education Strategy. The ACE approach makes use of grand and functional strategies implemented on the macro (national), meso (provincial) and micro (local) levels to enable the professional nurse to assist persons living with DM to achieve self-management of their condition. Grand strategies need to be implemented on a macro or meso level to enable the professional nurse to function effectively on a micro level. Assisting the patient has to go beyond merely improving knowledge about the condition but has to include individual goal setting as well as problem solving skills and coping strategies as part of a therapeutic relationship between the professional nurse and the person living with DM. The level of personal responsibility achieved by persons living with DM is affected by the memes which they hold regarding their level of health and their ability to address any barriers to self-management which they may experience. Making use of the process of the therapeutic relationship, the professional nurse is able to positively influence the memes held by persons living with DM and assist them in achieving a greater level of personal responsibility. The therapeutic relationship is potentially influenced by all three of the strategies described above. This study provides insight into the experiences of persons living with DM and of the diabetes nurse educators who assist them in Nelson Mandela Bay. Recommendations regarding the implementation of a National Diabetes Policy on a macro level are made, as well as recommendations for nursing practice, education and research. The strategies which were evaluated by an Expert Panel provide a tool for the professional nurse to use while assisting persons living with DM by facilitating the growth of personal responsibility leading to self-management.
- Full Text:
- Date Issued: 2011
Optimisation of pharmacological management of diabetes mellitus in a primary health care setting
- Authors: Dickason, Beverley Janine
- Date: 2007
- Subjects: Diabetes , Diabetes -- Treatment
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10161 , http://hdl.handle.net/10948/846 , http://hdl.handle.net/10948/d1012902 , Diabetes , Diabetes -- Treatment
- Description: Levels of diabetic care in primary health care settings in South Africa have been found to be sub-optimal. Knowledge deficits and inadequate practices have been implicated in the poor quality of local diabetes care. Type 2 diabetes and hypertension are commonly associated chronic conditions hence to optimise diabetic care, tight control of blood pressure is essential. Although guidelines for the overall management of diabetes in a primary health care setting have been published (Working Group of the National Diabetes Advisory Board, 1997; Society for Endocrinology, Metabolism and Diabetes of South Africa, 2002a), adherence to these guidelines has not yet been optimised in the primary health care setting. The objectives of the study were: to design and implement an educational intervention aimed at nursing staff, based on the South African guidelines for type 2 diabetes and hypertension, at a public sector primary health care clinic; to determine the impact of the educational intervention on the level of knowledge and attitudes of the nursing staff, and on the level of diabetic and blood pressure control achieved in the patient population, and to determine the impact of the educational intervention on pharmacological management of patients. A questionnaire was used to quantitatively assess the nursing staffs’ knowledge of the management of type 2 diabetes and hypertension at a primary health care level. A qualitative evaluation of the nursing staff attitudes was obtained using focus group interviews. The educational intervention, in the form of lectures and based on national diabetes and hypertension guidelines (Working Group of the National Diabetes Advisory Board, 1997; Society for Endocrinology, Metabolism and Diabetes of South Africa, 2002a; Milne et al., 2003), was then implemented and directed at the nursing staff at a primary health care clinic. A post-intervention evaluation was performed after four months by repeating the questionnaire and focus group interviews. Comparisons between the pre- and post-intervention questionnaire and focus group interviews evaluated the impact of the educational intervention on the knowledge and attitudes of nursing staff towards the management of type 2 diabetes. Pre- and post-intervention patient data was collected from patient medical files and compared to determine if the management of diabetes and hypertension improved in the patient population after the implementation of the educational intervention. The patient population consisted of 103 patients. The educational intervention resulted in an extremely significant improvement in the level of knowledge of the nursing staff [93 correct responses (28.3 percent; n = 329 (pre-intervention)) vs 223 correct responses (67.8 percent; n = 329 (post-intervention)); p < 0.0001, Fisher’s Exact test]. The educational intervention resulted in improved attitudes of nursing staff towards the management of diabetes. Ideal random blood glucose concentrations improved significantly [16 percent; n = 100 (pre-intervention) vs 22 percent; n = 100 (post-intervention); p = 0.0003; Student t test]. The number of patients with a compromised HbA1c level (> 8 percent) decreased by 2 [51; 49.5 percent, n = 103 (pre-intervention) vs 49, 47.5 percent, n = 103 (post-intervention)] which was not a significant improvement. Ideal blood pressure control improved by one from 38 patients [36.9 percent; n = 103 (pre-intervention)] to 39 patients [37.9 percent; n = 103 (post-intervention)] which was not significant. Optimal change of pharmacological management following the referral of an uncontrolled diabetic patient was only noted for 18 patients (20.2 percent, n = 89) referred in the post-intervention phase. Clinical inertia was identified as a major limitation to the optimisation of diabetes care. Implementation of an educational intervention based on the South African diabetes and hypertension guidelines at a public sector primary health care clinic was successful in improving the knowledge levels and attitudes of nursing staff
- Full Text:
- Date Issued: 2007
- Authors: Dickason, Beverley Janine
- Date: 2007
- Subjects: Diabetes , Diabetes -- Treatment
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10161 , http://hdl.handle.net/10948/846 , http://hdl.handle.net/10948/d1012902 , Diabetes , Diabetes -- Treatment
- Description: Levels of diabetic care in primary health care settings in South Africa have been found to be sub-optimal. Knowledge deficits and inadequate practices have been implicated in the poor quality of local diabetes care. Type 2 diabetes and hypertension are commonly associated chronic conditions hence to optimise diabetic care, tight control of blood pressure is essential. Although guidelines for the overall management of diabetes in a primary health care setting have been published (Working Group of the National Diabetes Advisory Board, 1997; Society for Endocrinology, Metabolism and Diabetes of South Africa, 2002a), adherence to these guidelines has not yet been optimised in the primary health care setting. The objectives of the study were: to design and implement an educational intervention aimed at nursing staff, based on the South African guidelines for type 2 diabetes and hypertension, at a public sector primary health care clinic; to determine the impact of the educational intervention on the level of knowledge and attitudes of the nursing staff, and on the level of diabetic and blood pressure control achieved in the patient population, and to determine the impact of the educational intervention on pharmacological management of patients. A questionnaire was used to quantitatively assess the nursing staffs’ knowledge of the management of type 2 diabetes and hypertension at a primary health care level. A qualitative evaluation of the nursing staff attitudes was obtained using focus group interviews. The educational intervention, in the form of lectures and based on national diabetes and hypertension guidelines (Working Group of the National Diabetes Advisory Board, 1997; Society for Endocrinology, Metabolism and Diabetes of South Africa, 2002a; Milne et al., 2003), was then implemented and directed at the nursing staff at a primary health care clinic. A post-intervention evaluation was performed after four months by repeating the questionnaire and focus group interviews. Comparisons between the pre- and post-intervention questionnaire and focus group interviews evaluated the impact of the educational intervention on the knowledge and attitudes of nursing staff towards the management of type 2 diabetes. Pre- and post-intervention patient data was collected from patient medical files and compared to determine if the management of diabetes and hypertension improved in the patient population after the implementation of the educational intervention. The patient population consisted of 103 patients. The educational intervention resulted in an extremely significant improvement in the level of knowledge of the nursing staff [93 correct responses (28.3 percent; n = 329 (pre-intervention)) vs 223 correct responses (67.8 percent; n = 329 (post-intervention)); p < 0.0001, Fisher’s Exact test]. The educational intervention resulted in improved attitudes of nursing staff towards the management of diabetes. Ideal random blood glucose concentrations improved significantly [16 percent; n = 100 (pre-intervention) vs 22 percent; n = 100 (post-intervention); p = 0.0003; Student t test]. The number of patients with a compromised HbA1c level (> 8 percent) decreased by 2 [51; 49.5 percent, n = 103 (pre-intervention) vs 49, 47.5 percent, n = 103 (post-intervention)] which was not a significant improvement. Ideal blood pressure control improved by one from 38 patients [36.9 percent; n = 103 (pre-intervention)] to 39 patients [37.9 percent; n = 103 (post-intervention)] which was not significant. Optimal change of pharmacological management following the referral of an uncontrolled diabetic patient was only noted for 18 patients (20.2 percent, n = 89) referred in the post-intervention phase. Clinical inertia was identified as a major limitation to the optimisation of diabetes care. Implementation of an educational intervention based on the South African diabetes and hypertension guidelines at a public sector primary health care clinic was successful in improving the knowledge levels and attitudes of nursing staff
- Full Text:
- Date Issued: 2007
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