Improvement noted after a multifaceted approach to diabetes mellitus management

Background: Optimal control of diabetes mellitus remains elusive, especially in developing countries. A comprehensive and standardised approach, coupled with intensive patient and clinician education, may provide the solution.Methods: Comprehensive datasheets accompanied by patient education from a multidisciplinary team and clinician retraining on diabetes management was introduced into the Edendale Hospital diabetes clinic in 2012. This study compares diabetes control starting October 1, 2012 to September 30, 2013 (Y1) to October 1, 2013 to September 30, 2014 (Y2).Results: Significant changes (p-values < 0.005) were noted in the following parameters between Y2 and Y1 respectively:* Mean HbA1c% (10.41 ± 2.91 vs. 11.26 ± 2.99).* Mean HbA1c in males (9.46 vs. 10.57) and (10.38 vs. 11.19) for females.* Mean HbA1c for type 1 (11.80 vs.10.77) and type 2 patients (10.91 vs.10.10).* Percentage of patients achieving triglyceride control (64.28 vs. 52.85).* Percentage of patients making lifestyle changes and performing home glucose monitoring.* Increase in female waist circumference (97.29 vs. 85.95 cm).* Increase in BMI in males (29.65 vs. 27.92 kg/m2).Conclusion: This multifaceted approach to diabetes care in a resource-limited clinic significantly improved glycaemic and triglyceride control. Obesity remains a major challenge. This model could serve as a blueprint for other such resource-limited clinics

Topological phase transition and the effect of Hubbard interaction on the one-dimensional topological Kondo insulator

The effect of a local Kondo coupling and Hubbard interaction on the topological phase of the one-dimensional topological Kondo insulator (TKI) is numerically investigated using the infinite matrix-product state density-matrix renormalization group algorithm. The groundstate of the TKI is a symmetry-protected topological (SPT) phase protected by inversion symmetry. It is found that on its own, the Hubbard interaction that tends to force fermions into a one-charge per site order is insufficient to destroy the SPT phase. However when the local Kondo Hamiltonian term that favors a topologically trivial groundstate with a one-charge per site order is introduced, the Hubbard interaction assists in the destruction of the SPT phase. This topological phase transition occurs in the charge sector where the correlation length of the charge excitation diverges while the correlation length of the spin excitation remains finite. The critical exponents, central charge and the phase diagram separating the SPT phase from the topologically trivial phase are presented.Comment: 15 pages, 22 figure

Diabetic patients served at a regional level hospital: What is their clinical picture?

Objectives: We describe the demographics, diabetic characteristics,  diabetic control and complications in the diabetes service in Edendale Regional Hospital, Pietermaritzburg, in this study. Diabetes mellitus, together with its complications, is increasing at an alarming rate worldwide. Good glycaemic control translates into lower long-term complications andlonger life expectancy. Previous studies performed in both the public and the private sectors have demonstrated that there is suboptimal diabetic control in South Africa.Design: This was a retrospective database analysis. Datasheets were designed to ensure a comprehensive and standardised assessment of patients attending Edendale Hospitalfs diabetic clinic. Data were stored in a designed-forpurpose database.Subjects and setting: Data from 653 first-visit diabetic patients visiting Edendale Hospitalfs diabetic clinic between 1 October 2012 and 30 September 2013 were collected.Outcome measures: Glycaemic control, diabetic complications and target blood pressure were the outcome measures studied.Results: A total of 653 first-visit patients were seen, of whom 77.03% were female and 83.40% were type 2 diabetes patients. Only 36.33% of the type 2, and 49.07% of the type 1, diabetes mellitus patients, achieved a target blood pressure of . 140/80 mmHg. Only 1.23% of the type 1, and 11.18% of the type 2, diabetes mellitus patients, achieved optimal  glycaemic control, defined as haemoglobin (Hb)A1c . 7%. The mean HbA1c in the patients with type 1 diabetes mellitus was 11.82%, and 10.52% in the type 2 diabetes mellitus patients.Conclusion: This study showed the suboptimal control of both diabetes mellitus and hypertension in the clinic, together with high rates of diabetes complications. Obesity remains a major modifiable risk factor in both type 1 and 2 diabetes patients. Blood glucose control in this resource-limited setting was similar in those patients with home blood glucose monitoring versus those without it

Connected OFCity Challenge: Addressing the Digital Divide in the Developing World

Over the past 50 years, the development of information and communications technology has provided unprecedented support to the steady economic growth of developed countries. In recent years, some of the largest growth has been reported in emerging economies, which, however, often lack adequate telecommunications infrastructure to further sustain their development. Although a number of service providers and system vendors have started to address the issue, the challenges they encounter are substantially different from those in the developed world, including an unreliable electricity grid, poor fiber infrastructure, low revenue expectations, and often a harsh climate environment. This paper reports use cases and solutions pertinent to the development of the networking infrastructure in emerging economies, provided by organizations directly involved in such activities. After providing some background information on the current state of network infrastructure and the main challenges for Africa and rural China, the paper provides details on two proposed solutions. The first focuses on the provisioning of services and network infrastructure through the development of low-cost data centers, whereas the second proposes cost-effective adaptation of both fiber and hybrid copper-fiber technology to rural areas. The article is concluded with a brief discussion on the complementarity of the two approaches

The burden of diabetes mellitus in KwaZulu-Natal’s public sector: A 5-year perspective

Background. Diabetes mellitus (DM), together with its devastating complications, has a huge impact on both the patients it affects and the global economy as a whole. The economies of developing countries are already under threat from communicable diseases. More needs to be done to stem the tide of non-communicable diseases like DM. In order for us to develop new strategies to tackle this dread disease we need to obtain and analyse as many data as possible from the geographical area where we work.Objective. To describe the burden of DM in the public sector of the province of KwaZulu-Natal (KZN), South Africa (SA).Method. Data on the number of diabetes visits, DM patients that were initiated on treatment, defaulters and DM-related amputations were accessed from the Department of Health records for the period 2010 - 2014 inclusive.Results. There was a decline in the number of patients initiated on treatment per 100 000 population from 2010 to 2014 inclusive (265.9 v. 197.5 v. 200.7 v. 133.4 v. 148.7). Defaulter rates for 2013 compared with 2014 were 3.31% v. 1.75%, respectively and amputation rates were 0.09% v. 0.05% for 2013 and 2014, respectively. There was a strong proportional relationship observed between the number of defaulters and number of diabetes-related amputations (r=0.801; p=0.000) (Pearson correlation). A notable percentage of DM patients ranging between 63% and 80% were commenced on pharmacological therapy at their local clinics rather than at hospitals in the province.Conclusion. Strategies directed towards detection and treatment of DM, together with decreasing defaulter rates and thereby decreasing diabetes-related amputations, need to be addressed urgently. The majority of patients were initiated on therapy at the clinic level. This emphasises the need to strengthen our clinics in terms of resources, staffing, and nursing and clinician education, as this is where diabetes control begins. Although this study was based solely in KZN, the second most populous province in SA, it probably reflects the current situation regarding DM in other provinces of SA as well

A deadly combination – HIV and diabetes mellitus: Where are we now?

Background. The combination of HIV infection and diabetes mellitus (DM) represents a collision of two chronic conditions. Both HIV and DM increase the risk of developing tuberculosis (TB). Health resources in developing countries are already under strain as a result of the TB epidemic and poor diabetic control would further worsen this epidemic. Optimal diabetic control provides one avenue of curbing the TB epidemic in developing countries.Objectives. To establish if there is a difference in blood pressure, lipid and glycaemic control and complications between HIV-infected and uninfected diabetic patients; and to compare characteristics among HIV-infected diabetic patients between those with optimal and suboptimal glycaemic control.Methods. This was a retrospective chart review of all patients who visited the Edendale Hospital diabetic clinic, Pietermaritzburg, from 1 October 2012 to 30 September 2013.Results. There were statistically significant differences noted in the following parameters between HIV-infected and uninfected diabetic patients: (i) mean HbA1c% (11.08% v. 10.14%, respectively); (ii) nephropathy defined by proteinuria (25.66% v. 15.43%); (iii) neuropathy (48.68% v. 42.10%); and (iv) Kidney Disease Outcomes Quality Initiative (KDOQI) stage ≥2 chronic kidney disease (30.87% v. 41.67%). There were no significant differences noted in the percentage of patients achieving the following target parameters between the two cohorts: (i) blood pressure (42.11% v. 35.62%); (ii) total cholesterol (36.84% v. 34.67%); and (iii) triglycerides (42.76% v. 40.19%). Within the HIV-infected diabetic cohort 85.23% displayed suboptimal glycaemic control. A significant percentage of HIV-infected diabetic patients on antiretroviral (ARV) therapy (89.36%) had suboptimal glycaemic control. HIV-infected female diabetic patients showed a significant increased waist circumference when compared with their HIV-uninfected counterparts.Conclusion. HIV-infected diabetic patients had significantly poorer blood sugar control and a higher incidence of neuropathy and nephropathy (when defined by overt proteinuria). There was a non-significant difference noted between the HIV-infected and uninfected diabetic patients with regard to blood pressure and lipid control. The majority of HIV-infected patients on ARVs failed to achieve target glycaemic control. Obesity remains a global challenge, as noted in both the HIV-infected and uninfected diabetic patients

Considering the role of social media: #BlackLivesMatter as a pedagogical intervention to decolonise curriculum

The COVID-19 pandemic resulted in a drastic transformation to schooling for students throughout the world. During this period, a number of issues arose in our local, national and global communities, including the death of George Floyd and subsequent protests and rallies organised by #BlackLivesMatter. Living through and witnessing many social issues, coupled with the new and enduring pandemic, furthered our understandings of how young people were engaging with these topics without the structures of schools to support them. This article presents the results of a case study where youth aged 15–17 years shared their experiences and understandings about many social justice issues they were observing. The most significant learning around these issues for youth occurred informally through social media as opposed to in the classroom, reinforcing that schools are not ethical spaces from which to challenge institutional, structural and systemic barriers to justice. As such, this article discusses the potential for formal education to be transformed into an ethical and decolonising space to learn about and challenge injustice