Subjects’ experiences of a nutrition education programme: a qualitative study of adults with type 2 diabetes mellitus living in a rural resource-limited setting in South Africa

Objective: The objective of the study was to explore the views and experiences of adults with type 2 diabetes mellitus on a nutrition education programme.Design: Interpretative phenomenological design.Setting: The setting was two community health centres in Moretele, North West province, South Africa.Subjects and outcome measures: The study subjects were adults with type 2 diabetes mellitus (n = 41, aged 40–70 years) participating in a nutrition education intervention (one-year randomised controlled trial). The intervention was based on the assessed nutrition education needs of the target group, and included the provision of nutrition education materials. Data were collected at the end of the training intervention (eight weeks) and at the end of the study (12 months). A self-administered, open-ended questionnaire was used at eight weeks (n = 31). Five focus group discussions were conducted at 12 months. A framework thematic analysis technique was employed.Results: The majority of participants indicated that they enjoyed the nutrition education programme at the two time periods. They were satisfied with its content and delivery. The education materials (pamphlet and fridge or wall poster) were seen as useful for the whole family, and as constant reminders of positive behaviour. Benefits indicated by the participants included a gain in health knowledge and skills, positive dietary changes, and improved health and family support. Participants also recommended the programme to other people with diabetes mellitus. Positive educator characteristics, such as competence, patience, being respectful and approachable, were cited as desirable.Conclusion: Participant-customised nutrition education can contribute to programme satisfaction, perceived benefits and adherence to the programme. The provision of education materials should form part of such programmes. Facilitators of nutrition education programmes should take responsibility for employing desirable personal attributes as this can enhance client participation.Keywords: diabetes mellitus, nutrition education programme, qualitative study, rura

Screening for Gestational Diabetes Mellitus: The Potential of MicroRNAs

Gestational diabetes mellitus (GDM) is associated with short- and long-term complications in both mothers and their offspring. Screening and early diagnosis of GDM is advocated as a strategy to prevent adverse pregnancy outcomes. However, there is currently no test that is amenable to routine screening, particularly in low-and middle-income countries. MicroRNAs (miRNAs) are small non-coding RNA molecules that regulate gene expression post-transcriptionally. In recent years, miRNAs have been the focus of increasing research due to their important role in regulating biological pathways and their aberrant expression during disease. The discovery of circulating miRNAs in maternal blood, and their altered expression during pregnancy-associated complications have increased interest into their potential as diagnostic biomarkers for GDM. In this review, we summarise studies that have investigated miRNAs in maternal blood thus providing an update of the current status of miRNAs as biomarkers for GDM. We also discuss the challenges of miRNA profiling, and highlight perspectives and recommendations for research

The prevalence and association of low testosterone levels in a South African male, diabetic, urban population

BACKGROUND : According to the literature, low serum testosterone levels are associated with diabetes mellitus. No or minimal data exist for its prevalence or predictors in South Africa. DESIGN : This was a cross-sectional study. SETTING : The setting was an academic centre, i.e. the University of Pretoria and Steve Biko Academic Hospital Diabetes Clinic. SUBJECTS : A total of 150 consecutive male patients aged 50 years and older with diabetes mellitus were selected using convenience sampling. OUTCOME MEASURES : The patients were evaluated for diabetes control and complications, and for hypogonadism symptoms. Early-morning serum testosterone levels were determined. RESULTS : The prevalence of androgen deficiency symptoms was 94.7%. Some 50% of the men had low total testosterone levels. Using multivariate logistic regression, the significant factors associated with low total testosterone were waist circumference and known cardiovascular disease. The prevalence of symptoms of androgen deficiency was very high; 94.7% of the patients reported a significant number of symptoms listed on the Androgen Deficiency in the Aging Male questionnaire. CONCLUSION : This study confirms the high prevalence of low testosterone levels in diabetic male patients in a tertiary setting. Universal screening remains controversial owing to uncertainty regarding the risks and benefits of testosterone therapy in this population group. Predictors of low testosterone levels were identified.Bayer for financing the cost of the serum testosterone levels.http://www.jemdsa.co.za/index.php/JEMDSAhb201

Screening for gestational diabetes mellitus in a South African population: Prevalence, comparison of diagnostic criteria and the role of risk factors

Background. The prevalence of gestational diabetes mellitus (GDM) is increasing. Most major world organisations now recommend universal screening for GDM based on the International Association of Diabetes in Pregnancy Study Groups (IADPSG) criteria. Currently there is a lack of consensus on the diagnostic criteria for GDM used in South Africa (SA). The Society for Endocrinology, Metabolism and Diabetes of South Africa’s revised guidelines recommend the use of the IADPSG criteria for the diagnosis of GDM.Objectives. To determine the prevalence of GDM in an SA population. We compared the prevalence of GDM using the various diagnostic criteria and evaluated the risk factors associated with GDM.Methods. This was a prospective cohort observational study carried out at a level 1 clinic in Johannesburg, SA. All pregnant women at <26 weeks’ gestation were recruited. Patients known to have GDM were excluded. At recruitment, a data questionnaire was completed and bloods were drawn for a random glucose test and measurement of the glycated haemoglobin level. A 75 g 2-hour oral glucose tolerance test (OGTT) was scheduled before 28 weeks’ gestation.Results. Five hundred and fifty-four patients (55.4%) completed the OGTT. The prevalence of GDM was 25.8% if universal screening and the IADPSG criteria were used. If universal screening and the National Institute for Health and Care Excellence (NICE) criteria were used, the prevalence was 17.0%. If selective risk factor-based screening was used, only 254 (45.8%) of the women would have had an OGTT. The prevalence of GDM in this instance would have been 15.2% with the IADPSG criteria and 3.6% with the NICE criteria. Two hundred and fifty-four patients (45.8%) had at least one risk factor for GDM. The presence of one or more risk factors had a poor sensitivity (58.7%) and specificity (58.6%) for the detection of GDM in our study population.Conclusions. The prevalence of GDM would be substantially increased if universal screening with the IADPSG criteria were to be employed. Risk factors are a poor screening test for GDM.

Physical activity : one of the cornerstones in the management of type 2 diabetes mellitus

Disease prevention not only entails stopping the development of the disease before it occurs, but also includes measures aimed at slowing down the progression of the established disease. Diabetes mellitus should be seen as an interacting occurrence between people and their environment. Thus the primary concern in prevention and treatment of type 2 diabetes mellitus should include changes in those structural, social and economic factors that are important determinants of lifestyle. Exercise has long been a cornerstone in the management of diabetes based on its potential to improve metabolic control and diminish complications. Presently the lack of understanding pertaining to exercise and its benefits, associated with type 2 diabetes mellitus as well as the absence of education and intervention programmes makes good diabetes management difficult to achieve. Exercise is undervalued in the management of type 2 diabetes mellitus. This may be due to a lack of understanding and motivation on the part of the person with diabetes mellitus as well as the absence of clear recommendations, encouragement and follow-up actions by health-care workers. Health-care workers should address these issues because most people with type 2 diabetes mellitus have the potential to derive benefit from regular, moderate levels of exercise.http://www.ajol.info/journal_index.php?jid=153&ab=ajpherdam201

Inter- and intra-laboratory variability of CD4 cell counts in Swaziland

BACKGROUND: Analytical variability in CD4 enumeration is well known, but few studies from southern Africa have quantified the inter- and intra-laboratory variability in CD4 count measurements. In addition, the possible impact of time lapse after sample collection on CD4 reliability is not well understood. METHODS: A cross-sectional study was conducted at Royal Swaziland Sugar Corporation Hospital and three laboratories, Lab A (comparator), Lab B (national reference) and Lab C (rural hospital). Blood from HIV-infected individuals was collected using routine venepuncture into separate specimens for each of the three laboratories. The samples were further subdivided at each laboratory: one was run at 12 hours and the second at 24 hours after venepuncture. The results of absolute CD4 count and CD4 percentage testing were compared within (intra-laboratory) and between (inter-laboratory) laboratories. RESULTS: Among 53 participants, the mean CD4 count at 12 hours was 373 cells/μl, 396 cells/μl and 439 cells/μl, and at 24 hours 359 cells/μl, 389 cells/ μl and 431 cells/μl, for laboratories A, B and C, respectively. The coefficient of intra-laboratory variation was 4%, 8% and 20% for CD4 count for laboratories A, B and C, respectively. Comparing 12- and 24-hour measurements, the mean difference (bias) within the laboratories between the two time points (and limits of agreement, LOAs) was 14 (-46 to 73), 8 (-161 to 177) and 7 (20 to 33) cells/μl for labs A, B and C, respectively. Comparing Lab A versus Lab B, lab A versus Lab C and Lab B versus Lab C, the inter-laboratory bias for the CD4 count at 12 hours was -32, -64 and -38 cells/μl, respectively. The corresponding LOAs were -213 to 150, -183 to 55, and -300 to 224, respectively. At 24 hours, the biases and LOAs were similar to those at 12 hours. CONCLUSIONS: CD4 counts appeared reliable at all three laboratories. Lab B and Lab C were clinically interchangeable with the comparator laboratory, Lab A, but not between themselves. Time to measurement does not affect the interlaboratory agreement within 12 and 24 hours.A University of Pretoria RESCOM grant partially covered the laboratory costs during the study.http://www.sajhivmed.org.z

Safety and tolerability of yellow fever vaccines

Yellow fever is a non-contagious, viral, multisystem syndrome, that causes an estimated 200 000 human infections annually, and has a high fatality rate. Yellow fever vaccination is one of the main methods of primary prevention. Although the yellow fever vaccine is largely considered to be safe, adverse events, which are sometimes life-threatening, can occur. This article explores the safety and tolerability of yellow fever vaccines.http://www.sajei.co.za/index.php/SAJE

Screening in primary care for diabetic retinopathy, maculopathy and visual loss in South Africa

OBJECTIVE : The aim of the study was to determine the prevalence of diabetic retinopathy, maculopathy and visual loss in primary care patients and to identify associated risk factors. RESEARCH DESIGN AND METHODS : We conducted a cluster randomised trial at primary care clinics in the Tshwane district in South Africa. Grades of retinopathy and maculopathy (with fundus camera) and visual acuity (Snellen chart) were assessed and, using mobile screening and teleophthalmology, clinical and biochemical testing was conducted to obtain information about glycaemic control and microvascular complications. RESULST : The prevalence rates for any retinopathy, preproliferative retinopathy and proliferative retinopathy were 24.9, 19.5 and 5.5%, respectively. The prevalence rates of diabetic maculopathy, observable maculopathy and referable maculopathy were 20.8, 11.8 and 9.0%, respectively. The presence of retinopathy was associated with high body mass index, systolic blood pressure, being on insulin treatment, high HbA1c and the presence of neuropathy. High systolic blood pressure, being on insulin treatment, high HbA1c level and high low-density lipoprotein choles- terol level as well as the presence of albuminuria were significant in predicting any diabetic maculopathy. Laser photocoagulation was given to 8.3% of patients from the mobile unit and 12% of patients were referred to the nearest hospital with an outpatient eye clinic for follow-up treatment of various other eye conditions. Using the WHO categories, the study found that 78.1% of diabetes patients had normal vision, 19.3% were visually impaired and 2.2% were severely impaired or blind. CONCLUSION : High prevalence rates for diabetic retinopathy, maculopathy and visual loss were found and associations were identified.The Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA), the African Population & Health Research Centre (APHRC) and research funds from the University of Pretoria.www.karger.com/opham2016Internal MedicineOphthalmologySchool of Health Systems and Public Health (SHSPH

The South African stroke risk in general practice study

Background. Incidence of stroke is increasing in sub-Saharan Africa and stroke prevention is an essential component of successful stroke management. General practitioners (GPs) are well placed to manage stroke risk factors. To design appropriate strategies for risk factor reduction we need to know the risk factor prevalence in each of the population groups attending GPs. The aim of this study was to establish the prevalence of stroke risk factors in the South African general practice population. Method. We conducted a multicentre, observational study of patients attending general practice in South Africa. Two hundred general practices were randomly selected from lists provided by pharmaceutical representatives. Each GP approached 50 consecutive patients aged 30 years and older. Patients completed an information sheet and the GP documented the patient’s risk factors. The resulting sample is relevant if not necessarily representative in a statistical sense. Results. A total of 9 731 questionnaires were returned out of a possible 10 000. The mean age of particpants was 50.7 years. Seventy-six per cent had 1 or more risk factors and 40% had 2 or more risk factors. Hypertension was the commonest risk factor in all population groups (55%) but was highest in black patients (59%). Dyslipidaemia was commonest in whites (37%) and least common in blacks (5%). Diabetes was commonest in Asians (24%) but least common in whites (8%). Risk factors other than smoking increased with age. Conclusion. This study provides unique data on the prevalence of stroke risk factors in a South African general practice population. Risk factors are common in all population groups, but differ in distribution among the groups. There is considerable opportunity to reduce the burden of stroke in South Africa through GP screening for and treatment of risk factors