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    Prevalence, traditional medicine use and co-morbidities among type 2 diabetes mellitus in outpatients - a cross sectional hospital-based survey in KwaZulu-Natal
    (2022-09-29) Chetty, Lauren; Reddy, Poovendhree; Govender, Nalini
    Throughout the world, diabetes mellitus (DM) affects people of all ages, irrespective of gender and ethnicity, and impacts both rural and urban areas, as well as developing and developed countries. The prevalence of DM in sub-Saharan Africa is a significant public health burden which is attributed to inadequate health care funding, limited medicinal access and the disproportionate provision of resources between private and public health care. Approximately 451 million adults worldwide have diabetes, with predictions of 693 million cases by 2045. Moreover, Type II diabetes mellitus (T2DM) accounts for approximately 90% of diabetics, making it the most common type. Premature morbidity and mortality are associated with it, leading to micro- and macrovascular complications. There is a growing trend for patients to use traditional medicine (TM) commonly known as complementary and alternative medicine in most countries, in an attempt to eliminate or minimize the consequences of their illnesses and improve their general health. Therefore, this study aimed to determine the prevalence and, extent of traditional medicine use and co-morbidities among T2DM in a regional hospital in KwaZulu-Natal. This was a quantitative and cross-sectional study made up of 2 phases. Phase 1 was based on a retrospective chart review of all outpatients who were treated for T2DM between August 2018- January 2019. Demographic data and existing comorbidities were obtained from the hospital registers. Phase 2 involved the prospective recruitment of participants using a structured questionnaire, to determine their use of home remedies/ traditional medicine for T2DM and their co-morbidities thereof. Data from phase 1 revealed significantly more female patients (3072) compared to male patients (1050) (p<0.001). Majority of the outpatients (77.42%) presenting with T2DM over the 6-month period were between the ages of 45 years and 74 years. There was a significant correlation between Indian female patients who presented with T2DM compared with African female patients (p<0.05). The more frequent comorbidities experienced by patients were hypertension (3212) and cardiovascular problems (460) with a prevalence of 77.9% and 11.16%, respectively. The likelihood of presenting with comorbidities increased significantly with age. Logistic regression test found that female patients with T2DM were at significantly higher risk of presenting with hypertension (odds ratio [OR] = 1.44, 95% CI:1.20;1.71), arthritis (OR = 2.20, 95% CI:1.51;3.20) and anaemia (OR = 2.42, 95% CI:1.40;4.19), whilst their risk for cardiovascular problems was significantly lower compared to male patients (OR = 0.67, 95% CI: 0.54;0.83). The results obtained in phase 2 indicated that out of a total of 340 participants (n=244) included, 72% of them were female. T2DM was most prevalent in those aged 45 to 59 (47.94%). Out of 340 participants, only 92 (27%) used TM most often, with Indians (58.24%) being the most frequent users. Nearly 78 % of patients (n = 101) were using TM in conjunction with hospital medication. Families and friends were the most common sources of TM knowledge. Lemon and honey, Aloe vera, bitter gourd or karela, green tea, cinnamon, curry leaves and tulsi leaves were reported as the most commonly used TM. Traditional medicine use was predicted by various factors, including gender, race, age, education, residence, and presence of DM, however, no significant predictors for TM usage was noted among the variables tested. Traditional medicine use among African participants was 0.56 times (OR=0.56, 95% CI=0.34, 0.93), lower than that of Indian participants. Demographic factors, such as gender, ethnicity, and age, influenced the prevalence of T2DM and comorbidities. To allocate medical resources effectively and according to the true burden of disease from complications caused by T2DM, flexible and adaptive approaches are needed for prevention and management of T2DM cases. Furthermore, the study highlighted a low prevalence rate of TM usage (27.06%) in T2DM patients. Traditional medicine was predominately used among females and ethnicity was found to be a significant predictor of TM usage. The data from this study can be used to develop a tracking system, which will inform the health care systems with current information and may reduce the exponential rise of the number of patients suffering from DM. Future research is needed to determine if herbal therapies are effective therapeutic options in managing T2DM due to their safety and multiple targeting effects. Traditional medicine/ home remedies may be more effective in the development of anti-diabetic drugs if systematic data regarding their structure, activity, and mode of action is collected.
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    An evaluation of the effectiveness of the sonogram and the clinical determination of the arterio-venous fistula site in the diabetic population entering the chronic haemodialysis program
    (2013) Ramnarain, Rakhee; Haffejee, A. A.; Adam, Jamila Khatoon
    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.
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    A comparison of the efficacy of Syzygium Jambolanum (Java Plum) 6CH and Syzygium Jambolanum (Java Plum) homoeopathic mother tincture in the treatment of type 2 diabetes mellitus in patients on Metformin?
    (2016) Mkhize, Pretty Brightness; Maharaj, Madhueshwaree; Ducray, Jennifer Frances
    Background Diabetes mellitus is a metabolic disorder with various aetiologies, characterised by hyperglycaemia, resulting from defects of carbohydrate, fat and protein metabolism due to the deficient action of insulin on target tissues caused by insensitivity to or lack of insulin or both. The long term effects of diabetes mellitus frequently include retinopathy, nephropathy and neuropathy and an increased risk of other diseases such as cardiac, peripheral arterial and cerebrovascular disease. According to the International Diabetes Federation (IDF) 387 million people have diabetes mellitus and this number is predicted to rise to 592 million worldwide by 2035. In 2014 diabetes mellitus caused 4.9 million deaths worldwide and every 7 seconds a person dies from diabetes mellitus. The growing incidence of diabetes mellitus is a worldwide concern because of the increase of economic costs and burden of disease that is due to the cardiovascular complications and the co-morbidities. Objective The aim of this double-blind, randomised clinical trial was to determine the efficacy of Syzygium jambolanum (Java plum) 6CH and Syzygium jambolanum (Java plum) homoeopathic mother tincture on daily fasting blood glucose and glycosylated haemoglobin levels in type 2 diabetes mellitus patients on Metformin® in the treatment of type 2 diabetes mellitus. Material and Method A sample consisted of 24 volunteers selected on the basis of inclusion and exclusion criteria. These participants were then randomly divided into two groups, 13 in the group receiving the homoeopathic potency and 11 in the group receiving the homoeopathic mother tincture. Each participant attended a total of five consultations with the researcher over a period of 14 weeks that included a 2 week baseline period followed by a 12 week treatment period, at the Durban University of Technology (DUT) or Kenneth Gardens Homoeopathic Day Clinic. At each consultation a detailed and comprehensive homoeopathic case history (Appendix D) was taken and a physical examination (Appendix E) was performed by the researcher. Participants were required to fill in a log sheet (Appendix C1 and C2) with their fasting blood glucose readings daily for 14 weeks, which included a 2 week baseline period followed by a 12 week treatment period. Participants were also required to have their glycosylated haemoglobin measurements tested pre- and post-treatment. Results Both groups reflected a statistically significant reduction in fasting blood glucose levels as compared to the baseline. The mean fasting blood glucose level in week 1 was 11.8802 whereas in week 13 the mean blood glucose level was 8.6590 with a p value ≤ 0.05 for the Syzygium jambolanum 6CH group and the mean blood glucose level in week 1 was 9.0338 with a standard whereas in week 13 the mean blood glucose level was 6.8591 with a p value ≤ 0.05 in the Syzygium jambolanum homoeopathic mother tincture. However there was no significant differences between the two groups (Syzygium jambolanum 6CH and Syzygium jambolanum homoeopathic mother tincture), the significance score was 0.623 when comparing reduction in fasting blood glucose levels. Both groups reflected a statistically non-significant reduction in the glycosylated haemoglobin (HbA1C) and there were no significant differences between the two groups when comparing reduction in HbA1C levels. Conclusion Both homoeopathic preparations of Syzygium jambolanum (mother tincture and 6CH) significantly reduce fasting blood glucose levels in patients with type 2 diabetes mellitus. This result suggests that Syzygium jambolanum has beneficial anti-diabetic effects and warrants further investigation.
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    A comparison of the effectiveness of two homoeopathic dosage forms of Momordica charantia in the treatment of type 2 diabetes mellitus in patients on metformin
    (2012-08-27) Govender, Saiesh; Maharaj, Madhueshwaree; Naude, David F.
    It was reported by the International Diabetes Federation (IDF) Diabetes Atlas, in 2003, that a prevalence figure of 3.4% exists for the 24 million South Africans between the ages of 20 and 79, with an expected increase to 3.9% by 2025. Considering that patients with diabetes are at increased risk of cardiovascular disease, blindness, amputation and renal failure it is therefore not surprising that the costs associated with diabetes are estimated to increase worldwide. It is clear that according to the current trends in dietary and exercise practices, South Africa will be affected by the rise in obesity and subsequent diabetes mellitus. It is critical that a concerted effort involving all parties concerned be made to combat this rapidly increasing problem (Rheeder, 2006:20). AIM The purpose of this double-blind, randomized clinical trial was to compare the effectiveness of Momordica charantia homoeopathic mother tincture as compared to Momordica charantia 6CH, in the treatment of type 2 diabetes mellitus in patients on Metformin. METHODOLOGY Thirty patients were recruited and were selected for the study on the basis of inclusion and exclusion criteria. These participants were then randomly and equally divided into two groups. Each participant attended a total of four consultations with the researcher, over a two month period, at the Durban University of Technology (DUT) Homoeopathic Day Clinic. At the commencement of the first consultation, each participant received the subject information letter (Appendix A) for perusal and the informed consent form (Appendix B) to sign. Following this, the researcher took a full, detailed iv case history (Appendix F) and performed a physical examination (Appendix G) of each patient. Participants were required to have a Glycosylated haemoglobin (HbA1C) test performed following the first and fourth consultations. Participants were also required to complete daily Log Sheets (comprising self administered fasting blood glucose readings using issued Bayer Ascensia Elite Glucometers) for the entire duration of the study (8 weeks). SPSS version 18 was used to analyse the data. A p value < 0.05 was considered as statistically significant. The time effect was assessed for intra-group comparison whereas the time x group treatment effect was assessed for inter-group comparison. Means were calculated for both fasting blood glucose and glycosylated haemoglobin for the two respective groups and tabulated in order to describe the data obtained (Descriptive statistics). RESULTS Both groups reflected a statistically non significant decrease in fasting blood glucose levels with no significant differences between the two groups when comparing reduction in fasting blood glucose levels. Group 1 (Momordica charantia homoeopathic mother tincture) reflected a non significant increase in glycosylated haemoglobin (HbA1C) levels while Group 2 (Momordica charantia 6CH) reflected a statistically significant increase over time in HbA1C levels. There were no significant differences between the two groups when comparing reduction in HbA1C levels.