Browsing by Subject "Diabetology"

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    The diabetic diet : education, compliance and practical applications
    (1983) Smith, Cynthia J; Jackson, W P U
    The aim of this thesis is to investigate different methods of improving the glycaemic control of diabetic out-patients, within the scope of the author's training both as a therapeutic dietitian and as a teacher. Evidence is presented from the literature, which indicates that high-carbohydrate, high-fibre diets are of benefit in diabetes, that supplements of viscous fibre improve glycaemic control, and that education of the diabetic patient may help to achieve good diabetic control, provided that the patient also complies with all parameters of therapy. Three main studies have been undertaken: - (1) An educational project, to investigate the effect of a mass-education programme on compliance and control in diabetic out-patients. (2) An investigation of the effect of long-term high-fibre diets in diabetic out-patients. (3) A study of the use of guar gum in the diabetic diet. In Study 1, a large random sample of patients attending a diabetes outpatient clinic were tested by means of a detailed questionnaire, in order to assess their existing knowledge of the disease. A suitable education programme was then devised and patients were exposed to this in the clinic situation. Another sample of patients was then re-tested with the same questionnaire and statistical analysis was used to assess the effect of this programme on knowledge, compliance and control. Results indicate that, while patients' knowledge scores improved, there was no improvement in dietary compliance and also no significant change in the standard of diabetic control in the clinic population. In Study 2 we investigated the practical aspects of administering a high-fibre diet to diabetic out-patients in Cape Town, in the light of the reported benefits of diets containing large amounts of dietary fibre (OF) in the control of diabetes. Readily-available, low-cost foodstuffs with a high OF content, were incorporated into suitable, individualised high-fibre meal plans for 10 selected diabetic out-patients. Patients were closely monitored over a period of 9 months, for 3 months of which the high-fibre diet was prescribed. Various parameters of glycaemic control were recorded and analysed, and the patients' compliance to the new regimen was assessed. Only 3 patients approached the projected fibre intake, but significant negative correlations were found between the dietary fibre increments and both mean plasma glucose and mean serum triglyceride changes. These findings suggest that, were it not for poor dietary compliance, a high-fibre diet might result in significant improvement in diabetic control, and that education and motivation are of prime importance when making major changes to patients' eating habits. Study 3 investigates the use of guar gum, when incorporated into the diabetic diet in both short- and medium-term studies. This viscous fibre has been shown by workers overseas to be effective in lowering postprandial glycaemia. In this study a palatable vehicle for the gum, a digestive-type biscuit, was tested for its effect on glycaemic control when incorporated into the usual meal plans of diabetic out-patients, and also against an oral glucose load as a reference standard. It was found to be effective in reducing the post-prandial rise in blood glucose, and in improving glycaemic control, as shown by reduced fasting blood glucose values and decreased 24-hour urinary glucose excretion. The biscuit proved to be palatable and acceptable to patients, and the guar gum was effective in much smaller quantities than have previously been tested. It may therefore prove a valuable adjunct to diabetes therapy. Results of these studies indicate that compliance to therapeutic recommendations is the crux of achieving good diabetic control. Increased diabetic knowledge alone does not lead to improved diabetic control, and compliance to altered eating habits is difficult to achieve unless prior education and motivation has taken place. The simplest means of achieving better glycaemic control of diabetes appears to be the use of a supplement of viscous fibre, which will improve the glycaemic response to the patients' usual meals.
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    Implementing and evaluating a weight reduction program for diabetic patients at a primary health care facility in the Western Cape
    (2016) Razack, Adil; Isaacs, Abdul Aziz
    Background: Diabetes is now the most common non-communicable disease globally and complications are resulting in increased disability, reduced life expectancy and enormous health costs for virtually every society. Medical Nutrition Therapy is important for the prevention, treatment, self-management of diabetes and the prevention or delay in onset of diabetes-related complications. The current nutritional guidelines for DM states that carbohydrates should make up 45-60% of the total nutritional intake and that low carbohydrate or high protein diets offer no long term success over healthy eating plans. Recent studies suggest that there may be merit in using low carbohydrate diets in diabetic patients. Aim and Objectives: The study aimed to implement and evaluate a program for weight loss in Diabetes Mellitus type 2 patients by comparing a Low carbohydrate diet to the conventional low fat diet. Changes in weight, waist circumference, blood pressure and blood parameters (creatinine, lipids and HbA1c) were recorded in both groups. Methods: The study design was that of a two group randomised parallel design, with one group following a low fat diet and the other a low carbohydrate diet. Both groups received advice on exercise and behaviour change. Clinical parameters were recorded at week 0 (baseline) and week 12 of the program. Patients were invited to participate in the study using leaflets, posters and via staff. A total of 10 patients per group were identified and followed. Results: Significant reductions were seen in weight loss and Hba1c in the Low Carbohydrate diet group which was not evident in the Low fat diet group. No significant change was seen in other parameters including BP, total cholesterol and serum creatinine for either group. Conclusion: Low Carbohydrate diets are effective in promoting weight loss and glucose control in diabetic patients. More research is recommended to assess patient's experience of following a low carbohydrate diet. Recommendations include training staff at facilities in our Sub-District on understanding and implementing Low Carbohydrate diets.
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    Studies on aspects of Autonomic Neuropathy in non Insulin dependent Diabetes
    (1980) Levitt, Naomi Sharlene; Levitt, Naomi Sharlene; Jackson, W P U
    Autonomic neuropathy (AN) is a well-recognized complication of diabetes mellitus. It has multiple clinical features and is often associated with debilitation and an increased mortality. However, there appears to be a paucity of knowledge with regard to its effects on hormone release and its biochemical sequelae. Recent evidence has accumulated suggesting a role for the autonomic nervous system in regulating release of a number of gastrointestinal hormones. It is therefore possible that autonomic dysfunction may be associated with altered gastrointestinal hormone release and indeed various studies have revealed abnormalities in t he release of these peptides in diabetes mellitus. The prime purpose of this thesis was to provide evidence which might contribute to an understanding of t he interrel a tionship between non insulin dependent diabetes (NIDDM), gastrointestinal hormone release and the autonomic nervous system. Thus studies to evaluate basal and stimulated release of the gastrointestinal hormones gluc a gon (IRG), pancreatic polypeptide (PP), gastrin, gastric inhibitory polypeptide (GIP) and somatostatin (SRIF-LI) have been undertaken in NIDDM. Studies were also carried out to assess whether AN may be implicated in abnormal release of these five gut hormones in diabetes and to determine if one of the hormones, PP, might be used as a marker for AN. Finally the effect of dietary fibre on glucose tolerance was studied to assess whether its effect would be altered in the presence of AN in NIDDM.
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    Studies on aspects of the physiology and pathophysiology of pancreatic polypeptide
    (1982) Sive, Alan Avrom; Vinik, A I
    Pancreatic polypeptide (PP) is a 36 amino-acid residue peptide which has recently been recognised in pancreatic endocrine cells. Although PP has a number of effects on gastrointestinal and pancreatic exocrine function, its physiological function has not been clarified. Studies were undertaken to elucidate four aspects of the physiology and pathophysiology of this candidate hormone. Firstly, factors affecting the release of human PP (hPP) were assessed in healthy subjects; secondly polyacrylamide gel electrophoresis was used to investigate molecular heterogeneity of the peptide; thirdly, the organ uptake and half-life time of endogenous PP was measured in pigs; and finally, basal and stimulated serum hPP concentrations were assayed in patients with acute pancreatitis, chronic pancreatitis and maturity-onset diabetes mellitus.