Experiences and challenges of adults living with type 2 diabetes mellitus presenting at the University Teaching Hospital in Lusaka, Zambia

Background: In 2015, Zambia reported 218,200 instances of Diabetes Mellitus (DM) with 8,232 diabetes-related fatalities. Insulin therapy and oral antidiabetic medications are two pharmacological therapies used to treat diabetes mellitus. Herbal medicine, on the other hand, has a lengthy history and is an easily accessible and economical therapeutic option. Patients with Type 2 Diabetes Mellitus (T2DM) are increasingly turning to herbal therapies as keeping to conventional regimens becomes more challenging. Aim: We aimed to assess the prevalence and patterns of herbal medicine use among Type 2 diabetes mellitus patients at the University Teaching Hospital. Methods: This cross-sectional study was conducted on 101 T2DM patients using a self-administered questionnaire from August to October 2021. Data were analysed using Statistical Package for Social Science (SPSS) version 26. Results: Of the 101 participants, (n = 93, 92.1%) used herbal medicines. Garlic (Allium sativum) was the most widely used herbal medication (58.4%), followed by Moringa (Moringa oleifera) at 42.6%, and mule (Myrrh) at 5%. The need to treat diabetes and other medical problems (n = 47, 50.5%) was the main reason for herbal medicines use, followed by family tradition or culture 36 (38.7%). The primary source of information about herbal medicines use was friends (n = 46, 45.5%), followed by family members (n = 38, 37.6%). The majority (n = 83, 82.2%) of the participants reported not having any adverse events from herbal medicines, and only (n = 10, 9.9%) had experienced side effects. Conclusion: There was a high use of herbal medicines among T2DM patients, particularly those aged between 45 and 76 years. From the standpoint of high prevalence and low disclosure rate, it is imperative for healthcare providers to strongly educate patients regarding the use of herbal medicines. In addition, the public need to be educated on pharmacovigilance so that they know the report of adverse events even those that may be associated with herbal medicines.

The growing global incidence of Type 2 Diabetes Mellitus (T2DM) underscores the pressing need to investigate practical and sustainable management strategies. Type 2 diabetes mellitus (T2DM) is a chronic health condition that necessitates continuous monitoring and long-term care to maintain blood glucose levels within optimal limits. One critical factor influencing diabetes self-management is family support, which encompasses emotional, instrumental, informational, and appreciative dimensions. Family members play a crucial role in supporting individuals with T2DM by assisting with daily care routines, promoting adherence to treatment regimens, and offering motivation. This scoping review aims to critically evaluate the significance of family support as a key component in enhancing self-management among individuals diagnosed with type 2 diabetes mellitus (T2DM). It will outline the key elements of family support and investigate their relationship with diabetes-related outcomes, including glycemic control, medication adherence, and dietary adherence. The review encompasses an analysis of 15 pertinent articles retrieved from three key databases: ScienceDirect, Google Scholar, and ProQuest. The keywords employed comprised "family or caregiver support" and "diabetes mellitus type 2," integrated through the use of Boolean operators. The findings of this review indicate that family involvement considerably contributes to improved health outcomes for patients with T2DM. Individuals possessing robust family support demonstrate enhanced medication adherence, improved blood glucose levels, and greater compliance with dietary recommendations. In concludion, the integration of family support within diabetes management interventions has the potential to facilitate more effective and holistic approaches to treating type 2 diabetes mellitus (T2DM).

The studies on the risk of tuberculosis (TB) in patients with type 1 diabetes mellitus (T1DM) alone are limited. We examined this relationship using a population-based retrospective cohort study. From claims data of the National Health Insurance system of Taiwan, we identified 5195 patients with T1DM newly diagnosed from 2002 to 2011 and 20,780 randomly selected controls without T1DM, frequency matched by age, sex, and year of diagnosis. Both cohorts were followed up until the end of 2011 to evaluate the risk of TB. The overall incidence of TB was 4.07-fold higher in the T1DM cohort than in the control cohort (1.18 vs 0.29 per 1000 person-years, P < 0.001). Compared with the controls, the Cox model estimated adjusted hazard ratios (HRs) of TB in patients with T1DM were greater in men than in women (4.62 vs 3.59) and in adults than in children (4.06 vs 3.37), but not significant. The adjusted HR was much greater for those with comorbidities than those without comorbidities (14.6 vs 1.62, P < 0.001). Compared with the controls, the patients with T1DM were also more likely to develop TB with multiple emergency room visits (adjusted HR: 116.1, 95% confidence interval [CI] = 43.8–307.4) or hospitalizations (adjusted HR: 86.5, 95% CI = 33.7–222.4). Patients with T1DM are at elevated risks of developing TB with much higher HRs for those with comorbidities, within the first year of diagnosis, and with frequent emergency cares or hospitalizations.

Diabetes Mellitus (DM) is a chronic metabolic disease that may have debilitating effect toward the whole life of type 2 diabetic patient, not only the physical aspect but also psychological aspect. Depression is one psychological disorder, therefore this condition requires a comprehensive management with involving family on nursing care. The purpose of this study was to identify the correlation among depression and family support with blood glucose level of type 2 DM patients. This study used an analytic correlational design with cross-sectional approach, recruited 166 respondents by purposive sampling method at Outpatient Ward of Internal Medicine Clinic, Sragen Public Hospital on September until November 2008. The CES-D (Center for Epidemiological Studies-Depressed Mood Scale) was used to assesed depressive symptoms while the DFBC (The Diabetes Family Behavior Checklist ) to determine the total score of family support. Chi Square, t-test independent and a multiple logistic regression were used to examine the relationship of depression and family support with blood glucose. The result revealed that there were significant relationships among depression and blood glucose level ( p value 0,0005) and family support ( p =0,0005). There was no significant correlation between economic status and blood glucose level ( p =0,052). In addition, family support became the most dominant factor related to blood glucose level (OR=10,925). Meanwhile, age, education level, and complications became the confounding factors. It concluded that there were relationship among depression and family support with blood glucose level of type 2 DM patients. The findings of this study suggested that screening individuals with diabetes for depressive symptoms and participation of family would be important aspect of diabetes care.

Background: Non-psychotic mental disorders including non-severe depressive, anxiety and organic disorders can have an impact on the course and prognosis of the underlying disease in patients with diabetes mellitus (DM). Therefore, assessment of their epidemiologic aspects is extremely important. Aim: Investigation of the types and prevalence of the major mental disorders among both type 1 DM (T1DM) and type 2 DM (T2DM) in-patients, determination of possible etiology of the organic involvement of the brain in T1DM patients as well as of the rate of diagnostics and management of mental disorders in DM patients in routine medical practice. Materials and methods: Part 1 was a cross-sectional study in 228 consecutive DM patients aged from 18 to 75 years, aimed at detection of current mental disorders. Part 2 was a cross-sectional study in 72 consecutive T1DM patients with in-depth assessment of signs of organic brain involvement. All patients underwent cognitive function tests. Mental disorders were diagnosed by a psychiatrist according to ICD-10 diagnostic criteria. Results: Mental disorders were found in 80.3% of patients, being significantly more prevalent in patients with T2DM (87.9%) than in T1DM patients (57.4%, р&lt;0.0001). Anxiety disorders as a whole were diagnosed as frequently as depressive ones (39.5% and 40.0%, respectively), being the most prevalent both in T1DM (35%) and T2DM (60%). Within the class of anxiety disorders, diabetes-specific phobias of injections and hypoglycemia were noted 8-fold more often (р&lt;0.01) in T1DM than in T2DM patients. Generalized (22.4 versus 9.3%) and organic (18 versus 0%) anxiety disorders as well as unipolar depressive episodes and dysthymia (40.2 versus 25.9%, р&lt;0.05) occurred considerably more often in T2DM than in T1DM patients. In total, signs of organic brain involvement were found in 37% of T1DM patients. Possible etiologic factors of organic brain disorders were as follows: craniocerebral injury including concussion of the brain, severe hypoglycemia, and diabetic ketoacidosis – in 40.7% of patients each; alcohol abuse – 30.7%; arterial hypertension – 22.2%; ante- and intranatal factors – 11.1%; neuroinfections/intoxications and occupational neurotropic factors – in 7.4% each; electric trauma, general malnutrition, stroke, and brain tumor – in 3.7% each. None of the listed potential causes could be found only in one patient with organic brain involvement (3.7%). In T1DM patients, organic brain involvement was nonspecific, and there was no evidence of its association with the level of glycated hemoglobin, acute and chronic vascular diabetic complications. Conclusion: The present investigation revealed a high prevalence of non-severe mental disorders with predominance of generalized anxiety disorders and unipolar protracted depressions in T2DM in-patients and specific phobias in T1DM patients. Organic brain involvement (encephalopathy) occurs in every third young T1DM patient; however, in the majority of cases, its potential etiology is linked with factors unrelated to DM or non-specific for DM (for example, hypoglycemia). In routine medical practice, diagnostics and treatment of mental disorders in DM patients are close to non-existent.

Background: One in three adolescents with type 1 diabetes mellitus (T1DM) experiences diabetes distress, which predicts poor self-management and glycemic control. Mindfulness-based interventions such as meditation have been associated with reduced psychological distress and health outcomes in different populations. This study explores the psychosocial barriers and facilitators of diabetes self-management and beliefs about meditation practices.Methods: Eight adolescents aged 15-19 who had been diagnosed with T1DM for more than a year were invited to participate in a 40-60-minute semi-structured one-on-one interview. Their parents were also invited to participate in the study. Three of the eight parents invited were able to participate in the study. Participants were asked about perceived psychosocial barriers and facilitators of diabetes self-management and their beliefs about meditation as a tool for addressing some of the psychosocial barriers to self-management. Data were analyzed using NVivo 10 (QSR International, Melbourne, Australia). Conventional content analysis was conducted based on an inductive coding approach.Results: Adolescents with T1DM had similar psychosocial challenges with managing T1DM, including high levels of diabetes distress and forgetfulness due to competing demands on their time. They also noted similar facilitators to effective self-management, such as the presence of family and peer support. Acceptance of T1DM diagnosis and personal commitment to self-management were also indicated as common facilitators of self-management. Adolescents with T1DM and parents of adolescents with T1DM believe that meditation can play a positive role in T1DM self-management by reducing diabetes distress and improving mental health and overall well-being.Conclusion: Results suggest that adolescents with T1DM and parents of adolescents with T1DM believe peer and family support is crucial to diabetes self-management. They also noted that diabetes distress and forgetfulness are primary barriers to self-management. Participants also see a potential for meditation to help manage general stress and diabetes distress, thereby aiding self-management. Further research is needed to explore meditation-based interventions to reduce diabetes distress in adolescents diagnosed with T1DM. The findings from this study can inform the development and implementation of meditation-based interventions that integrate family and peer support to reduce diabetes distress and enhance self-management in adolescents with T1DM.

To clarify the expression of N6-methyladenosine (m6 A) modulators involved in the pathogenesis of type 2 diabetes mellitus (T2DM). We further explored the association of serum insulin-like growth factor 2 mRNA-binding proteins 3 (IGF2BP3) levels and odds of T2DM in a high-risk population. The gene expression data set GSE25724 was obtained from the Gene Expression Omnibus, and a cluster heatmap was generated by using the R package ComplexHeatmap. Differential expression analysis for 13 m6 A RNA methylation regulators between nondiabetic controls and T2DM subjects was performed using an unpaired t test. A cross-sectional design, including 393 subjects (131 patients with newly diagnosed T2DM, 131 age- and sex-matched subjects with prediabetes, and 131 healthy controls), was carried out. The associations between serum IGF2BP3 concentrations and T2DM were modeled by restricted cubic spline and logistic regression models. Two upregulated (IGF2BP2 and IGF2BP3) and 5 downregulated (methyltransferase-like 3 [METTL3], alkylation repair homolog protein 1 [ALKBH1], YTH domain family 2 [YTHDF2], YTHDF3, and heterogeneous nuclear ribonucleoprotein [HNRNPC]) m6 A-related genes were found in islet samples of T2DM patients. A U-shaped association existed between serum IGF2BP3 levels and odds of T2DM according to cubic natural spline analysis models, after adjustment for body mass index, waist circumference, diastolic blood pressure, total cholesterol, and triglyeride. Multivariate logistic regression showed that progressively higher odds of T2DM were observed when serum IGF2BP3 levels were below 0.62 ng/mL (odds ratio 3.03 [95% confidence interval 1.23-7.47]) in model 4. Seven significantly altered m6 A RNA methylation genes were identified in T2DM. There was a U-shaped association between serum IGF2BP3 levels and odds of T2DM in the general Chinese adult population. This study provides important evidence for further examination of the role of m6 A RNA methylation, especially serum IGF2BP3 in T2DM risk assessment.

BackgroundSurgical perioperative deaths and major complications are important contributors to preventable morbidity, globally and in sub-Saharan Africa. The surgical safety checklist (SSC) was developed by WHO to reduce surgical deaths and complications, by utilising a team approach and a series of steps to ensure the safe transit of a patient through the surgical operation. This study explored barriers and enablers to the utilisation of the Checklist at the University Teaching Hospital (UTH) in Lusaka, Zambia.MethodsA qualitative case study was conducted involving members of surgical teams (doctors, anaesthesia providers, nurses and support staff) from the UTH surgical departments. Purposive sampling was used and 16 in-depth interviews were conducted between December 2018 and March 2019. Data were transcribed, organised and analysed using thematic analysis.ResultsAnalysis revealed variability in implementation of the SSC by surgical teams, which stemmed from lack of senior surgeon ownership of the initiative, when the SSC was introduced at UTH 5 years earlier. Low utilisation was also linked to factors such as: negative attitudes towards it, the hierarchical structure of surgical teams, lack of support for the SSC among senior surgeons and poor teamwork. Further determinants included: lack of training opportunities, lack of leadership and erratic availability of resources. Interviewees proposed the following strategies for improving SSC utilisation: periodic training, refresher courses, monitoring of use, local adaptation, mobilising the support of senior surgeons and improvement in functionality of the surgical teams.ConclusionThe SSC has the potential to benefit patients; however, its utilisation at the UTH has been patchy, at best. Its full benefits will only be achieved if senior surgeons are committed and managers allocate resources to its implementation. The study points more broadly to the factors that influence or obstruct the introduction and effective implementation of new quality of care initiatives.

Subclinical left ventricular (LV) dysfunction is prevalent in type 2 diabetes (T2DM). As obesity has been proposed as one causal factor in the disease process, this could bias the reported prevalences. We wanted to characterize echocardiographic LV dysfunction in obese T2DM subjects as compared to non-diabetic obese controls. One hundred patients with T2DM without clinical signs of heart failure (29% females, mean ± SD age 58.4 ± 10.5 years, body mass index (BMI) 30.1 ± 5.5 kg/m(2), blood pressure (BP) 141 ± 18/83 ± 9 mmHg) and 100 non-diabetic controls (29% females) matched for age (58.6 ± 10.5 years), BMI (29.8 ± 4.0 kg/m(2) and systolic BP (140 ± 14 mmHg) underwent echocardiography and color tissue Doppler imaging (TDI). Diastolic function was evaluated with conventional Doppler recordings and early (e') and late (a') myocardial velocities. The ratio between early transmitral filling (E) and the corresponding myocardial tissue velocity (e') served as an index of LV filling pressure. T2DM patients had more concentric hypertrophy with a relative wall thickness of 0.42 ± 0.07 vs controls 0.38 ± 0.07, P < 0.001. The T2DM group had signs of diastolic dysfunction with lower E/A ratio (0.91 ± 0.27 vs. 1.12 ± 0.38, P < 0.001), deceleration time (195 ± 49 vs 242 ± 72 ms, P < 0.001), e' (5.7 ± 2.0 vs. 6.6 ± 1.8 cm/s, P = 0.001), and a' (6.5 ± 2.0 vs. 7.6 ± 1.5 cm/s, P < 0.001) compared to the controls, and higher E/e' (13.3 ± 4.7 vs. 11.1 ± 3.5, P < 0.001). Thus, there were indications of pseudo normalization and increased filling pressure in the T2DM group, whereas the controls had evidence for relaxation abnormalities without elevated filling pressure. Compared to a non-diabetic obese group, more advanced subclinical impairment of diastolic function was seen in T2DM.

The Effect of Vitamin D Supplementation on Glycemic Control and Body Mass Index in the Obese, Vitamin D Deficient Adult with Type 2 Diabetes Mellitus: A Systematic Review Protocol

The relationship between type 1 diabetes mellitus (T1DM) and periodontal disease may exhibit by the alteration of bone metabolism. However, evidence for this relationship is scarce and inconclusive. Thus, the aims of the present study were to investigate salivary receptor activator of nuclear factor kappa-β (RANK), receptor activator of nuclear factor kappa-β ligand (RANKL), osteoprotegerin (OPG) gene expression and the RANKL:OPG ratio in T1DM and non-T1DM. Secondary objective was to determine the relationships of RANK, RANKL and OPG gene expression to clinical parameters of T1DM and periodontal disease. Twenty patients with T1DM and twenty age-matched non-T1DM were recruited. Clinical periodontal parameters were measured. Total RNA was isolated from non-stimulated saliva, and the relative gene expressions of RANK, RANKL, OPG and RANKL:OPG ratio were determined by quantitative real-time polymerase chain reaction. The T1DM group had significantly higher mean periodontal parameters than the non-T1DM group, while the mean plaque scores of both groups were not significantly different. There was a trend of higher relative gene expression of RANK, RANKL, and the RANKL:OPG ratio and lower expression of OPG in T1DM group but no statistic significant different when compared to non-T1DM. In the T1DM group, RANKL:OPG correlated with the percentage of bleeding sites, whereas RANK, RANKL, and HbA1c levels correlated with pocket depth. Bone metabolisms demonstrating by decreased OPG gene expression and upregulated of RANK, RANKL, RANKL:OPG with higher pocket depth and bleeding in T1DM may play an important role in periodontal destruction in T1DM.

Glycemic control and outcome of cancer patients.

Integrated biomarker profiling of the metabolome associated with impaired fasting glucose and type 2 diabetes mellitus in large-scale Chinese patients.

Comparison of Characteristics Between Chinese Patients Taking Glucagon-like Peptide 1 Receptor Agonists and Insulin: A Cross-sectional Database Analysis

Identification of KCNJ15 as a Susceptibility Gene in Asian Patients with Type 2 Diabetes Mellitus