Explanatory models of adult patients with type 2 diabetes mellitus from urban centers of central Ethiopia

Experience of stigma among persons with type 2 diabetes in Africa: a systematic review

Diabetes stigma is a pervasive social phenomenon with significant impacts on individuals living with type 2 diabetes mellitus (T2DM). Despite the negative health impact of diabetes stigma, little is known about the experience of this phenomenon in Africa. This review aimed to synthesize existing quantitative and qualitative studies that examine the experiences and outcomes of T2DM stigma in Africa. A mixed studies review methodology was utilized to conduct this research. Relevant articles were identified by searching the Cumulative Index to Nursing and Allied Health Literature, PubMed, MEDLINE and PsycINFO databases. The mixed method appraisal tool was used to assess the quality of included studies. Of 2626 records identified, 10 articles met the inclusion criteria. The prevalence of diabetes stigma was as high as 70%. The results of the review indicate that individuals with T2DM in Africa are labelled as 'having HIV', 'nearing their death' and 'wasting resources'. These experiences were associated with low quality of life, disease concealment and avoidance of self-management behaviours. The findings highlight the urgent need for further stigma-centric studies to fully understand how T2DM stigma is experienced in Africa. The evidence from such studies would inform the development and evaluation of effective interventions to address this social consequence of T2DM.

"High blood pressure comes from thinking too much": Understandings of illness among couples living with cardiometabolic disorders and HIV in Malawi

Cardiometabolic disorders (CMD) such as hypertension and diabetes are increasingly prevalent in sub-Saharan Africa, placing people living with HIV at risk for cardiovascular disease and threatening the success of HIV care. Spouses are often the primary caregivers for people living with CMD, and understanding patients' and partners' conceptions of CMD could inform care. We conducted semi-structured interviews with 25 couples having a partner living with HIV and either hypertension or diabetes. Couples were recruited from HIV clinics in Malawi and were interviewed on beliefs around symptoms, causation, prevention, and treatment for CMD. Data were analyzed at the individual and dyadic levels using framework analysis and Kleinman's theory of explanatory models as a lens. On average, participants were 51 years old and married for 21 years. Approximately 57%, 14%, and 80% had hypertension, diabetes, and HIV. Couples endorsed a combination of biomedical explanatory models (beliefs around physical and mental health) and traditional explanatory models (beliefs around religion and natural remedies), although tended to emphasize the biomedical model. Half of couples believed stress was the main cause of hypertension. For diabetes, diet was believed to be a common cause. In terms of prevention, dietary changes and physical activity were most frequently mentioned. For disease management, medication adherence and diet modifications were emphasized, with some couples also supporting herbal remedies, stress reduction, and faith in God as strategies. Participants were generally more concerned about CMD than HIV due to poor access to CMD medications and beliefs that CMD could lead to sudden death. Within couples, partners often held many of the same beliefs but diverged around which etiological or preventive factors were most important (e.g., stress versus diet) and the best diet for CMD. Health education programs should involve primary partners to build knowledge of CMD and address overlap with HIV, and reinforce accurate information on lifestyle factors for the prevention and treatment of CMD.

Willingness to Receive mHealth Services Among Patients with Diabetes on Chronic Follow-up in Public Hospitals in Eastern Ethiopia: Multicenter Mixed-Method Study

Background

Management of diabetes requires a long-term care strategy, including support for adherence to a healthy lifestyle and treatment. Exploring the willingness of patients with diabetes to receive mHealth services is essential for designing efficient and effective services. This study aimedto determine willingness to receive mHealth services and associated factors, as well as explore the barriers to receive mHealth services among patients with diabetes.

Methods

A multicenter mixed-method study was employed from September 1 to November 30, 2022. For the quantitative part, a total of 365 patients with diabetes receiving chronic follow-up at three public hospitals were enrolled. Data were gathered using structured questionnaires administered by interviewers, entered into Epi-data version 4.6, and analyzed using Stata version 17. A binary and multivariable logistic regression model was computed to identify the associated factors. For qualitative, eight key informants and seven in-depth interviews were conducted. After verbatim transcription and translation, the data were thematically analyzed using ATLAS.ti V. 7.5.

Results

Overall, 77.3% had access to a mobile phone, and 74.5% of them were willing to receive mHealth services. Higher odds of willingness to receive mHealth services were reported among patients with an age below 35 years [AOR = 4.11 (1.15-14.71)], attended formal education [AOR = 2.63 (1.19-5.77)], without comorbidity [AOR = 3.6 (1.54-8.41)], <1-hour travel to reach a health facility [AOR = 3.57 (1.03-12.36)], answered unknown calls [AOR = 2.3 (1.04-5.13)], and were satisfied with health-care provider service [AOR = 2.44 (1.04-5.72)]. In the qualitative part, infrastructure, health facilities, socioeconomic factors, and patients' behavioral factors were major identified barriers to receiving mHealth services.

Conclusion

In this study, the willingness to receive mHealth services for those who have access to mobile phones increased. Additionally, the study highlighted common barriers to receiving mHealth services.

The "Life-World" trip of type 2 diabetes patients with allopathic treatment options: a triangulated qualitative investigation

BACKGROUND

Patients with type 2 diabetes usually start treatment with oral hypoglycaemic medications once they have been diagnosed. They eventually require insulin injections. We looked into the experiences of such patients with allopathic treatment alternatives over the course of their journey.

METHODS

The study was conducted using a qualitative inquiry (phenomenological approach triangulated with modified grounded theory) from July 2019 to January 2020. A total of 24 participants (11 men and 13 women) were recruited purposively and interviewed face-to-face until theoretical saturation was reached. QDA Miner Lite v2.0.9 was used to categorise the data.

RESULTS

The majority of patients had no previous notions regarding their illness. They did not have an emotional reaction to being diagnosed. They were uncomfortable on oral hypoglycaemic agents because of uncontrolled blood glucose and gastrointestinal disturbances, which were thought to be the main causes for medication changes. Initial insulin treatment experiences included fear of injection pain, difficulty self-injecting, and a sense of last resort. Insulin's effectiveness, ease of injection with a little needle, and lack of gastrointestinal discomfort were all key reasons in changing the patients' minds about it. Patients have rigorously adhered to insulin since it was found to improve health and bring life.

CONCLUSION

The "life-world" journey of patients with type 2 diabetes with allopathic treatment options was started to be informed of the "unknown" (diabetes), which leads to the "ugly life" (with oral agents), and bridge to and living with the "terrible" (insulin), which was later found to be effective and perceived as "life."KEY MESSAGESPatients with type 2 diabetes believed that life with oral hypoglycaemic medications was "boring."The major reasons for switching to insulin were "uncontrolled blood sugar levels" and "gastrointestinal disturbances" brought on by oral medications.Insulin first terrified type 2 diabetes patients, but they eventually referred to it as "life."

Patients' perceptions, associations, and justifications for the causes of diabetes in North-East Ethiopia: A qualitative study

BACKGROUND AND AIMS

Diabetes management is strongly influenced by patients' beliefs about its causes. The study examined type 2 diabetes patients' perceptions of the causes of their illness in North-East Ethiopia.

METHODS

The study used a phenomenological approach triangulated with modified grounded theory based on the Causative Dimension of Self-Regulated Model, and was conducted from July 2019 to January 2020. Purposive sampling was used to select the participants. Semi-structured in-depth face-to-face interviews with twenty-four (11 males and 13 females) participants were used to collect data until saturation. QDA Miner Lite v2.0.8 was used to perform analysis, which was then discussed based on the themes that emerged.

RESULTS

The patients expressed and justified the causes of their illness by evidencing the temporal proximity of the onset of symptoms or indicators and specific misfortune. As such, diabetes has been attributed to emotional reactions, psycho-economic situations, supernatural evil spirits, substance use, nutritional problems, and other illness; emotional reactions, with psycho-economic and supernatural spirits being the most common. These causes were justified by referring to a specific earlier misfortune that related to the onset of the indicators.

CONCLUSION

Patients' perceptions for attributing their illness were linked with emotional, psycho-economic, and supernatural evil spirits and justified by a specific life calamity by establishing the temporal association of symptoms with that adversity; which entails culture-specific psycho-social and educational interventions in diabetes care. Moreover, the finding necessitates that the causality justifications and linkages to misfortunes be included in the Causality Dimension of the Self-Regulated Model.

Sufferings of its consequences; patients with Type 2 diabetes mellitus in North-East Ethiopia, A qualitative investigation

Background

The burden of diabetes in Ethiopia is exponentially increasing with more than 68% of people with it being undiagnosed and a death rate of 32%. It is a disease impacting patients with negative somatic, psychological, social, and economic consequences. Patients in Ethiopia have very low awareness about chronic complications, which is very worrying. The study aimed to explore the consequences of their disease experienced by type 2 diabetes patients in North-East Ethiopia.

Methods

The study employed a phenomenological approach informed by the consequences dimension of the Common-Sense Model. It was conducted from July 2019 to January 2020 using purposive sampling with face-to-face in-depth interviews, for about three weeks, until reaching theoretical saturation. The data were collected from twenty-four type 2 diabetes patients, who were selected to include various socio-demographic characteristics. The data were organized by QDA Miner Lite v2.0.8 and analyzed thematically using narrative strategies.

Results

Using Common-Sense Model as a framework, the diabetes consequences experienced by the participants were categorized as complications and impacts. While the most common complications were cardiovascular disorders (hypertension, erectile dysfunction, heart and kidney problems, hyperlipidemia, edema, stroke, and fatigue) and ocular problems; the most common impacts were psychosocial (dread in life, suffering, family disruption, hopelessness, dependency, and craving), and economic (incapability and loss of productivity) problems.

Conclusion

The patients here were bothered by diabetes complications as well as its psycho-social, economic and somatic consequences; being the psycho-social impacts the most common. As a result, the patients have been suffering in the dread of “what can come next?” This dictates that holistic care, based on Common-Sense Model, is needed in providing special emphasis to psycho-social issues.

In vivo hypoglycemic, antihyperglycemic and antidyslipidemic effects of the solvent fractions of Hagenia abyssinica leaves in mice

Background

Hagenia abyssinica leaves have been used traditionally for the management of different diseases including diabetes mellitus (DM) although the antidiabetic effect of different solvent fractions of hydromethanol H. abyssinica leaf extract has not been scientifically studied. Thus, this study was conducted to investigate the in vivo hypoglycemic, antihyperglycemic and antidyslipidemic effects of the solvent fractions of Hagenia abyssinica leaf extract.

Methods

The antidiabetic effect of the solvent fractions was evaluated in normal, oral glucose loaded and streptozotocin-induced diabetic mice. Hypoglycemic, antihyperglycemic, antidyslipidemic activities and effect on body weight change were evaluated after administration of three different doses of the solvent fractions (100, 200, and 400 mg/kg). One-way ANOVA followed by Tukey's post hoc test was used for data analysis, and p<0.05 was considered as statistically significant.

Results

The crude hydromethanol extract of H. abyssinica leaves did not show any sign of toxicity at the dose of 2000 mg/kg in mice. In normoglycemic mice, both aqueous and ethyl acetate fractions of H. abyssinica leaves showed significant (P<0.05) hypoglycemic activity. In oral glucose loaded mice, the two doses of the aqueous fraction, 200 mg/kg (p<0.05) and 400 mg/kg (p<0.001), showed a significant antihyperglycemic effect at 60 and 120 minute post-oral glucose loading while the ethyl acetate fraction showed significant antihyperglycemic effect at 60 (P<0.05 for 200 mg/kg and P<0.001 for 400 mg/kg) and 120 min (P<0.01 for 400 mg/kg) post-oral glucose loading. In single dose-treated diabetic mice, all doses of the solvent fractions caused a significant (P<0.05) reduction in blood glucose level except 100 mg/kg of the aqueous and chloroform fractions. Additionally, repeated daily treatment with the aqueous fraction significantly reduced hyperglycemia, body weight loss, and improved dyslipidemia of diabetic mice.

Conclusion

This study has revealed that the solvent fractions of H. abyssinica leaves possess in vivo blood-glucose-lowering activities on normal, oral glucose loaded, and streptozotocin-induced diabetic mice. Additionally, the aqueous fraction prevented diabetic body weight loss and dyslipidemia in mice after repeated daily dose administration.

Meta-analysis of studies on depression prevalence among diabetes mellitus patients in Africa

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion or insulin action. It can be caused by the consumption of carbohydrate meals or medication side effects. Depression as a comorbid condition in an individual with diabetes is accountable for increased disability, mortality, and significant health problem in patients. As a continent, Africa does not have an overall estimation of depression prevalence among diabetes mellitus patients at a regional level. Consequently, this study's purpose was to use the meta-analysis method to summarize estimates of extant studies that have reported depression prevalence among patients with diabetes mellitus in Africa. The literature search method was executed to classify studies with reported depression prevalence with evidently designed inclusion and exclusion criteria. In total, 20 studies from sundry screened articles were appropriate for ultimate inclusion in the meta-analysis. Since substantial heterogeneity was expected, a random-effects meta-analysis was carried out using the number of cases with a total sample size to estimate the prevalence of diabetes mellitus at a regional level. The residual amount of heterogeneity was found to be high according to the statistics of τ² = 0.06; I² = 99.10%, chi-square = 2184.85, degree of freedom = 19 and P =< 0.001. The pooled depression prevalence was 40% within a 95% confidence interval of 29%–51%. The meta-regression analysis result showed that none of the included moderators contributed to the heterogeneity of studies. The result of effect size estimates against its standard error showed publication bias with a P-value of 0.001. The meta-analysis findings of this study have indicated that depression prevalence in Africa is still high. Reporting on numerous risk factors like socio-demographic characteristics were not possible in this study because of a lack of completeness in the included articles. Consequently, screening diabetes patients for comorbid depression with its associated risk factors is highly recommended.

In Vitro α-Amylase and α-Glucosidase Inhibitory and Antioxidant Activities of the Crude Extract and Solvent Fractions of Hagenia abyssinica Leaves

BACKGROUND

The leaves of Hagenia abyssinica have been used in the management of diabetes mellitus in Ethiopian folk medicine. Thus, this study is aimed at investigating the in vitro α-amylase and α-glucosidase inhibitory and antioxidant activities of the crude extract and solvent fractions of H. abyssinica leaves.

METHODS

The in vitro α-amylase and α-glucosidase inhibitory and antioxidant activities of the plant extract were assessed using 3,5-dinitrosalicylic acid (DNSA), p-nitro-phenyl-a-D glucopyranoside (p-NPG), and 1,1-diphenyl-2-picrylhydrazyl (DPPH) assays, respectively. Each value of percent inhibition of α-amylase, α-glucosidase, and DPPH scavenging effect was presented as means ± SEM (n = 3).

RESULTS

The α-amylase inhibitory activity of the crude extract and solvent fractions was found to be concentration-dependent. The strongest activity was exhibited by the crude extract at the highest concentration with a percentage inhibition of 74.52% (IC50, 14.52 μg/ml) followed by water fraction 68.24% (IC50, 16.31 μg/ml), ethyl acetate fraction 61.57% (IC50, 18.73 μg/ml), and chloroform fraction 56.87% (IC50, 21.57 μg/ml) of H. abyssinica leaves. In the α-glucosidase inhibition assay, the maximum activity was exhibited by the aqueous fraction 62.54% (IC50, 11.67 μg/ml) followed by ethyl acetate fraction 54.97% (IC50, 15.89 μg/ml), crude extract 46.79% (IC50, >16.5 μg/ml), and chloroform fraction 36.44% (IC50, >16.5 μg/ml). In the antioxidant assay, the crude extract exhibited the highest antioxidant activity 86.36% (IC50, 10.25 μg/ml) followed by water fraction 78.59% (IC50, 13.86 μg/ml), ethyl acetate fraction 71.58% (IC50, 16.34 μg/ml), and chloroform fraction 63.65% (IC50, 18.83 μg/ml).

CONCLUSION

This study has revealed that H. abyssinica leaves possess noticeable in vitro α-amylase and α-glucosidase inhibitory and antioxidant activities.

Thirst for Information and Needs Reflections of Type 2 Diabetes Patients Receiving Insulin Treatment in North-East Ethiopia: A Qualitative Exploration

Objectives:

Ongoing, proactive, planned, and patient-centered diabetes education is the cornerstone of care for all persons with diabetes. Thus, the aim of this study was to explore the information needs of type 2 diabetes mellitus patients receiving insulin treatment in North-East Ethiopia.

Methods:

The study was conducted from July 2019 to January 2020 using a qualitative enquiry (phenomenological approach) with purposive sampling. Face-to-face in-depth interviews were used to collect data until reaching theoretical saturation. The participants were type 2 diabetes patients receiving insulin treatment. They were identified from the diabetes patients’ registration book at the diabetes clinic and interviewed at their appointment time, and were selected to include wide variations in terms of socio-demographic characteristics. Twenty-four participants (11 men and 13 women), with a median age of 57 years, were interviewed. The data were organized using QDA Miner Lite version 2.0.7 and analyzed thematically using narrative strategies.

Results:

Most participants had not heard of diabetes before their diagnosis. They had limited knowledge of diabetes, but ascribed different connotations for it in the local language (Amharic). The needs reflections of patients were categorized into diabetes education and participants’ recommendations. Diabetes education was totally absent at hospitals, and patients received education primarily from the Ethiopian Diabetes Association and broadcast and digital media. Thus, the major concern of patients was the availability of diabetes education programs at health institutions.

Conclusions:

Patients’ main concern was the absence of routine diabetes education, which necessitates urgent action to implement diabetes education programs, especially at health institutions.

Evaluation of In Vivo Antidiarrheal Activity of Solvent Fractions of Hagenia abyssinica (Rosaceae) in Swiss Albino Mice

Background

Ethiopia has several medicinal plants that have been used for their antidiarrheal activity. Hagenia abyssinica is the most commonly used medicinal plant for the management of diarrhea in Ethiopia. Thus, this study's aim is to investigate the antidiarrheal effect of solvent fractions of H. abyssinica.

Methods

Antidiarrheal activity of extract fractions obtained from different solvents was evaluated by using small intestine transit, enteropooling, and castor oil-induced diarrhea animal models. In all animal models, the solvent fractions treated groups were treated with three different doses (100 mg/kg, 200 mg/kg, and 400 mg/kg) of the solvent fractions, while the negative control group was treated with a vehicle (distilled water), and positive control group was treated with loperamide.

Results

The acute toxicity test revealed that the LD₅₀ of H. abyssinica is > 2000 mg/kg. In castor oil-induced, the solvent fractions of H. abyssinica (at 200 mg/kg and 400 mg/kg) significantly (P < 0.05–0.001) prolonged the stool frequency, reduced the weight of feces, and delayed diarrheal onset time as compared with the negative control group. The fractions produced a significant (P < 0.05) antimotility effect at the doses of 200 mg/kg and 400 mg/kg as compared to the negative control. All solvent fractions at the middle and higher doses showed a statistically significant dose-dependent reduction in the volume of intestinal contents and weight of the feces. However, the solvent fractions of H. abyssinica at a dose of 100 mg/kg failed to produce a statistically significant activity in all parameters (number of wet feces, the onset of diarrhea, and number of total feces) when compared with the negative control group.

Conclusion

The extract fractions obtained from different solvents have shown significant antidiarrheal activity. Thus, this finding supports the claimed traditional use of H. abyssinica leaves for the treatment of diarrhea.

Factors influencing healthcare providers' attitude and willingness to use information technology in diabetes management

BACKGROUND

The use of information technologies could help to improve communications between patients and care providers, might improve overall patient management practice. However, the potential for implementing these patient management options in Ethiopia has not been well documented. This institution-based survey aimed to describe the attitude and willingness of care providers towards the use of information technologies for managing diabetes patients, and factors influencing their interest.

METHODS

A cross-sectional quantitative survey was conducted on 423 study participants from February to March 2020 at two teaching hospitals in Northwest Ethiopia, where remote monitoring patients had not been implemented. A pretested self-administered questionnaire was used to collect the required data. Other than descriptive statistics, the binary logistic regression analysis method was used to identify factors associated with attitude. Also, the negative binomial regression method was used to identify factors associated with willingness to use information technologies.

RESULT

A total of 406 participants (69.7%, n = 283 nurses and 30.3%, n = 123 physicians) were completed survey. Overall, 64% of respondents had a favorable attitude towards remote monitoring, and the majority of them were willing to use voice call (74.4%), text message (62.1%), video conference (61.3%), e-mail (60.6%), and social media (57.4%) as a source of communication to support patients. The result of regression analysis shows that having a computer (AOR = 2.3, 95% CI: [1.3, 3.8]), innovativeness (AOR = 2.8, 95% CI: [1.8, 4.3]), and practice of supporting patient by electronic technologies (AOR = 1.7, 95% CI: [1.1, 2.6]) were significantly associated with attitude to remote monitoring. Attitude towards remote monitoring (IRR = 2.3, 95% CI: 1.1-4.7), computer use (IRR = 1.3, 95% CI: 1.162-3.023), frequently searching health-related information (IRR = 1.7, 95% CI: 1.459-6.570), gender (IRR = 1.2, 95% CI: 1.0-5.1), awareness towards remote monitoring (IRR = 1.4, 95% CI: 1.1-2.7) were significantly associated with willingness to use information technologies.

CONCLUSION

Improving the intention and skill of using computers should be a major point of attention for teaching hospitals who wish to improve their care providers' attitudes to remote monitoring and willingness in using information technologies. Besides, the awareness of professionals is crucial for improving willingness.

Anti-Oxidant Potential and Antimalarial Effects of Acanthus polystachyus Delile (Acanthaceae) Against Plasmodium berghei: Evidence for in vivo Antimalarial Activity

BACKGROUND

Malaria is among the most devastating and widespread tropical parasitic diseases which is more prevalent in developing countries. Acanthus polystachyus (Acanthaceae) leaves are traditionally used for the treatment of malaria in Ethiopia. This study aimed to investigate the in vivo antimalarial and in vitro antioxidant activity of the leaves extract of Acanthus polystachyus.

MATERIALS AND METHODS

The leaves part of A. polystachyus were extracted using 80% methanol. The antioxidant effect of Acanthus polystachyus extract was evaluated by using (DPPH) diphenyl-2-picrylhydrazyl assay model. To evaluate the antimalarial effect of the A. polystachyus extract, Plasmodium berghei ANKA strain (chloroquine sensitive) was used to infect the mice in three different experimental protocol: suppressive, curative, and prophylactic test models.

RESULTS

The leaves extract of Acanthus polystachyus significantly (P<0.05-0.0001) suppressed the parasitemia in all experimental protocol. The extract exhibited a chemosupression of 27.64%, 33.67% and 49.25% in 4-day suppressive test; 33.76%, 39.24% and 53.59% in curative test, and 25%, 32.84% and 50% in prophylactic tests at dose of 100, 200, and 400mg/kg, respectively. The extract also extended the mean survival time, prevented the bodyweight loss and body temperature drop, and packed cell volume significantly (P<0.05) as compared to the negative control. Dose-dependent antioxidant activity was shown by the leaf extract of A. polystachyus with an IC50 value of 9.37µg/mL.

CONCLUSION

The current finding showed that the leaves extract of Acanthus polystachyus has revealed promising antimalarial effects. Thus, this finding supports the traditional use of A. polystachyus for the treatment of malaria.

Evaluation of in vitro and in vivo Anti-Diabetic, Anti-Hyperlipidemic and Anti-Oxidant Activity of Flower Crude Extract and Solvent Fractions of Hagenia Abyssinica (Rosaceae)

BACKGROUND

The flower of Hagenia abyssinica (Rosaceae) has been used in traditional health systems to treat diabetes mellitus in Ethiopia and Tanzania. However, the antidiabetic activity of this medicinal plant is not scientifically validated and authenticated. The present study aimed to investigate the in vitro and in vivo anti-diabetic activity of flower crude extract and solvent fractions of Hagenia abyssinica.

METHODS

The in vitro α-amylase inhibition and antioxidant activity of the crude extract and solvent fractions of Hagenia abyssinica were evaluated by using 3,5-dinitrosalicylic acid (DNSA) and diphenyl-2-picrylhydrazyl (DPPH) assay model, respectively. Blood glucose lowering activity of 80% methanolic flower crude extract and solvent fraction was studied in four animal models: normoglycemic mice model, oral glucose loaded mice model, single dose-treated streptozotocin-induced diabetic mice model, and repeated dose-treated streptozotocin-induced diabetic mice model. The effect of the crude extract and solvent fraction of Hagenia abyssinica on diabetic lipid profile and body weight was also studied.

RESULTS

The acute toxicity study of Hagenia abyssinica flower extract did not show mortality in the animals at the limit dose of 2g/kg during the observation period. The result of α-amylase enzyme inhibition activity was found in a dose-dependent manner, the strongest activity was shown by ethyl acetate fraction (54.23% inhibition at 800 μg/mL) compared to the standard acarbose having 91.87% inhibition at 800 μg/mL. Among these extracts, the crude extract had the highest antioxidant activity (58.38% inhibition at 500 μg/mL). The crude extract of H. abyssinica showed significant blood glucose-lowering effect on normoglycemic mice and oral glucose loaded mice. In streptozotocin-induced diabetic mice model, the crude extract and ethyl acetate fraction significantly decreased the fasting blood glucose level after 14 days of treatment. There were significant reductions in serum total cholesterol, serum triglycerides, very low-density lipoprotein, and low-density lipoprotein. However, there were significant increments in body weight and high-density lipoprotein as compared to untreated diabetic mice.

CONCLUSION

The result demonstrated the beneficial biochemical effects of Hagenia abyssinica extract by inhibiting α-amylase, scavenging diphenyl-2-picrylhydrazyl (DPPH) and improving serum lipid profile levels. The flower crude extract and solvent fractions of Hagenia abyssinica are effective in lowering blood glucose levels in diabetic and normoglycemic mice. The claimed traditional use as antidiabetic has scientific ground.

Antidiabetic and Anti-hyperlipidemic Effects of the Crude Hydromethanol Extract of Hagenia abyssinica (Rosaceae) Leaves in Streptozotocin-Induced Diabetic Mice

BACKGROUND

The leaves of Hagenia abyssinica (Rosaceae) have been used traditionally for the management of diabetes mellitus. Thus, this study aimed to evaluate the antidiabetic and anti-hyperlipidemic activity of Hagenia abyssinica leaves crude extract in streptozotocin-induced diabetic mice.

METHODS

Antidiabetic and anti-hyperlipidemic activity of the crude extract of Hagenia abyssinica was studied in streptozotocin-induced diabetic mice. The effects of the extract on fasting blood glucose level, body weight, and serum lipid profiles were analyzed. One-way ANOVA followed by Tukey's post hoc test was used for data analysis and p<0.05 was considered as statistically significant.

RESULTS

Hagenia abyssinica leaves crude extract showed significant (p<0.05-p<0.001) blood-glucose-lowering activity. Moreover, the crude extract of H. abyssinica reduced the fasting blood glucose level by 23.21%, 38.20%, 43.53%, and 58.99%, respectively, for CE100, CE 200, CE 400, and GLC 5 mg/kg on the 14th day of treatment. After diabetic mice were treated with H. abyssinica (100, 200 and 400 mg/kg) for 14 days, there was a significant decrease in serum total cholesterol, very-low-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and serum triglyceride and a significant increase in body weight, and HDL-cholesterol level as compared to diabetic control.

CONCLUSION

The present findings revealed that H. abyssinica leaves could be useful for the management of diabetes mellitus and other abnormalities related to this metabolic disorder. Thus, the present study may support the traditional use of H. abyssinica for diabetes mellitus treatment.

Access to mobile phone and willingness to receive mHealth services among patients with diabetes in Northwest Ethiopia: a cross-sectional study

OBJECTIVES

This study aimed at determining access to mobile phone and willingness to receive mobile phone-based diabetes health services as well as identify associated factors in Northwest Ethiopia.

DESIGN

An institution-based cross-sectional survey was conducted from February to March 2016.

PARTICIPANTS

Systematic randomly selected 423 patients with diabetes.

SETTING

University of Gondar Hospital diabetic clinic.

MAIN OUTCOME MEASURES

The main outcome measure was willingness to receive diabetic health service via mobile phone voice call or messaging services.

RESULTS

Out of 423 patients with diabetes, 329 (77.8%) had access to a mobile phone. Among the latter, 232 (70.5%) were willing to receive mobile phone-based health services. The educational status of patients (adjusted OR (AOR): 2.6 (95% CI: 1.2 to 5.58)), route of medication (AOR: 3.2 (95% CI: 1.44 to 7.1)), transportation mechanism (AOR: 4.1 (95% CI: 1.2 to 13.57)), travel time to health facility (AOR: 0.3 (95% CI: 0.12 to 0.82)), current use of mobile phone as appointment reminder (AOR: 2.6 (95% CI: 1.07 to 6.49)) and locking mobile phone with passwords (AOR: 4.6 (95% CI: 1.63 to 12.95)) were significantly associated with the willingness to receive mobile phone-based diabetic health services.

CONCLUSION

Access to a mobile phone and willingness to receive mobile phone-based health services were high. Educational status, route of medication, transportation mechanism, time to reach the service, using mobile phone as appointment reminder and locking mobile phone with passwords were significantly associated factors. Given the high proportion of access and willingness of patients to receive mobile phone-based health services, mHealth interventions could be helpful.

Incorporating patients' perspectives into the initial stages of core outcome set development: a rapid review of qualitative studies of type 2 diabetes

Conducting systematic reviews of qualitative studies to incorporate patient perspectives within the early stages of core outcome set (COS) development can be resource intensive. We aimed to identify an expedited approach to be used as part of the wider COS development process. Specifically, we undertook a rapid review of qualitative studies of patients' views and experiences of type 2 diabetes. We searched MEDLINE from inception to June 2017 to identify studies reporting qualitative empirical findings of perspectives of people with type 2 diabetes. Qualitative methodological filters were used to minimize irrelevant references. Drawing on content analysis, data synthesis involved identifying text in eligible studies relevant to outcomes of type 2 diabetes and interpreting and categorizing this according to the 38 core domains of the Core Outcome Measures in Effectiveness Trials taxonomy. Of 146 studies screened, 26 were included. Four hundred and fifty-eight outcomes were derived from the included studies. In comparison to the outcomes extracted from clinical trials, more life impact outcomes were derived from the qualitative studies, but fewer physiological/clinical outcomes. Outcomes relating to 'mortality/survival' and 'role functioning' were more prevalent in studies conducted in low/middle-income countries. This rapid review and synthesis of qualitative studies identified outcomes that had not previously been identified by a systematic review of clinical trials. It also identified differences in the types of outcomes given prominence to in the clinical trials and qualitative literatures. Incorporating qualitative evidence on patient perspectives from the outset of the COS development process can help to ensure outcomes that matter to patients are not overlooked. Our method provides a pragmatic and resource-efficient way to do this. For those developing international COS, our method has potential for incorporating the perspectives of patients from diverse countries in the early stages of COS development.

Patients' Illness Perceptions of Type 2 Diabetes: A Scoping Review

BACKGROUND

People's personal perceptions, or illness representations, of type 2 diabetes can act as barriers to successful self-management.

INTRODUCTION

Understanding patients' subjective perceptions of type 2 diabetes can aid the design of evidence-based care and appropriate educational programmes. This scoping review provides a narrative account of previous knowledge of patients' illness representations of type 2 diabetes.

METHODS

Quantitative and qualitative studies that explored patients' illness representations of type 2 diabetes, as defined by Leventhal's Common Sense Model, were included.

RESULTS

Thirty four studies were identified for this review, but only 14 studies were carried out in a general population of people with diabetes. Illness representations varied across study populations. While it is clear that the perceptions of ethnic minorities and marginalised groups are embedded in their historical and cultural backgrounds, it is also important to understand the views of the wider population.

CONCLUSION

The review highlights the need for self-management interventions to reflect the target population's representations of type 2 diabetes in order to inform interventions and clinical practice.

Experiences of type 2 diabetes in sub-Saharan Africa: a scoping review

Background

The prevalence of diabetes in Sub-Saharan Africa (SSA) is growing rapidly. Qualitative research on experiences of type 2 diabetes in SSA is emerging, but no qualitative synthesis has been attempted. This scoping review aims to redress this lack of synthesis and to extract policy-relevant suggestions from the literature.

Methods

Scoping review methodology was employed. Eleven online databases were searched (CINAHLplus, Cochrane Library, EBESCOhost, GALE Group, MEDLINE, Pro-Quest, Pscyhinfo, Pubmed, SCOPUS, Web of Science, WorldCat), using terms designed to identify qualitative studies of experiences of diabetes in SSA. Findings from records identified in the search were analysed inductively in NVivo 10 in three stages, to produce an analytical synthesis of studies of diabetes experiences in SSA.

Results

Searches were conducted in 2017 and identified 2743 records, which were reduced to 21 after screening. The earliest identified record was published in 2003 and there was a clustering of records published between 2014 and 2016. The 21 records were based in eight SSA countries: Cameroon, Ethiopia, Ghana, Senegal, South Africa, Tanzania, Uganda, and Zimbabwe. A majority of the studies were conducted in Ghana (5) and South Africa (5), limiting the generalisability of our findings.The analytical synthesis produced five themes: identifying type 2 diabetes (how participants conceptualise and position their illnesses); hybridity of diabetes care (how multiple forms of care are often blended and/or pursued concurrently); impediments, improvisation and diabetes management (describing challenges faced, how these are responded to and management via diet and physical activity); sources of support (who supports participants and how); and diabetes and HIV/AIDs (the ways in which the two conditions are sometimes confused and how stigma is often experienced).

Conclusions

The experiences of people with type 2 diabetes in SSA are under-researched across the region, pointing to a gap in knowledge. Interpreting our analytical synthesis, we suggest three priority areas for policy makers and implementers. Firstly, uncertainties relating to access to diabetes treatment need to be reduced. Secondly, more needs to be done to acknowledge and alleviate the economic struggles that those with diabetes face. Finally, high-quality information and education would improve recognition and management of the condition.