Epidemiology and knowledge of selfcare of diabetes mellitus, obesity and hypertension in Guyana and beneficial use of Momordica charantia, in combination with daily exercise and diet modification, to treat these non-communicable diseases

Hanoman, Carlin A. (2023) Epidemiology and knowledge of selfcare of diabetes mellitus, obesity and hypertension in Guyana and beneficial use of Momordica charantia, in combination with daily exercise and diet modification, to treat these non-communicable diseases. Doctoral thesis, University of Central Lancashire.

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In 2018, The World Health Organization (WHO) identified chronic non-communicable diseases (NCDs) or chronic diseases (CDs) as cardiovascular diseases (CVDs), diabetes mellitus (DM) obesity, cancer, stroke, chronic respiratory diseases (CRD), cerebrovascular disease (CVD), kidney failure (KF) and dental diseases. CVDs are further classified into heart failure or cardiomyopathy, hypertension, atherosclerosis, coronary artery diseases (CAD), sudden cardiac death (SCD), arrhythmias and others. DM, obesity and hypertension are three major global health NCDs affecting people in both developed and low-and middle- income developing countries such as Guyana. These diseases are interrelated where obesity is a risk factor for DM and both obesity and DM are risk factors for hypertension. The prevalence of all three NCDs are very high, and they are also very costly to treat in Guyana. Diabetes is classified mainly into type 1 DM (T1DM) and type 2 DM (T2DM) and 85-90% of diabetics suffer from T2DM. Obesity is when someone has a basal metabolic index (BMI) of 30 and over. Likewise, hypertension (HTN) or high blood pressure (HBP) is when someone has elevated BP over20/90 mm Hg and over. Modern life- style habits including overeating but not the right food, sedentary living, stress, genetic pre-disposition and others risk factors can lead obesity, diabetes and hypertension. Guyana is cursed with the ‘obese-diabetic-hypertensive time bomb’. This study investigated the epidemiology and cost-effective ways to treat these NCDs in Guyana and how knowledge of obesity and diabetic self-care management can prevent long–term complications associated with obesity and DM. In tackling the scientific problem, this study investigated the roles of regular exercise, diet modification and use of bitter melon or corilla (Momordica charantia), a local anti-diabetic vegetable in Guyana to treat obesity, diabetes and hypertension in newly diagnosed patients.
The main epidemiological findings in this study reveal that the three NCDs increased in prevalence gradually over the years especially among both adult males and females but significantly more so among females, especially when they reach the ages between 46 to 69 years. In addition, almost twenty five percent of adult Guyanese failed to diagnose their medical conditions and many of those who are diagnosed prefer to seek advice from a traditional healer and take herbal remedies to treat their diseases rather than taking prescribed drugs. Data also show that such NCDs as diabetes, hypertension and CVDs are responsible for more deaths in Guyana and rank high globally.
Initial time-course treatment and glucose tolerance tests (GTTs) reveal that M charantia consumption (5-20 grams twice daily as either a juice (weight/volume) can reduce blood sugar, blood pressure and other blood biomarkers such as total lipids (cholesterol) and triglycerides significantly (p<0.05) in diabetes-treated patients after 6 weeks compared to week 1 of the study (These effects were dose-dependent. The results also show that the hypoglycaemic effects were more pronounced when M charantia was combined with diet modification, exercise and the orthodox medicine, diamicron MR. M charantia had no synergistic effect on blood glucose when it was combined with dimicron MR. Measurement of blood cation levels using inductively -coupled plasma mass spectrometry (ICPMS) in plasma from diabetic and age-matched healthy control subjects reveal no significant change in the levels of the cations. Chemical analysis of M charantia revealed that it is rich in vitamin C, some cations, phenolic contents and antioxidant compounds

Similarly, daily intake of M charantia either alone or in combination with physical activity and diet modification can reduce body weight and significantly (p<0.05) decrease blood pressure (BP), total lipids and triglycerides in obese subjects after 6 weeks of treatment compared to the start of the study (In newly diagnosed hypertensive patients, M charantia either alone or combined with regular exercise and diet modification can reduce significantly (p<0.05) high blood pressure after 6 weeks of treatment compared to week 1 at the start of the study. M charantia had no significant effect on BP when it was combined with orthodox medicine, amlodipine, a calcium channel blocker).

The results also show that knowledge of the respondents using a questionnaire about T2DM self-care management was overall poor. Thus, the study concluded that the higher the level of knowledge about T2DM self-care, the less likely the diabetic patients will develop diabetes-related complications, as noted by the higher scoring of the control group. Therefore, effective health promotion and education programmes are recommended to target T2DM patients, as well as pre-diabetic and non-diabetic persons (chapter 6). However, obese patients have a good knowledge of obesity, but they were still obese. In conclusion, the results of this study have shown that M charantia, diet modification and daily exercise, either alone or in combination have potential cost-effective effects in treating diabetes, obesity and hypertension and knowledge of self-care management about diabetes can delay end-organ complications.

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