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An investigation into the prevalence of prediabetes in Durban, South Africa, as well as the associated hormonal imbalances and MicroRNA expression patterns in patients with prediabetes.
(2024) Sosibo, Aubrey Mbulelo.; Khathi, Andile.; Ngubane, Phikelelani Siphosethu.
Background Prediabetes constitutes a metabolic state linked with an elevated risk of all-cause mortality. The International diabetes federation has projected a substantial increase in the prevalence of pre-diabetes, particularly in middle-income countries. Despite this, there is a lack of research looking into pre- diabetes in middle-income countries, leading to a significant number of undiagnosed cases. Additionally, there exists a limited understanding of hormonal imbalances and their correlation with pre-diabetes. The exploration of the link between epigenetic factors and pre-diabetes is also insufficient, particularly in developing countries such as South Africa. There is a compelling need for more pre- diabetes-related research that will represent middle-income populations in order to assist in mitigating the anticipated surge in prediabetes and type 2 diabetes mellitus (T2DM). Therefore, this research project aimed to assess the systematic prevalence of pre-diabetes and its correlates in South Africa and the specific prevalence of pre-diabetes in King Edward Hospital, the second-largest tertiary hospital in Southern Africa, based in Durban, South Africa. The paucity of pre-diabetes-related research on hormonal imbalances relative to T2DM led us to quantify the difference in hormone concentration levels between persons with pre-diabetes and those without pre-diabetes. Lastly, the miRNA expression changes in pre-diabetes participants and the association between microRNAs and HbA1c-determined dysglycemia were examined for the first time in a population based in Durban. Methods Per the PRISMA 2020 guidelines, a first-of-its-kind systematic and meta-analysis review was conducted to estimate the overall prevalence of pre-diabetes and its correlates in South Africa. Then, a retrospective study design was adopted, with a sample size of 364, to investigate the prevalence of pre- diabetes in a clinical setting based in Durban. After that, hormone concentrations were measured from stored plasma samples through multiplexing using the Luminex MAGPIX System to determine the occurrence of hormonal imbalances in subjects with pre-diabetes. Lastly, microRNAs were extracted from plasma samples and converted to cDNA in order to perform RT-qPCR. The RT-qPCR quantified the expression of microRNA targets previously unexplored in the study population (miRNA-34a-5p, miRNA-145-5p, and let-7f-5p) between persons with pre-diabetes and normoglycemia. Results The meta-analysis generated a pre-diabetes pooled prevalence of 15,56 % in the South African population. The prevalence differed across the ethnic groups, mainly affecting the Indian, Coloured, African and then white ethnic groups, respectively. The common correlates of pre-diabetes were hypertension, obesity and a sedentary lifestyle. The retrospective prevalence study showed a mammoth 54 % and 67 % prevalence of pre-diabetes when using the respective WHO and ADA diagnostic criteria for pre-diabetes. The following hormones, c-peptide, cortisol, progesterone, estradiol, T3, T4, and adiponectin, were dysregulated in persons with pre-diabetes and significantly correlated with HbA1c. Of the three candidate miRNAs, only miRNA-34a-5p showed a significant relative fold expression difference between pre-diabetes and individuals with normoglycaemia. Moreover, the receiver operator characteristic curve analysis for miR-34a-5p produced an AUC of 0.806, Conclusion The meta-analysis study showed a substantial prevalence of pre-diabetes across the country, and the study’s prevalence analysis in King Edward Hospital indicates that it is burgeoning. The growing pre- diabetes prevalence suggests a looming incidence of overt T2DM if left unattended. Hence, the outcomes highlight the need to strengthen pre-diabetes surveillance in order to implement diabetes prevention policies and interventions effectively. Moreover, the management of pre-diabetes care may need to consider a more holistic approach by monitoring the hormonal imbalances that were found to correlate with HbA1c. Future research should explore the therapeutic potential of targeting these hormonal pathways, including the possibility of hormone replacement interventions. Notably, miR-34a-5p was found to be associated with dysglycemia and a potential future risk marker or diagnostic marker for pre-diabetes.
The effects of pregestational prediabetes as a risk factor for preeclampsia in pregnant female Sprague rats and the adverse effects of pregestational prediabetes on the placenta, liver and kidney function.
(2024) Siboto, Anelisiwe.; Ngubane, Phikelelani Sethu.; Khathi, Andile.; Sibiya, Ntethelelo Hopewell.
Introduction Preeclampsia (PE) is a pregnancy complication that is diagnosed after 20 weeks of gestation with new onset hypertension and proteinuria. The risk factors of PE arise from trophoblastic and non-trophoblastic risk factors. The risk factors of PE include chronic hypertension, obesity and preexisting type 2 diabetes mellitus (T2DM). The onset of T2DM is preceded by PD and the prevalence of PD is increased exponentially in the developing countries due to urbanization, adapting to westernized diets that have high calories and normalized sedentary lifestyle. This westernized diet is associated with adverse effects on the heart, kidney and the liver. However, there are no reports of PD and its effects on pregnancy. In this study we investigated the effects of pregestational PD as a risk factor for PE in pregnant female Sprague rats and the adverse effects of maternal PD on the placenta, liver and kidney function. Methods Eighteen (18) female Sprague Dawley rats (150–180 g) were obtained from Biomedical Research Unit. High fat high carbohydrate (HFHC) with drinking water supplemented with fructose (HFHC+fructose) induced prediabetic female Sprague Dawley rats and LNAME induced preeclamptic female Sprague Dawley rats were used for this study. Parameters including non-fasting blood glucose concentration, body weights, blood pressure, fluid intake and urine output were monitored on gestational day (GND) 0, 9 and 18 during gestation period. Following sacrifice, parameters such as VEGF, PlGF, sFlt-1, NO, liver triglycerides, TNF α and liver function enzymes, lipid peroxidation, antioxidant status, kidney injury molecule (KIM 1), podcin, neprhin, creatinine, urea, albumin and electrolytes, were measured. Results The prediabetic group showed impaired non-fasting glucose, dyslipidemia, high blood pressure, impaired placenta function as evidenced by reduction in VEGF an PlGF and an increase in sFlt-1, impaired kidney function showed by increased plasma KIM-1, increased urinary podocin and nephrin and impaired electrolyte handling. The prediabetic group also showed impaired liver function as evidenced by increased plasma liver enzymes, increased liver oxidative stress and increased liver inflammation. Conclusion The diet-induced prediabetic rats showed impaired glucose handling and an imbalance in pro-angiogenic and antiangiogenic factors which lead to metabolic disturbances such as endothelial dysfunction, liver and kidney injury.
Unpredictable Stress on Metabolic and Molecular Changes Associated with Memory Decline in Lipopolysaccharide-Challenged Rats.
(2025) Sibiya, Khethelo Mayenziwe.; Luvuno, Mluleki.; Mabandla, Musa Vuyisile.
Background. South Africa, a low- to middle-income country, faces a high burden of maternal and neonatal morbidity and mortality, with hypertensive disorders of pregnancy— particularly preeclampsia— contributing substantially to these outcomes. Magnesium plays a critical role in vascular regulation, endothelial function, and blood pressure control. Although magnesium sulphate is well established in the management of severe pre-eclampsia, the relationship between circulating maternal magnesium levels and the development of pre-eclampsia remains poorly understood, especially in populations with high rates of obesity and HIV. Aim. To investigate the association between maternal serum magnesium concentrations and preeclampsia, and to examine the influence of HIV status and obesity on this relationship in a South African antenatal population. Methods. This cross-sectional study included 252 pregnant Black South African women, categorised into: First Visit Normotensive (First VisitNT), Term Normotensive (TermNT), early-onset preeclampsia (EOPE), and late-onset pre-eclampsia (LOPE). Serum magnesium was measured using atomic absorption spectrophotometry. Differences between groups were assessed using analysis of variance (ANOVA) with Bonferroni post-hoc tests, while associations with preeclampsia were examined using chi-square tests and multinomial logistic regression, adjusting for body mass index, HIV status, and gestational age. Results. Among normotensive women, serum magnesium levels declined significantly from the first antenatal visit to term (0.78 ± 0.08 mmol/L vs. 0.72 ± 0.10 mmol/L; p < 0.001). This decline was not observed in women with pre-eclampsia, whose magnesium levels remained stable or slightly elevated. Hypomagnesaemia (<0.66 mmol/L) was most prevalent in the TermNT group (23.9%) and was associated with lower odds of pre-eclampsia (odds ratio [OR] = 0.216, 95% confidence interval [CI]: 0.065–0.721, p = 0.013). Obesity was a strong predictor of both early-onset pre-eclampsia and late-onset pre-eclampsia, whereas HIV status showed no significant association with magnesium levels or pre-eclampsia risk. Conclusion. In this cohort, normotensive pregnancies showed a physiological decline in serum magnesium, a pattern absent in pre-eclampsia. The inverse association between hypomagnesaemia and preeclampsia suggests altered magnesium regulation in hypertensive pregnancies rather than a protective effect of low magnesium. These findings highlight the complexity of magnesium’s role in pre-eclampsia pathophysiology and underscores the need for longitudinal studies to clarify causality and inform targeted antenatal interventions.
Affect and investment in language learning: the case of English in Saudi Arabia.
(2026) Satardien, Sameer.; Pillay, Ansurie.
This study examines how affective experiences shape students’ investment in learning English within a preparatory programme at a Saudi Arabian university. It argues that affect is not merely a psychological state but is also a social force that shapes how students engage, belong and construct meaning in English learning contexts. Adopting an interpretivist research paradigm, the study implemented a qualitative research approach and utilised a descriptive case study design. Data were collected using two open-ended questionnaires and two narrative writing tasks administered to Saudi Arabian first-year preparatory university students. The questionnaires were completed by 394 students (Questionnaire 1 and Narrative 1) and 230 students (Questionnaire 2 and Narrative 2). A thematic analysis was employed to identify patterns across emotional experiences, motivational processes and investment trajectories. The findings show that emotions such as confidence, pride and enjoyment induced sustained investment, whereas frustration, fear and anxiety (test anxiety, the fear of negative evaluation and communication apprehension) led to withdrawal, avoidance, and defensive learning postures. This study reveals that the emotions experienced by students were, at times, socially mediated through teacher behaviour, assessment pressure, and peer judgment, showing that affect and investment are dynamically linked. Two emergent concepts in language learning, namely emotional detachment and emotional displacement, explain how students redirect or suppress negative emotions in response to repeated failure or exclusion, demonstrating that affect can reshape long-term motivation and investment. The study introduces the affective pathways model of investment, which integrates emotion, identity, and engagement, to understand a student’s lived experiences of language learning. This contribution expands current theoretical understandings and demonstrates the methodological value of large-scale qualitative design. It aligns its pedagogical significance with Saudi Arabia’s Vision 2030 and the Graduate Attributes Framework, which emphasise developing confident, adaptable, and globally competent graduates prepared for meaningful participation in an interconnected world.
Exploring the lived experiences of South African students in international student mobility programmes: a phenomenological study.
(2025) Zondo, Normah Happy.; Shawa, Lester Brian.
This study offers a phenomenologically grounded account of South African students’ lived experiences of international student mobility (ISM), foregrounding the voices of ten first-generation students from two South African universities. Situated within the enduring inequalities of South Africa’s higher education landscape and the asymmetries that structure global internationalisation, the research examines student mobility to institutions in the Global North. The data were generated in the post-COVID-19 period, a context that heightened institutional uncertainty, intensified resource constraints, and reshaped imaginaries of global participation. Conceptually, the study draws on phenomenological, sociological, and interpretive theoretical traditions to frame mobility as an embodied, relational, and structurally mediated experience. Phenomenology provides the ontological and methodological grounding for attending to lifeworld, intentionality, and intersubjectivity, positioning lived experience as the primary site of meaning. Sociological perspectives illuminate the structuring effects of habitus, capital, and global stratification, while interpretive and affective frameworks foreground relationality, emotion, and the circulation of power within transnational spaces. An explicitly intersectional and decolonial orientation challenges celebratory and technocratic accounts of internationalisation, interrogating instead the epistemic hierarchies and structural constraints that shape who moves, under what conditions, and toward which futures. Methodologically, the study is based on in-depth narrative interviews analysed through Interpretative Phenomenological Analysis (IPA). This approach enabled a detailed exploration of participants’ sense-making across the full arc of mobility, from pre-departure processes and expectations, through academic and social encounters abroad, to post-return reintegration. The findings reveal that mobility is neither a linear pathway to global competence nor a uniformly transformative experience. Instead, it unfolds as a complex negotiation shaped by aspiration, constraint, and agency. Participants described opaque selection procedures, uneven funding structures, and perceptions of institutional gatekeeping during the predeparture phase. While abroad, they navigated unfamiliar pedagogical cultures, racialised and classed positioning, and the emotional labour of adaptation within Global North institutions. Upon return, many encountered limited institutional recognition of their expanded knowledge and shifting identities, producing tensions between personal transformation and institutional inertia. Across these phases, students’ lifeworlds, shaped by rurality, race, gender, and first-generation status, travelled with them, mediating both opportunity and exclusion.