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- Volume 10, Issue 3, 2005
Journal of Endocrinology, Metabolism and Diabetes in South Africa - Volume 10, Issue 3, 2005
Volume 10, Issue 3, 2005
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 10, pp 70 –72 (2005)More Less
Extracted from text ... NEWS ? NEWS ? NEWS ? NEWS ? NEWS ? NEWS World Diabetes Day 2005 - diabetes and foot care World Diabetes Day 2005 - which takes place on 14 November - has as its theme diabetes and foot care, under the slogan 'Put feet first: Prevent amputations'. The last in the series of themes on diabetes complications that began in 2001, complications of the foot are also among the most serious and most costly complications of diabetes. Between 40% and 70% of all lower extremity amputations are related to diabetes, and the incidence of lower leg amputation among ..
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 10 (2005)More Less
Extracted from text ... New Optium Xceed Diabetes Monitoring System Abbott Diabetes Care, a division of Abbott Laboratories, and Novo Nordisk, have launched the MediSense Optium Xceed Diabetes Monitoring System and the new, improved MediSense Optium Plus Blood Glucose Test Strip. Optium Xceed is the only home glucose monitor (in addition to MediSense Optium) that enables people with diabetes to measure both blood glucose and blood ketone levels with one simple, easy-to-use meter. The stylish and attractive system has been designed to make everyday testing as simple as possible. Compact, lightweight and durable, Optium Xceed has been designed to fit comfortably in the ..
Author Fraser PirieSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 10 (2005)More Less
Extracted from text ... JEMDSA 76 November 2005, Vol. 10, No. 3 A number of landmark studies have made it abundantly clear that the goals of diabetes care involve striving for optimal metabolic and blood pressure control. The message is now loud and clear: lower HbA1C, lower lowdensity lipoprotein cholesterol, and lower blood pressure. Failure to achieve these targets makes the person with diabetes susceptible to macrovascular and microvascular disease, with the attendant consequences. In the clinical situations faced by many practitioners in South Africa, however, attainment of these goals is an unrealistic expectation. Although this should not detract from efforts to maximise metabolic ..
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 10 (2005)More Less
Extracted from text ... JEMDSA 80 November 2005, Vol. 10, No. 3 The International Diabetes Federation (IDF) is a global non-governmental organisation with more than 190 member associations in over 140 countries. Consequently it represents millions of people with diabetes, their families and others who care for them. The IDF mission is to 'promote diabetes care, prevention and a cure worldwide'. As such it acts as an advocate for people with diabetes and their health care providers. The IDF holds an international congress in a different location every 3 years. The last congresses have taken place in Mexico (Mexico City), Finland (Helsinki) and ..
Author Stephen HoughSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 10 (2005)More Less
Extracted from text ... JEMDSA 82 November 2005, Vol. 10, No. 3 Following the very successful inaugural training course on osteoporosis, presented jointly by the National Osteoporosis Foundation of South Africa (NOFSA) and the International Osteoporosis Foundation (IOF) in May 2004 and attended by more than 150 delegates, the need for an update has become apparent. The 2nd NOFSAIOF Course has therefore been scheduled to take place during the weekend of 10 - 12 February 2006 at the President Hotel, Bantry Bay, Cape Town. Based on the established IOF course which has been held annually in Lyon, France, for more than 15 years, ..
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 10, pp 86 –90 (2005)More Less
<I>Background.</I> Diabetes mellitus is a common chronic disease needing long-term glycaemic control to prevent complications. Guidelines are available for achievement of optimal glycaemic control, but these are seldom properly instituted. <br><I>Objectives.</I> To determine if a physician education programme and a structured consultation schedule would improve the quality of diabetes patient care in a diabetes clinic. <br><I>Setting.</I> Two tertiary care diabetes clinics at Kalafong Hospital, Pretoria. <br><I>Study design.</I> Quasi-experimental controlled before-and after study. <br><I>Methods.</I> A baseline audit of the quality of care in two comparable diabetes clinics was performed. Three hundred patients were randomly selected for an audit of their hospital records: 141 from the intervention and 159 from the control clinics. Thereafter a physician training programme and a structured consultation schedule were introduced to the intervention clinic and maintained for a 1-year period. The control clinic continued with care as usual. Process and outcome measures were determined at a post-intervention audit and compared between the two groups. Consultation time was measured for both the intervention and control groups and data were compared. <br><I>Results.</I> At baseline the intervention and control groups did not differ significantly with regard to process and outcome measures. After intervention the intervention group had significantly higher process measure scores than the control group (<I>p</I> < 0.01). HbA<SUB>1c</SUB> did not significantly differ between the two groups (<I>p</I> = 0.60). The average number of clinic visits reduced over time for the intervention group compared with the control group (<I>p</I> < 0.01), but the average consultation times were significantly longer (<I>p</I> < 0.01). <br><I>Conclusion.</I> The introduction of a physician education programme and a structured consultation schedule improved the quality of care delivered at a tertiary care diabetes clinic.
Barriers to initiating insulin therapy in patients with type 2 diabetes mellitus in public-sector primary health care centres in Cape TownSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 10, pp 94 –99 (2005)More Less
<I>Background.</I> The majority of patients with type 2 diabetes mellitus in Cape Town who attend primary care community health centres (CHCs) have unsatisfactory glycaemic control. Insulin is rarely prescribed despite its being indicated for type 2 diabetic patients with inadequate metabolic control on maximum oral glucose-lowering agent (OGLA) therapy. <br><I>Objective.</I> The study examined barriers to initiating insulin therapy in poorly controlled type 2 diabetes patients on maximum OGLAs in CHCs in the Cape Town metropole. <br><I>Methods.</I> Five focus group discussions and 10 in-depth semi-structured individual interviews were conducted with 46 medical officers working at the CHCs. The discussions and interviews were transcribed and common themes were identified and categorised. <br><I>Results.</I> Doctor, patient, and system barriers to initiating insulin therapy were identified. Doctors' barriers include lack of knowledge, lack of experience with and use of guidelines related to insulin therapy, language barriers between doctor and patients, and fear of hypoglycaemia. Patient barriers were mistaken beliefs about insulin, noncompliance, lack of understanding of diabetes, use of traditional herbs, fear of injections, and poor socioeconomic conditions. System barriers were inadequate time, lack of continuity of care and financial constraints. <br><I>Conclusion.</I> Suggestions for overcoming barriers include further education of doctors on insulin initiation and the use of standardised guidelines. In addition, a patient-centred approach with better communication between doctors and patients, which may be achieved by reorganising aspects of the health system, may improve patient knowledge, address mistaken beliefs, improve compliance and help overcome barriers. Further research is needed to investigate these recommendations and assess patients' and nurses' perceptions on initiating insulin therapy.
Author Kenneth R. HuddleSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 10, pp 102 –107 (2005)More Less
<I>Objective.</I> To audit the outcome of pregnancy among diabetic black women in Soweto following the introduction of a specialised service. <BR><I>Design and methods.</I> An analysis of patients' records was conducted for the period 1992 - 2002. Maternal characteristics, aspects of treatment and its complications, mode of delivery and perinatal outcome are reported. The incidence of postpartum glucose intolerance in women with gestational diabetes was assessed. Major outcomes from this study are compared with those of an earlier study conducted from 1983 to 1992. <BR><I>Results.</I> A total of 733 diabetic pregnancies was managed over 11 years: 348 women had gestational diabetes, 172 had type 1 diabetes and 213 had type 2 diabetes. Insulin was used in all but 23 women. Mean (<U>+</U> standard deviation (SD)) capillary blood glucose levels varied between 5.7 (<U>+</U> 0.72) and 6.2 (<U>+</U> 0.95) mmol/l in the 3 groups. Severe maternal hypoglycaemia was most common in the type 1 diabetes group (14%). Mean (<U>+</U> SD) neonatal weight varied between 2 922.3 g (<U>+</U> 753) and 3 073.3 g (<U>+</U> 727). Caesarean section rates exceeded 60% in all 3 groups. Overall, 13.1% of women had hypertension, 31.3% of whom had proteinuric hypertension. There were no cases of progressive pre-eclampsia. The combined perinatal mortality (PMN) rate was 3.7%, compared with 15.6% in the 'control' group. Major congenital malformations occurred in 11 pregnancies (1.5%). There were 2 maternal deaths. Postpartum impaired glucose tolerance / diabetes occurred in 25.9% of women with gestational diabetes. Combining the 2 studies (1983 - 1992 and 1992 - 2002), 1 087 pregnancies were managed over 20 years using a similar protocol. There were no significant differences in major outcomes between the 2 studies. The overall PMN of 4.5% is significantly lower than that of the combined 'control' group (19.9%). Postpartum glucose intolerance was documented in 28.5% of women. <BR><I>Conclusions.</I> The institution of a specialised service for pregnant diabetic women from Soweto for a sustained period of 20 years proved feasible and was of significant benefit. The interventions, centred around a diabetes nurse educator, were relatively simple and easy to implement. Late presentation / referral of patients remains a problem. Persistence of glucose intolerance postpartum in women with gestational diabetes was common and provides an opportunity for preventive measures to be introduced.
Author F.P.R. De VilliersSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 10, pp 110 –111 (2005)More Less
Extracted from text ... JEMDSA 110 November 2005, Vol. 10, No. 3 Lipohypertrophy and lipoatrophy of injection sites was a major problem with the old impure insulins.1 The problem improved somewhat with the advent of the monocomponent bovine and porcine insulins and the current pure human insulins, such that lipoatrophy in particular is now very rare.1, 2 However it now manifests more subtly, with thickening of the skin rather than the formation of lumps and pitting. Even diabetologists have been known to miss it, when not looking for it carefully. The complication has occurred with the new genetically engineered modified human insulins, with and ..
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 10, pp 113 –116 (2005)More Less
Extracted from text ... November 2005, Vol. 10, No. 3 113JEMDSA Obesity is defined as an excess accumulation of body fat associated with increased fat cell size and number. Obesity is a common and serious medical problem worldwide, especially in industrialised countries, but the prevalence of obesity is also increasing in developing countries such as South Africa.1 One of the key factors accounting for this may be increased urbanisation.2 The movement of populations from rural to urban areas is associated with major changes in lifestyle, particularly the increased availability of calorie-dense foods and drinks. Although obesity is associated with social stigma in Western countries, ..