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- Volume 11, Issue 1, 2006
Journal of Endocrinology, Metabolism and Diabetes in South Africa - Volume 11, Issue 1, 2006
Volume 11, Issue 1, 2006
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 11 (2006)More Less
Extracted from text ... May 2006, Vol. 11, No. 1 JEMDSA NEwS ? NEwS ? NEwS ? NEwS ? NEwS ? NEwS World Diabetes Day 2006 World Diabetes Day, which is marked on 14 November, this year has as its theme 'Diabetes in the disadvantaged and the vulnerable'. Under the slogan 'Diabetes care for everyone' the World Diabetes Day 2006 campaign aims to raise awareness of disadvantaged communities and vulnerable groups in both developed and developing countries that experience difficulties in accessing optimal health care because they are outside the health care system, or for some reason are less likely to access or ..
Author Fraser PirieSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 11, pp 4 –5 (2006)More Less
Extracted from text ... JEMDSA May 2006, Vol. 11, No. 1 Defining normal adrenocortical responses (especially glucocorticoid responses) to various stimuli has been a topic of debate for many years in clinical endocrinology. The current view states that a serum total cortisol concentration of 550 nmol/l (20 ?g/dl) or more in response to stimulation with adrenocorticotrophic hormone (ACTH) indicates normal adrenal responsiveness and reserve and precludes the requirement for exogenous steroid supplementation.1 This is generally accepted for both the high-dose (250 ?g) and low-dose (1 ?g) ACTH stimulation tests, although blood levels of ACTH are significantly above physiological levels for the high-dose (1 ..
Author Stephen HoughSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 11, pp 7 –8 (2006)More Less
Extracted from text ... May 2006, Vol. 11, No. 1 JEMDSA Osteoporotic fractures are a common and important cause of disability and death worldwide. Antiresorptive agents like the bisphosphonates or the oestrogen analogues have been shown in large randomised controlled trials (RCTs) to significantly reduce the rate of osteoporotic fractures. These agents do not, however, abrogate fractures or the deranged skeletal microarchitecture that characterises osteoporosis; they only modestly and often transiently increase bone mineral density (BMD), and are not free of sideeffects. Moreover, since bone formation and resorption are usually tightly coupled, even in most types of osteoporosis, the decrease in bone resorption ..
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 11, pp 10 –14 (2006)More Less
<I>Background.</I> Diabetes constitutes a significant health problem in South Africa. Early detection and good management can prevent or delay complications, with national guidelines for diabetes treatment now available to facilitate this. However, problems are being encountered with their implementation and there is evidence that preventive care is still inadequate in South Africa. Community health workers (CHWs) are lay personnel employed to serve as a link between professional health care staff and the community. They visit homes and can be a powerful force for diabetes prevention and adherence to treatment regimens, given appropriate knowledge. <br><I>Method.</I> We conducted a study to evaluate the knowledge, beliefs and attitudes of a group of CHWs serving a poor urban area, using focus groups and personal interviews. <br><I>Results.</I> The CHWs did not have the requisite knowledge, attitudes and beliefs to make a positive impact on prevention and management of diabetes. For example, they cited eating sugar as a cause of diabetes. They advised folk remedies that purportedly diluted the blood sugar. Their patients took prescribed medication irregularly. Obesity was not considered an important risk factor. Poverty, however, was recognised as an obstacle to proper treatment. <br><I>Conclusion.</I>Training is clearly needed to empower the CHWs with skills to work within their communities to identify risk factors for diabetes and other non-communicable diseases, with emphasis on diet and physical activity.
Adrenocortical function in hospitalised patients with active pulmonary tuberculosis receiving a rifampicin-based regimen - a pilot studySource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 11, pp 16 –21 (2006)More Less
<I>Objective.</I> To assess whether adrenocortical function was compromised in patients with active tuberculosis (TB) during the first 5 days of therapy with either a rifampicin-based or ciprofloxacin-based regimen. <br><I>Design.</I> Patients were randomised into two groups of 10 each. Adrenocortical function was compared in both groups by the measurement of biochemical indices, electrolytes, osmolality and pituitary-adrenocortical hormones. Adrenal reserve was assessed by intravenous 250 µg adrenocorticotropin hormone (ACTH) stimulation tests. <br><I>Setting.</I> Department of Medicine, Johannesburg Hospital. <br><I>Subjects.</I> Twenty hospitalised patients who were diagnosed with TB. <br><I>Outcome measures.</I> Respiratory rate, pulse rate and blood pressure were recorded, and urinary sodium and osmolality were measured. Serum ACTH, cortisol, dehydroepiandros-terone-sulphate (DHEA-S) and aldosterone were assayed. <br><I>Results.</I> None of the patients demonstrated biochemical evidence of overt adrenal insufficiency. There were no significant differences between the two groups before or during therapy for any biochemical indices, electrolytes, hormones or calculated osmolality. Mean basal cortisol concentrations were substantially elevated and DHEA-S levels were consistently subnormal, resulting in a high cortisol / DHEA-S ratio. In the ciprofloxacin group, cortisol responses to ACTH stimulation on day 1 were not significantly lower than on day 5. In the rifampicin group, cortisol concentrations decreased at each time point on day 5 compared with day 1 (p = 0.001). However, a significantly higher mean incremental rise from the basal cortisol concentration was measured on day 5 at 60 minutes (p = 0.04). In the entire cohort of 20 patients, 40% demonstrated an incremental cortisol rise of < 250 nmol/l after ACTH stimulation on day 1. <br><I>Conclusions.</I> Rifampicin did not additionally impair adrenocortical function during the initial period of therapy. The high cortisol / DHEA-S ratio might be of clinical relevance.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 11, pp 24 –29 (2006)More Less
<I>Objectives.</I> To compare the ability of fasting glucose, glycosylated haemoglobin (HbA<sub>1c</sub>), the American Diabetic Association (ADA) score and measures of the metabolic syndrome (waist circumference, high-density lipoprotein (HDL), and triglycerides) in predicting an initial diagnosis of diabetes mellitus or abnormal glucose tolerance based on the World Health Organization (WHO) criteria. <br><I>Design.</I> A cross-sectional, diagnostic study was undertaken of 120 patients admitted to the cardiology wards of Pretoria Academic Hospital for elective coronary angiographic studies. <br><I>Main outcome measures.</I> All subjects underwent a modified glucose tolerance test whereby fasting and 2-hour post glucose (75 g) plasma glucose levels were measured. Using the revised WHO criteria, the overall incidence of diabetes was found to be 11.7% (95% confidence interval (CI): 6.5 - 19) and the overall incidence of abnormal glucose tolerance was 46% (CI: 37 - 55). <br><I>Results.</I> In univariate analysis for the diagnosis of diabetes, HbA<sub>1c</sub> (p < 0.05) yielded the largest area (0.76) under the receiver operating characteristic (ROC) curve, with a sensitivity of 21%, specificity of 99%, positive predictive value (PPV) of 75% and negative predictive value (NPV) of 91%. For the prediction of abnormal glucose tolerance, applying multivariate analysis using a logistic regression model, the combination of age, ethnic group, serum HDL, serum triglycerides and HbA<sub>1c</sub> yielded an area under the ROC curve of 0.79, sensitivity of 66%, specificity of 80%, PPV of 76% and a NPV of 71%. <br><I>Conclusion.</I> Most subjects with diabetes mellitus (9 of 14) would not have been detected if a 2-hour oral glucose tolerance test had not been done. Addition of either HbA<sub>1c</sub> or lipid parameters to the model of age and ethnic group were similar in predicting abnormal glucose tolerance.
Author Addisu Y. MengeshaSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 11, pp 32 –34 (2006)More Less
A cross-sectional study was undertaken to determine the serum lipid profile of diabetes mellitus (DM) patients receiving treatment at Gaborone City Council clinics. A total of 401 patients were studied over a 3-month period. It was found that 33.5% had hypercholesterolaemia and 38.9% hypertriglyceridaemia. The mean low-density lipoprotein (LDL) levels were higher in females than in males, but there was no difference in LDL levels between type 1 and 2 DM patients. There was no difference in cholesterol, triglyceride and highdensity lipoprotein (HDL) levels between genders or between type 1 and 2 patients. Hyperlipidaemia was associated with high body mass index. Only hypertriglyceridaemia was associated with high blood pressure. Hyperlipidaemia was not associated with exercise, smoking or alcohol consumption in the DM patients studied.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 11, pp 35 –36 (2006)More Less
Extracted from text ... 35 May 2006, Vol. 11, No. 1 JEMDSA Protos: The first dual-action bone agent for osteoporosis Servier Laboratories recently announced the launch of its new osteoporosis drug Protos (strontium ranelate) in South Africa. Indicated for the treatment of postmenopausal osteoporosis to reduce the risk of both vertebral and non-vertebral fractures, including the hip, 1 Protos is a new first-line option in the treatment of postmenopausal osteoporosis. The first in a new therapeutic class, Protos is categorised as a 'dual action bone agent'. Whereas other therapies either prevent bone loss (the antiresorptive agents) or promote bone formation only (the anabolic agents), ..