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- Volume 12, Issue 2, 2007
Journal of Endocrinology, Metabolism and Diabetes in South Africa - Volume 12, Issue 2, 2007
Volume 12, Issue 2, 2007
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 12 (2007)More Less
The Diabetic Foot Working Group (DFWG) of South Africa was officially launched at the Diabetic Foot Symposium at the joint congress of the Association of Surgeons of South Africa (ASSA), Vascular Society of Southern Africa (VASSA) and South African Gastroenterology Society (SAGES) on 10 August 2007 at Sun City.
Author Stephen HoughSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 12, pp 52 –54 (2007)More Less
The association between type 2 diabetes mellitus (T2DM), obesity, hypertension, dyslipidaemia, hyperuricaemia and coronary vascular disease (CVD) was recorded more than 70 years ago, and in 1977 Haller coined the term metabolic syndrome (MS) to describe this group of disorders.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 12, pp 56 –60 (2007)More Less
Background and objectives. Diabetes affects approximately 1 million South Africans. Hospital admissions, the largest single item of diabetes expenditure, are often precipitated by hyperglycaemic emergencies. A recent survey of a 200-bed hospital, serving approximately 1.3 million Cape Town residents, showed that hyperglycaemic emergencies comprised 25.6% of high-care unit admissions. A study was undertaken to determine the reasons for, and financial cost of, these admissions.
Methods. All hyperglycaemic admissions during a 2-month period (1 September - 31 October 2005) were surveyed prospectively. Admissions were classified using the American Diabetes Association classification of hyperglycaemic emergencies. Demographic data, and the reason for, duration of and primary outcome of admission, were recorded. The following costs per admission were calculated using public-sector pricing: (i) total costs; (ii) patient-specific costs; (iii) non-patient-specific costs; and (iv) capital costs.
Results. Sepsis (36%), non-compliance with therapy (32%) and a new diagnosis of diabetes (11%) were the predominant reasons for admission of 53 hyperglycaemic emergency cases. Mean duration of hospital stay was 4 days, with an in-hospital mortality of 7.5%. Mean cost per admission was R5 309. Clinical staff (25.8%), capital (25.6%) and overhead (34%) costs comprised 85.4% of expenditure.
Discussion and recommendations. Hyperglycaemic admissions, costing more than R5 300 per patient, represent a health burden that has remained unchanged over the past 20 years. Urgently required primary care preventive strategies include early diagnosis of diabetes, timely identification and treatment of precipitating causes, specifically sepsis, and education to improve compliance.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 12, pp 60 –64 (2007)More Less
Diabetic retinopathy is the fifth leading cause of global blindness, affecting an estimated 1.8 billion people and responsible for 4.8% of blindness. In South Africa, it is the third leading cause of blindness after cataract and glaucoma, and is responsible for 5% of blindness (0.04% of the total population). Cataract and refractive error are prioritised for the first phase of Vision 2020 in South Africa, while strategies to deal with diabetic retinopathy are recommended as a priority for the second phase. These strategies will include provision of adequate screening and argon laser treatment.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 12, pp 65 –71 (2007)More Less
Objectives. To estimate the burden of disease attributable to diabetes by sex and age group in South Africa in 2000.
Design. The framework adopted for the most recent World Health Organization comparative risk assessment (CRA) methodology was followed. Small community studies used to derive the prevalence of diabetes by population group were weighted proportionately for a national estimate. Population-attributable fractions were calculated and applied to revised burden of disease estimates. Monte Carlo simulation-modelling techniques were used for uncertainty analysis.
Setting. South Africa.
Subjects. Adults 30 years and older.
Outcome measures. Mortality and disability-adjusted life years (DALYs) for ischaemic heart disease (IHD), stroke, hypertensive disease and renal failure.
Results. Of South Africans aged ≥30 years, 5.5% had diabetes which increased with age. Overall, about 14% of IHD, 10% of stroke, 12% of hypertensive disease and 12% of renal disease burden in adult males and females (30+ years) were attributable to diabetes. Diabetes was estimated to have caused 22 412 (95% uncertainty interval 20 755 - 24 872) or 4.3% (95% uncertainty interval 4.0 - 4.8%) of all deaths in South Africa in 2000. Since most of these occurred in middle or old age, the loss of healthy life years comprises a smaller proportion of the total 258 028 DALYs (95% uncertainty interval 236 856 - 290 849) in South Africa in 2000, accounting for 1.6% (95% uncertainty interval 1.5 - 1.8%) of the total burden.
Conclusions. Diabetes is an important direct and indirect cause of burden in South Africa. Primary prevention of the disease through multi-level interventions and improved management at primary health care level are needed.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 12, pp 72 –74 (2007)More Less
Riedel's thyroiditis is a rare disorder that mainly affects middle-aged women. Dense fibrosis disrupts the normal thyroid architecture and replaces the normal thyroid architecture, and can extend beyond the thyroid capsule.
This is the first report of a case of Riedel's thyroiditis associated with systemic, multifocal fibrosis in a black South African patient.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 12, pp 74 –76 (2007)More Less
A non-functional pituitary macroadenoma commonly presents with headaches and / or visual field defects, which may even extend to blindness. Although symptoms are often present before diagnosis they are frequently not appreciated because they are nonspecific, require a focused history and are therefore erroneously attributed to other causes.