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- Volume 15, Issue 2, 2010
Journal of Endocrinology, Metabolism and Diabetes in South Africa - Volume 15, Issue 2, 2010
Volume 15, Issue 2, 2010
Author Fraser PirieSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 15 (2010)More Less
Heraclitus of Ephesus (535-475 BC) was a Greek philosopher who stated : "There is nothing permanent except change". This is an apt description of the current state of diabetes diagnosis, in the light of the proposal by the American Diabetes Association to include HbA1C as a diagnostic criterion. This proposal has generated a vociferous response, including a statement from the SEMDSA executive committee published in this issue of JEMDSA, as well as a number of studies examining the diagnostic accuracy of HbA1C.
Position statement on the use of HbA1C assays for the diagnosis of diabetes mellitus - The Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) : SEMDSA position statementAuthor Aslam AmodSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 15, pp 71 –73 (2010)More Less
In July 2009, an International Expert Committee appointed by the American Diabetes Association (ADA), the European Association for the Study of Diabetes (EASD) and the International Diabetes Federation (IDF) published a report recommending that the glycated haemoglobin (HbA1C) assay be used for the diagnosis of diabetes in non-pregnant individuals. The report documents the shortcomings of plasma glucose measurements, the advantages and limitations of the HbA1C assay, and recommends threshold values for the diagnosis of diabetes and the identification of individuals at high risk for diabetes, i.e. those with impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). These recommendations (summarised in Table I) were meant to stimulate debate and discussion. An important prerequisite is that the laboratory and HbA1C assay being considered for diagnostic use must be certified by the National Glycohemoglobin Standardization Program (NGSP).
NOFSA policy statement on the association between calcium supplementation and cardiovascular disease : NOFSA policy statementAuthor Stephen HoughSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 15, pp 75 –77 (2010)More Less
Following the publication of an article by Mark Bolland and coworkers in the British Medical Journal of 29 July 2010, on the association between calcium supplementation for osteoporosis and an increased risk of myocardial infarction, much concern and confusion exist among patients and doctors alike as to the safety and efficacy of these agents.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 15, pp 79 –82 (2010)More Less
Objective : People living with diabetes mellitus (DM) are prone to varied forms of complications which often lead to their premature death. The vulnerability has the greatest impact in type 2 DM because of larger numerical strength, insidious onset and late recognition especially in resource-poor nations like Nigeria. This study is designed to provide information on current trends in mortality among type 2 DM patients.
Design : The study was a 10-year retrospective analysis of causes of death and contributing factors in type 2 DM patients. Information was obtained from case files and the hospital death register.
Setting : It was carried out in adult medical wards and the accident / emergency unit of the University of Ilorin Teaching Hospital, Ilorin, Nigeria.
Subjects : The study subjects were type 2 DM patients who were admitted from the diabetic clinic and / or accident and emergency units of the hospital. Data analysis was done using SPSS, version 16.
Outcome measures : The study is an attempt to provide insight into preventive measures against complications that culminate in the premature death of Nigerians with type 2 DM. The findings may form a basis for future research on characteristics of type 2 DM in our environment.
Results : The overall mortality rate was 32.5% with mean age at diagnosis and death being 53.43 + 15.07 and 57.07 + 14.29 respectively. Systemic hypertension was present in 50% of the study population with male and female rate of 55% and 43% respectively. The highest number of admissions were due to diabetic hyperglycaemic emergencies, septicaemia and diabetic foot syndrome (DFS). Mortality rates were highest in those that presented with hypoglycaemia, stroke and diabetic foot syndrome. There was gender disparity in the first three major causes as more males died from DFS and stroke while females accounted for the majority of deaths from diabetic ketoacidosis (DKA).
Conclusion : Type 2 DM is a common cause of morbidity and mortality in Nigeria. The contributory factors to high mortality were ignorance, poor hygiene, infections, lack of foot care and inadequate glycaemic / blood pressure control. There is a need to improve hygiene and provide education programmes targeted at DM patients on proper foot care and good glycaemic and blood pressure control. We should emphasise the importance of early diagnosis of diabetes and proper management.
Bariatric surgery : risks and recommendations for the prevention of perioperative thromboembolism : review articleSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 15, pp 84 –86 (2010)More Less
Globally the numbers of overweight, obese and severely obese people are increasing rapidly. High incidences of obesity and overweight have been documented for the South African population (Table Ia and Ib). Although polygenetic factors play an important role in obesity, environmental factors should also be considered. A sedentary occupation and lifestyle with easy access to energy dense foods is a major contributor to the obesity epidemic. For patients with a BMI > 40 kg/m2, who have failed to successfully lose weight, bariatric surgery is a treatment option. This surgical intervention can achieve long-term sustained weight loss and often induces resolution of comorbidities such as diabetes, sleep apnoea, hyperlipidaemia and hypertension (Table II).
Author G. JardineSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 15, pp 88 –90 (2010)More Less
Obesity is a multifactorial condition involving genetic, environmental and behavioural factors. For most people wanting to lose weight, little can be done to alter genetics or their environment. What is generally required is a change in behaviour that will result in re-balancing the energy equation. Weight loss is a result of reducing energy input from the diet and increasing energy output through exercise. This simple solution can only be achieved with changing obese people's eating behaviour. To start the process of change, people need to be self-motivated. Behavioural treatment is goal focused, using specific weight loss goals and / or dietary goals which are attainable. Behavioural treatment is also process orientated : it involves helping people to identify which eating behaviours are unhelpful and to plan how to change them. Lastly, behavioural treatment involves implementing a sequence of small dietary changes rather than one large change. It is based on the principle that successfully making small changes leads to the successful achievement of long-term goals.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 15, pp 92 –94 (2010)More Less
Phaeochromocytomas are catecholamine-secreting tumours that arise from chromaffin tissue. The majority of tumours arise within the adrenal gland and are benign; extra-adrenal phaeochromocytomas are also referred to as paragangliomas. Approximately 76% of phaeochromocytomas occur sporadically; the remaining 24% are familial, and therefore genetic conditions, including multiple endocrine neoplasia type 2 (MEN2), neurofibromatosis type 1 (NF1), Von Hippel-Lindau (VHL) syndrome and hereditary paragangliomaphaeochromocytoma syndrome should be considered as part of the differential diagnosis. In this article, we report on two black families with unusual phaeochromocytomas, diagnosed with VHL syndrome.
Accord Healthcare launches metformin
Looking for the Smart way for your patients to manage their diabetes? : press releaseSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 15 (2010)More Less
CEPHEUS recruitment target met
AstraZeneca's survey on undertreatment of hypercholesterolaemia in SA ahead of schedule : press releaseSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 15 (2010)More Less
AstraZeneca's national survey to quantify the degree of undertreatment of hypercholesterolaemia in this country is ahead of schedule, according to the AstraZeneca clinical team driving the study. Known as CEPHEUS (Centralised pan-South African Survey on the treatment of hypercholesterolemia), the study recruited its first patient in mid-November 2009 and just five months later, on 23 April 2010, the final patient was enrolled. A week ahead of the projected timelines, the study has completed the recruitment phase of what is expected to be a landmark survey of 3 000 patients.
Author Angela SobeySource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 15 (2010)More Less