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- Volume 17, Issue 2, 2012
Journal of Endocrinology, Metabolism and Diabetes in South Africa - Volume 17, Issue 2, 2012
Volume 17, Issue 2, 2012
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 17, pp 1 –96 (2012)More Less
Author Stephen HoughSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 17, pp 67 –68 (2012)More Less
Osteoporosis is defined by the World Health Organization (WHO) as a systemic skeletal disease that is characterised by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture which usually involves the wrist, spine, hip, ribs, pelvis or humerus. In 1994, the WHO proposed a stratified definition of osteoporosis, which was updated in 2008, that encompassed the concepts of both low bone mass and fracture. According to this classification, there are four general categories: normal, low bone mass (osteopenia), osteoporosis and severe osteoporosis.
Author Jeannie BergSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 17 (2012)More Less
The new SEMDSA guidelines for type 2 diabetes were introduced at SEMDSA 2012, held in the beautiful city of Cape Town.
Revising these guidelines was akin to a conductor leading his orchestra. Long before the performance season begins, a number of creative and business decisions have to be taken. He or she does not just stand up at the performance and swing a baton.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 17, pp 72 –76 (2012)More Less
The development of obesity, as well as resultant type 2 diabetes, hypertension and cardiovascular disease, is causing concern in South Africa. Following the discovery of leptin in 1994, hopes were raised that the manipulation of the leptin axis might yield successful therapy for obesity. Although hope still remains, the role of leptin is more complex than was first envisaged. Strong evidence indicates that there is an important role for leptin in obesity-related hypertension, although the net effects of hyperleptinaemia on cardiovascular pathophysiology remain complex and are not clearly understood. Therefore, the cardiovascular side-effects of leptin as a possible antiobesity drug deserve greater attention.
Cut-off values of distal forearm bone density for the diagnosis of central osteoporosis in black postmenopausal South African women : original researchSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 17, pp 78 –83 (2012)More Less
Background : The objective of this study was to establish a triage cut-off point or threshold for peripheral bone mineral density (BMD), applicable to black postmenopausal women, and that could be used as a screening method to differentiate between women with normal BMD, and those with possible central osteoporosis. This was a cross-sectional study design conducted in the North West province. Central and peripheral BMD was measured in 184 black, urban postmenopausal women.
Method : Receiver operating curves (ROC) analysis was used to establish cut-off points. Sensitivity, specificity, positive and negative predictive value, odds ratios and likelihood ratios were determined.
Results : The results showed a prevalence rate of 41.3% for central osteoporosis. The area under the curve (AUC) for osteoporosis at the hip was 0.818, and for the spine, it was 0.771. Using the optimum cut-off point (0.371 g/cm2), our results showed a misclassification rate of ≈ 49% for spine osteoporosis, and a negative predictive value of 0.825. Women who had a forearm BMD below this threshold were ~ 10 times more likely to have osteoporosis of the spine.
Conclusion : We recommend using 0.371 g/cm2 as a cut-off point to differentiate between women who have normal BMD, and those with possible osteoporosis of the spine.
Diabetes guidelines and clinical practice : is there a gap? The South African cohort of the International Diabetes Management Practices Study : original researchSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 17, pp 85 –90 (2012)More Less
Objectives : The objective of this survey was to determine the therapeutic management of patients with diabetes in the South African private healthcare environment.
Design : The International Diabetes Management Practices Study is an international multicentre and observational study. In this paper, the local South African data from the cross-sectional cohort study are discussed.
Setting : South African healthcare providers who were involved in the management of patients with diabetes.
Subjects : Subjects included male and female adult patients who were diagnosed with type 1 or type 2 diabetes mellitus and who consulted their healthcare provider during a specified period of two weeks.
Outcome measures : Information on patient demographic and socio-economic profiles, relevant medical histories, data on previous and concomitant antidiabetic treatments, glycaemic status, patient education levels and the impact of diabetes on absenteeism and hospitalisation was collected.
Results : A total of 899 patients from 54 healthcare centres in South Africa participated. The mean age of patients in the study was 53.35 ± 14.47 years. The duration of diabetes was longer in type 1 diabetic patients. Of the type 2 diabetic patients, 46.4% were on oral antidiabetic monotherapy and 44.1% on two oral medications. Metformin was the most commonly prescribed oral medication. Of the 242 patients with type 2 diabetes on insulin and oral combination, 175 were on one oral medication combined with insulin therapy. The mean haemoglobin A1c (HbA1c) of study participants was 8.2%.
Conclusion : These data demonstrate that in accordance with current global findings, the glycaemic control of the majority of a cohort of patients with diabetes managed in the private healthcare sector in South Africa was suboptimal when assessed according to HbA1c levels.
Enzymatic and genetic polymorphisms of paraoxonase-1 in the Gabonese population : the relation to lipid parameters in patients with diabetes : original researchSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 17, pp 92 –99 (2012)More Less
Background : The objective was to study the relationship between the paraoxonase-1 activity, genetic polymorphisms and lipid parameters in a black patient population.
Method : This study investigates patients with type 2 diabetes and hypertension for which concentrations of total high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, triglycerides, apolipoprotein AI, apolipoprotein B100, the latency time of oxidation of small and dense LDL, arylesterase activity and genetic polymorphism of paraoxonase-1 at positions T(-107)C, L55M and Q192R were determined and compared to healthy subjects.
Results : Concerning the T(-107C) polymorphism, the -107T allele is higher in healthy subjects (0.325) than in those with diabetes (0.660). This was the same for the 55M allele, whereas the -107C allele was lower in healthy patients (0.675) than in patients with diabetes (0.340). Paraoxonase-1 activity was lower in patients with diabetes than in healthy subjects, irrespective of genotype. The -107CC genotypes had higher HDL cholesterol AI apolipoprotein I concentrations than -107TT in the control group (p-value = 0.0001), patients with diabetes (p-value = 0.002), and patients with hyptertension (p-value = 0.001). This result was also obtained with the 55LL genotype.
Conclusion : The prevalence of paraoxonase-1 alleles associated with lesser enzyme activities was found to be more common in patients with diabetes than in the control group. Possibly, this genetic distribution contributes to the high cardiovascular risk that is observed in certain black patients, compared to that in white patients.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 17, pp 101 –104 (2012)More Less
Thyrotoxicosis is listed as a cause of pulmonary arterial hypertension (PAH). The aetiopathogenesis remains largely uncertain, but an autoimmune mechanism has been postulated, among others. In this setting, other causes of PAH need to be actively sought and excluded prior to attributing it to the thyrotoxicosis. The importance of recognising this condition is that it is usually reversible with restoration of a euthyroid state. We describe three patients who presented with thyrotoxicosis and features of PAH in whom other causes were excluded with various investigations. We also demonstrated reversibility of the pulmonary hypertension upon restoration of a normal thyroid state.
Association of waist circumference with perception of own health in urban African males and females : the Sympathetic Activity and Ambulatory Blood Pressure in Africans (SABPA) study : diabetes educationSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 17, pp 106 –112 (2012)More Less
Background : Current waist circumference (WC) cut-points of the Joint Statement Consensus (JSC) (male ≥ 94 cm, female ≥ 80 cm) were compared with a recently proposed WC cut-point (RPWC) (male ≥ 90 cm, female ≥ 98 cm). In this study, we aimed to compare the two cut-points to assess the association between central obesity and perception of own health.
Method : We determined blood pressure and fasting bloods [glucose, high-density lipoprotein (HDL) and triglycerides] as metabolic syndrome markers for 171 urban teachers. Perception of own health was determined via the General Health Questionnaire-28 (GHQ-28) to indicate probable psychological distress or a psychiatric disorder or caseness (≥ 4).
Results : The RPWC was an improved discrimination between the WC groups on perception of own health as reflected in the GHQ-28 subscales. In the male group, higher scores were found in the RPWC high WC group (≥ 90 cm) with regard to somatic symptoms, social dysfunction and GHQ-28 caseness, compared to those of the low WC groups (< 90 cm). Compared to the RPWC high WC females (≥ 98 cm), the low WC (< 98 cm) reflected significantly higher anxiety and sleeplessness subscale scores.
Conclusion : Our results suggest that the RPWC (men 90 cm, women 98 cm), (determined in this African cohort when adding GHQ-28 caseness as a discriminatory variable between WC cut-point), distinguished better between WC groups based on their perception of own health than the JSC cut-point.