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- Volume 18, Issue 2, 2013
Journal of Endocrinology, Metabolism and Diabetes in South Africa - Volume 18, Issue 2, 2013
Volume 18, Issue 2, 2013
Author Willie MollentzeSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 18 (2013)More Less
The thought-provoking review by Rosemary Flynn, an experienced clinical psychologist, Coping with children with diabetes: Is this burden too great for parents to bear? on page 82, is a must-read for all healthcare workers who are involved in the management of children with type 1 diabetes mellitus. This article draws attention to the psychological difficulties that parents of children with type 1 diabetes may develop. The author provides guidance on how to screen parents for post-traumatic stress disorder and proffers practical advice on how to assist parents to cope, especially in the early stages of a condition that places great strain on the family unit.
Coping with children with diabetes : is this burden too great for parents to bear? : DESSA editorialAuthor R. FlynnSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 18, pp 82 –86 (2013)More Less
When a child is diagnosed with type 1 diabetes, good management thereof mean keeping the blood glucose levels as near to normal as possible. This is challenging at the best of times. Usually, the challenge sits squarely on the shoulders of the parents, most often the mother of the child. According to the International Society for Pediatric and Adolescent Diabetes, "psychological factors are the most important influences that affect the care and management of diabetes". While this is entirely true of children with diabetes, it is also true that the psychological health of parents is equally important.
Determining ethnic-, gender-, and age-specific waist circumference cut-off points to predict metabolic syndrome : the Sympathetic Activity and Ambulatory Blood Pressure in Africans (SABPA) study : original researchSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 18, pp 88 –96 (2013)More Less
Objective : The aim was to determine receiver-operating characteristic (ROC) waist circumference (WC) cut-off points best associated with metabolic syndrome (MetS) in a cohort of South African teachers.
Design : Target population study.
Setting and subjects : Four hundred and nine urban black (Africans) and white (Caucasians) from the Kenneth Kaunda district in North West province, between the ages of 25 and 65 years old, were stratified according to gender and age (25-45 years and 46-65 years).
Outcome measures : Anthropometric, fasting overnight urine and biological markers for MetS.
Results : ROC analysis determined pathological WC cut-off points of 91 cm for African men and 84 cm for African women. It is recommended that WC cut-off points should be 97 cm for Caucasian men and 84 cm for Caucasian women. Pathological WC cut-off points significantly predicted MetS in all ethnic-, gender- and age-specific groups, especially in male groups, with odds ratios of 7.6 [95% confidence interval (CI): 3.4-17.1, p-value = 0.00) for African men and 6 (95% CI: 3-12.1, p-value = 0.00) for Caucasian men.
Conclusion : ROC-developed WC cut-off points were found to be good predictors of MetS in a South African cohort, especially in the men. Further research in prospective cohort studies is warranted to verify our findings.
A survey of metabolic syndrome in first-degree relatives (fathers) of patients with polycystic ovarian syndrome : original researchSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 18, pp 98 –103 (2013)More Less
Objectives : Women with polycystic ovarian syndrome (PCOS) are at twice the risk of developing metabolic syndrome, compared to women from the general population. The aim of this study was to assess the prevalence of metabolic syndrome in the first-degree relatives (fathers) of patients suffering from PCOS.
Design : This was a case control study.
Setting and subjects : The study was conducted on 34 fathers of women with PCOS who presented at gynaecological clinics in Shiraz, Iran (as the case group), and 34 fathers of healthy women (as the control group).
Outcomes measures : Metabolic syndrome was determined according to Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) indices. A blood sample was obtained to assay serum insulin, blood sugar, testosterone and lipoproteins. The data were analysed using independent t-test, Fisher's exact test and the chi-square test.
Results : According to the ATP III index, the prevalence of metabolic syndrome was 29.35% in the fathers of the PCOS patients and 8.8% in the fathers of women in the control group (p-value < 0.05). According to the IDF index, this rate was 17.41 in the fathers of patients with PCOS (p-value < 0.05). According to the quantitative insulin sensitivity check and homeostasis model insulin resistance indices, the prevalence of insulin resistance, hypertension, type 2 diabetes and hypercholesterolaemia was higher in the fathers of patients with PCOS than in the control group, but the difference was not significant (p-value > 0.05).
Conclusion : The fathers of the women with PCOS were at a higher risk of developing metabolic syndrome, hypertension, dyslipidaemia, impaired glucose tolerance and diabetes.
The prevalence of subclinical hypothyroidism among patients with diabetes mellitus at the Kalafong Hospital Diabetes Clinic : a cross-sectional study : original researchSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 18, pp 106 –110 (2013)More Less
Objective : The purpose of this study was to determine the prevalence of subclinical hypothyroidism among patients with diabetes mellitus at the Kalafong Diabetes Clinic in Pretoria.
Design : Cross-sectional study.
Setting and subjects : Five hundred and sixty-five patients with diabetes mellitus (type 1, type 2 or unknown), who were following-up at the Kalafong Hospital Diabetes Clinic.
Outcome measures : The thyroid stimulating hormone (TSH) levels of patients were evaluated. Patients with TSH levels > 5.66 IU/ml (upper reference limit of the Kalafong National Health Laboratory Services laboratory) subsequently underwent repeat thyroid function evaluation, including T4 level, to determine the prevalence of subclinical hypothyroidism.
Results : A total of 563 patients met the inclusion criteria for this study and underwent TSH evaluation. The prevalence of subclinical hypothyroidism was found to be 0.9% in the study population, and 1.6% in a subgroup of patients with type 2 diabetes mellitus.
Conclusion : The prevalence of subclinical hypothyroidism in this South African population of patients with diabetes was significantly lower than that stated in the literature. This holds true for both the general population and populations of patients with diabetes mellitus. To our knowledge, there is no data available for the prevalence of subclinical hypothyroidism in the general population in South Africa for comparison with the study group.
Awareness and practices of foot self-care in patients with diabetes at Dr Yusuf Dadoo district hospital, Johannesburg : original researchSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 18, pp 112 –118 (2013)More Less
Objectives : To determine awareness and foot self-care practices in patients with diabetes.
Design : A cross-sectional descriptive study.
Setting and subjects : This study was conducted on 120 consecutive patients with diabetes at the outpatient department of Dr Yusuf Dadoo district hospital, Krugersdorp, Johannesburg. A researcher-administered questionnaire, adapted from the Summary of Diabetic Self-Care Activities, collected information on participants' demographics, clinical co-morbidities, awareness and foot self-care practices. The researcher also conducted a foot examination to identify foot pathologies. Data analysis included descriptive statistics, chi-square and t-tests, and logistic regression.
Outcome measures : Patients' awareness of, and practices pertaining to, foot self-care.
Results : Of the 120 participants, the majority were blacks (59.2%), female (60%) and unemployed (68.3%). The mean age was 56.3 years. Athlete's foot was the most common foot problem that occurred in 16.2% of participants. While only 24.2% reported awareness of foot self-care, 71.7% had performed foot self-care sometimes in the past, and 69.2% had done so at least one day within the last week. Only 5.8% of participants had had their feet examined by a podiatrist, and 32.5% by a doctor or nurse. Approximately 46.7% regularly soaked their feet in water, 7.5% applied talcum powder to dry their feet, 54.2% inspected their shoes and 25% walked barefoot. Smoking was the only variable that was significantly associated with finding a foot ulcer.
Conclusion : Poor participants' awareness and foot self-care practices highlight critical gaps in the care provided to patients with diabetes. Interventions which empower patients and healthcare professionals to regularly perform foot examinations and foot self-care are required to improve diabetic foot care in South Africa.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 18, pp 120 –122 (2013)More Less
Non-islet cell tumour-induced hypoglycaemia is an uncommon, but serious complication of malignancy. The aetiopathogenesis is largely as a result of tumoral overproduction of incompletely processed insulin-like growth factor-II. We describe the case of a 30-year-old black male patient who presented with recurrent hypoglycaemic episodes in the absence of diabetes or any medications known to cause hypoglycaemia. Extensive investigations revealed that the hypoglycaemia was the result of an advanced hepatocellular carcinoma.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 18, pp 125 –127 (2013)More Less
A 73-year-old female patient with osteoporosis, who had been taking alendronate for over 15 years, sustained bilateral, atypical femoral fractures two years apart. There was evidence of a stress fracture preceding the current fracture, as seen in the X-rays performed two years prior. Subsequently, she was found to have primary hyperparathyroidism.