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- Volume 20, Issue 1, 2015
Journal of Endocrinology, Metabolism and Diabetes in South Africa - Volume 20, Issue 1, 2015
Volume 20, Issue 1, 2015
Author William De LangeSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20 (2015)More Less
Welcome to Bloemfontein, the 'the city of roses', for the Society for Endocrinology, Metabolism and Diabetes of South Africa's (SEMDSA) annual congress. Celebrating its 50th anniversary, the SEMDSA 2015 congress promises to be an event to remember. The congress takes place on the campus of the University of the Free State.
Author Brynne Ascott-EvansSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20 (2015)More Less
Stephen Hough was one of the finest clinician-scientists to have emanated from South Africa. In his early thirties, and already an established researcher with numerous degrees in medicine and science, he was earmarked by his mentors for advanced training in the USA. From 1979-1981, he worked at Washington University in St Louis, Missouri, while on a two-year research fellowship in Endocrinology and Metabolism. This centre was famed for its work in metabolic bone disease and jump-started Stephen's lifelong passion for this field, and osteoporosis, in particular.
Author Larry DistillerSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20, pp 6 –8 (2015)More Less
I was encouraged to join the Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) in 1971 as a medical registrar who had developed an interest in Endocrinology. At that time, the fledgling society, only six years old, had already been home to a number of individuals who had moved on to greener pastures overseas. In particular, both Arthur Rubenstein and Irving Spitz went on to establish enormous international reputations.
Author Gabriel EksteenSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20, pp 9 –14 (2015)More Less
South Africans carry an unacceptably high burden of hypertension [high blood pressure (BP)]. Up to 30% of adults are known to be hypertensive. It was estimated to have caused 46 888 deaths and 390 860 disability-adjusted life years in 2000. Hypertension is the most common reason for attending primary health care and also the most common diagnosis (13.1%) in South Africa. High salt consumption is a key driver of hypertension, and there is strong evidence to indicate that South Africans consume up to 2-3 times the recommended daily allowance of 5 g. The sources of this dietary salt intake are split between salt from processed food and discretionary salt, which is salt that is added at home during cooking and at the table. The National Department of Health recently legislated salt reduction in certain processed foods. While this will reduce one source of salt in the diet, it does not deal with discretionary salt use. Global experience shows that the best means of reducing salt consumption is a combined approach of lowering salt levels in processed food, together with a parallel public education and consumer awareness campaign. Whereas other countries have attempted to reduce salt through voluntary participation from industry, South Africa is the first country to embark on the legislated route on a basket of food products. Salt Watch, an initiative established by a multisectoral coalition group, is South Africa's national salt reduction education and awareness campaign. The Heart and Stroke Foundation South Africa (HSFSA) was nominated as the implementing body of the campaign, which is supported by the National Department of Health.
Anderson-Fabry disease : recommendations for its diagnosis, management and treatment in South Africa, 2014 : guidelinesSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20, pp 15 –23 (2015)More Less
Background: Anderson-Fabry disease (AFD) is a rare, X-linked lysosomal storage disorder that leads to the accumulation of globotriasylceramide in the lysosomes in tissues throughout the body. The responsible gene is α-galactosidase A, found at chromosome Xq22. More than 400 mutations have been identified. The disease usually presents in childhood, is progressive and multisystem, and results in increasing disability and premature death.
Objective: The objectives of these guidelines are to provide a standard of care for patients with AFD that is in keeping with that internationally, but which is also realistic for South Africa, and to provide a shared-care model for treating physicians and funders with regard to various aspects of care for these patients.
Recommendations: All heathcare professionals involved in the diagnosis and management of AFD should take note of these guidelines and try to implement them in clinical practice as far as possible.
Validation: These guidelines were developed through general consensus by the Lysosomal Storage Disorder Medical Advisory Board, and are largely based on the UK 2005 national guidelines for AFD, but have also been updated to include new treatment recommendations for enzyme replacement therapy based on evidence from subsequent publications.
Conclusion: It is the intention that these guidelines will benefit all patients suffering from AFD disease, and enable them to be diagnosed and offered the best possible available care.
50th Congress of the Society for Endocrinology, Metabolism and Diabetes of South Africa : oral presentationsSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20, pp 24 –36 (2015)More Less
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20, pp 38 –46 (2015)More Less
Use of diabetes data management software reports by health care providers, patients with diabetes, and caregivers improves accuracy and efficiency of data analysis and interpretation compared with traditional logbook data : first results of the Accu-Chek Connect Reports Utility and Efficiency Study (ACCRUES) : Journal of Diabetes Science and Technology 9(2)Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20, pp 50 –58 (2015) http://dx.doi.org/10.1177/1932296814557188More Less
We assessed users' proficiency and efficiency in identifying and interpreting self-monitored blood glucose (SMBG), insulin, and carbohydrate intake data using data management software reports compared with standard logbooks. This prospective, self-controlled, randomized study enrolled insulin-treated patients with diabetes (PWDs) (continuous subcutaneous insulin infusion [CSII] and multiple daily insulin injection [MDI] therapy), patient caregivers [CGVs]) and health care providers (HCPs) who were naïve to diabetes data management computer software. Six paired clinical cases (3 CSII, 3 MDI) and associated multiple-choice questions/answers were reviewed by diabetes specialists and presented to participants via a web portal in both software report (SR) and traditional logbook (TL) formats. Participant response time and accuracy were documented and assessed. Participants completed a preference questionnaire at study completion. All participants (54 PWDs, 24 CGVs, 33 HCPs) completed the cases. Participants achieved greater accuracy (assessed by percentage of accurate answers) using the SR versus TL formats: PWDs, 80.3 (13.2)% versus 63.7 (15.0)%, P < .0001; CGVs, 84.6 (8.9)% versus 63.6 (14.4)%, P < .0001; HCPs, 89.5 (8.0)% versus 66.4 (12.3)%, P < .0001. Participants spent less time (minutes) with each case using the SR versus TL formats: PWDs, 8.6 (4.3) versus 19.9 (12.2), P < .0001; CGVs, 7.0 (3.5) versus 15.5 (11.8), P = .0005; HCPs, 6.7 (2.9) versus 16.0 (12.0), P < .0001. The majority of participants preferred using the software reports versus logbook data. Use of the Accu-Chek Connect Online software reports enabled PWDs, CGVs, and HCPs, naïve to diabetes data management software, to identify and utilize key diabetes information with significantly greater accuracy and efficiency compared with traditional logbook information. Use of SRs was preferred over logbooks.
Diabetic patients served at a regional level hospital : what is their clinical picture? : original researchSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20, pp 60 –66 (2015)More Less
Objectives: We describe the demographics, diabetic characteristics, diabetic control and complications in the diabetes service in Edendale Regional Hospital, Pietermaritzburg, in this study. Diabetes mellitus, together with its complications, is increasing at an alarming rate worldwide. Good glycaemic control translates into lower long-term complications and longer life expectancy. Previous studies performed in both the public and the private sectors have demonstrated that there is suboptimal diabetic control in South Africa.
Design: This was a retrospective database analysis. Datasheets were designed to ensure a comprehensive and standardised assessment of patients attending Edendale Hospital's diabetic clinic. Data were stored in a designed-forpurpose database.
Subjects and setting: Data from 653 first-visit diabetic patients visiting Edendale Hospital's diabetic clinic between 1 October 2012 and 30 September 2013 were collected.
Outcome measures: Glycaemic control, diabetic complications and target blood pressure were the outcome measures studied.
Results: A total of 653 first-visit patients were seen, of whom 77.03% were female and 83.40% were type 2 diabetes patients. Only 36.33% of the type 2, and 49.07% of the type 1, diabetes mellitus patients, achieved a target blood pressure of ≤140/80 mmHg. Only 1.23% of the type 1, and 11.18% of the type 2, diabetes mellitus patients, achieved optimal glycaemic control, defined as haemoglobin (Hb)A1c ≤7%. The mean HbA1c in the patients with type 1 diabetes mellitus was 11.82%, and 10.52% in the type 2 diabetes mellitus patients.
Conclusion: This study showed the suboptimal control of both diabetes mellitus and hypertension in the clinic, together with high rates of diabetes complications. Obesity remains a major modifiable risk factor in both type 1 and 2 diabetes patients. Blood glucose control in this resource-limited setting was similar in those patients with home blood glucose monitoring versus those without it.
Diabetic nephropathy in a tertiary care clinic in South Africa : a cross-sectional study : original researchSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20, pp 67 –73 (2015)More Less
Objective: The aim of this study was to determine the prevalence of micro- or macroalbuminuria in type 1 and type 2 diabetic patients, and to examine the relationship with the diabetes control parameters such as haemoglobin (Hb)A1c, blood pressure (BP) and lipids.
Design: This was an analytical cross-sectional study.
Setting and subjects: The study consisted of 754 patients with either type 1 or type 2 diabetes, attending a diabetes clinic at the Kalafong Hospital in Pretoria, South Africa.
Outcome measures: Micro- or macroalbuminuria and estimated glomerular filtration rate (eGFR) were the outcome measures.
Results: An HbA1c > 7% was recorded in 88.9% of the patients, and low-density lipoprotein cholesterol ≥ 1.8 mmol/l in 81%. Overall, the prevalence of micro- or macroalbuminuria was 33.6%. Logistic regression revealed that HbA1c, the duration of diabetes, systolic BP, male sex and triglycerides were predictive of microalbuminuria.
Conclusion: The prevalence of micro- or macroalbuminuria in this study fell within the ranges of what has previously been reported in Africa. HbA1c and the duration of diabetes were the strongest predictors of microalbuminuria in all of the patients, and age was the strongest predictor of a low eGFR. Diabetes was poorly controlled, making the progression to end-stage renal failure a real concern in these patients.
Author Gail MkeleSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20, pp 74 –76 (2015)More Less
The production of glucagon-like peptide 1 (GLP-1), an incretin hormone, has been shown to be abnormally low in patients with type 2 diabetes, suggesting that GLP-1 may be a contributor in the pathogenesis of the disease. New type 2 diabetic medications target incretin hormones in their mechanism of action. The incretin effect is based on the understanding that oral glucose has a greater stimulatory effect on insulin secretion than that of intravenous glucose. Over the past few years, a number of therapeutic agents, acting either as incretin mimetics, e.g. GLP-1 agonists, or inhibitors of the breakdown of GLP-1, e.g. dipeptidyl peptidase-4 inhibitors, have become available as treatment options for the management of type 2 diabetes.
European-South Africa collaboration on the genetic basis of gonadotropin-releasing hormone deficiency in failure to progress through puberty and infertility : newsSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20, pp 78 –79 (2015)More Less
Reproductive capacity, the key element for species survival, depends on a complex organ network involving the hypothalamus, pituitary, gonads, and internal and external genitalia. This system is centrally controlled by incompletely understood neuroendocrine mechanisms integrated at the hypothalamic level, whose elucidation is the research focus. Vertebrate reproduction depends entirely upon the neurosecretion of the decapeptidegonadotropin-releasing hormone (GnRH) from less than 4 000 GnRH neurons in the preoptic area of the hypothalamus. The coordinated pulsatile release of GnRH from this neural network directs the synthesis and secretion of the gonadotropins, luteiniaing hormone and follicle-stimulating hormone, which, in turn, stimulate steroidogenesis and gametogenesis in the gonads. Although all mammalian species depend upon this common pathway to initiate reproduction, little is known about the molecular mechanisms underlying the ontogeny and regulation of GnRH neurons. The human disease model of congenital isolated GnRH deficiency, characterised by the abnormal development and/or function of GnRH neurons, and resulting in the failure of sexual maturation and infertility, has been a powerful source of novel information. This syndrome has a rich genetic and phenotypic heterogeneity, and represents a unique investigative opportunity with which to understand the biology of genes controlling human reproduction, and for the purposes of developing novel diagnostic tools and targeted therapies for infertility and reproductive medicine.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20 (2015)More Less
This unusual compendium is the result of collaboration between an experienced clinical endocrinologist, Dr Jana Brunová, and her well-known radiologist husband, Prof Josef Bruna. The book is richly illustrated with images collected over a lifetime, which include the decade that the couple spent in Bloemfontein, South Africa.