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- Journal of Endocrinology, Metabolism and Diabetes in South Africa
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- Volume 20, Issue 2, 2015
Journal of Endocrinology, Metabolism and Diabetes in South Africa - Volume 20, Issue 2, 2015
Volume 20, Issue 2, 2015
Author M. DednamSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20, pp 4 –9 (2015) http://dx.doi.org/10.1080/16089677.2015.1056468More Less
This short review is intended to simplify the interpretation of thyroid function tests (TFTs) in general practice. The relationship between thyroid hormones and the use of TFTs, as well as thyroid antibodies, is discussed. An overview of the management of common thyroid disorders is included. Less common conditions, e.g. thyroid-stimulating hormone-secreting pituitary tumour and thyroid hormone resistance, are not discussed in this review.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20, pp 11 –16 (2015) http://dx.doi.org/10.1080/16089677.2015.1056468More Less
Thyroid gland disturbances are the second most common endocrine disorder after diabetes mellitus. Given that approximately 200 million people in the world have some form of thyroid disease, it is no wonder that thyroid function tests, i.e. thyrotropin and free thyroxine (T4), currently account for a significant portion of the routine workload of clinical chemistry laboratories. This was not the case more than 100 years ago.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20, pp 18 –26 (2015) http://dx.doi.org/10.1080/16089677.2015.1056468More Less
Background : Hypothyroidism is a common clinical condition confronting all healthcare practitioners yet there remains uncertainty about the optimal medication and optimum treatment targets. In addition, many patients remain symptomatic despite using recommended medications and attaining recommended treatment targets.
Methods : All endocrinologists in South Africa who consented to be part of the guideline process were assigned various aspects of the management of patients with thyroid disease. In each section the current literature was reviewed and the level of evidence was graded. This information was then presented at a guideline meeting. Where evidence was lacking a consensus among participants was adopted.
Results : This guideline provides 11 recommendations for the management of primary hypothyroidism, secondary hypothyroidism and subclinical hypothyroidism in adults.
Conclusions : This is the first South African guideline for the management of hypothyroidism in adults and represents a comprehensive review of the current literature in an attempt to provide evidence-based guidance for all healthcare practitioners regarding the many clinical aspects encountered when managing patients with hypothyroidism.
The achievement of glycaemic, blood pressure and LDL cholesterol targets in patients with type 2 diabetes attending a South African tertiary hospital outpatient clinic : researchSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20, pp 81 –86 (2015) http://dx.doi.org/10.1080/16089677.2015.1056468More Less
Objectives : To determine differences in the control of multiple diabetes control parameters in a select group of subjects with type 2 diabetes (T2DM) after a four-year follow-up period.
Design : Cross-sectional study.
Setting and subjects : The initial 2009 study population consisted of 666 T2DM patients of whom only 261 (39.2%) were audited at the Charlotte Maxeke Johannesburg Academic Hospital.
Outcome measures : Using a public sector database, retrospective data were obtained on the treatment of participants with T2DM attending a tertiary care setting and a descriptive analysis was done.
Results : The mean age was 64 (SD 10.6) years, women represented 55% of the cohort and the mean duration of diabetes was 16 years (range 2-40 years) in 2013. Fewer patients achieved an HbA1c goal (of < 7%) in 2013 (15.5%) compared with 2009 (25.4%), whilst an additional 13.7% and 25.0% of the 261 patients reached blood pressure targets (< 140/80 mmHg) and LDL-C targets (< 2.5 mmol/L), respectively.
Conclusion : Overall, more patients in the study reached blood pressure and LDL-C targets but there were difficulties in achieving optimal glycaemic levels over the four-year period. This study highlights the complexities of managing risk factors in T2DM, especially glucose control.
The prevalence and clinical significance of acanthosis nigricans in diabetic and non-diabetic women of mixed ancestry : researchSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20, pp 87 –91 (2015) http://dx.doi.org/10.1080/16089677.2015.1056473More Less
Objectives : The purpose of this study was to improve our understanding of the prevalence of acanthosis nigricans (AN) and its clinical relevance in our mixed-ancestry population and to investigate its association with abnormal glucose metabolism, obesity and hypertension.
Design : This was a cross-sectional study.
Settings and subjects : A total of 390 healthy mixed-ancestry females were recruited from the dermatology outpatient clinic at Tygerberg Hospital.
Outcomes measured : A short questionnaire was administered, whereafter participants were inspected for the presence and degree of AN. Height, weight, blood pressure and random fingerpick blood glucose were measured.
Results : AN was observed in 30% (n = 116) of participants, and most commonly found in the nape of the neck (94%, n = 109). Participants with AN were younger (p = 0.005), and of higher body mass (p < 0.001) with a higher random blood glucose (p = 0.04). AN was more commonly seen in diabetics (p = 0.004). The presence and severity of AN in the neck correlated far better with BMI and blood glucose than other sites, including the axilla.
Conclusion : AN was found to be extremely common, with a prevalence of 30% in this group. An association with blood glucose levels, diabetes and obesity was demonstrated, proving that it is not just a normal ethnic phenomenon. No association with blood pressure or hypertension was found.
The prevalence and association of low testosterone levels in a South African male, diabetic, urban population : researchSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20, pp 92 –97 (2015) http://dx.doi.org/10.1080/16089677.2015.1056478More Less
Background : According to the literature, low serum testosterone levels are associated with diabetes mellitus. No or minimal data exist for its prevalence or predictors in South Africa.
Design : This was a cross-sectional study.
Setting : The setting was an academic centre, i.e. the University of Pretoria and Steve Biko Academic Hospital Diabetes Clinic.
Subjects : A total of 150 consecutive male patients aged 50 years and older with diabetes mellitus were selected using convenience sampling.
Outcome measures : The patients were evaluated for diabetes control and complications, and for hypogonadism symptoms. Early-morning serum testosterone levels were determined.
Results : The prevalence of androgen deficiency symptoms was 94.7%. Some 50% of the men had low total testosterone levels. Using multivariate logistic regression, the significant factors associated with low total testosterone were waist circumference and known cardiovascular disease. The prevalence of symptoms of androgen deficiency was very high; 94.7% of the patients reported a significant number of symptoms listed on the Androgen Deficiency in the Aging Male questionnaire.
Conclusion : This study confirms the high prevalence of low testosterone levels in diabetic male patients in a tertiary setting. Universal screening remains controversial owing to uncertainty regarding the risks and benefits of testosterone therapy in this population group. Predictors of low testosterone levels were identified.
Successful treatment of cutaneous mucormycosis in a young diabetic with end-stage renal disease using combination systemic antifungal agents : researchSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20, pp 98 –100 (2015) http://dx.doi.org/10.1080/16089677.2015.1056485More Less
Habitual physical activity, peripheral neuropathy, foot deformities and lower limb function : characterising prevalence and interlinks in patients with type 2 diabetes mellitus : researchSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20, pp 101 –107 (2015) http://dx.doi.org/10.1080/16089677.2015.1056482More Less
Background : Patients with type 2 diabetes mellitus (T2DM) may have diverse foot problems, but how these problems are linked with physical activity is not clear. This study investigated the prevalence of foot problems among patients with T2DM and investigated how the problems were related to physical activity.
Methods : Habitual physical activity, peripheral neuropathy, lower limb functions and foot deformities of 246 T2DM patients were respectively assessed with the Baecke Physical Activity Questionnaire, Michigan Neuropathy Screening Instrument, Lower Limb Function Scale, and a self-designed foot deformity audit form.
Results : Habitual physical activity index (3.2 ± 0.83) was highest in work-related activities; 69 (26.1 %) patients presented with peripheral neuropathy and 52 (19. 7%) had the lowest limb function. Pes planus was the most prevalent foot deformity (20.1%). Significant differences existed in physical activity indices across deformity groups (p < 0.05) and total activity index was related to neuropathic and lower limb function scores (p < 0.05).
Conclusion : A higher work-related but reduced participation in sports and leisure time physical activity among the patients was observed. Habitual physical activity was lowest in patients with a forefoot deformity, higher neuropathic scores and lesser lower limb function scores. Patients with T2DM in these categories may be a target for special physical activity intervention programmes.