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- Volume 20, Issue 3, 2015
Journal of Endocrinology, Metabolism and Diabetes in South Africa - Volume 20, Issue 3, 2015
Volume 20, Issue 3, 2015
Author W.F. MollentzeSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20 (2015)More Less
The obesity epidemic in South Africa is completely out of hand. The prevalence of obesity (BMI ≥30 kg/m2) in women increased from 34% in 19951 to 39% in 2013 while an additional 25% of women were overweight (BMI 25-29.9 kg/m2). The corresponding rates for obesity and overweight among men were 11% and 20%2. Adolescents between the ages of 15 and 17 years were included in these data. Of all women in sub-Saharan Africa, South African women have the highest prevalence of obesity. The contribution of obesity to the burden of disease in South Africa is staggering. In 2000, 87% of type 2 diabetes, 68% of hypertensive disease, 61% of endometrial cancer, 45% of ischaemic stroke and 38% of ischaemic heart disease were attributed to excess body weight. In the same year 7% of all deaths in South Africa was attributed to obesity-related comorbidities. 4 Gestational diabetes with its foetal complications are also strongly and positively linked to overweight and obesity. In this edition of the Journal (p 9-14) Hall et al reports that overweight or obesity was present at booking in 95% of women who went on to develop gestational diabetes. It is a sobering thought that the unbridled increase in the prevalence of obesity in the US may soon counteract the steady rise in life expectancy observed over the last two centuries.
Author A. MaraisSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20, pp 4 –8 (2015) http://dx.doi.org/10.1080/16089677.2015.1056468More Less
The inability to attain or maintain a penile erection sufficient for sexual intercourse is a common problem experienced by a third of men over the age of 40 years. Erectile dysfunction (ED) is a debilitating disease which can have profound psychological effects on personal relationships and the social well-being of the affected individual. The diagnosis and evaluation of sexual dysfunction has been well described, and several validated algorithms are available to quantify the classification and severity. The International Index of Erectile Function and the Sexual Health Inventory for Men questionnaires are commonly used in the initial assessment of ED. Several risk factors have been linked to the pathophysiology of ED. Endothelial damage has been the focus of many recent studies. An evaluation of cardiovascular status, in addition to the administration of questionnaires to men with ED, might reduce mortality and improve sexual quality of life.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20, pp 9 –14 (2015) http://dx.doi.org/10.1080/16089677.2015.1069015More Less
Objective: The management of pregnant women with diabetes mellitus places a significant burden on healthcare systems. Significant global changes have been proposed with regard to the diagnosis and management of women with diabetes mellitus in pregnancy. The study aims were to document the contemporary numbers, treatments and outcomes of diabetes mellitus in pregnancy, with particular focus on gestational and type 2 diabetes mellitus.
Design, subjects and setting: A retrospective audit was performed of pregnant women (n = 278) with diabetes mellitus, managed over a 12-month period in a combined secondary and tertiary unit in South Africa.
Results: Of the 278 cases analysed, 60% had gestational and 33% type 2 diabetes mellitus. The perinatal mortality ratio for all diabetes mellitus in pregnancy was 52.6:1 000, with only one early neonatal death. Ninety-five per cent and 70% of women with gestational and type 2 diabetes mellitus, respectively, were overweight or obese. Chronic hypertension was present in 23% of women with gestational and in 42% of women with type 2 diabetes mellitus. The glycosylated haemoglobin decreased from 6.7%at diagnosis to 6.4% at delivery in the gestational diabetes mellitus group, and from 7.5% at booking to 6.6% at delivery in the type 2 diabetes mellitus subjects. Lifestyle modification and metformin sufficed in 88% of women with gestational diabetes mellitus. Insulin was only required in 12% of pregnancies with gestational and in 53% of pregnancies with type 2 diabetes mellitus.
Conclusion: Pregnancies complicated by gestational and type 2 diabetes mellitus are common and challenging. The addition of the oral agent, metformin, lowers the need for insulin therapy.
Baseline patient profiling and three-year outcome data after metabolic surgery at a South African centre of excellence : researchSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20, pp 16 –27 (2015) http://dx.doi.org/10.1080/16089677.2015.1085700More Less
The bariatric team at Waterfall City Hospital in Gauteng has performed 820 metabolic surgeries under the guidance of an extended team, and with comprehensive record keeping. Baseline profiling on more than 50 variables afforded insight into patients undergoing surgery. The available outcome data over three years were comparable with those in the documented literature. The attempted weight loss period prior to agreeing to surgery was 16-18 years. Weight loss in the overall cohort was 29% at three years, with a two-year outcome as follows : diabetes mellitus remission of 81.6% in males and 83.1% in females, full and part-hypertension resolution of 84.8% in males and 74.6% in females, hyperlipidaemia on no treatment of 76.8% in males and 72.1% in females, and sleep apnoea of 75.5% in males and 76.8% in females. Separating out the diabetic group indicated a diabetes mellitus remission of 73.9% in males and 75.1% in females at one year. Improvement in the components of metabolic syndrome was demonstrated in the total cohort. There was an worse profile and higher risk in the male patients. Similarly, higher risk was recorded in the biliopancreatic diversion-duodenal switch cohort, and there was a higher percentage of elected diabetic patients. A wide range of revision surgery was performed, with a higher complication rate (20%) experienced compared to that recorded with the primary surgeries. The morbidity data were separated into medical and surgical morbidity. Major medical morbidity was documented at 5.6% and surgical morbidity at 3.9%. Surgical morbidity in the first 250 cases was reported to be 6% vs. 2.7% in the last 570 cases. Mortality for the cohort was noted to be 0.1%.
Incidence and progression of diabetic retinopathy within a private diabetes mellitus clinic in South Africa : researchSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20, pp 28 –34 (2015) http://dx.doi.org/10.1080/16089677.2015.1090159More Less
Objective: The study objective was to examine the influence of glycaemic control and ethnic variations on the incidence and progression of diabetic retinopathy (DR). Design, subjects and setting: Eight hundred and ninety-two persons with type 1 diabetes mellitus, and 1 998 persons with type 2 diabetes mellitus, who were enrolled in a private diabetes mellitus management programme in South Africa, participated in the study. Survival analyses were conducted to assess the relationship between the risk factors and the incidence of DR and referable DR, and the progression of DR.
Outcome measures: Cumulative incidence of diabetic retinopathy and referable diabetic retinopathy.
Results: The seven-year cumulative incidence of DR and referable DR was 536 and 50 cases per 1 000 persons with type 1 diabetes mellitus without DR at baseline, and 351 and 47 cases per 1 000 persons with type 2 diabetes mellitus. The seven-year cumulative incidence of referable DR was 332 cases per 1 000 persons with type 1 diabetes mellitus with background DR at baseline, and 360 cases with type 2 diabetes mellitus, representing a seven- and eightfold increase compared to no DR at baseline. After controlling for known risk factors for DR, a high baseline haemoglobin A1c (HbA1c) and non-Caucasian ethnicity were associated with the incidence of referable DR in patients with type 1 and type 2 diabetes mellitus.
Conclusion: It was revealed in the first study to report on the incidence and progression of DR in South Africa that a high baselineHbA1c, ethnicity, and the presence of background DR increased the risk of the development of referable DR.
The prevalence and associations of erectile dysfunction in a South African male diabetic urban population : researchSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20, pp 36 –42 (2015) http://dx.doi.org/10.1080/16089677.2015.1090185More Less
Background: Erectile dysfunction (ED) is a common condition in patients with type 1 or type 2 diabetes mellitus. The prevalence and predictors in our patient population are unknown since minimal data exist for this condition in South Africa.
Method: An observational, cross-sectional study was performed on 150 consecutive male patients aged ≥ 50 years, with either type 1 or type 2 diabetes mellitus, attending the Steve Biko Academic Hospital Diabetes Clinic. These patients were evaluated for diabetes mellitus control and medical complications, and for the presence of ED. Morning serum testosterone levels were determined.
Results: Some degree of ED was reported in 95% of the patients, with 51% reporting serious dysfunction. Using multivariate logistic regression, it was determined that the significant factors associated with ED were age, body mass index, the peripheralneuropathy score and diuretic therapy. Differences in quality-of-life scores were seen in some ED subgroups.
Conclusion: This study confirms the high prevalence of ED in diabetic male patients in a tertiary setting. It is suggested that universal screening should be performed for this population group. Multiple predictors of ED were identified in this study. ED negatively affected quality of life, but not in a statistically significant way.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 20, pp 43 –44 (2015) http://dx.doi.org/10.1080/16089677.2015.1080483More Less
Diffuse normolipaemic plane xanthoma is a rare form of xanthoma usually associated with an underlying haematological or inflammatory condition, and may present many years prior to the onset of systemic illness. We present a case of this uncommon condition occurring in association with a monoclonal gammopathy of unknown significance.