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- Journal of Endocrinology, Metabolism and Diabetes in South Africa
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- Volume 21, Issue 1, 2016
Journal of Endocrinology, Metabolism and Diabetes in South Africa - Volume 21, Issue 1, 2016
Volume 21, Issue 1, 2016
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 21, pp 1 –2 (2016) http://dx.doi.org/10.1080/16089677.2016.1150574More Less
Sleep - how seriously do we need to take it?
There is a perception that time spent asleep is time wasted. Anecdotally one hears of people sleeping no more than 3-4 h per night with no apparent ill effects. As tempting as a short sleep regime sounds, we know that sleep is critical for survival. In 1983 Rechtschaffen and colleagues showed that rats developed pathology and died within 14 to 21 days of total sleep deprivation. Data accumulated over the past 40 years from prospective cohort studies indicate higher all-cause mortality rates among people who sleep either less than 6 h or more than 9 h per night. We also know that sleep loss affects neurobehavioural performance, metabolism and obesity, and psychological health.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 21, pp 3 –4 (2016) http://dx.doi.org/10.1080/16089677.2015.1117191More Less
Pituitary apoplexy is an uncommon condition and medical emergency that classically presents with abrupt onset of severe headache, nausea, fever, impaired level of consciousness, visual disturbances and a variable degree of ocular paresis. The constellation of signs, symptoms and cerebrospinal fluid findings in keeping with meningitis is considered a rare presentation of pituitary apoplexy and often leads to a misdiagnosis of infectious meningoencephalitis. We present the case of a 52 year old male admitted with a diabetic ketoacidosis who subsequently developed a severe headache with features of meningism. Haematological tests revealed an elevated white cell count and C-reactive protein, and lumbar puncture demonstrated a marked neutrophilic pleocytosis and elevated protein. Ceftriaxone was commenced for the presumptive diagnosis of bacterial meningitis, but resulted in no improvement in the patient's condition and so imaging studies were performed which revealed the presence of an incidental pituitary macroadenoma with intra-lesional haemorrhage, thus providing the diagnosis of pituitary apoplexy. The patient recovered with conservative management consisting of hormonal replacement therapy and continues to follow up at our facility.
Acute management of hyperlipaemic pancreatitis : a successful reduction in triglyceride levels with simultaneous insulin infusion and plasma exchange : case reportSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 21, pp 5 –7 (2016) http://dx.doi.org/10.1080/16089677.2015.1118230More Less
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 21, pp 8 –12 (2016) http://dx.doi.org/10.1080/16089677.2015.1129704More Less
Background: Optimal control of diabetes mellitus remains elusive, especially in developing countries. A comprehensive and standardised approach, coupled with intensive patient and clinician education, may provide the solution.
Methods: Comprehensive datasheets accompanied by patient education from a multidisciplinary team and clinician retraining on diabetes management was introduced into the Edendale Hospital diabetes clinic in 2012. This study compares diabetes control starting October 1, 2012 to September 30, 2013 (Y1) to October 1, 2013 to September 30, 2014 (Y2).
Results: Significant changes (p-values < 0.005) were noted in the following parameters between Y2 and Y1 respectively:
* Mean HbA1c% (10.41 ± 2.91 vs. 11.26 ± 2.99).
* Mean HbA1c in males (9.46 vs. 10.57) and (10.38 vs. 11.19) for females.
* Mean HbA1c for type 1 (11.80 vs.10.77) and type 2 patients (10.91 vs.10.10).
* Percentage of patients achieving triglyceride control (64.28 vs. 52.85).
* Percentage of patients making lifestyle changes and performing home glucose monitoring.
* Increase in female waist circumference (97.29 vs. 85.95 cm).
* Increase in BMI in males (29.65 vs. 27.92 kg/m2).
Conclusion: This multifaceted approach to diabetes care in a resource-limited clinic significantly improved glycaemic and triglyceride control. Obesity remains a major challenge. This model could serve as a blueprint for other such resource-limited clinics.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 21, pp 13 –15 (2016) http://dx.doi.org/10.1080/16089677.2016.1160539More Less
Type 2 diabetes mellitus (T2DM) is a progressive disease characterised by beta cell dysfunction and insulin resistance. Beta cell dysfunction progresses to beta cell failure. Many patients with T2DM are managed with oral agents until complications develop. 'Clinical inertia' in T2DM, defined as lack of initiation or intensification of therapy when clinically indicated, is common among clinicians. Patients are exposed to hyperglycaemia for a long time resulting in glucotoxicity to beta cells, leading to further beta cell deterioration. The traditional approach to the management of T2DM is lifestyle change, diet, exercise, weight loss, oral agents and, lastly, insulin. This traditional approach is usually carried out step-by-step and at a slow pace, with insulin offered as a last option. By the time insulin therapy is initiated, complications have already developed. It is, therefore, important for clinicians to be aware of the importance of initiating insulin therapy early to prevent poor glycaemic control and the development of diabetes-related complications.