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- Journal of Endocrinology, Metabolism and Diabetes in South Africa
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- Volume 9, Issue 3, 2004
Journal of Endocrinology, Metabolism and Diabetes in South Africa - Volume 9, Issue 3, 2004
Volume 9, Issue 3, 2004
Author Fraser PirieSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 9, pp 71 –73 (2004)More Less
Author Stan LipschitzSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 9, pp 72 –73 (2004)More Less
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 9, pp 79 –83 (2004)More Less
<I>Objectives.</I> To determine the value of ankle and toe blood pressure indices and pedal pulse palpation in the assessment of peripheral arterial disease in subjects with type 2 diabetes mellitus (DM). <br><I>Design.</I> Cross-sectional study. <br><I>Subjects.</I> A convenience sample of 85 female subjects with type 2 DM underwent a series of peripheral vascular assessments at the diabetes clinic of a community hospital. <br><I>Outcome measures.</I> Palpation of the pedal pulses, Doppler-derived ankle brachial systolic blood pressure indices, photo plethysmographic-derived toe brachial systolic blood pressure indices and antero-posterior radiographs of both feet. <br><I>Results.</I> Mean values were 1.15 (standard deviation (SD): 0.17) and 0.76 (SD: 0.17) for ankle brachial index (ABI) and toe brachial index (TBI) respectively. The differences between the two indices increased from 0.36 (95% confidence interval (CI): 0.32 - 0.41) to 0.58 (95% CI: 0.46 - 0.70) depending on whether ABI was less or greater than 1.3. The correlation coefficient for left versus right foot was 0.62 and 0.71 for ABI and TBI respectively. The relationship between ABI and TBI is non-linear with a cut point close to 1.3. Both ABI and TBI were significantly lower in subjects who had both pedal pulses absent on palpation. <br><I>Conclusions.</I> The relationship between ABI and TBI is linear below an ABI of 1.3. but with a wide 95% prediction interval. If both pedal pulses are absent the ABI is significantly diminished compared with when both pulses are present, even though not necessarily below 0.9.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 9, pp 84 –88 (2004)More Less
<I>Aims.</I> Previous studies of type 2 diabetes mellitus have indicated a benign renal outcome after long-term follow-up. The aim of this study was to determine how often renal failure due to diabetic nephropathy was a cause of death in patients with type 2 diabetes. <br><I>Methods.</I> Prospective observational study of 59 South African patients with type 2 diabetes over a 12-year period. During the study repeated clinical evaluations were accompanied by measurements of serum creatinine, serum cholesterol, random blood sugar, and urine protein/creatinine ratios. <br><I>Results.</I> The mean duration of diabetes at the end of the study was 17.8 years. There was a wide variation in the time from clinical diagnosis of diabetes to macroproteinuria (mean 9.7 years, SD 5.9, range 0 - 21) and the rate of deterioration of renal function. This rate correlated with poor control of blood pressure, a glucose level of > 14 mmol/l, heavy proteinuria, a high retinopathy score, a body mass index of < 28 and the number of pack years of smoking. <br>At the end of the study 47 patients (79.7%) had died. Of these deaths 17 (28.8%) were due to chronic renal failure. <br><i>Conclusions.</I> In contrast to other studies we have shown that in a developing country renal failure in type 2 diabetic patients is a major cause of death. Determining the prognosis for an individual patient is difficult as there are wide ranges in the time of onset of proteinuria, the rise in serum creatinine and the time to ultimate progression to end-stage renal failure.
Author A. ParrishSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 9, pp 89 –90 (2004)More Less