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- Volume 17, Issue 3, 2012
Journal of Endocrinology, Metabolism and Diabetes in South Africa - Volume 17, Issue 3, 2012
Volume 17, Issue 3, 2012
Author Stephen HoughSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 17, pp 115 –116 (2012)More Less
The time has finally come, more than 16 years after the inception of JEMDSA in 1996, for me to hand over the reigns as Editor-in-Chief to Professor Willie Mollentze, currently Head of the Department of Medicine at Bloemfontein. I can think of few individuals better equipped to carry out this job than Willie, and wish him well on the exciting road ahead.
Placing the Outcome Reduction with an Initial Glargine Intervention (ORIGIN) trial in context : review articleSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 17, pp 118 –120 (2012)More Less
The results of the Outcome Reduction with an Initial Glargine Intervention (ORIGIN) trial were presented at the American Diabetes Association meeting in June 2012. The purpose of this study was to assess whether there would be any reduction in cardiovascular (CV) events if insulin glargine was started early in the course of diabetes. Therefore, the selected patients were those who were at high risk of CV events, but with impaired fasting glucose, impaired glucose tolerance or recent onset of type 2 diabetes. After 6.5 years, no differences were seen in primary outcomes, namely CV death, myocardial infarction, stroke, revascularisation procedures or hospitalisation for heart failure. However, the early institution of insulin therapy using glargine was found to be an effective means of maintaining glycaemic control in this patient group. As expected, patients on glargine insulin experienced slightly increased rates of both non-severe and severe hypoglycaemia, and slight weight gain. Neither of these problems was considered to be a limiting factor in the early use of glargine insulin. A second arm of the study was designed to assess the role of omega-3 fatty acids in the prevention of CV events. The results of this arm showed no benefit and do not support the use of omega-3 fatty acids as prophylactic therapy in these patients. While the ORIGIN trial is unlikely to alter clinical practice regarding the treatment of either dysglycaemia or new-onset diabetes, it has demonstrated that glargine insulin is relatively safe when used early in diabetes and can maintain near-normal glycaemic control for over six years, without increased cancer risk and with a neutral effect on CV outcomes.
Author V.J. BrownSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 17, pp 122 –126 (2012)More Less
Insulin pump therapy is an option for intensive insulin therapy in patients with type 1 diabetes who meet the criteria described in this article. Pump therapy may assist in the reduction of haemoglobin A1c (HbA1c) and the frequency of severe hypoglycaemia. It can also lead to improvements in awareness of hypoglycaemia and quality of life. Careful assessment of patients is vital, as pump therapy is an expensive treatment option and can be dangerous if used incorrectly. Intensive education of patients who meet the criteria is essential. This will reduce possible risks associated with pump therapy. A team approach is needed, consisting of a minimum of a doctor and a diabetes educator who are experienced in pump therapy, as well as a registered dietitian who has expertise in carbohydrate counting. A psychologist is also a useful member of the team and can help with patient assessment and selection.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 17, pp 128 –132 (2012)More Less
Chronic ulcers are a common complication in diabetes. The nature of diabetic foot ulcers makes them difficult to manage and treat. A dynamic management plan is required to treat diabetic lower limb ulcerations. This involves a strategic approach, including mechanical offloading, wound debridement, wound dressing, patient education and surgical intervention. Alternative methods have been developed, of which phototherapy is one. Phototherapy, or low-level laser therapy (LLLT), is a therapeutic treatment modality that has been found to enhance wound healing. Its therapeutic properties have been determined by means of in vitro, in vivo and animal studies. Some studies have shown that the clinical application of phototherapy has a positive effect on the process of wound healing. Therefore, LLLT has the potential to decrease the level of secondary complications, improve wound regeneration, and ultimately improve patient quality of life. This review will discuss the concept of chronic wound management by means of LLLT in patients who suffer from type 2 diabetes.
Carotid intima-media thickness and its associations with type 2 diabetes mellitus in South Africans : original researchSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 17, pp 135 –140 (2012)More Less
Objectives : Carotid intima-media thickness (CIMT) is a surrogate marker of subclinical atherosclerosis and a predictor of cardiovascular events. Few studies in Africa have evaluated CIMT and its associations in people with type 2 diabetes mellitus. This study measured CIMT in a sample of mainly black South African patients with type 2 diabetes mellitus, and evaluated the association of demographic and clinical risk factors with CIMT.
Design : Cross-sectional study.
Setting : Kafalong Hospital, a large community hospital in Pretoria that mainly serves an urban black community.
Subjects : Patients with type 2 diabetes mellitus.
Outcome measures : We evaluated clinical, biochemical and CIMT ultrasound measurements in a standardised fashion.
Results : In 185 patients, the univariate significant predictors of mean far-wall CIMT were age [beta 0.007 (standard error 0.001)], systolic blood pressure [beta 0.001 (standard error 0.000)] and inverse serum creatinine [beta -8.15 (standard error 3.23)]. Low-density lipoprotein cholesterol, apolipoprotein A-1, apolipoprotein B:A-1 ratio and apolipoprotein B:A-1 ratio > 1.2 all had p-values below 0.1, but above 0.05. Age had the largest R-squared (20%). The multivariate models did not explain more of the variation in CIMT than did age alone.
Conclusion : Lipid parameters were related to CIMT in our study population. However, this did not reach statistical significance in this relatively small sample, and lipids added very little to the variability of CIMT compared with age alone.
Beta-2 microglobulin as a predictor of peripheral arterial disease in diabetes : the effect of estimated glomerular filtration : original researchSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 17, pp 141 –144 (2012)More Less
Background : Peripheral arterial disease (PAD) is common in patients with type 2 diabetes mellitus. Its definitive diagnosis requires ultrasound or angiography. Beta-2 microglobulin (β2 microglobulin) has been proposed as a diagnostic marker for PAD. The objective of the study was to evaluate the diagnostic value of β2 microglobulin for PAD in patients with diabetes and varying renal function.
Design : This was a cross-sectional study.
Setting : An academic centre (University of Pretoria and Steve Biko Academic Hospital Diabetes Clinic).
Subjects : One hundred and eight convenience-sampled patients.
Outcome measures : Patients completed a questionnaire and had toe and arm blood pressure (toe-arm index), as well as serum β2 microglobulin and creatinine, measured.
Results : Beta-2 microglobulin did not differ (p-value = 0.34) between those subjects with PAD (n = 43) and those without PAD (n = 65). In a linear regression model, the interaction term between estimated glomerular filtration rate categories and the inverse of β2 microglobulin was highly significant (p-value = 0.001).
Conclusion : Although the sample size was small, β2 microglobulin did not distinguish between subjects with and without PAD. Renal function and its effects on the association between β2 microglobulin and PAD need further study.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 17, pp 145 –147 (2012)More Less
Paraganglia are neuroendocrine organs that originate from the neural crest cells that are closely associated with the autonomic nervous system. Paragangliomas and phaeochromocytomas are tumours that arise from these organs. Paragangliomas are extra-adrenal tumours that can be divided into sympathetic and parasympathetic, and are further categorised by site. The term "phaeochromocytoma" is reserved for intra-adrenal tumours. The most common location of these extra-adrenal paragangliomas is the inferior para-aortic region (also known as the organ of Zuckerkandl). Other extra-adrenal sites that have been described include the bladder, pelvis, prostate, ovaries and thorax. According to McNicol, the estimated incidence of paragangliomas is 1:300 000. At least 30% of paragangliomas have a hereditary occurrence. Approximately 10% are syndromic. We describe a case of extra-adrenal pelvic paraganglioma that caused hypertension in pregnancy.
Source: Journal of Endocrinology, Metabolism and Diabetes in South Africa 17, pp 149 –153 (2012)More Less
Pregnancy- and lactation-associated osteoporosis is a rare syndrome of spontaneous fractures occurring in late pregnancy or lactation. Early diagnosis and management is essential, because of the severity of the morbidity associated with these fractures. Prior to therapy, other reversible causes of osteoporosis should be excluded through adequate investigation. Treatment includes cessation of breastfeeding, the provision of adequate pain relief, and the use of specific osteoporosis drugs, preferably those with short-term bone retention. Although there is no persuasive evidence that calcium and vitamin D requirements increase during pregnancy or lactation compared to the non-pregnant woman of childbearing age, it is advisable to ensure that women are vitamin D replete during pregnancy and lactation.
South African Dyslipidaemia Guideline Consensus Statement
A joint statement from the South African Heart Association (SA Heart) and the Lipid and Atherosclerosis Society of Southern Africa (LASSA) : guidelineSource: Journal of Endocrinology, Metabolism and Diabetes in South Africa 17, pp 155 –165 (2012)More Less
The European Society of Cardiology together with the European Atherosclerosis Society published updated dyslipidaemia guidelines in 2011. SA Heart and the Lipid and Atherosclerosis Society of Southern Africa officially adopt these guidelines. This statement adapts aspects of the guidelines to the South African situation. Using the updated Framingham risk charts, interventional strategies are based according to the cardiovascular risk score and low-density lipoprotein cholesterol (LDL-C) levels. The Framingham risk score refers to the 10-year risk of any cardiovascular event, and includes four categories of risk. Treatment targets are those of the European guidelines. The LDL-C goal is 1.8 mmol/l for the very high-risk group (>30%), 2.5 mmol/l for the high-risk group (15 - 30%), and 3 mmol/l for those below 15% risk. Intensive management of dyslipidaemia in South Africa will significantly reduce the cardiovascular disease health burden.