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VOLUME 15 NUMBER 2 • NOVEMBER 2018
43
SA JOURNAL OF DIABETES & VASCULAR DISEASE
EDITORIAL
From the Editor’s Desk
Correspondence to: FA Mahomed
Head of Clinical Unit; Endocrinology, Department
of Internal Medicine, University of the Free State,
Bloemfontein
e-mail:
MahomedFA@ufs.ac.zaS Afr J Diabetes Vasc Dis
2018; 1
5
: 43
I
n this issue, the main areas of interest are cardiovascular risk
factors, including hypertension in Africa, and renal disease in
type 2 diabetes.
Amadi and co-workers (page 44) assessed the cluster of high
cardiovascular risk factors in male long-distance truck drivers in
Nigeria, with a view to improving health awareness in this group.
The prevalence of hypertension in patients with diabetes is
approximately two-fold higher than in similar individuals without
this disease. Muddu
et al.
(page 57) found very high rates of
hypertension in newly diagnosed type 2 diabetes patients in
Uganda, and few were aware of their hypertension status. Routine
assessment and treatment was found to be necessary to prevent
complications and death.
This is a common theme in this issue of the journal. Hypertension
is a clear public health target in Africa.
Dzudie and colleagues, for the PASCAR task force on
hypertension (page 74), outline such a programme in excellent
detail. The aim of the programme was to develop guidance on
implementation strategies for effective detection, treatment and
control of hypertension in sub-Saharan Africa. They highlight a
10-point action plan that they wish to be implemented by African
governments to reduce the incidence of hypertension by 25% by
2025. They should be complimented and supported for initiating
this essential health plan.
Shogade
et al.
(page 64) describe a clear association between
microalbuminuria and left ventricular diastolic dysfunction. The
association between microalbuminuria and renal impairment
in diabetes has been described,
1
as has the association between
macroalbuminuria and cardiovascular death.
1
This study shows
that the cardiac changes occur at an earlier stage than expected
and that microalbuminuria can be used as a marker for renal and
cardiac involvement. This can be used clinically to intervene more
aggressively in the management of the patient at an earlier stage.
Rayner elegantly reviews the renal protective effect of sodium
glucose transporter 2 (SGLT-2) inhibitors used in the treatment of
patients with type 2 diabetes, outlining the mechanisms at play.
One of the SGLT-2 inhibitors is dapagliflozin, which the DECLARE
study affirms to be safe for use in terms of cardiovascular risk.
2
Demir and co-workers looked at whether the choice of statin
matters; they compared endothelial function after one-year use of
atorvastatin or rosuvastatin. There was no difference between the
two statins and both showed a beneficial change in measurements
of endothelial function.
References
1. Adler AI, Stevens RJ, Manley SE, Bilous RW, Cull CA, Holman RR. Development and
progression of nephropathy in type 2 diabetes: The United Kingdom Prospective
Diabetes Study (UKPDS 64).
Kidney Int
2003;
63
(1): 225–325.
2. Wiviott SD, Raz I, Bonaca MP, Mosenzon O, Kato ET, Cahn A, et al. Dapagliflozin
and cardiovascular outcomes in type 2 diabetes.
New Engl J Med
2018; Nov 10.
doi: 10.1056/NEJMoa1812389. [Epub ahead of print].