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VOLUME 17 NUMBER 1 • JULY 2020
3
SA JOURNAL OF DIABETES & VASCULAR DISEASE
FROM THE EDITOR’S DESK
From the Editor’s Desk
Correspondence to: FA Mahomed
Head of Internal Medicine, Madadeni Hospital
Newcastle, KwaZulu-Natal
holds
rank
in hypertension
ZARTAN 50, 100 mg.
Each tablet contains 50, 100 mg losartan potassium respectively. S3 A41/7.1.3/0287,
0289. NAM NS2 08/7.1.3/0067, 0086. For full prescribing information, refer to the professional information
approved by SAHPRA, 31 August 2019.
ZARTAN CO 50/12,5, 100/25.
Each tablet contains 50, 100 mg
losartan potassium and 12,5, 25 mg hydrochlorothiazide respectively. S3 A42/7.1.3/1068, 1069. NAM NS2
12/7.1.3/0070, 0071. For full prescribing information, refer to the professional information approved by
SAHPRA, 31 July 2019.
ZNCE559/05/2020.
CUSTOMER CARE LINE
0860 PHARMA (742 762) / +27 21 707 7000
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n this issue of the journal, a wide range of topics is covered.
Phiri and co-workers (page 4) studied gestational diabetes
mellitus (GDM) inMalawi and compareWorld Health Organisation
(WHO) and International Association of Diabetes in Pregnancy study
group (IADPSG) criteria. They show a marked difference in prevalence
between the two sets of criteria and also show a poor correlation
with the cheaper screening tool, finger-prick glucose test. Apart from
adding to much-needed data on GDM in Africa, they also highlight
the problem of cost of screening for GDM on a population level
versus the unknown impact on improvement of health outcomes in
a poorly resourced setting. This demonstrates the ongoing problem
of achieving consensus on the definition of GDM.
1
Olamoyegun
et al.
(page 10) discuss diabetic neuropathy in a
tertiary-hospital setting in Nigeria. They show the usefulness of
clinical examination in detecting foot pathology in diabetes, even
where nerve-conduction testing is not accessible or feasible. This
is reassuring for clinicians working in this setting. It would be
interesting to see this study repeated in a primary-care setting. For
example, in Chile,
2
a much higher prevalence of neuropathy was
found. A study in a primary-care setting in South Africa showed
a low rate of assessment for complications.
3
Another option is to
consider the development of podiatrist-run evaluation centres.
4
Muluvhu and colleagues (page 15) assessed obesity and
hypertension in a group of government employees in South Africa.
They found high levels of obesity and hypertension and females
were more prone to this. This indicates possible areas for lifestyle
and health interventions. Basic interventions could yield important
benefits, such as a reduction in cardiovascular risk by an estimated
80%,
5
and are worth investing in on a population level.
Mokgwathi and Mwita (page 23) examined some cardiovascular
risk factors in a group of adolescents in Botswana and picked up
an early signal of obesity and hypertension. Females seemed to
be more affected. The burden of cardiovascular disease in older
adults may therefore have its seeds in this young group, and again,
this represents a great opportunity for intervention in lifestyle and
health education.
An American study
6
studying youth obesity gives an example
of an intervention such as mindful eating in the family setting. We
need to look at creative ways to engage the youth in participating
in healthier lifestyles.
Wang and co-workers (page 29) describe an interesting case of
cardiac arrest and prolonged cardiac dysfunction after accidental
insulin-induced hypokalaemia. Their heroic, high-tech efforts
ensure a favourable outcome for the young patient.
Rossing and Patel (page 33) report on diabetes and thrombo-
embolic risk, with a special focus on risk reduction with non-vitamin
K antagonist oral anticoagulants (NOACs). These produce benefit
and fewer side effects compared to warfarin. This report is followed
by an instructive case by Dalby (page 36).
Drug trends looks at diabetes risk associated with statin use
(page 38). Much is written about this topic and good summaries
are published.
7-9
The risk of developing diabetes increases with
dose of statin and level of preceding risk for diabetes. Overall, the
consensus seems to be that the cardiovascular benefits of statins
still outweigh the risk of diabetes.
7-9
Alternatives to statins, such as
PSK9 inhibitors, can be considered where there is a very high risk of
diabetes or in patient preference.
References
1. McIntyre HD, Colagiuri S, Roglic G, Hod M. Diagnosis of GDM: A suggested
consensus.
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2. Ibarra CTR, Rocha JJL, Hernández RO, Nieves RER, Leyva RJ. Prevalence of
peripheral neuropathy among primary care type 2 diabetic patients.
Rev Medica
de Chile
2012;
140
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3. Webb EM, Rheeder P, van Zyl DG. Diabetes care and complications in primary care
in the Tshwane district of South Africa.
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2015;
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4. Morrison CL, Morrison G, Harmes S. Development of a podiatry led community
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6. Dalen J, Brody JL, Staples JK, Sedillo D. A conceptual framework for the expansion
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Childhood Obesity
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7. Maki KC, Dicklin MR, Baum SJ. Statins and Diabetes.
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et al.
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