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SA JOURNAL OF DIABETES & VASCULAR DISEASE
EDITORIAL
VOLUME 9 NUMBER 2 • JUNE 2012
51
and reflect on the opportunity to improve outcomes for hospitalised
hyperglycaemic patients.
Improved peri-operative care of diabetic patients could have very
significant benefits for reaching these new WHA targets. A recent
South African registry
1
of outcomes in patients with myocardial
infarction, admitted to South African hospitals, has shown that
23.9% of admitted patents were diabetic and the presence of
diabetes was a major predictor of death in the first year.
Two research studies are published in this issue. Awell-conducted
Nigerian study compares the cardiovascular morbidity and mortality
of African normotensive type 2 diabetes patients and hypertensive
non-diabetic patients. The diabetic patients had more burden of
cardiovascular risk factors than the non-diabetic hypertensives.
Interestingly, the prevalence of microalbuminuria was similar in the
normotensive diabetics to that of the hypertensive non-diabetics.
Cardiovascular disease was found to account for most morbidity
and mortality in the diabetic patients. Therefore diabetics should
have regular and specialised cardiovascular care to minimise
disabilities.
In the other research article, from the Cape Peninsula University
of Technology and the University of Stellenbosch, the relationship
between oxidised low-density lipoprotein (oxLDL) and the
generation of auto-antibodies against oxLDL was investigated.
The authors found that decreased levels of anti-oxLDL antibodies
were associated with increased cardiovascular risk scores. The
results partially support the role of these antibodies as an indirect
assessment of oxidative stress.
In our Diabetes Educator’s Focus, Gerda van Rensburg, podiatrist,
CDE, Houghton, notes that the presence of peripheral arterial disease
(PAD) is an independent risk factor for increased mortality due to
associated cardiovascular disease. Patients with PAD have the same
relative risk for death from cardiovascular events as patients with a
history of coronary and cerebrovascular disease. Early detection of
PAD will enable early risk intervention and improve outcomes. Read
this practical advice on screening for PAD.
South Africa has a lively conference and symposium programme.
We report on a meeting in Marseilles, France, the incretin leadership
summit held in South Africa with experts from Africa, India
and the Middle East, and the 47th SEMDSA congress highlights.
We thank our contributors and the reviewers of research articles.
Reference
Shamroth C, ACCESS South Africa investigators. Management of acute coronary
1.
syndrome in South Africa: insights from the ACCESS (Acute Coronary Events –
a Multinational Survey of Current Management Strategies) registry. Advance
publication
Cardiovasc J Afr
, 13 March 2012. DOI: 10.5830/CVJA-2012-017
Correspondence to: Dr Landi Lombard
Netcare Kuilsrivier Hospital, Cape Town
Tel: +27 0(21) 900-6350
e-mail: lclombard@mweb.co.za
S Afr J Diabetes Vasc Dis
2012;
9
: 51.
G
lobal targets for reducing death (and disability) from non-
communicable diseases have been set for the first time by
the 65th World Health Assembly (WHA), of which South
Africa is a prominent participatory member. This declaration will
demand better care and treatment for patients with diabetes, heart
disease, cancer and chronic respiratory disease, and prevention
of the development of these conditions by advocating healthier
lifestyle choices.
For the medical community in South Africa, this will pose
significant challenges, particularly with regard to improving
outcomes for diabeticpatients. Fortunately therearenewtherapeutic
agents available in South Africa to improve glucose control and
overall health outcomes in diabetes. Recently announced SEMDSA
guidelines for type 2 diabetes management are also a first as they
represent truly national guidelines with the involvement of all
stake holders, including Government, healthcare funders and the
diabetes care team.
In this issue of the journal, we hope to promote better diabetes
care. We present two expert reviews on peri-operative care of
diabetic patients. The first is by Dr Gregory Hough, Port Elizabeth,
which calls for a change in attitude to the level of care required to
bring diabetic patients safely through surgery. Dr Hough reviews
the subject and discusses general treatment principles and the
use of hypoglycaemic agents in peri-operative care. He points to
the vital roles of the endocrinologist and the diabetic patients
themselves. He notes that ‘patients should be encouraged to
participate in the management of their diabetes during this
period’.
In a hands-on approach, Dr Adri Kok, specialist physician,
Johannesburg, provides practical advice for specific in-hospital
settings,suchasnon-criticallyillpatientsexperiencinghypoglycaemia,
planning surgery on the diabetic patent, and care of the diabetic
patient in the intensive care unit. While these two articles do have
overlapping principles, they nonetheless complement one another
First global target to reduce non-communicable
diseases by 25% by 2025
LANDI LOMBARD