SA Journal of Diabetes & Vascular Disease: Vol 10, Issue 1, March 2013

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SAJDVD: VOLUME 10, ISSUE 1, MARCH 2013

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The pendulum is swinging : editorial
Authors: Lombard, Landi; Published: 2013
From: South African Journal of Diabetes and Vascular Disease, Vol 10, Issue 1, Mar, Pages: 3
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Abstract: My endocrinology training at the Endocrine Unit of Tygerberg Hospital was under the supervision and watchful eye of Prof Stephen Hough. He deserves credit for having built up this unit, mostly on his own, over many years. He used to love talking about how the pendulum swings in medicine, often from one extreme to the other.
Managing the world's number one chronic disease : a healthcare funder's perspective : funding diabetes care
Authors: Published: 2013
From: South African Journal of Diabetes and Vascular Disease, Vol 10, Issue 1, Mar, Pages: 4-6
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Abstract: Discovery Health provides a funder's perspective on the management of diabetes. The Discovery Health Medical Scheme is South Africa's largest open medical scheme.
Medical management of type 2 diabetes mellitus : a frustrating battle with the funders : funding diabetes care
Authors: Lombard, Landi; Published: 2013
From: South African Journal of Diabetes and Vascular Disease, Vol 10, Issue 1, Mar, Pages: 7-8
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Abstract: There is currently a worldwide pandemic of type 2 diabetes that is spiralling out of control and threatening to overwhelm healthcare systems. South Africa is no exception, and the escalating incidence of obesity here suggests that it will get worse. The brunt of this pandemic will have to be managed at a primary-care level where general practitioners and primary-care nurses will play a vital role.
Dietary management of type 2 diabetes : review
Authors: May, Wayne; Published: 2013
From: South African Journal of Diabetes and Vascular Disease, Vol 10, Issue 1, Mar, Pages: 9-11
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Abstract: The management of diabetes has evolved over the years and has become more individualised with time. As we learn more we have come to understand that we need better approaches if we are to reduce the incidence of diabetes and its complications, no more so than with regard to diet. Recently there has been much controversy with regard to the ideal diet, and the aim of this article is to look critically at the evidence to see if there is one ideal diet.
More reasons to encourage smokers to quit : evidence in practice
Authors: Published: 2013
From: South African Journal of Diabetes and Vascular Disease, Vol 10, Issue 1, Mar, Pages: 11
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Abstract: Two new articles confirm that, despite comprehensive knowledge that smoking is hazardous, it remains a major threat to public health.
Insulin-related weight gain in patients with type 2 diabetes : case examples, mechanisms and an approach to management : review
Authors: Webb, David; Omar, Mak; Kok, Adri; Published: 2013
From: South African Journal of Diabetes and Vascular Disease, Vol 10, Issue 1, Mar, Pages: 12-16
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Abstract: Case study 1: A 64-year-old male who has had type 2 diabetes for 19 years came for an assessment. His other problems were hypertension, dyslipidaemia and silent cardiac ischaemia. Up to seven years ago he had been on gliclazide, but, because of poor glycaemic control (HbA1c = 8.1%), insulin glargine was added as a basal insulin. His weight at the time was 92.8 kg. Since then he had steadily gained weight, having put on 5 kg. He then went on a strict diet and exercise programme, while metformin was substituted for gliclazide and insulin glargine was continued. He lost 2 kg with these measures and the weight remained stable at 94.6 kg for three months. His HbA1c level was 9.2 % at this visit. A GLP-1 analogue was then added. This resulted in steady weight loss as well as improvement in glycaemic control so that a year later his weight was 84.4 kg and HbA1c level was 6%. Meanwhile, over this period, the dose of his basal insulin had to be reduced from 66 to 30 units nocte.
Case study 2: Mr B is a 60-year-old male patient, diagnosed with type 2 diabetes 10 years ago. For the last six years he has been treated with oral hypoglycaemic drugs and high doses of insulin. On a regimen of aspart/protamine aspart 30/70, 102 units daily in split doses, his HbA1c level was 8.1% and his weight had steadily increased to 158.9 kg. He was switched to basal bolus insulin plus pioglitazone and metformin. On a total daily dose of glargine 50 units plus aspart 48 units in divided doses, his HbA1c level improved to 6.1%, but his weight increased further to 165.4 kg (body mass index > 45 kg/m2). Six months ago he was started on a GLP 1 analogue. On a current regimen of insulin detemir 14 units nocte, with aspart as required, a GLP1 analogue and metformin 1 g twice daily, his weight has decreased to 141.8 kg, and waist circumference from 146 cm in 2006 to 137 cm in 2012. His HbA1c level is 7.4%. Subjectively, he feels better and reports improved quality of life in terms of energy and effort tolerance, improved sleep, and less joint pain. He is motivated to continue with his weight loss and improving his diabetes control.
Hypertriglyceridaemia in type 2 diabetes : prevalence, risk and primary care management : review
Authors: Sinclair, Alan; Published: 2013
From: South African Journal of Diabetes and Vascular Disease, Vol 10, Issue 1, Mar, Pages: 18-22
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Abstract: Cardiovascular disease (CVD) associated with type 2 diabetes will impose an increasing burden on primary care over the next few decades. Several mutually reinforcing factors account for the increased CVD risk among patients with diabetes, including hypertriglyceridaemia, the importance of which has been generally underestimated. A consensus from the literature suggests that fasting triglyceride levels of 1.7 mmol/l or above may be a cause for cardiovascular concern and warrant further investigation. Apart from CVD, hypertriglyceridaemia can increase the risk of pancreatitis. Clinicians in primary care should become active in identifying and managing secondary causes of hypertriglyceridaemia and encourage patients with diabetes to implement lifestyle changes. Statins are the mainstay of treatment for diabetic dyslipidaemia that remains inadequately controlled. However, the National Institute for Health and Clinical Excellence (NICE) suggests prescribing a fibrate if triglyceride levels remain > 4.5 mmol/l after addressing secondary causes. Clinicians could consider adding a fibrate if triglyceride levels remain between 2.3 and 4.5 mmol/l despite statin monotherapy for patients at high CVD risk. NICE advocates a trial of highly concentrated, licensed omega-3 fish oils if lifestyle measures and fibrate fail to adequately reduce hypertriglyceridaemia.
Correct words and language assist weight-loss consultations : evidence in practice
Authors: Published: 2013
From: South African Journal of Diabetes and Vascular Disease, Vol 10, Issue 1, Mar, Pages: 22
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Abstract: General practitioners' choice of words may have a direct impact on patients' weight loss, according to a recent UK qualitative study. The study used 34 semi-structured face-to-face and telephone interviews to explore the acceptability of various weight-status terms and their effectiveness in motivating lifestyle changes. Interview transcripts were analysed using the systematic framework approach.
Painful diabetic peripheral neuropathy : review
Authors: Kaplan, Hilton; Published: 2013
From: South African Journal of Diabetes and Vascular Disease, Vol 10, Issue 1, Mar, Pages: 23-31 Full text: Click here to order »
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Abstract: Marchal de Calvi gave the first description of neuropathic pain in 1864. FW Pavy, a Guy's Hospital physician and a pupil of Claude Bernard, the father of modern physiology, described in 1885 the symptoms of diabetic polyneuropathy as '... of darting or lightening pains... Or there may be great pain... I have noticed that these pains may be worse at night' and some patients 'could not feel properly in their legs' and that 'these features may be accompanied by loss of the patellar reflexes.'
Helping patients on insulin to travel safely : patients as partners
Authors: Waddingham, Sandra; Published: 2013
From: South African Journal of Diabetes and Vascular Disease, Vol 10, Issue 1, Mar, Pages: 32-35
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Abstract: People with diabetes need to plan carefully for holidays, especially if they are treated with insulin. Although much of the advice will be the same as for the general population, these patients are more vulnerable and will need to take particular care in looking after themselves to avoid any ill health while away from home.
Changing dietary habits and associated nutritional deficiencies impact on urban African patients living with heart failure in Soweto : diabetes news
Authors: Wagenaar, P.; Published: 2013
From: South African Journal of Diabetes and Vascular Disease, Vol 10, Issue 1, Mar, Pages: 35-36
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Abstract: Changing dietary habits and consequent nutritional deficiencies are having a significant impact on the health status of individuals living with chronic heart failure (CHF) in Soweto. These were the findings of a study published in January 2013.
South African studies in the international literature : considerations of ethnicity and gender in chronic diseases of lifestyle : diabetes news
Authors: Hardy, G.; Published: 2013
From: South African Journal of Diabetes and Vascular Disease, Vol 10, Issue 1, Mar, Pages: 36-37
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Abstract: The current global attention directed at non-communicable diseases (NCDs) is being driven at the highest levels, with the World Health Assembly adopting the important new global target of a 25% reduction in preventable NCD deaths by 2025 (the 25 by 25 goal). South Africa, and indeed sub-Saharan Africa, is currently a melting pot of confounding factors affecting both risk and prevalence of chronic diseases of lifestyle, now reaching epidemic proportions in the developing world. Addressing social and economic inequalities among disadvantaged groups, regulation of the food, drink, alcohol and tobacco industries, and learning from the lessons of the HIV and TB epidemics are all vital to tackling NCDs on a national and international level.
SANOFI diabetes specialist weekend 2012, Cape Town : drug trends
Authors: Hardy, Glenda; Published: 2013
From: South African Journal of Diabetes and Vascular Disease, Vol 10, Issue 1, Mar, Pages: 39-42
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Abstract: Sanofi hosted their annual specialist diabetes meeting in Cape Town in November 2012. Pieter Taljaard of Sanofi opened the meeting with a brief address, raising the concern that the number of diabetes patients in South Africa is increasing annually by 18 000. Sanofi are committed to treatment and innovation in the management of types 1 and 2 diabetes in both the public and private sectors.
Second-generation sulphonylureas : gliclazide modified release (60 mg) reviewed in clinical practice for type 2 diabetes : drug trends
Authors: Published: 2013
From: South African Journal of Diabetes and Vascular Disease, Vol 10, Issue 1, Mar, Pages: 43-44
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Abstract: The modern use of sulphonylureas (SU) in the management of type 2 diabetes focuses on second-generation agents with a lower risk of hypoglycaemia and weight gain than older agents. This is particularly important as the recently available oral incretin mimetics offer modest HbA_1c level reduction with minimal or no hypoglycaemic events and are either weight neutral or may result in weight loss.
Weight training lowers risk of type 2 diabetes : evidence in practice
Authors: Published: 2013
From: South African Journal of Diabetes and Vascular Disease, Vol 10, Issue 1, Mar, Pages: 44
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Abstract: Men involved in weight training for more than 150 minutes a week have a 34% lower risk of type 2 diabetes than those doing no exercise. Although regular physical exercise is the cornerstone of diabetes prevention and management, the role of weight training has not been previously studied in detail.

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