SAJDVD: VOLUME 11, ISSUE 1, MARCH 2014
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- From diet to stem cell transplants :
editorial
Authors: Lombard, Landi
From: South African Journal of Diabetes and Vascular Disease, Vol 11, Issue 1, Nov 2014
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Abstract: Diet in the management of both type 1 and type 2 diabetes has been extensively discussed and debated over many decades. This topic has recently resurfaced and the controversy is now more widespread than ever. It is surprising how poorly studied such an important component of diabetes care is. Currently, lifestyle modification is the second most potent therapy in type 2 diabetes after insulin therapy, and it is more successful in lowering HbA1c levels than any of the new therapies added in the last 20 years.
- The effects of acute hypoglycaemia
on cognitive function in type 1 diabetes :
review
Authors: Inkster, Berit / Frier, Brian M.
From: South African Journal of Diabetes and Vascular Disease, Vol 11, Issue 1, Nov 2014
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Abstract: Throughout life with type 1 diabetes mellitus people with the condition are exposed to multiple episodes of hypoglycaemia associated with insulin therapy. Hypoglycaemia affects several domains of cognitive function. Studies in non-diabetic adults and in people with type 1 diabetes have shown that almost all domains of cognitive function are impaired to some degree during acute hypoglycaemia, with complex tasks being more greatly affected. The specific cognitive functions of attention and memory are both profoundly impaired during hypoglycaemia. These cognitive processes are fundamental to the performance of many day to day tasks. Their impairment disrupts everyday life and raises safety concerns for the pursuit of activities such as driving. Mood and emotion are also negatively affected by hypoglycaemia, resulting in tense tiredness, while motivation is reduced, and anger may be generated in some individuals. Hypoglycaemia can cause embarrassing social situations, and may lead to chronic anxiety and depression in people with type 1 diabetes. At present few therapeutic measures can modify or ameliorate the effects of hypoglycaemia on cognitive function, so instigation of measures to prevent exposure to hypoglycaemia is of major clinical importance, while preserving good glycaemic control.
- Hypoglycaemia unawareness :
practical avoidance and management : review
Authors: Webb, David / Magan, Alkesh
From: South African Journal of Diabetes and Vascular Disease, Vol 11, Issue 1, Nov 2014
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Abstract: In diabetic patients requiring insulin, hypoglycaemic events are inevitable and severe hypoglycaemia is one of the most feared complications of the disease. It is associated with not only physical discomfort, cognitive dysfunction and loss of personal control, but sometimes more severe consequences, including coma and death. In comparison with conventional glucose targets, iatrogenic hypoglycaemia is up to six times more common with intensive therapy and remains the most important barrier to sustained good glucose control. Neural tissue is dependent on a continuous supply of glucose for maintenance of function. Consequently, the development of symptoms in response to low glucose levels is essential for recognising impending neuroglycopenia and to provoke timeous corrective measures to restore glucose balance. Unawareness of hypoglycaemia and failure to develop warning symptoms therefore increases the risk of severe hypoglycaemia and its associated morbidity.
- Glycaemic control and cardiovascular
outcomes in diabetes : review
Authors: Das, Biswajit / Mishra, Trinath Kumar
From: South African Journal of Diabetes and Vascular Disease, Vol 11, Issue 1, Nov 2014
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Abstract: While type 1 diabetes mellitus (DM) is characterised by insulin deficiency due to pancreatic beta-cell destruction, type 2 DM is characterised by a state of longstanding insulin resistance (IR), compensatory hyperinsulinaemia and varying degrees of elevated plasma glucose levels (PG), associated with clustering of cardiovascular (CV) risk and the development of macrovascular disease prior to the diagnosis of DM. Coronary artery disease (CAD) accounts for 70% of mortality and morbidity in patients with diabetes.
Studies in diabetes care have helped prevent or reduce microvascular complications in type 1 and 2 diabetes. However the same cannot be said about macrovascular disease. Despite all data concerning the association between diabetes and cardiovascular disease (CVD), the exact mechanism by which diabetes is linked to atherosclerosis is incompletely understood, and this is especially true in the case of hyperglycaemia. The positive effect of intensive glucose management in comparison to non-intensive glucose control is far from proven.
The DCCT and UKPDS studies have shown that while glycaemic control is important for preventing long-term macrovascular complications, early glucose control is far more rewarding (metabolic memory). Later trials such as ACCORD, ADVANCE and VADT do not advocate tight glycaemic control. In fact, the ACCORD trial has shown increased mortality with tight glucose control. Tight glucose control may be beneficial in selected patients with short disease duration, long life expectancy and no CVD. In critically ill patients, a blood glucose target of 140-180 mg% is fairly reasonable and achievable. The ESC/EASD guidelines of October 2013, like those of the ADA, AHA and ACC, continue to endorse a treatment target for glucose control in diabetes of HbAlc level < 7%, based predominantly on microvascular disease with acknowledged uncertainty regarding the effect of the intensive glucose control on CVD risk. Management of hyperglycaemia in diabetics should not be considered in isolation; diabetics require multifactorial intervention for hypertension, dyslipidaemia and microalbuminuria besides hyperglycaemia. In fact, the combined use of antihypertensives, aspirin and lipid-lowering agents makes it difficult to discern the beneficial effects of antihyperglycaemic therapy.
- High-protein diets and renal disease
: is there a relationship in people with type 2
diabetes? : review
Authors: Parry-Strong, Amber / Leikis, Murray / Krebs, Jeremy D.
From: South African Journal of Diabetes and Vascular Disease, Vol 11, Issue 1, Nov 2014
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Abstract: Diabetic kidney disease is the greatest cause of kidney disease worldwide and a cause of significant morbidity and mortality - in New Zealand it accounts for more than 50% of patients receiving renal dialysis. Diet and lifestyle modification are recognised as the cornerstones of management of type 2 diabetes. Dietary interventions to aid weight loss and improve glycaemic control typically increase total energy intake from protein by about 10%. The effects of increased protein intake on kidney function and progression of kidney disease in type 2 diabetes has not been established. Evaluation of the literature reviewed here suggests that there is some evidence for the benefit of treating existing nephropathy with protein restriction, but no evidence that increasing protein intake in patients with microalbuminuria accelerates diabetic nephropathy, or causes it in those with normal renal function. Substituting chicken, fish and vegetable protein sources for red meat may be helpful, while retaining a focus on other aspects of a healthy diet, such as high fibre, will ensure that potential risks are minimised.
- Diabetes and stem cells : endogenous effects
and reparative mechanisms : review
Authors: Seewoodhary, Jason / Evans, Peter J.
From: South African Journal of Diabetes and Vascular Disease, Vol 11, Issue 1, Nov 2014
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Abstract: Stem cells offer a novel approach to diabetes care based on regeneration, which can potentially shift treatment paradigms towards curation; therapeutic approaches have honed in on generating functional stem cell-derived islet cells for transplantation. Other approaches include stimulating endogenous stem cell replication followed by differentiation into functional islet cells in situ. This review critically considers the impact of diabetes on endogenous stem cells and discusses the potential utility of stem cell therapies for the treatment of diabetes.
- Glucagon-like peptide-1-based
therapies : effects beyond blood glucose control
: review
Authors: Sivaraman, Subash C. / Barber, Thomas M. / O'Hare, Paul / Randeva, Harpal S.
From: South African Journal of Diabetes and Vascular Disease, Vol 11, Issue 1, Nov 2014
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Abstract: Therapies based on the gut-derived glucagon-like peptide-1 (GLP-1) are a recent addition to the treatment of type 2 diabetes. They are either inhibitors of the enzyme di-peptidyl peptidase 4 (DPP-4), which inactivates GLP-1, or analogues of GLP-1 that are resistant to enzymatic degradation. Clinical trials show that long-term treatment with these classes of drugs have a favourable impact on the patient's lipid profile, reduce systolic blood pressure and reduce abdominal obesity, suggesting a significant cardiovascular benefit in addition to glycaemic control. Transient nausea and vomiting are common adverse effects with this class of drugs and may occur due to reduction in gastric motility. GLP-1 based drugs might be associated with a slight increase in the risk of acute pancreatitis, but there is no evidence that these drugs cause pancreatic cancer in humans. GLP-1 based therapy induces medullary thyroid cancer in rat models, but there is no evidence of it increasing the risk in humans. In animal models, GLP-1 and its analogues improve markers of diabetic nephropathy and diabetic neuropathy by modulating inflammatory pathways. In a rat model of diabetes, GLP-1 analogues preserve pancreatic beta-cell function and beta-cell mass. On-going studies are investigating whether these benefits are replicated in humans. GLP-1 based drugs have a favourable effect on cardiovascular risk factors. They should be used with caution in patients at risk of pancreatitis. Animal studies suggest improvement in microvascular complications of diabetes.
- Invasive Staphylococcus aureus
infections in diabetes mellitus : review
Authors: Hakeem, Lukman / Laing, Robert B.S. / Tonna, Ivan / Douglas, John G. / Mackenzie, Alexander R.
From: South African Journal of Diabetes and Vascular Disease, Vol 11, Issue 1, Nov 2014
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Abstract: Staphylococcus aureus, the most virulent of the many staphylococcal species, has remained a major cause of morbidity and mortality despite the availability of numerous effective anti-staphylococcal antibiotics. S. aureus causes disease through both toxin-mediated and non-toxin-mediated mechanisms. This organism is responsible for both healthcare-associated and community-based infections ranging from relatively minor skin and soft tissue infections to severe life-threatening systemic infections. Patients with diabetes mellitus are at increased risk of invasive S aureus infections. This article focuses on the spectrum of invasive S aureus infections and discusses the clinical features, investigations and management of these infections in patients with diabetes mellitus.
- Follow-up study reveals an
encouraging, though small, improvement in
accuracy of labelling of omega-3 fish oil
supplements : drug trends
Authors: Wagenaar, P.
From: South African Journal of Diabetes and Vascular Disease, Vol 11, Issue 1, Nov 2014
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Abstract: Scientific research and media exposure have led to a substantial rise in fish oil supplementation over the past five years. Even though omega-3 (n-3) fatty acid supplements capture only 13% of the US n-3 product market, the highest retail dollar value of the supplements is in the fish oil as opposed to packaged food, beverages and infant formulas where the n-3 content is relatively small. The South African market for fish oil capsules is estimated to be worth about R65 million.
- Flora shares 10 tips for a
cholesterol-lowering diet : diabetes news
From: South African Journal of Diabetes and Vascular Disease, Vol 11, Issue 1, Nov 2014
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Abstract: 'Simple and consistent changes to our lifestyle can reduce our risk of heart disease', says former president of the Association for Dietetics in South Africa, Berna Harmse. 'As South Africans, we should be more aware of cholesterol and heart health in general, as we have a very high incidence of heart disease in our country.'
- Flora saves lives in Villiersdorp :
diabetes news
From: South African Journal of Diabetes and Vascular Disease, Vol 11, Issue 1, Nov 2014
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Abstract: Villiersdorp residents have shown the nation that they have heart by coming together in a commitment to lower their cholesterol levels and get heart healthy in the Flora 21-day cholesterol challenge. The initiative, to test and lower a community's cholesterol levels with a lifestyle programme, was designed to dramatically improve heart health within 21 days. Those who participated have made South African history as it is the first time that an initiative like this has taken place in South Africa.
- Launch of Diaphage : diabetes news
From: South African Journal of Diabetes and Vascular Disease, Vol 11, Issue 1, Nov 2014
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Abstract: Cipla announces the launch of Diaphage (metformin), a new addition to its diabetes portfolio. Metformin is now well established as the primary 'anchor' oral anti-diabetic agent for the management of diabetes. Diaphage is indicated for type 2 diabetes mellitus when diet has failed and especially if the patient is overweight.
LATEST EDITORS' CHOICE
Interesting
features, including:
- Cardiometabolic risk factors in male long-distance bus drivers
- Endothelial dysfunction in patients with hyperlipidaemia
- Hypertension in newly diagnosed diabetic patients in Uganda
- Microalbuminuria and left ventricular dysfunction in type 2 diabetes
- SGLT-2 inhibitors in type 2 diabetes: protecting kidney and heart
- African roadmap: 25% hypertension control in Africa by 2025
RELIABLE EXPERT INFORMATION
The SAJDVD’s main focus is
providing new and relevant information for doctors,
nurses and allied professionals involved in caring
for the diabetes patient.
But as we are part of the larger Diabetes team, we would like to reach out to all patients with relevant information. So here it is!
But as we are part of the larger Diabetes team, we would like to reach out to all patients with relevant information. So here it is!
