SAJDVD: VOLUME 16, ISSUE
2, NOVEMBER
2019
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- From the Editor’s Desk
Authors: MAHOMED, FA
From: South African Journal of Diabetes and Vascular Disease, Vol 16, Issue 2, November 2019
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- High risk of falls in young to middle-aged adults (20–55 years) with diabetes
Authors: VERA-GENEVEY HLAYISI, CHRISTINE ROGERS, LEBOGANG RAMMA
From: South African Journal of Diabetes and Vascular Disease, Vol 16, Issue 2, November 2019
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Background: Falls, leading to accidents or unintentional injury, are the second most prominent cause of death worldwide, and over 80% of fall-related fatalities occur in low-income countries. Few investigations in South Africa have focused on fall risk, specifically among young to middle-aged adults (younger than 55 years of age) with diabetes.
Aims: This study aimed to determine fall risk in young to middle-aged adults (20–55 years of age) with diabetes and compare it to those without diabetes. A secondary aim was to determine the association between fall risk and characteristics of diabetes, including type, duration (in years), control (glycaemic status), age, gender and diabetes co-morbidities (peripheral neuropathy and vision difficulties).
Methods: A cross-sectional, matched-groups design with a cohort (individuals with diabetes) and control (non-diabetic) group was utilised. Assessments carried out in both groups included: the Dynamic Gait Index (DGI), the Modified Clinical Test of Sensory Integration (M-CTSIB), the Diabetic Neuropathy Symptoms (DNS) score and a visual acuity screen. Data were analysed using both descriptive and inferential statistical tests.
Results: A total of 192 participants between 20 and 55 years of age were assessed, 110 in the cohort and 82 in the control. The DGI showed 22% of the cohort participants were at risk of falling compared to only 1% of those in the control group. The M-CTSIB showed more than half (56%) of the cohort participants were at risk of falling and only up to 21% in the control group. The difference in fall-risk findings between the two groups for both DGI and M-CTSIB was statistically significant (p < 0.001). As expected, in both the DGI and M-CTSIB assessments, in the cohort group, those with symptoms of peripheral neuropathy and visual difficulties showed an even higher prevalence of fall risk compared to those without. In the cohort group, longer diabetes duration and uncontrolled glycaemic status correlated with increased risk of falling.
Conclusion: This study determined in that young to middleaged South African adults with diabetes were at a higher risk of falling when compared to those without diabetes. These findings highlight the need to assess fall risk in young to middle-aged patients with diabetes to enable early identification and appropriate rehabilitation. Furthermore, prevention of falls through health education and balance screening in patients with diabetes may be a feasible strategy to minimise the negative impact of falls and injuries in a developing country such as South Africa.
- A cross-sectional cohort study with microvascular complications in patients with type 2 diabetes with and without hypothyroidism
Authors: LOUISE JOHNSON, BRIAN RAYNER
From: South African Journal of Diabetes and Vascular Disease, Vol 16, Issue 2, November 2019
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Objectives: Previous reports have suggested an association between hypothyroidism and macrovascular complications in type 2 diabetes (T2DM) but the association with microvascular complications is not well documented. This study aimed to determine whether there were significant differences in these complications in patients with T2DM with and without hypothyroidism.
Methods: This was a retrospective, cross-sectional, case– control study from a single centre specialising in diabetes in South Africa. T2DM was defined by American Diabetes Association criteria. The cases were all patients treated for hypothyroidism and the controls were clinically and biochemically confirmed euthyroid, who were under follow up between 1 January and 1 July 2016. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate (eGFR) of < 60 ml/min, determined by the CKD-epidemiology collaboration equation (CKD-EPI) and/or albumin/creatinine ratio > 3 mg/mmol. Diabetic retinopathy (DR) was defined as the presence of aneurysms, bleeds, exudates and new vessel formation on the retina examined by an ophthalmologist. Diabetic peripheral neuropathy (DPN) was defined as the presence of symptoms, loss of 128-Hz sensation and abnormal 10-gm monofilament. Cardiovascular disease (CVD) was defined as the presence of major adverse cardiovascular events (MACE).
Results: There were 148 cases and 162 controls. Compared to the controls, the cases were older (65.6 vs 59.4 years, p < 0.00001), more likely to be female (67.6 vs 39.5%, p < 0.0001) and white (89.2 vs 79.6%, p = 0.02), have a lower HbA1c level (7.5 vs 8.2%, p = 0.0001), eGFR (64.4 vs 72.7 ml/min, p = 0.0006) and triglyceride level (2.18 vs 2.55 mmol/l, p = 0.04), have a higher high-density lipoprotein cholesterol level (1.13 vs 1.02 mmol/l, p = 0.001), a longer duration of diabetes (14.8 vs 11.6 years, p = 0.001) and using fewer antidiabetic agents (1.82 vs 2.19, p = 0.001). There was a higher prevalence of CKD (44 vs 57.8%, p = 0.03) and CVD (59.3 vs 45.3, p = 0.06), and a trend towards higher DR (66.7 vs 47.6, p = 0.09). There was no difference in body mass index, hypertension, lowdensity lipoprotein cholesterol level (all patients received statin therapy), DPN and amputations. After adjusting for confounding factors, there was no association between CKD and DR, and hypothyroidism, but the trend to association with CVD persisted (OR 1.97. p = 0.07).
Conclusions: Hypothyroidism in T2DM was not associated with microvascular disease after adjusting for confounding factors. There was a nearly two-fold risk of CVD. The study is limited by the retrospective and observational design.
- Ellisras Longitudinal Study 2017: elevated serum levels of carboxymethyl-lysine, an advanced glycation end-product, are associated with higher odds of developing endothelial dysfunction in black South African patients with type 2 diabetes mellitus (ELS 29)
Authors: MOTETELO ALFRED MOGALE, CATHERINE MARTHA MHLANGA, STANLEY SECHENE GOLOLO, AGUSTINE ADU
From: South African Journal of Diabetes and Vascular Disease, Vol 16, Issue 2, November 2019
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This case–control study investigated the association between major types of serum advanced glycation end-products (AGEs) and selected serum/plasma markers of endothelial dysfunction in black patients with type 2 diabetes mellitus at Dr George Mukhari Academic Hospital. Serum AGEs were measured using either enzyme-linked immunosorbent assay (ELISA) or spectrofluoremetry. Serum markers of endothelial dysfunction were measured using either ELISA or calometry. The correlation and associations between major types of serum AGEs and markers of endothelial dysfunction were investigated using the Spearman correlation coefficient and bivariate logistic regression analysis, respectively. Although both serum total immunogenic AGEs and serum carboxymethyl-lysine (CML) were moderately and negatively associated with endothelial dysfunction, only serum CML was significantly associated with a higher odds for the development of endothelial dysfunction (low nitric oxide levels) in our diabetic subjects. It can therefore be concluded from this study that high serum levels of CML may predispose to endothelial dysfunction in black South Africans with type 2 diabetes.
- Plasma phospholipid fatty acid patterns are associated with adiposity and the metabolic syndrome in black South Africans: a cross-sectional study
Authors: ALICE ACHIENG OJWANG, HERCULINA SALOME KRUGER, MANJA ZEC, CRISTIAN RICCI, MARLIEN PIETERS, IOLANTHÉ MARIKE KRUGER, EDELWEISS WENTZEL-VILJOEN, CORNELIUS MATTHEUS SMUTS
From: South African Journal of Diabetes and Vascular Disease, Vol 16, Issue 2, November 2019
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Background: Diets rich in n-6 polyunsaturated fatty acids (PUFAs) and saturated fatty acids (SFA) have been associated with increased risk of obesity and the metabolic syndrome (MetS), but the evidence is inconsistent, whereas diets high in n-3 long-chain (LC)-PUFAs are associated with lower risk. There is limited information about the association of plasma phospholipid fatty acids (FAs) with obesity and the MetS among black South Africans.
Objective: To investigate the association of dietary FAs and plasma phospholipid FA patterns, respectively, with measures of adiposity (body mass index, waist circumference, waist-to height ratio) and the MetS in black South Africans. Methods: Factor analysis was used to identify FA patterns from 11 dietary FAs and 26 individual plasma phospholipid FAs. Cross-sectional association of the identified patterns with measures of adiposity and the MetS was investigated. A random sample of 711 black South African adults aged 30 to 70 years (273 men, 438 women) from the North West Province was selected from the South African leg of the Prospective Urban and Rural Epidemiology (PURE) study. Sequential regression models adjusted for confounders were applied to investigate the association between dietary FAs and plasma phospholipid FA patterns with measures of adiposity and the MetS.
Results: Two patterns were derived from dietary FAs and six patterns from plasma phospholipid FAs that explained the cumulative variance of 89 and 73%, respectively. The association of FA patterns with adiposity and the MetS was weaker for dietary FA patterns than for plasma phospholipid FA patterns. The plasma phospholipid FA pattern with high loadings of saturated FAs (high-Satfat) and another with high loadings of n-3 very-long-chain PUFAs (n-3 VLC-PUFAs) were positively associated with measures of adiposity and the MetS, while patterns with positive loadings of LC monounsaturated fatty acids (n-9 LC-MUFA) and a positive loading of n-3 essential FAs (n-3 EFA) showed inverse associations with the MetS and some measures of adiposity.
Conclusions: The n-9 LC-MUFA and n-3 EFA patterns seemed to provide possible protective associations with adiposity and the MetS, whereas the high-Satfat and n-3 VLC-PUFA patterns were associated with adiposity and the MetS in our study participants. The results are reflective of the metabolic difference between overweight and obese compared to lean individuals.
- Ellisras Longitudinal Study 2017: association of hypertension with increasing levels of adiposity in 10- to 14-year-old boys and girls in the Eastern Cape (ELS 31)
Authors: A CHUNGAG, CM TATA, CR SEWANI-RUSIKE, W NEL, BN NKEH-CHUNGAG
From: South African Journal of Diabetes and Vascular Disease, Vol 16, Issue 2, November 2019
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Objectives: Previous studies suggest a strong relationship between obesity and hypertension. This study aimed at evaluating the prevalence of hypertension and prehypertension in 10- to 14-year-old boys and girls in the Eastern Cape Province of South Africa and to determine the association between blood pressure parameters and selected measures of adiposity.
Methods: A cross-sectional, school-based study of 540 10- to 14-year-old children from seven schools in the Eastern Cape Province was carried out. Anthropometry and blood pressure parameters were determined.
Results: All measures of adiposity and blood pressure were significantly higher in the girls (p < 0.05). The prevalence of hypertension and pre-hypertension was over 20 and 12%, respectively. Systolic blood pressure and pulse pressure were associated (r > 0.27; p < 0.05) with increasing levels of adiposity.
Conclusion: This study highlights the importance of weightcontrol strategies for the prevention of hypertension in these adolescents and later on in life.
- Clinical outcome of intracoronary versus intravenous high-dose bolus administration of tirofiban in diabetic patients undergoing primary percutaneous coronary intervention
Authors: AHMED A GHONIM, ABDALLA MOSTAFA, AHMED EMARA, ALAA S ALGAZZAR, MOHAMMED A QUTUB
From: South African Journal of Diabetes and Vascular Disease, Vol 16, Issue 2, November 2019
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Background: Previous trials remain inconsistent regarding the advantages and hazards related to intracoronary (IC) compared with intravenous (IV) administration of thrombolytics. We aimed to evaluate the safety and effectiveness of IC versus IV tirofiban administration in diabetic patients (DM) with acute ST-segment elevation myocardial infarction (STEMI) during primary percutaneous coronary intervention (PCI)
Methods: This trial included 95 patients who were randomised to high-dose bolus plus a maintenance dose of tirofiban administered either IV or IC. The groups were compared for the incidence of composite major adverse cardiac events (MACE) at 30 days. Levels of cardiac markers were recorded pre- and post-intervention for myocardial perfusion.
Results: The MACE were not different between the groups, but post-procedure myocardial blush grade (MBG) 3 and thrombolysis in myocardial infarction (TIMI) 3 flow were significant in the IC group (p = 0.45, 0.21, respectively), favouring the IC strategy. Peak values of both creatine kinase-muscle/brain (CK-MB) and high-sensitivity troponin T (hs-TnT) were significantly lower in the IC group (155.68 ± 121, 4291 ± 334 ng/dl) versus the IV group (192.4 ± 86, 5342 ± 286 ng/dl) (p = 0.021, p = 0.035, respectively). The peak value was significantly lower in the IC group than the IV group in terms of ST-segment resolution and 30-day left ventricular ejection fraction (LVEF) (p = 0.016 and 0.023, respectively).
Conclusion: Thirty days post PCI, IC tirofiban was more efficient in ameliorating blood flow in the coronary arteries and myocardial tissue perfusion in DM patients after STEMI despite bleeding events, and MACE rates showed no significant difference between the groups. The IC group showed better improvement in LVEF.
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