SAJDVD: VOLUME 17, ISSUE
1,
JULY
2020
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- From the Editor’s Desk
Authors: Mahomed, FA
From: South African Journal of Diabetes and Vascular Disease, Vol 17, Issue 1, November 2020
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- Prevalence of gestational diabetes mellitus in urban women in Blantyre, Malawi: a cross sectional study evaluating diagnostic criteria and traditional risk factors
Authors: TJ Phiri, M Kasiya, TJ Allain
From: South African Journal of Diabetes and Vascular Disease, Vol 17, Issue 1, July 2020
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Background: Gestational diabetes mellitus (GDM) is associated with maternal and neonatal complications. The application of appropriate diagnostic criteria is essential. There is a paucity of GDM prevalence data for African countries, including Malawi.
Objectives: This study aimed to establish the prevalence of GDM in Blantyre, Malawi and assess the implications of applying different cut-off points for diagnosis as defined by WHO criteria and the recently established International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria. It evaluated the relevance of internationally defined risk factors for GDM and compared the risk factors and prevalence between women accessing antenatal care in private hospitals to those accessing antenatal care at government hospitals. Patients at private hospitals are generally of a higher socio-economic status, have better access to care and are more likely to have a sedentary lifestyle and Westernised diet.
Methods: In this cross-sectional study, 2 274 consecutive women presenting at five antenatal clinic sites in Blantyre were screened for GDM, employing a random blood glucose (RBG) test. Of these, 250 women were randomly selected for an oral glucose tolerance test (OGTT). Logistic regression was used to quantify the association between various exposure variables and prevalence of GDM. Characteristics of patients attending government and private antenatal clinics were compared.
Results: The study population was predominantly urban, with a mean age of 25 years (range 14–43) with 66% being in the third trimester. The mean RBG level was 5.1 mmol/l (range 2.4–10.6) and verall prevalence of GDM based on the OGTT was 1.6 and 24% using the WHO and IADPSG criteria, respectively. GDM, diagnosed using WHO criteria, was associated with older maternal age, high parity, and attendance at government antenatal linics but not with mid upper-arm circumference, a positive family history of diabetes mellitus (DM) or previous poor neonatal outcome.
- Prevalence of diabetic neuropathy and risk factors for diabetic foot ulcers among patients in a tertiary health institution
Authors: Michael Adeyemi Olamoyegun, Akinyele Taofiq Akinlade, Gbadebo Oladimeji Ajani, Emmanueal Yemi Fagbemiro
From: South African Journal of Diabetes and Vascular Disease, Vol 17, Issue 1, November 2020
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Background: Diabetic foot is one of the most devastating chronic complications of diabetes mellitus and is usually preceded by many risk factors, including peripheral neuropathy. An understanding of these potential risk factors enables early recognition and modification where possible. Hence this study aimed to assess prevalence of peripheral neuropathy and other risk factors for the development of diabetic foot.
Methods: This study involved adults diagnosed with type 2 diabetes who were consecutively recruited from the LAUTECH Teaching Hospital Diabetes Clinic, Ogbomoso, Nigeria. Participants were surveyed for the presence of foot ulcers, skin changes, deformities, dystrophic nails and sensory europathy, using a 10-g Semmes-Weinstein monofilament, 128-Hz tuning fork, diabetic neuropathy symptoms score and diabetic neuropathy examination score.
Results: The mean age was 62.08 ± 8.70 years and 47.5% were male. Diabetes duration as 4.97 ± 4.10 years. The prevalence of active foot ulceration among the study participants was 14.4%. Diabetic peripheral neuropathy (DPN) was diagnosed with monofilament insensitivity in 24.5% of patients, vibration insensitivity in 9.4%, no joint position sense in 12.2%, diabetic neuropathy examination in 15.1% and diabetic neuropathy symptoms score in 41.0%. We found dry skin in 24.5%, claw toes in 19.4%, dystrophic nails in 18.7%, calluses in 11.5% and gangrene n 4.3%.
Conclusion: There was a high prevalence of DPN in our patients, with a significant prevalence of diabetic foot ulcer in 14.4%. It is suggested that regular screening for DPN should be performed, with the aim of early recognition and prevention of factors predisposing to foot ulceration.
- Relationship between obesity and blood pressure among employees in
the Vhembe district municipality of Limpopo Province, South Africa
Authors: Takalani Clearance Muluvhu, Makama Andries Monyeki, Gert Lukas Strydom, Abel Lamina Toriola
From: South African Journal of Diabetes and Vascular Disease, Vol 17, Issue 1, November 2020
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Objective: The aim of this study was to investigate the relationship between obesity and blood pressure among employees of the Vhembe district municipality of Limpopo province.
Methods: A cross-sectional study was conducted among 452 local government employees (207 males, 245 females) aged 24–65 years. Body mass index (BMI), blood pressure (BP) and waist circumference (WC) measurements, and waist-toheight ratio (WHtR) were assessed. Data were analysed using Statistical Package for Social Sciences (SPSS) statistics, version 21.
Results: The results showed that 27% of the participants were classified as overweight and 34% as obese, with females being more overweight and obese (29 and 48%, respectively) compared to males (24 and 17%, respectively). Twenty-five per cent of the participants were hypertensive, with females (27%) showing a higher prevalence compared to males (22%). Based on BMI categories, the obese group (35%) had a higher prevalence of hypertension in contrast to groups that were of normal weight (18%) and overweight (22%). The results also showed that systolic blood pressure (SBP) was positively (p ≤ 0.05) correlated with BMI (r = 0.15), WC (r = 0.26) and WHtR (r = 0.29) in the normal and overweight groups (WC, r = 0.23 and WHtR, r = 0.26), and WHtR correlated with SBP (r = 0.26) and diastolic blood pressure (DBP) (r = 0.19).
Conclusion: The study showed a high prevalence of overweight, obesity and hypertension, with females more affected than their male counterparts. BMI, WC and WHtR were positively correlated with SBP in the normal and overweight groups, with WHtR positively correlated with both SBP and DBP in the overweight group. Therefore, it is recommended that intervention regimes designed to address obesity and hypertension should consider risk awareness for cardiovascular diseases, impaired quality of life and productivity among local government employees.
- Prevalence of hypertension and selected cardiovascular risk factors
among adolescents in selected rural and urban secondary schools in Botswana
Authors: Matshidiso Mokgwathi, Julius Chacha Mwita
From: South African Journal of Diabetes and Vascular Disease, Vol 17, Issue 1, November 2020
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Background: Adolescent hypertension and other cardiovascular risk factors tend to track into adulthood. Consequently, there is a need to determine the prevalence of hypertension and pre-hypertension, and its co-existence with glycaemia, obesity, tobacco and alcohol use among senior secondary school students in Botswana.
Methods: A cross-sectional study was undertaken between December 2015 and March 2016 among students in selected rural and urban senior secondary schools in Botswana. Data were collected through a self-administered questionnaire, measurements and fasting blood glucose testing. Participants were asked about cigarette smoking, alcohol use and levels of physical activity. Body weight, height, waist circumference, blood pressure and fasting blood glucose levels were measured. Hypertension, pre-hypertension, overweight and obesity were defined based on gender, age and height from normative tables.
Results: A total of 252 students with a mean age (standard deviation) of 17.1 (0.9) years participated in the study. Rural students were older than urban students (17.5 vs 16.7 years; p < 0.001). The prevalence of hypertension and prehypertension were 13.1 and 15.5%, respectively. Physical inactivity (37.7%), overweight/obesity (10.3%) and alcohol intake (9.1%) were also prevalent. Cigarette smoking was rare (2.0%). Impaired fasting glucose levels were found n 1.6% of participants, and none had diabetes mellitus. Hypertension (p < 0.001) and cigarette smoking (p = 0.019) were more prevalent among male than female participants. Female students were more likely to be overweight or obese than male students (p < 0.001). There were no urban–rural differences in hypertension, pre-hypertension and smoking. Urban students were more likely to drink alcohol than rural students (p = 0.008).
Conclusion: Hypertension, overweight/obesity and alcohol intake were common among these adolescents in Botswana. Strategies to reduce the risk factors of cardiovascular diseases should be urgently developed and implemented to prevent cardiovascular disease-related morbidity and mortality in the future.
- Persistent cardiac arrest caused by profound hypokalaemia after
large-dose insulin injection in a young man with type 1 diabetes mellitus:
successful rescue with extracorporeal membrane oxygenation and subsequent
ventricular assist device
Authors: Ying-hsiang Wang, Chien-sung Tsai, Yi-ting Tsai, Chih-yuan Lin, Hsiang-yu Yang, Jia-lin Chen, Po-shun Hsu
From: South African Journal of Diabetes and Vascular Disease, Vol 17, Issue 1, November 2020
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Abstract: A 28-year-old man who had a history of type 1 diabetes mellitus with poor medication compliance was referred to the emergency department of our institute with suspected diabetic ketoacidosis. The patient developed sudden cardiac arrest following continuous insulin administration. Laboratory data revealed severe hypokalaemia. Cardiopulmonary resuscitation was performed immediately for 63 minutes. Although his spontaneous circulation resumed, the haemodynamics remained unstable. Peripheral extracorporeal membrane oxygenation was therefore employed for mechanical circulatory support. Echocardiography under these conditions revealed generalised hypokinesia of the bilateral ventricles. The left ventricular ejection fraction was only 10–15%. The chest film revealed bilateral pulmonary congestion. The patient developed multiple organ dysfunction, including acute kidney injury, liver congestion and persistent pulmonary oedema, although the hypokalaemia resolved. A temporary bilateral ventricular assist device (Bi-VAD) was used for superior systemic perfusion and unloading of the bilateral ventricles after 16 hours of extracorporeal membrane oxygenation support. After the start of maintenance using the Bi-VAD, extracorporeal membrane oxygenation was discontinued and the inotropic agents were tapered down immediately. Subsequently, the haemodynamics stabilised. All the visceral organs were well perfused with Bi-VAD support. Subsequent echocardiography demonstrated recovery from the myocardial stunning, with the left ventricular ejection fraction returning to 50–60%. The Bi-VAD was gradually weaned and successfully removed 12 days after implantation. The patient had an uneventful recovery and was discharged without organ injury. Over one year of follow up in our out-patient clinic, adequate cardiac function and improved diabetes control were found.
- Diabetes and thromboembolic risk
Authors: Peter Rossing, Manesh Patel
From: South African Journal of Diabetes and Vascular Disease, Vol 17, Issue 1, November 2020
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Introduction: Today most practising clinicians are aware of the rampant spread of diabetes throughout the world. Most estimates suggest that diabetes affects between 30% and 35% of the population. This report considers the interface between diabetes and cardiovascular disease, which manifests as coronary artery disease, stroke and/ or peripheral arterial disease, chronic kidney disease (CKD), atrial fibrillation (AF) and their individual and combined impacts on prognosis. Professor Peter Rossing discusses the links between diabetes and kidney disease and Professor Manesh Patel considers the interrelationships between diabetes, AF, chronic kidney injury and peripheral arterial disease, pointing out recent observations on the effect of NOACs in these settings. A significant percentage of patients with diabetes also have CKD; 28% will have albuminuria, 20% will have impaired renal function and 10% will have the combination of both of these. Approximately 60% of diabetics have normal kidney function (Fig. 1). Glycaemic control is important, as glycaemia is related not only to the occurrence of micro- and macrovascular complications in the kidneys, but also in the eyes, vascular system and heart. Type 2 diabetes mellitus (T2DM), often associated with obesity, can lead to kidney disease either via the metabolic pathway of hyperglycaemia or through a dynamic pathway caused by hypertension that leads to intense pressure in the kidney, glomerulosclerosis, fibrosis and the further increase of blood pressure. Resultant progressive kidney disease can lead to end-stage kidney disease (Fig. 2).
- Anticoagulation case study: special
considerations in diabetes and CKD
Authors: Anthony Dalby
From: South African Journal of Diabetes and Vascular Disease, Vol 17, Issue 1, November 2020
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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!
