SA Journal of Diabetes & Vascular Disease: Vol 3, Issue 3, September 2006

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SAJDVD: VOLUME 3, ISSUE 3, SEPTEMBER 2006

Increasing choice to treat obesity : editorial
Authors: Bailey, Clifford J.; Day, Caroline; Published: 2006
From: South African Journal of Diabetes and Vascular Disease, Vol 3, Issue 3, Aug / Sep, Pages: p.111
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Inhaled insulin : overcoming barriers to insulin therapy? : review
Authors: Bellary, Srikanth; Barnett, Anthony H.; Published: 2006
From: South African Journal of Diabetes and Vascular Disease, Vol 3, Issue 3, Aug / Sep, Pages: p.114-119
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Abstract: Inhaled insulin is a new route of insulin delivery that can be used in the treatment of type 1 and type 2 diabetes. It offers an alternative and additional means of insulin administration, and has been received with particular satisfaction by patients who dislike injections. Trials indicate that inhaled insulin can be used effectively for pre-meal bolus intensification of treatment. Pre-meal inhaled insulin with Exubera<SUP>(R)</SUP> has shown faster absorption and similar duration of action to regular subcutaneous insulin with an overall similar glucodynamic effect. Although bioavailability is lower, mainly due to losses in the upper airways, this is compensated for by dose. The commonest side effect reported with inhaled insulin, as with subcutaneous insulin, was hypoglycaemia, almost a quarter of patients noted a cough which settled with continued treatment. Increased antibody titres and changes in lung function return to normal on discontinuation of inhaled insulin. Quality of life scores indicate patient preference for inhaled versus injected insulin, thus increased choice may improve adherence to treatment regimens. However, true cost:benefit analyses have to be undertaken as do studies in children, smokers and people with respiratory conditions, e.g. asthma.
Pharmacological approaches to reduce adiposity : review
Authors: Day, Caroline; Bailey, Clifford J.; Published: 2006
From: South African Journal of Diabetes and Vascular Disease, Vol 3, Issue 3, Aug / Sep, Pages: p.120-124
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Abstract: Acatalogue of antiobesity agents came and went during the last century. The current weight loss agents orlistat and sibutramine are now to be joined by rimonabant, a cannabinoid-1 (CB1) receptor antagonist that acts centrally to decrease appetite and peripherally to reduce lipogenesis in adipose tissue. Use of rimonabant is based on evidence that the endogenous cannabinoid system is overactive in obesity, mainly due to increased expression of CB1 receptors. Weight loss attributed to rimonabant (about 5 kg over one year) was associated with improved insulin sensitivity, reduced triglyceride and increased high density lipoprotein cholesterol. Like other antiobesity agents rimonabant should be used as an adjunct to lifestyle advice. Although there are several potential antiobesity agents in development these are mostly at an early stage of clinical evaluation.
Sulphonylureas and cardiovascular risk : facts and controversies : review
Authors: Valensi, Paul; Slama, Gerard; Published: 2006
From: South African Journal of Diabetes and Vascular Disease, Vol 3, Issue 3, Aug / Sep, Pages: p.127-133
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Abstract: Cardiovascular complications are the principal cause of death in type 2 diabetes. The importance of glycaemic control in preventing cardiovascular complications has been demonstrated. However, some oral antidiabetic agents and especially some sulphonylureas (SU) have been accused of having a deleterious effect on cardiovascular risk. A retrospective analysis of the administrative database of Saskatchewan Health for 5, 795 subjects, identified by their first-ever dispensation for an oral antidiabetic agent, suggests that a higher exposure to SUs was associated with increased mortality. Nevertheless, the effects of SUs on cardiac ATP-sensitive potassium channels in experimental studies vary between agents and studies, so that the clinical relevance of this phenomenon is unclear. Moreover, 11 years of follow-up of patients randomised to glibenclamide or chlorpropamide in the United Kingdom Prospective Diabetes Study demonstrated no adverse effects on a range of cardiovascular end points. Despite SU structural differences and differences in binding to cardiac SU receptors, the clinical evidence base does not support the selection of one sulphonylurea over another on the basis of ischaemic preconditioning, possibly because ischaemic preconditioning may be blunted or absent in diabetes. The main objective remains the prevention or delay of diabetic complications through improvement of glycaemic control together with other cardiovascular risk factors.
Gaining control of diabetes through nutrition : achieving best practice
Authors: Shand, Lesley; Published: 2006
From: South African Journal of Diabetes and Vascular Disease, Vol 3, Issue 3, Aug / Sep, Pages: p.136-139
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Abstract: Self-care and self-monitoring are priorities for diabetics. Good nutrition is an integral part of this self-care, but there are many misconceptions surrounding diabetic nutritional treatment. For example, diabetics were previously told to avoid sugar. We now know that sugar can be included in a diabetic's diet as long as it forms part of a healthy, balanced diet.1 Sweeteners, therefore, may be used in limited amounts, but may not be necessary if the amount of sugar is regulated.
South African comment by Larry A Distiller on pharmacological approaches to reduce adiposity : achieving best practice
Authors: Day, Caroline; Baile, Clifford J.; Published: 2006
From: South African Journal of Diabetes and Vascular Disease, Vol 3, Issue 3, Aug / Sep, Pages: p.139
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The MERCURY II trial : benefits of rosuvastatin
Authors: Izzat, Lena; Published: 2006
From: South African Journal of Diabetes and Vascular Disease, Vol 3, Issue 3, Aug / Sep, Pages: p.140-144
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Abstract: Measuring Effective Reductions in Cholesterol Using Rosuvastatin therapy (MERCURY II) was a 16-week, randomised, open-label study in high-risk subjects with primary hypercholesterolaemia, comparing efficacy and safety following a switch after eight weeks from the accepted/potential start doses of atorvastatin (10 and 20 mg) and simvastatin (20 and 40 mg) to the most widely used doses of rosuvastatin (10 and 20 mg) or remaining on initial therapy. <br>At 16 weeks, significantly more patients switched to rosuvastatin had achieved their National Cholesterol Education Programme/Adult Treatment Panel III (NCEP/ATP III) low-density lipoprotein cholesterol (LDL-C) targets than those who remained on atorvastatin or simvastatin, also patients with hypertriglyceridaemia were more likely to achieve their LDL-C, non high-density lipoprotein cholesterol (HDL-C) and apo B goals when switched to rosuvastatin. A greater number of patients deemed very high risk achieved their optional NCEP/ATP III LDL-C target of < 1.8 mmol/L (70 mg/dL) when switched to rosuvastatin from either atorvastatin or simvastatin. All statin regimes were well tolerated with a comparable side effect profile. <br>In high-risk patients, where new lipid targets are especially difficult to achieve, switching to rosuvastatin 10 or 20 mg was a safe and effective strategy.
A user perspective on Continuous Subcutaneous Insulin Infusion (CSII) therapy : achieving best practice
Authors: Ford, Melissa P.; Published: 2006
From: South African Journal of Diabetes and Vascular Disease, Vol 3, Issue 3, Aug / Sep, Pages: p.145-146
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Abstract: For this patient, clinical benefits of CSII are complemented by quality-of-life benefits. CSII allows her to eat, exercise, work, and socialise similarly to non-diabetic peers, mitigating psychosocial impacts of insulin dependence. Tailoring insulin dosage more precisely to meet insulin requirement has allowed her to pursue educational and personal goals while maintaining a healthy weight and an optimal HbA1C, without severe hypoglycaemia or diabetic ketoacidosis.
South African perspective on insulin pumps : achieving best practice
Authors: De Wit, E.W.; Published: 2006
From: South African Journal of Diabetes and Vascular Disease, Vol 3, Issue 3, Aug / Sep, Pages: p.147-149
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Lipid-lowering therapy is associated with resolution of exudates in diabetic maculopathy : case report
Authors: Sheth, Hiten G.; Aslam, Sher; Feher, Michael D.; Davies, Nigel; Published: 2006
From: South African Journal of Diabetes and Vascular Disease, Vol 3, Issue 3, Aug / Sep, Pages: p.150-152
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PREDICTIVE study indicates that diabetes can be effectively treated without causing weight gain : drug trends in diabetes
Authors: Published: 2006
From: South African Journal of Diabetes and Vascular Disease, Vol 3, Issue 3, Aug / Sep, Pages: p.153
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Simvastatin effectively reduced all TG-rich liporoteins (VLDL and LDL) in type 2 diabetes using VAP analysis : drug trends in diabetes
Authors: Published: 2006
From: South African Journal of Diabetes and Vascular Disease, Vol 3, Issue 3, Aug / Sep, Pages: p.154
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Abdominal obesity and CV risk : does waist circumference tell the story? : drug trends in diabetes
Authors: Published: 2006
From: South African Journal of Diabetes and Vascular Disease, Vol 3, Issue 3, Aug / Sep, Pages: p.155-156
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Rapid time action of insulin glulisine (Apidra) maintained in obese patients : drug trends in diabetes
Authors: Published: 2006
From: South African Journal of Diabetes and Vascular Disease, Vol 3, Issue 3, Aug / Sep, Pages: p.158
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Early use of pre-prandial, short-acting insulin shows b-cell protection in type 2 diabetes : drug trends in diabetes
Authors: Published: 2006
From: South African Journal of Diabetes and Vascular Disease, Vol 3, Issue 3, Aug / Sep, Pages: p.158
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Telmisartan provides superior BP reduction from morning to morning compared to other leading ARBs : advertorial
Authors: Published: 2006
From: South African Journal of Diabetes and Vascular Disease, Vol 3, Issue 3, Aug / Sep, Pages: p.160
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