SA Journal of Diabetes & Vascular Disease: Vol 4, Issue 4, November 2007

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SAJDVD: VOLUME 4, ISSUE 4, NOVEMBER 2007

Title: Diabetic renal disease in South Africa : editorial
Authors: Van Rensburg, B.W.J.
From: South African Journal of Diabetes and Vascular Disease, Vol 4, Issue 4, Oct / Nov
Published: 2007
Pages: 155-156
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Abstract: Unfortunately, the discovery of insulin several decades ago did not resolve the problem of diabetes mellitus. Patients were able to survive the initial metabolic morbidity for longer, but soon the long-term complications, and particularly, damage of the blood vessels caused by the high glucose levels, became apparent.
Title: Treating to target in type 2 diabetes : the impossible dream? : editorial
Authors: Joffe, Barry; Kramer, Brian; Distiller, Larry
From: South African Journal of Diabetes and Vascular Disease, Vol 4, Issue 4, Oct / Nov
Published: 2007
Pages: 157-158
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Abstract: The incidence of type 2 diabetes is increasing rapidly throughout the world, especially in developing countries. Accelerated cardiovascular disease is a major long-term complication, being responsible for as much as 75% of the mortality in some communities.
Title: Challenges in developing therapies for the metabolic syndrom : review
Authors: Matfin, Glenn
From: South African Journal of Diabetes and Vascular Disease, Vol 4, Issue 4, Oct / Nov
Published: 2007
Pages: 159-163
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Abstract: Metabolic syndrome refers to a clustering of cardiovascular (CV) risk factors within a single individual. The established risk factor such as obesity, type 2 diabetes, dyslipidaemia, hypertension, and other emerging risk factors are closely related to intra-abdominal adiposity. Insulin resistance is also considered to be an important factor in the aetiology of this syndrome. The emerging risk factors include dysfunction of inflammation, coagulation, platelets, fibrinolysis, lipoproteins, endothelium, and other biological processes. Despite the potential utility of having all the CV risk factors under one umbrella term, debate continues about the very existence of the metabolic syndrome and its diagnostic criteria. Nevertheless, the component risk factors include some of the most common and serious public health challenges facing the developed and developing world today. By treating component risk factors, many existing therapies and new drugs in development target several aspects of metabolic syndrome. However, no drug is currently approved specifically for treatment of the metabolic syndrome.
The essential features of the metabolic syndrome, and some of the challenges in developing treatment options are discussed herein.
Title: Microvascular complications : evaluation and monitoring relevance to clinical practice, clinical trials, and drug development : review
Authors: Greenstein, Adam; Tavakoli, Mitra; Mojaddidi, Moaz; Al-Sunni, Ahmed; Matfin, Glenn; Malik, Rayaz A.
From: South African Journal of Diabetes and Vascular Disease, Vol 4, Issue 4, Oct / Nov
Published: 2007
Pages: 164-169
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Abstract: The long-term microvascular complications of diabetes pose a major health burden. Although, much of the focus has been on the macrovascular complications, it is clear that the microvascular complications have a significant impact on both morbidity and mortality amongst diabetic patients. Indeed retinopathy, nephropathy, and neuropathy compete as the leading causes of premature blindness, end-stage renal disease, and non-traumatic lower-limb amputation, respectively. Furthermore, complications develop and progress in unison and indeed share many common risk factors. Effective evaluation and monitoring of these complications in clinical practice is clearly important, however, it is also relevant to clinical intervention studies, and drug development programs addressing microvascular complications. Novel diagnostic and therapeutic strategies are continually evolving in this area and will be discussed in more detail in this review.
Title: Pre-diabetes : clinical relevance and therapeutic approach : review
Authors: Pratley, Richard E.; Matfin, Glenn
From: South African Journal of Diabetes and Vascular Disease, Vol 4, Issue 4, Oct / Nov
Published: 2007
Pages: 170-178
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Abstract: Type 2 diabetes mellitus is epidemic in most developed and many developing countries. The associated morbidity, mortality and high costs of care, make type 2 diabetes an important global public health challenge and target for prevention. Patients at high risk for type 2 diabetes can be diagnosed by fasting glucose levels or responses to an oral glucose tolerance test (OGTT). Such patients are also at increased risk for cardiovascular disease (CVD). Since obesity and physical inactivity are important risk factors for type 2 diabetes, lifestyle interventions, emphasising modest weight loss and increases in physical activity, should be recommended for most patients with pre-diabetes. Such interventions are safe and effective and also reduce risk factors for CVD. Several oral antidiabetic agents have been shown to be effective at delaying onset of type 2 diabetes. Thiazolidinediones (TZDs) reduced incident diabetes by ~60%, whilst metformin, acarbose and orlistat are only about half as effective as the TZDs. Pharmacological interventions may be appropriate for patients at particular risk for developing diabetes, but the benefits of treatment need to be balanced against the safety and tolerability of the intervention. If pharmacological treatment is warranted, metformin should be considered first because of its favourable overall safety, tolerability, efficacy, and cost profile.
Title: Delivering improved management and outcomes in diabetic kidney disease in routine clinical care : achieving best practice
Authors: Hardy, Kevin J.; Furlong, Niall J.; Hulme, Shirley A.; O'brien, Sarah V.
From: South African Journal of Diabetes and Vascular Disease, Vol 4, Issue 4, Oct / Nov
Published: 2007
Pages: 179-184
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Abstract: Aim: To examine the impact of service re-design on management and outcomes in type 2 diabetic patients with microalbuminuria and diabetic nephropathy.
Methods: The impact of implementation of evidence-based processes of care (blood pressure [BP] control, glycaemic control, renin-angiotensin-aldosterone system blockade, aspirin and cholesterol-lowering therapy, and smoking cessation) on progression to nephropathy in 338 microalbuminuria patients; and on death, doubling of serum creatinine, new end-stage renal failure (ESRF) and cardiovascular events in 127 nephropathy patients is described.
Results: Effective implementation of evidence-based processes of care improved surrogate outcomes (BP, HbA1C and low density lipoprotein-cholesterol), was associated with little progression of microalbuminuria to nephropathy (6.1 per 100-patient-years), and in diabetic nephropathy patients were associated with rates of doubling of serum creatinine (1.4 per 100-patient-years), progression to ESRF (1.1 per 100-patient-years), cardiovascular events (3.2 per 100-patient-years) and mortality (2.2 per 100-patient-years) that compares favourably with landmark trials.
Conclusion: Service re-design in the management of type 2 diabetic kidney disease can deliver improved care and outcomes comparable with landmark trials in a routine clinical care setting.
Title: Treating to target in type 2 diabetes : achieving best practice
Authors: Keigher, Carol; Avalos, Gloria; Dunne, Fidelma
From: South African Journal of Diabetes and Vascular Disease, Vol 4, Issue 4, Oct / Nov
Published: 2007
Pages: 185-187
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Abstract: Patients with type 2 diabetes have a three-fold increased risk of developing vascular disease with death in 75% due to a vascular complication. Large prospective studies have demonstrated the benefits of treating patients with type 2 diabetes to strict targets regarding blood pressure (BP), lipids and glucose. Using both American Diabetes Association and Joint British Societies / Guidelines we assessed the effectiveness of this 'treat-to-target' policy in diabetic patients attending secondary care. Of 321 patient notes analysed 54-87% were within target for total cholesterol, 80-84% for LDL cholesterol, 77% for HDL cholesterol, 51% for triglycerides, 44-61% for systolic BP, 62% for diastolic BP and 30-44% for HbA1C. In the secondary care setting we are performing well for lipids, less well for BP and poorly for HbA1C.
Title: Chronic wounds : optimising wound management : disease focus
Authors: Clarkson, Ayesha; Kirby, Mike
From: South African Journal of Diabetes and Vascular Disease, Vol 4, Issue 4, Oct / Nov
Published: 2007
Pages: 188-190
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Abstract: Practice and other community-based nurses play a central role in achieving high quality wound care in patients treated initially in general practice and in those who have been discharged from hospital. This article summarises some of the wound management products available for chronic wounds, and the importance of continued wound care in the primary care setting, before focusing on one of the latest approaches - total negative pressure (TNP).
Title: Comment : a South African perspective on chronic wounds : optimising wound management : achieving best practice
Authors: Sinclair, Werner
From: South African Journal of Diabetes and Vascular Disease, Vol 4, Issue 4, Oct / Nov
Published: 2007
Pages: 191
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Abstract: The care of chronic wounds remains a challenge, more so than that of acute wounds. Acute wounds are usually seen in patients subjected to surgery or trauma and they almost always occur in skin that was healthy prior to the injury, making recovery and healing so much easier, as long as the circulation is not impaired and secondary infection can be prevented.
Title: You and your treatment : starting on metformin : keep and copy series
From: South African Journal of Diabetes and Vascular Disease, Vol 4, Issue 4, Oct / Nov
Published: 2007
Pages: 193
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Abstract: Metformin is prescribed to people who have diabetes, a condition where your body is not able to control its own sugar (glucose) level. High sugar levels in the blood can damage the blood vessels in your body so it is important to keep levels as close to normal as possible.
Title: Special report on the EASD meeting : Amsterdam 2007 : special reprot
Authors: Koning, J.M.M.
From: South African Journal of Diabetes and Vascular Disease, Vol 4, Issue 4, Oct / Nov
Published: 2007
Pages: 194-196
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Abstract: The 43rd annual meeting of the European Association for the Study of Diabetes (EASD) was held in Amsterdam, the Netherlands, from 18-21 September 2007.
Title: Approval in the EU for use of NovoRapid(R) in the elderly : drug trends
From: South African Journal of Diabetes and Vascular Disease, Vol 4, Issue 4, Oct / Nov
Published: 2007
Pages: 196
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Abstract: Novo Nordisk announced at the 2007 EASD congress that the European Commission had approved rapid-acting insulin, NovoRapid(R) (insulin aspart) for treatment of diabetes in the elderly and in people with renal or hepatic impairment.
Title: Positive benefit-risk balance for rosiglitazone and pioglitazone : drug trends
From: South African Journal of Diabetes and Vascular Disease, Vol 4, Issue 4, Oct / Nov
Published: 2007
Pages: 197
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Abstract: Finalising a review of the benefits and risks of the thiazolidinediones (TZDs), rosiglitazone (Avandia) and pioglitazone (Actos), on 18 October 2007 the European Medicines Agency concluded that the benefits of these antidiabetic medicines continue to outweigh their risks in the approved indications.
Title: Rimonabant effects on visceral fat confirmed by CT scan : drug trends
From: South African Journal of Diabetes and Vascular Disease, Vol 4, Issue 4, Oct / Nov
Published: 2007
Pages: 197
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Abstract: The first direct evidence of the effects of Acomplia(R) (rimonabant) in significantly reducing human visceral fat (the metabolically active fat wrapped around the vital organs in the abdomen, such as liver and pancreas) was presented at the 43rd annual meeting of the European Association for the Study of Diabetes (EASD).
Title: Vascular-protective effects of metformin : drug trends
From: South African Journal of Diabetes and Vascular Disease, Vol 4, Issue 4, Oct / Nov
Published: 2007
Pages: 198-199
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Abstract: The vascular-protective effects of metformin are similar to those achieved with lipidlowering or blood pressurelowering therapy, placing this agent on an equal footing with these first-line therapies in type 2 diabetes treatment.
Title: Advancing the science of aspirin in primary prevention of vascular events : drug trends
From: South African Journal of Diabetes and Vascular Disease, Vol 4, Issue 4, Oct / Nov
Published: 2007
Pages: 201-202
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Abstract: Underutilisation of aspirin, the most well-researched and cost-effective therapy in preventive cardiovascular medicine, will come under increased scrutiny as the Bayer Healthcare-sponsored ARRIVE study gathers momentum across the globe.
Title: Diabesity : the weight of the world : drug trends
From: South African Journal of Diabetes and Vascular Disease, Vol 4, Issue 4, Oct / Nov
Published: 2007
Pages: 203
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Abstract: Diabesity, the combination of obesity and diabetes, is a serious pandemic in the 21st century and the most significant public health problem facing many communities.
Title: Novo Nordisk and IDF join forces against childhood diabetes : diabetes news
From: South African Journal of Diabetes and Vascular Disease, Vol 4, Issue 4, Oct / Nov
Published: 2007
Pages: 204
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Abstract: A t the EASD in Amsterdam, Novo Nordisk and the International Diabetes Federation (IDF) presented a global overview of the diabetes burden among children and adolescents.

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