SA Journal of Diabetes & Vascular Disease: Vol 7, Issue 1, March 2010

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SAJDVD: VOLUME 7, ISSUE 1, MARCH 2010

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Screening for chronic kidney disease (CKD) and practical issues related to diabetic nephropathy : editorial
Authors: Rayner, Brian; Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 1, Mar, Pages: 3-6
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Abstract: South Africa, similar to the rest of the world, is facing an epidemic of chronic kidney disease (CKD), with death rates from end-stage renal disease (ESRD) rising by 67% from 1999 to 2006. The major drivers of this epidemic are type 2 diabetes and / or hypertension in the rest of the world, but in South Africa, HIV-associated nephropathy (HIVAN) is an important contributory factor. Increasingly, HIV infection may occur in the context of both diabetes and hypertension, and both articles reprinted in this edition of the South African Journal of Diabetes and Vascular Disease must be read in this context. Because of the critical shortage of nephrologists in South Africa, it is essential for endocrinologists and specialist physicians to be cognisant of the basics of screening, monitoring and treatment of CKD, as it is not possible for all patients to be evaluated by a nephrologist.
Post-meal blood glucose testing in adults with diabetes : 2009 UK and Ireland consensus group recommendations
Authors: Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 1, Mar, Pages: 6
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Abstract: Managing post-meal blood glucose (PMBG) as well as fasting plasma glucose levels makes a significant contribution to overall glucose control in all people with diabetes ('glucose triad'). Specifically targeting PMBG can help optimise average long-term glucose levels. Recently published UK and Ireland 2009 consensus group recommendations provide guidance as to when PMBG levels can be useful in various patient groups, and offer practical advice as to how best to introduce PMBG testing into existing testing programmes.
The problem of diabetic nephropathy and practical prevention of its progression : review
Authors: Wright, Julian; Vardhan, Anand; Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 1, Mar, Pages: 7-11
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Abstract: In common with all countries in the developed world, the United Kingdom is experiencing a dramatic increase in the incidence of diabetes and chronic kidney disease. The most common cause of renal impairment is diabetes. The evolution of diabetic nephropathy is usually predictable with evidence-based interventions available at each stage. This review examines this evidence and gives practical advice on the management of patients with diabetic nephropathy.
Diagnosing and monitoring CKD in practice : review
Authors: Lewis, Robert; Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 1, Mar, Pages: 13-15
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Abstract: Diagnosing chronic kidney disease (CKD) and monitoring kidney function are key steps in improving management. This article reviews the recommendations on making a diagnosis of CKD, including staging patients, and the tests available for monitoring kidney function, with explanations of how to test patients, what the findings mean, and how to act on the findings.
Save these dates
Authors: Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 1, Mar, Pages: 15
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Abstract: Save these dates
Diet-related knowledge and anthropometric status of children aged six to 10 with type 1 diabetes mellitus in KwaZulu-Natal : research article
Authors: Pillay, Kirthee; Maunder, Eleni; Naidoo, Kimesh; Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 1, Mar, Pages: 16-22
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Abstract: Objectives: To assess the diet-related knowledge and anthropometric status of children with type 1 diabetes.
Methods: A cross-sectional observational study was carried out. A total of 30 subjects whose ages ranged from six to 10 years were included in the study, which was carried out at the paediatric diabetic clinics at Grey's Hospital, Pietermaritzburg and Inkosi Albert Luthuli Central Hospital (IALCH), Durban in KwaZulu-Natal. Diet-related knowledge was assessed using a multiple-choice questionnaire, and anthropometric status was assessed using height and weight measurements.
Results: Overall, the sample of patients had a relatively good diet-related knowledge, as the mean diet-related knowledge score for the sample was 67%. Subjects eight years and older had a significantly higher mean diet-related knowledge score than children under eight years of age (76 vs 61%). Subjects attending IALCH (n = 22) had a significantly higher mean diet-related knowledge score than subjects attending the Grey's Hospital clinic (n = 8) (71 vs 56%). Anthropometric results were as follows: healthy weight (n = 18), underweight (n = 1), overweight (n = 2), at risk of overweight (n = 9), stunted (n = 4).
Conclusion: The diet-related knowledge of the sample was relatively good. The majority of the subjects (60%; n = 18) had a healthy weight and a minority (30%; n = 9) were at risk of overweight. A few were stunted (13%; n = 4).
Achieving blood pressure control in patients with type 2 diabetes and diabetic renal disease by a nurse-led protocol-based clinic : achieving best practice
Authors: Mugarza, Julie A.; Wilding, John P.; Woodward, Ann; Hayden, Katharine; Gill, Geoffrey V.; Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 1, Mar, Pages: 23-27
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Abstract: Evidence-based management of type 2 diabetic renal disease requires use of angiotensin converting enzyme inhibitor (ACE inhibitor) inhibitors or angiotensin receptor blockers (ARBs), with strict blood pressure control which is difficult to achieve in standard doctor-led diabetic clinics and we have therefore developed a nurse-led clinic using a therapeutic algorithm. ACE inhibitor or ARB treatment was maximised, and antihypertensive drugs titrated or added to optimise blood pressure control. Patients were seen monthly until target blood pressure was met, and then discharged for review of blood pressure control 12 months later. Of 71 patients completing the programme, 52 (72%) had microalbuminuria, and 19 (28%) nephropathy. ACE inhibitor or ARB usage increased from 66 to 91% at review (p = 0.0004). Systolic blood pressure fell from 152 ± 21 to 131 ± 18 mmHg (p < 0.0001) and diastolic blood pressure from 76 ± 13 to 68 ± 10 mmHg (p < 0.0001). Microalbuminuria rates fell but estimated glomerular filtration rates rose. Structured nurse-led clinics are useful in the optimisation of treatment for type 2 diabetic patients with renal disease.
Are we doing enough to save diabetes services in South Africa? : letter
Authors: Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 1, Mar, Pages: 28
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Abstract: As clinicians in South Africa, we seem to be disconnected from the planning of public health services and my question, directed at my colleagues, is whether we can contribute more.
Prescribing for patients with chronic kidney disease : hands on
Authors: Kirby, Michael; Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 1, Mar, Pages: 29-33
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Abstract: Chronic kidney disease (CKD) affects renal drug elimination and other important processes involved in drug disposition, including absorption, drug distribution and non-renal clearance. As a result, the reduced renal excretion of a drug or its metabolites can cause toxicity and the sensitivity to some drugs is increased even if elimination is unimpaired.
Diabetes news
Authors: Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 1, Mar, Pages: 33-34
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Abstract: Two-year update : liraglutide patients lose 5% of their body weight.
Stop press : liraglutide approved for type 2 diabetes.
How to protect your kidneys from diabetic kidney disease : patient information leaflet
Authors: Flooks, R.; Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 1, Mar, Pages: 35
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Abstract: Diabetes mellitus is associated with an array of complications. Since there has been an increase in the prevalence of diabetes mellitus, diabetic nephropathy has also become more common.
Secunda's 'diabetes whisperer' a community worker who loves what she does : diabetes personality
Authors: Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 1, Mar, Pages: 37-38
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Abstract: Secunda-based pharmacist, Jeannie Berg, is her town's most vocal and committed diabetes educator. Her unique approach to her work is inspired by the movie The Horse Whisperer. 'I have a poster of horses on the back of the door to my office and whenever I have a patient in front of me, I'm also able to look beyond them at the picture. It reminds me not to be dogmatic, prescriptive and dictatorial. Just as horses respond better to whispers in their ear than to being whipped and tied down, so patients are more likely to gain understanding of their diabetes and follow your advice if you explain calmly, reason with them and coax them gently. I call myself "the diabetes whisperer", she laughs.
Southern African Hypertension Society congress report, Johannesburg, 2010 : drug trends
Authors: Wagenaar, P.; Aalbers, J.; Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 1, Mar, Pages: 39-41
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Abstract. Hypertension in low- and middle-income countries, Prof YK Seedat. The renin-angiotensin system of adipose tissue. highlights a greater role for RAAS blockers in treating hypertension in the metabolic syndrome, Prof Rhian Touyz. Lessons from the Canadian Hypertension Education Program (CHEP) guidelines, Prof Rhian Touyz. Fixed-drug combination in the treatment of hypertension and hyperlipidaemia in the developing world, Prof YK Seedat. Fasting plasma arginine concentrations and ambulatory blood pressure, Dr Geoff Candy. Treating of Helicobacter pylori lowers blood pressure in black South Africans with hypertension, Dr Geoff Candy. Cardiovascular function and psychological distress in urbanised black South Africans: the SABPA study, Dr Nyiko Mashele. Ambulatory versus conventional blood pressure control in an urban developing community of African ancestry, Dr Muzi Maseko. Does ambulatory arterial stiffness approximate arterial stiffness effects when estimating associations with target-organ changes?, Dr Olebogeng Majane
Managing warfarin use in diabetic patients : drug trends
Authors: Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 1, Mar, Pages: 42, 44
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Abstract: Warfarin, the only available oral coumarin anticoagulant in South Africa, is widely prescribed for the prevention and management of arterial and venous thrombo-embolism. It has a narrow therapeutic index and a wide inter-individual variability in its therapeutic response.
Early metformin monotherapy in type 2 diabetes reduces drug failure : a contemporary clinical practice study : drug trends
Authors: Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 1, Mar, Pages: 44
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Abstract: Primary metformin failure occurs commonly in treatment-naïve type 2 diabetes patients. The first clinical practice study to evaluate the benefits of immediate versus delayed metformin therapy for type 2 diabetes using contemporary hyperglycaemic targets has shown that metformin's benefits last longer if therapy is initiated within three months of diagnosis. This is in line with guideline recommendations of early metformin therapy and is consistent with the hypothesis that early initiation of metformin preserves beta-cell function.

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