SA Journal of Diabetes & Vascular Disease: Vol 7, Issue 4, November 2010

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SAJDVD: VOLUME 7, ISSUE 4, NOVEMBER 2011

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Recent advances in the pharmacological management of painful diabetic neuropathy : a South African perspective and comment : editorial
Authors: Lamacraft, Gillian; Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 4, Nov, Pages: 135-137
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Abstract: Painful diabetic neuropathy (PDN) is an under-diagnosed and under-treated condition and it is appropriate that this journal has reprinted Tesfaye and Selvarajah's article on the treatment of PDN. The prevalence of diabetes in South Africa, currently estimated at 3.9 to 9%, will probably double in the next 20 years. The country is passing through an economic and health transition, which is resulting in a population more at risk for diabetes, i.e. older and more overweight. As the prevalence of diabetes increases, so will the prevalence of PDN.
An historic event : non-communicable diseases in sub-Saharan Africa acknowledged at last? : editorial
Authors: Mollentze, W.F.; Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 4, Nov, Pages: 138
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Abstract: It was an historic event when the first Diabetes Leadership Forum for Africa was held on 30 September and 1 October in Johannesburg (see report in this edition). The meeting was co-hosted by the International Diabetes Federation, the World Diabetes Federation and the Non-Communicable Disease Global Alliance. The forum was attended by healthcare workers, NGOs, officials from the World Health Organisation, several ministers of health or their representatives from sub-Saharan African (SSA) countries, including the Caribbean islands. The event was sponsored by Novo Nordisk and organised from their offices in Greece. The aim of the forum was to discuss the way forward on how best to deal with the epidemic of non-communicable diseases (NCDs) in SSA.
Recent advances in the pharmacological management of painful diabetic neuropathy : current topics
Authors: Tesfaye, Solomon; Selvarajah, Dinesh; Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 4, Nov, Pages: 139-142
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Abstract: Painful diabetic peripheral neuropathy (DPN) affects 10-26% of all diabetic patients and continues to pose significant clinical / treatment challenges. Pharmacological treatment of painful DPN includes tricyclic antidepressants (TCAs), selective serotonin nor-adrenaline reuptake inhibitors (SNRIs), selective serotonin reuptake inhibitors, anticonvulsants, opiates, the antioxidant alpha lipoic acid, membrane stabilisers, topical capsaicin etc. Over the past five years many compounds have undergone clinical trials and new agents have immerged. Current first-line therapies for painful DPN are a TCA, SNRI (such as duloxetine) or anticonvulsants (such as pregabalin or gabapentin), taking into account patient co-morbidities and cost. On the basis of cost NICE has recently recommended the use of TCAs before the other first-line agents of painful DPN. Second-line therapies include opiates such as tramadol, morphine and oxycodone.
Cognitive decline : the relevance of diabetes, hyperlipidaemia and hypertension : review
Authors: Etgen, Thorleif; Sander, Dirk; Bickel, Horst; Sander, Kerstin; Forstl, Hans; Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 4, Nov, Pages: 143-148
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Abstract: Cognitive decline including mild cognitive impairment describes a heterogeneous condition with cognitive changes between normal ageing and dementia. Cognitive impairment can be promoted or caused by treatable somatic factors. In this review, three important cardiovascular risk factors, diabetes mellitus, hypercholesterolaemia and hypertension, and their association with cognitive decline, are assessed. Though there are many hints of a causal association between diabetes mellitus and the development of cognitive decline, definitive proof of a protective effect of antidiabetic treatment by controlled or randomised placebo-controlled studies is needed. In midlife, elevated cholesterol levels comprise a risk factor for cognitive decline. In elderly subjects, cholesterol levels decline and are not clearly associated with cognitive impairment. The evidence for treatment of hypercholesterolaemia by statins solely for prevention of cognitive decline remains unclear. There is an age-dependent relationship between blood pressure and cognitive impairment. Midlife hypertension is associated with an increased risk of developing cognitive decline and antihypertensive treatment may therefore be beneficial, whereas hypertension later in life does not carry the same risk of cognitive dysfunction. Diagnosis of these somatic factors is essential in cognitive impairment, as diligent treatment may improve cognitive performance and postpone the manifestation of dementia.
Comparison of HLA class II antigens between three type 1 diabetes groups in the central region of Algeria : research article
Authors: Raache, R.; Benyahia, A.; Amroun, H.; Attal, N.; Hamiane, W.; Azzouz, M.; Lacet, L.; Haworth, S.; Boudiba, A.; Abbadi, M.C.; Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 4, Nov, Pages: 149-153
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Abstract: In human type 1 diabetes (T1D), both genetic and environmental factors are involved in the pathogenesis of the disease. The strongest genetic contribution has been mapped to the major histocompatibility complex (MHC) on the short arm of chromosome 6, which encodes the human leukocyte antigens (HLA). It is estimated that HLA class II gene polymorphisms account for 20 to 50% of familial aggregation of type 1 diabetes. Several studies have clearly demonstrated that there are susceptibility and protective markers at HLA-DR and -DQ. In this study, HLA class II antigens were investigated using a serological method in 210 T1D patients from the central region of Algeria, and compared to 140 healthy controls. Marker frequencies were compared between three groups of diabetics : children, juveniles and adults with latent autoimmune diabetes (LADA), and the control group. The frequency was calculated for HLA-DR and -DQ. Significant differences were detected between T1D patient and the control groups for the frequencies of HLA-DR3, -DR4, -DQ2 and -DQ8 (DQ3) but there were no significant differences in these antigen frequencies between the three T1D groups versus the controls, with the respective frequencies of HLA-DR3 (71.76, 66.67, 70% vs 31.43%), HLA-DR4 (64.71, 48.89, 52.50% vs 26.43%), HLA-DQ2 (76.47, 66.67, 75% vs 39.29%) and HLA-DQ8 (3) (64.71, 46.67, 47.50% vs 19.29%). Mantel-Haenszel tests were used to calculate the odds ratio for the presence of type 1 diabetes in association with HLA-DR3, -DR4, -DQ2 and -DQ8 (3). The values for each respective HLA antigen were as follows : for the T1D children (OR: 5.54; 5.1; 5.02; 7.67) for the juveniles (OR: 4.36; 2.66; 3.09; 3.66) and for LADA (OR: 5.09; 3.08; 4.64; 3.79). The heterozygous phenotype HLA-DR3/DR4 increased the risk (conferred the highest susceptibility) (OR: 8.79, 2.68, 4.23 for children, juveniles and the LADA group, respectively). These results confirm the positive association between T1D and HLA class II antigens, as previously reported in other populations in the central region of Algeria.
Postural hypotension : disease focus
Authors: Waddingham, Sandra; Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 4, Nov, Pages: 154-155
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Abstract: As we aim for tighter and tighter blood pressure control to minimise the cardiovascular complications of diabetes, the risk of postural hypotension increases. In this article we discuss what postural hypotension is and how to identify it and confirm diagnosis. We also consider the main causes and the relationship between diabetic neuropathy and postural hypotension as well as prevention and treatment strategies.
African Diabetes Leadership Forum calls for activism around non-communicable diseases : African focus
Authors: Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 4, Nov, Pages: 156-159
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Abstract: The Diabetes Leadership Forum Africa 2010, which took place in Johannesburg at the end of September, highlighted the urgent need to address the burden of diabetes and other non-communicable diseases (NCDs) in the developing world. To date, NCDs have been overshadowed by the perceived more urgent priority of addressing infectious diseases such as HIV/AIDS, tuberculosis (TB) and malaria.
Incretin mimetics : where will they make a difference? : achieving best practice
Authors: Kok, Adri; Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 4, Nov, Pages: 160-162
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Abstract: The incretin mimetics have recently been added to our available choice of anti-hyperglycaemic agents in South Africa. As our targets for diabetes control tighten, our available choices of treatment, by necessity, will need to be expanded. The benefits that the incretin mimetics afford include weight loss that is sustained, possible beta-cell sparing and of course significant lowering of the blood glucose level.
Making a difference among disadvantaged diabetic children in the southern Cape : diabetes personalities
Authors: Wagenaar, Peter; Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 4, Nov, Pages: 165
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Abstract: Dr Jacques van Staden and Sr Maureen Barnard recently won the Servier award for Community Involvement in Diabetes for their sterling work in the southern Cape. Based in George, they also treat patients from as far afield as Beaufort West, Knysna and Heidelberg. 'It's a great honour to be recognised in this way', says Sr Barnard, while Dr van Staden admits to being 'dumbstruck', given that the award came as a complete surprise. 'While it's a great privilege to have our work noticed in this way, when all is said and done, we do it first and foremost because we love and care passionately about it', he said.
EASD Watch - 2010 Update from Stockholm : summaries
Authors: Published: 2010
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Abstract:
Diabetes morbidity and mortality
The effects of insulin beyond glycaemia
HbA1c for diabetes mellitus diagnosis : need for reassessment?
Treatment of diabetes
Diabetic nephropathy : clinical trials
Diabetes and bone disease
Diabetes and pregnancy
Diabetes, insulin and cancer risk : you and your patient
Authors: Wagenaar, Peter; Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 4, Nov, Pages: 173
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Abstract: Since a series of articles published in Diabetologia in mid-2009 spotlighted a possible link between diabetes, obesity and certain cancers, the topic has been discussed extensively within the worldwide diabetes fraternity. That there is indeed a connection is now certain, but the exact nature thereof remains unclear, not least because there are so many confounding factors in the mix.
Journal update : focus on neuropathy
Authors: Aalbers, J.; Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 4, Nov, Pages: 174-175
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Abstract:
Epidemiology of neuropathy
Diagnosis of neuropathy
Treatment of neuropathy
Once-daily duloxetine reduces pain symptoms : drug trends
Authors: Aalbers, J.; Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 4, Nov, Pages: 176
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Abstract: Duloxetine (Cymbalta), an effective antidepressant, has been shown to reduce pain in diabetic patients with peripheral neuropathy who did not have clinical depression.
Lilly supports development of diabetes youth leaders : advertorial
Authors: Published: 2010
From: South African Journal of Diabetes and Vascular Disease, Vol 7, Issue 4, Nov, Pages: 176
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Abstract: As an industry leader in diabetes care, Lilly Pharmaceuticals has once again furthered their commitment to patients with diabetes by sponsoring a diabetes youth leadership camp, in order to educate, train and motivate diabetes ambassadors, who are then able to educate communities and mentor newly diagnosed children.

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