41 / 44
VOLUME 11 NUMBER 4 • NOVEMBER 2014
175
SA JOURNAL OF DIABETES & VASCULAR DISEASE
LEARNING FROM PRACTICE
10. NICE-SUGAR Study Investigators, Finfer S, Liu B, Chittock DR,
et al.
Hypoglycemia
and risk of death in critically ill patients.
N Engl J Med
2012;
367
: 1108–1118.
http://dx.doi.org/10.1056/NEJMoa120494211. Buchleitner AM, Martínez-Alonso M, Hernández M,
et al
. Perioperative glycaemic
control for diabetic patients undergoing surgery.
Cochrane Database Syst Rev
2012;
9
: CD007315
12. Lanspa MJ1, Hirshberg EL, Phillips GD,
et al
. Moderate glucose control is associated
with increased mortality compared with tight glucose control in critically ill patients
without diabetes.
Chest
2013;
143
: 1226–1234.
http://dx.doi.org/10.1378/chest.12-2072
13. Okabayashi T, Shima Y, Sumiyoshi T,
et al
. Intensive versus intermediate glucose
control in surgical intensive-care unit patients.
Diabetes Care
2014; Mar 12. [Epub
ahead of print].
14. Signal M, Le Compte A, Shaw GM,
et al
. Glycemic levels in critically ill patients: are
normoglycemiaandlowvariabilityassociatedwithimproved outcomes?
JDiabetesSci
Technol
2012;
6
: 1030–1037.
http://dx.doi.org/10.1177/19322968120060050615. Nygren J, Soop M, Thorell A,
et al
. Preoperative oral carbohydrate administration
reduces postoperative insulin resistance.
Clin Nutr
1998;
17
: 65-71.
http://dx.doi.org/10.1016/S0261-5614(98)80307-5
16. Ljungqvist O, Thorell A, Gutniak M,
et al.
Preoperative nutrition – elective surgery in
the fed or the overnight fasted state.
Clin Nutr
2001;
20
(Suppl. 1): 167–171. http://
dx.doi.org/10.1054/clnu.2001.0462
17. Tran S, Wolever TH, Errett LE,
et al.
Preoperative carbohydrate loading in patients
undergoing coronary artery bypass or spinal surgery.
Anesth Analg
2013;
117
:
305–313.
http://dx.doi.org/10.1213/ANE.0b013e318295e8d1
18. Perrone F, da-Silva-Filho AC, Adômo IF,
et al.
Effects of preoperative feeding
with a whey protein plus carbohydrate drink on the acute phase response and
insulin resistance. A randomized trial.
Nutr J
2011;
10
: 66–72.
http://dx.doi.
org/10.1186/1475-2891-10-66
19. Noblett SE, Watson DS, Huong H,
et al.
Pre-operative oral carbohydrate loading in
colorectal surgery: a randomized controlled trial.
Colorectal Dis
2006;
8
: 563–569.
http://dx.doi.org/10.1111/j.1463-1318.2006.00965.x
20. Gustafsson UO, Hausel J, Thorell A,
et al
. Adherence to the enhanced recovery
after surgery protocol and outcomes after colorectal cancer surgery.
Arch Surg
2011;
146
: 571–577.
http://dx.doi.org/10.1001/archsurg.2010.30921. Eskicioglu C, Forbes SS, Aarts MA,
et al
. Enhanced recovery after surgery (ERAS)
programs for patients having colorectal surgery: a meta-analysis of randomized
trials.
J Gastrointest Surg
2009;
13
: 2321–2329.
http://dx.doi.org/10.1007/s11605-009-0927-2
22. Zargar-Shostani K, Paddison JS, Booth RJ,
et al.
A prospective study on the
influence of a fast-track program on postoperative fatigue and functional
recpvery after major colonic surgery.
J Surg Res
2009;
154
: 330–335. http://
dx.doi.org/10.1016/j.jss.2008.06.023
23. Kanamori R, Shimamura M, Kinoshita M,
et al.
Preoperative carbohydrate
administration prevents catabolism of fat and protein in patients undergoing
elective laparoscopic colectomy. Final report 1AP5-10.
Eur J Anaesthesiol
2012;
29
: 17.
24. Dhatariya K, Flanagan D, Hilton L,
et al.
Management of adults with diabetes
undergoing surgery and elective procedures: improving standards (2011). www.
diabetes.nhs.uk
25. Gustaffson UO, Nygren J, Thorell A,
et al.
Pre-operative carbohydrate loading may
be used in type 2 diabetes patients.
Acta Anaesthesiol Scand
2008;
52
: 946–951.
http://dx.doi.org/10.1111/j.1399-6576.2008.01599.x26. Jodlowski T, Dobosz M, Noga M. Preoperative oral carbohydrate load in colorectal
surgery reduces insulin resistance and may improve outcomes – preliminary
results of prospective randomized study.
Clin Nutr
2011;
6
(Supplements PP052):
134.
27. Ziegler MA, Catto JA, Riggs TW,
et al.
Risk factors for anastomotic leak and
mortality in diabetic patients undergoing colectomy: analysis from a statewide
surgical quality collaborative.
Arch Surg
2012;
147
: 600–605.
http://dx.doi.
org/10.1001/archsurg.2012.77
28. Breuer JP, von Dossow V, von Heymann C,
et al.
Preoperative oral carbohydrate
administration to ASA III-IV patients undergoing elective cardiac surgery.
Anesth
Analg
2006;
103
: 1099–1108.
http://dx.doi.org/N
ovember 14 marked World Diabetes
Day and this year, the condition has
been under the microscope even more than
usual, thanks to leading sport scientist and
author of
The Real Meal Revolution
, Prof
Tim Noakes.
Addressing parliament recently, Noakes
stated that South Africa is sitting on a ‘time
bomb’
1
if diabetes and obesity are not
addressed. ‘I want us to all save South Africa;
that’s what we are here to do. Because if
we don’t reverse (the) obesity and diabetes
epidemic, our nation disappears’, said Noakes.
‘And this is because we will go financially
bankrupt because we don’t have the money to
provide medical services in the near future.’
2
Dr Larry Distiller, a world-renowned
endocrinologist who specialises in diabetes,
and the founder of the Centre for Diabetes
and Endocrinology, also recently commented
that ‘the diabetes tsunami is here.’
3
Type 1
diabetes is an autoimmune condition that
affects approximately 5–10% of people with
diabetes.
4
The other 90–95% of diabetics
suffer from type 2 diabetes, a condition
caused by a combination of bad eating
Diabetes and obesity: South Africa’s healthcare crisis
habits, weight gain, and a lack of exercise
that leads firstly to insulin resistance and later
to diabetes.
5
Three-and-a-half million South
Africans currently suffer from diabetes, with
many more still undiagnosed.
6
Alison Vienings, executive director of the
Self-Medication Manufacturers Association
of South Africa (SMASA), points out, ‘People
with a body mass index (BMI) of 30 kg/m
2
or more are up to 80 times more likely to
develop type 2 diabetes than people with
a BMI of less than 22 kg/m
2
.
7
South Africa
is currently on track to becoming one
of the most obese nations in the world.
Regrettably, it already holds the title of the
fattest country in sub-Saharan Africa.’
8
World Health Organisation predictions
are that the incidence of obesity-driven
diabetes in sub-Saharan Africa will double
in the next 20 years.
9
Clearly, action is
necessary, but what? According to Noakes,
the way to address the current situation is
through a high-fat, high-protein diet and by
consuming less sugar and processed food,
and fewer carbohydrates – an approach that
has been met with a range of responses.
Government, on the other hand, is
considering introducing a sugar tax on
sugar-sweetened beverages (SSBs)
10
that
will hopefully make South Africans think
twice before consuming them. A research
article by academics from the University
of the Witwatersrand predicts that such a
move may lead to a decrease of more than
220 000 obese adults in South Africa.
11
According to Vienings, responsible self-
care can help stem the tide of both diabetes
and obesity in South Africa. ‘Detecting
diabetes early, getting the right medical care,
eating healthily and exercising regularly can
reduce the risk of developing complications
associated with the disease’,
12
she explains.
‘Similarly, watching what you eat and
committing to a regular exercise programme
can prevent obesity, which so often leads to
type 2 diabetes.’
In conclusion, she strongly recommends a
visit to your local healthcare professional or
doctor immediately if you display any or all
of the symptoms associated with diabetes,
or are concerned that your BMI may be
higher than it should be.
Diabetes News