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VOLUME 8 NUMBER 2 • JUNE 2011
REPORTS
SA JOURNAL OF DIABETES & VASCULAR DISEASE
DIABETES AND THE
MUSCULOSKELETAL SYSTEM
Dr BJ van Rensburg
Clues to underlying endocrinopathy in an
arthritic patient include the presence of carpal
tunnel syndrome, calcium pyrophosphate dis-
ease, diffuse myalgia and Raynaud’s syndrome.
Diabetes-related complications include cheiro-
arthropathy, diabetic amyotrophy, diabetic
arthropathy and diabetic osteolysis.
Conditions with an increased incidence in
people with diabetes include frozen shoulder,
reflex sympathetic dystrophy, flexor tenosyno-
vitis, Dupuytren’s contracture, carpal tunnel
syndrome, diffuse idiopathic skeletal hyperos-
tosis, bone infections, avascular necrosis, gout
and pseudogout.
DIABETES AND OSTEOPOROSIS
Prof FS Hough, Division of Endocrinology,
Department of Medicine, Stellenbosch University
The incidence of osteoporosis is markedly
increased in type 1 diabetes and the risk of
hip fracture is thought to be increased 10- to
15-fold. This correlates with the duration of
diabetes. Osteoporosis is due to low-forma-
tion bone disease, which is the direct result of
insulin deficiency, and is improved by insulin
administration.
In type 2 diabetes, the bone mineral density
may be low, normal or increased, yet fracture
risk is two-fold higher than in non-diabetics.
Increased fracture risk might be associated
with a higher propensity to fall, peripheral neu-
ropathy or poor bone quality.
Thiazolidinediones are PPAR agonists that
decrease bone formation and lead to increased
fracture rate, especially lower-limb fractures in
women. This decreased bone formation may
be due to differentiation of mesenchymal stem
cells into fat cells instead of osteoblasts.
DIABETES AND THE FRAILTY
SYNDROME
Prof WF Mollentze
Organ function and physiological reserve
decline with age and this makes the elderly vul-
nerable to minor stress. The frailty syndrome
can be diagnosed by three or more of the fol-
lowing: muscle wasting, slow performance,
fatigue, and unintentional weight loss.
The syndrome may have a genetic basis and
may also be influenced by factors such as lack
of exercise, poor nutrition and chronic disease.
A predilection to falls may be caused by vita-
min D deficiency, hypogonadism, neurogenic
orthostatic hypotension, postprandial hypo-
tension, hypoglycaemia, peripheral neuropa-
thy and sarcopenia.
Management must include a comprehen-
sive assessment and management strategies
as follows: appropriate exercise, vitamin D
replacement, testosterone replacement, treat-
ing visual disturbances (e.g. cataracts), avoid-
ing hypoglycaemia and adjusting target ranges
to more realistic values (glucose 7–9 mmol/l,
HbA
1c
7.5–8.5%, BP
<
150/90 mmHg).
QUALITY CONTROL OF
LABORATORY DATA
Dr A Don-Wauchope, Hamilton Regional Lab-
oratory Medicine Program, Hamilton Ontario,
Canada and Department of Pathology and
Molecular Medicine, McMaster University,
Hamilton Ontario, Canada
It is important to know what affects the quality
of the result of any test. The variables include
clinical information on the request form,
sample transport and storage conditions, the
actual test run, and the report and interpre-
tation that follows. The coefficient of varia-
tion is important to help the user understand
the inherent analytical variability of the assay,
for example insulin has a high coefficient of
variation and HbA
1c
has a much lower value.
Laboratory analysis is assessed by external
quality-control programmes and evaluated by
laboratory accreditation.
Interactions with medications are also
important, for example, vitamin C and uric
acid may affect creatinine determinations,
and fibrates may increase creatinine levels in
patients. This can have a major impact on clini-
cal decision-making.
The analytical assays of creatinine and HbA
1c
values have improved over the last few years
and now laboratory performance is reaching
internationally agreed targets. Glucose analy-
ses have been standardised for many years and
continue to perform well. The more specialised
assays, such as insulin and C-peptide determi-
nations, require ongoing improvement.
CHRONIC DIALYSIS IN A DIABETIC
PATIENT
Dr P Raubenheimer
Several aspects were covered, including the
expense of dialysis, the impact of limitation
of resources on criteria for accepting patients
into a dialysis programme in South Africa, the
increasing demand for dialysis, and the rela-
tively cheaper option of transplantation. The
problem of too few donors and some strate-
gies to improve organ donation were also dis-
cussed.
THE INCRETIN DEBATE
Dr L Mac Robertson, Dr G Ellis
Despite some light-hearted ribbing, the two
participants agreed that incretins are valu-
able new drugs with much promise. Some of
the drugs featured included those promot-
ing weight loss/weight neutrality, controlling
hyperglycaemia, reducing hypoglycaemia, sup-
pressing glucagon production, restoring first-
phase insulin secretion and those with possible
beneficial effects on
b
-cell function and
b
-cell
mass.
J Aalbers, Special Assignments Editor;
Dr Fazleh Mohamed, contributing editor
It's the
shell that
makes
safer.
R
Safety-Coated
R
81mg
The ORIGINAL low dose aspirin
for optimum cardio-protection
Hp
Each tablet contains Aspirin 81mg. Reg.No.: 29/2.7/0767
Pharmafrica (Pty) Ltd, 33 Hulbert Road, New Centre, Johannesburg 2001
Under licence from Goldshield Pharmaceuticals Ltd. U.K.
