VOLUME 8 NUMBER 3 • SEPTEMBER 2011
133
SA JOURNAL OF DIABETES & VASCULAR DISEASE
CDE WATCH
CDE WATCH
TABLE OF CONTENTS
2011 UPDATE FROM THE CENTRES FOR
DIABETES EXCELLENCE
CDE annual meeting
Contributor:
J Aalbers
First symposium on injection technique held in South Africa.............................................................. 133
Treating the untreatable type 2 patient................................................................................................ 134
Sanofi-Aventis recognises excellence in clinical care at CDE centres in South Africa.......................... 134
Metformin – discovered, lost and rediscovered..................................................................................... 134
Haemochromatosis and diabetes........................................................................................................... 135
Fear and diabetes.................................................................................................................................... 135
The changing gut microbiome: is it killing us?...................................................................................... 135
This annual meeting, the 13th CDE post-
graduate forum, was held in East London
and attended by about 400 delegates rep-
resenting CDE centres around the country.
In his comments, Prof Pankaj Joshi, chair-
ing the first academic session noted the
need for the CDE branches to extend their
expertise to other healthcare professionals,
clinics and patients outside the CDE. ‘The
majority of patients with diabetes in South
Africa are being treated outside the CDE
network. We, as CDE, must think about
outreach programmes to clinics in rural
areas and engage with these communities
to assist with the local health crisis in obes-
ity and diabetes’, he said.
Evidence-based approaches in
diabetes care
We must remember the ‘grey’ between
the black and white of evidence-based
medicine when we treat individual
patients
Dr Paula Diab, Diabetologist,
Johannesburg
First symposium on injection tech-
nique held in South Africa
Sponsored by Lilly and BD Medical’s Diabe-
tes Care Division, this workshop was led by
Dr Anders Frid, head of the Endocrinology
Clinic, Skane University Hospital, Malmo,
Sweden. He presented a global view of injec-
tion techniques, based on research from 27
countries and their experts in the TITAN ini-
tiative (third Injection Technique workshop,
2009), which updated data from 10 years
earlier (both BD-sponsored studies).
Using CT scans and MRIs showing insulin
distribution following injection, important
trends in good clinical practice are emerg-
ing. Aspects of significance are:
22–24 July 2011
SUMMARIES
There is a trend to shorter needles all
•
over the world and the 12.5-mm needle
could become obsolete, as there is no
real medical reason for its use.
Skin thickness is the same in all patients
•
and varies only between 1.5 and 3 mm
regardless of the gender, age, body
weight or race of the individual.
If you pinch the skin fold, you can always
•
provide a good site for injection at a 90°
angle to the surface of the skin fold.
Lipodystrophy has not decreased in
•
incidence over the past 10 years and
ongoing patient education is required,
despite the broad-based improvement
in needles and pens.
One in five patients forget the advice
•
given by the nurse educator/sister when
initiating insulin therapy, so do include
regular reminders in your patients’ edu-
cation support programmes.
Intramuscular injection of long-acting
•
analogues must be avoided due to the
risk of severe hypoglycaemia.
For rapid-acting analogues, injection
•
into fat tissue is preferable but not
essential as absorption rates are similar
from fat tissue and resting muscle.
Intramuscular injection of NPH should
•
be avoided since rapid absorption and
serious hypoglycaemia can result.
Premixed insulins – regular/NPH mix
•
– should be given in the abdomen
to increase speed of absorption of
short-acting insulin. Any mix of NPH
should be given in the thigh/buttock
in the evening as this leads to slower
absorption and lower risk of nocturnal
hypoglycaemia.
Site rotation is vital and nurse-led
•
inspection is the best way of identifying
poor injection techniques.
Remember, bariatric surgery offers
remission, not cure – the underlying
β
-cell dysfunction remains
Dr Laura Blacking, Johannesburg
Additional reading: New injection recommendations for
patients with diabetes.
Diabetes Metab
2010;
36
(2):
S1–S29.
