VOLUME 8 NUMBER 3 • SEPTEMBER 2011
139
SA JOURNAL OF DIABETES & VASCULAR DISEASE
JOURNAL UPDATE
lial lining of vasculature, regulates GLP-1
levels. Treatment with GLP-1 is effective in
lowering blood glucose levels, is cardiopro-
tective in type 2 diabetes patients, and pos-
sibly reduces cardiovascular risk when used
in these patients. DPP4 inhibitors increase
circulating levels of GLP-1 in animal models
and may also have beneficial effects on pan-
creatic beta-cell regeneration.
Obese, pre-diabetic rats were treated for
four weeks with 10 mg/kg/day of a DPP4
inhibitor PFK275-055.
Ex vivo
perfusion was
used to subject the hearts to ischaemia/reper-
fusion to determine infarct size, functional
recovery and post-ischaemic activation of
proteins associated with cardiac protection.
Adult ventricular cardiomyocytes were
isolated to determine insulin sensitivity.
Other assessments included body weight,
intra-peritoneal fat weight, and insulin and
GLP-1 levels. Histological examination of the
pancreas was also performed.
Results indicated that treatment of obese,
pre-diabetic rats with a DPP4 inhibitor for
a period of four weeks normalised GLP-1
levels, improved beta-cell to alpha-cell ratios
of the pancreas, lowered plasma insulin
levels over time and protected the heart
against ischaemia/reperfusion injury. This
was evident from the smaller infarct devel-
opment after a period of regional ischaemia
followed by reperfusion.
Source: Huisamen B, Genis A, Marais E, Lochner A. Pre-
treatment with a DPP-4 inhibitor is infarct sparing in
hearts from obese, pre-diabetic rats.
Cardiovasc Drugs
Ther
2011;
25
(1): 13–20. PubMed PMID: 21088878.
Non-communicable diseases in
sub-Saharan Africa
Current disease projections for sub-Saha-
ran Africa (SSA) indicate increases in NCDs
caused by demographic and epidemiologi-
cal transitions, although estimates are based
on sparse data. Drivers of these epidemics
are urbanisation and changes in lifestyle,
associated with economic development,
including changes in diet, physical activity,
smoking, adiposity and alcohol use.
This literature review and data summary
examines the prevalence and incidence of
cardiovascular diseases, type 2 diabetes
mellitus and cancer, and their risk factors in
SSA. These were found to vary considerably
between countries, urban/rural location and
other sub-populations. Hypertension, smok-
ing and obesity were the most frequently
reported risk factors, although alcohol
use, hypercholesterolaemia and sedentary
behaviour were infrequently measured.
Global burden of disease studies sug-
gest that the age-standardised death rates
from NCDs are higher in at least four SSA
countries (DRC, Nigeria, Ethiopia and South
Africa) than in high-income countries.
Cardiac diseases and their risk factors are
increasing in SSA, with ischaemic heart dis-
ease the leading cause of death among men
(second among women)³ ≥ 60 years of age.
The most important risk factors for non-
fatal myocardial infarction were diabetes,
hypertension, abdominal obesity, smoking
and abnormal blood lipids. Higher income,
education, urban living and psychosocial
stress each appear to be associated with
increased risk of myocardial infarction.
Hypertension is the most important pre-
dictor of stroke in SSA, with the prevalence
of hypertension consistently higher in urban
areas. The prevalence of diabetes mellitus
ranged from 0 to 16%, however some rural
screening programmes found that up to
85% of cases were undiagnosed.
Complications of poorly treated diabe-
tes are common, with a high prevalence of
retinopathy, nephropathy, neuropathy, dia-
betic foot and advanced peripheral organ
damage. Diabetic morbidity and mortal-
ity in SSA are attributed to late diagnosis,
severe vascular complications and generally
poor blood glucose control. Irregular meals
among poor populations contribute to fre-
quent hypo- and hyperglycaemic episodes.
Urgent action is required to mitigate the
burgeoning epidemic of NCDs in Africa.
Ongoing inadequate resources for treatment
highlight the role of primary prevention in
protecting public health, as late diagnosis
leads to poorer health outcomes. Increased
diagnoses of NCDs would lead to a corre-
sponding need for higher-capacity health
services, which are currently over-stretched,
to diagnose and treat these conditions.
Source: Dalal S, Beunza JJ, Volmink J, Adebamowo C,
Bajunirwe F, Njelekela M,
et al
. Non-communicable dis-
eases in sub-Saharan Africa: what we know now.
Int J
Epidemiol
2011 Apr 28. [Epub ahead of print] PubMed
PMID: 21527446.
Glenda Hardy
DATE
PLACE
CONFERENCE
1–4 December 2011
University of Sharjah, UAE
12th Symposium of the International Diabetes Epidemiology Group
4–8 December 2011
Dubai, UAE
IDF World Diabetes Congress
8–11 February 2012
Barcelona, Spain
5th International Conference on Advanced Technologies and Treatments for Diabetes
5–9 May 2012
Florence, Italy
European Congress of Endocrinology
8–12 June 2012
Philadelphia, USA
72nd American Diabetes Association Scientific Sessions
10–13 October 2012
Istanbul, Turkey
ISPAD 2012 – 38th Annual Meeting of the International Society for Pediatric and Adolescent
Diabetes
4–6 December 2012
Dubai, UAE
1st American Diabetes Association Middle East Congress
Diabetes Prevention and Treatment
Diabetes diary for 2011–2012 congresses
