VOLUME 9 NUMBER 4 • NOVEMBER 2012
183
SA JOURNAL OF DIABETES & VASCULAR DISEASE
REPORT
TABLE OF CONTENTS
The haematology of diabetes: emerging perspectives...............................................................................183
The concept and rationale for early insulin therapy in type 2 diabetes.......................................................184
Managing difficult type 1 diabetes...........................................................................................................184
The Ascending Star lecture: Through the looking glass.............................................................................185
Improving adherence (self-management) in type 2 diabetes......................................................................186
Exercise in type 1 diabetes: a double-edged sword...................................................................................186
Diabetes in the elderly..............................................................................................................................187
Vitamin D and diabetes: a D-lemma.........................................................................................................188
A long walk to better foot care in South Africa.........................................................................................188
2012
UPDATE FROM THE CENTRES
FOR DIABETES EXCELLENCE
CDE Annual Meeting
24–26
August 2012
Contributors:
P Wagenaar, G Hardy
SUMMARIES
CDE WATCH
A record number of delegates attended
the 14th annual CDE post-graduate forum,
recently hosted in Boksburg, East Rand. This
2012
meeting lived up to the precedent of
educational excellence that has been firmly
established in prior CDE activities. A varied
and interesting range of relevant topics
was presented, within which two consist-
ent themes of circumspection emerged.
Firstly, to be heeded, the alarming evidence
that globally, 2011 saw a prevalence of dia-
betes equal to figures previously projected for
2030.
Africa currently has a diabetic popula-
tion of 12.1 million, which is now expected
to almost double to 23.9 million by 2030.
These staggering numbers highlight
the Herculean task that lies ahead; to ade-
quately and appropriately treat diabetes
from a multi-disciplinary approach, and to
counter the economic impact and financial
cost of such a response (a non-response too
is expensive). Globally, 11% of healthcare
expenditure in adults is directed towards
the management of diabetes, with diabetic
complications being the primary cost driver.
The second emergent theme requires
some consideration. The paradox of bal-
ancing cost-effective and evidence-based
diabetes guidelines with the outcomes-ef-
fective trend of individualising patient care
could be like walking a tightrope. What
remains evident, however, is that a health-
care team approach is best in the long-term
management of diabetes.
The haematology of diabetes:
emerging perspectives
Prof Peter Jacobs and Lucille Wood,
Stellenbosch University and Tygerberg
Academic Hospital
‘
Changes in haematology predate the
development of diabetes and we need to
correct blood glucose pre-emptively. This
requires recognising the predator time-
ously, as well as changing the interface
between diabetes and haematology, with
a closer and better-structured interaction
between diabetologists/endocrinologists
and haematologists.’
Whereas previously the focus was
largely on managing changes in the blood
after diagnosis, risk factors should be rec-
ognised and addressed before abnormali-
ties occur in blood formation. This requires
a move away from the preoccupation with
simply diagnosing and treating anaemia, to
a more constructive and beneficial focus on
achieving early, optimal glycaemic control.
All components of the blood system
are invariably affected by hyperglycaemia,
something that happens concurrently.
‘
Anaemia is an iceberg phenomenon, and
early intervention can potentially prevent
the damage consequent on the erythro-
poietic stress caused by chronic hyperg-
lycaemia, which may be clinically silent.
Anaemia accelerates the cardiovascular
complications of diabetes. If we interact
more closely, we can prevent its progres-
sion’, said Prof Jacobs.
Prof Jacobs believes that contemporary
therapeutic strategies are obsolete. ‘All dia-
betic patients have abnormal red cell sur-
vival. A hypoxic environment in the kidney
leads to impaired generation of erythro-
poietin. Hyperglycaemia is a phenomenon
that activates changes in the haemato-
poietic state, accelerating the progression
from pre-diabetes to diabetes. This is a
modifiable risk factor, so it’s important to
act promptly.’
The importance of even mild anaemia
has been unappreciated. ‘Diabetes has
many effects and metabolic changes that
Prof Peter Jacobs
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