Pub Date : 2022-01-21DOI: 10.1080/16089677.2021.2018803
R. Dreyer, A. Beukes, M. Hoffmann, Wessel Meyer, A. Coetzee
Background: Stress hyperprolactinemia is a common cause of elevated prolactin (PRL) and often leads to additional investigation and radiation exposure. The results of PRL serial sampling in healthy adult volunteers to determine the utility of delayed collection are reported. Methods: Cannulated serial PRL samples were collected from 30 healthy adult volunteers between April and May 2018 at 20-minute intervals from arrival to 60 minutes (T0, T20, T40 and T60). Exclusion criteria were known risk factors for hyperprolactinemia, and patients fasted for six hours. Cortisol (CORT) was collected as a surrogate marker for stress. Results: Thirty (30) adult volunteers (n = 15 female) had a mean age of 34.7 (+/- 9.5), and mean baseline PRL of 9.7 μg/l in males and 15.8 μg/l females. Elevated PRL-T0 was observed in four volunteers (n = 3 male), all of which normalised at different intervals by T60 with serial sampling. The highest PRL was 33.7 μg/ml, normalised at T20, and had concomitant elevated cortisol levels, which remained elevated at T60. The delta decrease (Δ) for PRL was negative for all intervals (p < 0.05) and mirrored the delta decrease of cortisol (p < 0.05). Conclusion: In 30 healthy adult volunteers presenting for cannulated serial PRL sampling, four had elevated baseline levels that normalised at different intervals up to T60. The delta decrease (Δ) for PRL was negative for all intervals.
{"title":"The utility of serial prolactin sampling in healthy adult volunteers","authors":"R. Dreyer, A. Beukes, M. Hoffmann, Wessel Meyer, A. Coetzee","doi":"10.1080/16089677.2021.2018803","DOIUrl":"https://doi.org/10.1080/16089677.2021.2018803","url":null,"abstract":"Background: Stress hyperprolactinemia is a common cause of elevated prolactin (PRL) and often leads to additional investigation and radiation exposure. The results of PRL serial sampling in healthy adult volunteers to determine the utility of delayed collection are reported. Methods: Cannulated serial PRL samples were collected from 30 healthy adult volunteers between April and May 2018 at 20-minute intervals from arrival to 60 minutes (T0, T20, T40 and T60). Exclusion criteria were known risk factors for hyperprolactinemia, and patients fasted for six hours. Cortisol (CORT) was collected as a surrogate marker for stress. Results: Thirty (30) adult volunteers (n = 15 female) had a mean age of 34.7 (+/- 9.5), and mean baseline PRL of 9.7 μg/l in males and 15.8 μg/l females. Elevated PRL-T0 was observed in four volunteers (n = 3 male), all of which normalised at different intervals by T60 with serial sampling. The highest PRL was 33.7 μg/ml, normalised at T20, and had concomitant elevated cortisol levels, which remained elevated at T60. The delta decrease (Δ) for PRL was negative for all intervals (p < 0.05) and mirrored the delta decrease of cortisol (p < 0.05). Conclusion: In 30 healthy adult volunteers presenting for cannulated serial PRL sampling, four had elevated baseline levels that normalised at different intervals up to T60. The delta decrease (Δ) for PRL was negative for all intervals.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"6 1","pages":"75 - 77"},"PeriodicalIF":0.5,"publicationDate":"2022-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87814287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-21DOI: 10.1080/16089677.2021.2018802
T. Sookan, A. Vaizie, T. Pillay, S. Moodley, S. Naidoo, K. Naidoo
Background: Self-management of type 2 diabetes mellitus (T2DM) in South Africa (SA) is sub-optimal, with exercise reported to be the least employed modality of self-management. This study aimed to evaluate the knowledge, attitudes and perceptions of T2DM patients regarding T2DM self-management, and to explore participants’ awareness and acceptance of the role of biokineticists in the management of T2DM. Methods: This cross-sectional, descriptive study was conducted in October 2019 at an urban, district hospital in South Africa. A validated questionnaire was administered to T2DM outpatients. Participants’ knowledge was evaluated by true/false questions, and their attitudes and perceptions on a five-point Likert scale. Results: Reported adherence to prescribed diabetes medication by participants (n = 150) was high, at 96%. However, only 60% of participants reported exercising regularly; 47.3% followed a recommended diet for T2DM; and 32.7% took appropriate care of their feet. Responses given by the participants regarding their knowledge and perceptions indicated good insight into the role of exercise in the management of T2DM (94.7%). There was low awareness of the field of biokinetics, with 74% of participants admitting no knowledge of ‘biokinetics’. However, after receiving information on the role of the biokineticist in T2DM, 92% of participants were willing to work with a biokineticist to manage their T2DM. Conclusion: There was low reported adherence to exercise, diet and foot care among participants, despite good knowledge about, and attitudes to, the modalities of T2DM self-management. Majority of participants (92%) expressed a willingness to work with a biokineticist to manage their T2DM. However, there is a need for greater awareness and employment of biokineticists in the multidisciplinary team to help improve the uptake of exercise by patients with T2DM.
{"title":"Exploring the role of the biokineticist in diabetes self-management: a survey of patients’ knowledge, attitudes and perceptions about exercise","authors":"T. Sookan, A. Vaizie, T. Pillay, S. Moodley, S. Naidoo, K. Naidoo","doi":"10.1080/16089677.2021.2018802","DOIUrl":"https://doi.org/10.1080/16089677.2021.2018802","url":null,"abstract":"Background: Self-management of type 2 diabetes mellitus (T2DM) in South Africa (SA) is sub-optimal, with exercise reported to be the least employed modality of self-management. This study aimed to evaluate the knowledge, attitudes and perceptions of T2DM patients regarding T2DM self-management, and to explore participants’ awareness and acceptance of the role of biokineticists in the management of T2DM. Methods: This cross-sectional, descriptive study was conducted in October 2019 at an urban, district hospital in South Africa. A validated questionnaire was administered to T2DM outpatients. Participants’ knowledge was evaluated by true/false questions, and their attitudes and perceptions on a five-point Likert scale. Results: Reported adherence to prescribed diabetes medication by participants (n = 150) was high, at 96%. However, only 60% of participants reported exercising regularly; 47.3% followed a recommended diet for T2DM; and 32.7% took appropriate care of their feet. Responses given by the participants regarding their knowledge and perceptions indicated good insight into the role of exercise in the management of T2DM (94.7%). There was low awareness of the field of biokinetics, with 74% of participants admitting no knowledge of ‘biokinetics’. However, after receiving information on the role of the biokineticist in T2DM, 92% of participants were willing to work with a biokineticist to manage their T2DM. Conclusion: There was low reported adherence to exercise, diet and foot care among participants, despite good knowledge about, and attitudes to, the modalities of T2DM self-management. Majority of participants (92%) expressed a willingness to work with a biokineticist to manage their T2DM. However, there is a need for greater awareness and employment of biokineticists in the multidisciplinary team to help improve the uptake of exercise by patients with T2DM.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"29 1","pages":"70 - 74"},"PeriodicalIF":0.5,"publicationDate":"2022-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78870497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-02DOI: 10.1080/16089677.2021.2002586
R. Chetty, S. Pillay
Background: The prevalence of diabetes mellitus (DM) in South Africa (SA) is 12.80% and is rising, while that of HIV infection remains the highest globally (13%). Literature varies on the associations between glycaemic control and age in patients living with DM (PLWD). Through effective anti-retroviral treatment (ART), HIV-infected patients can now live longer and develop co-morbidities as experienced by HIV-uninfected patients. Identification of challenges faced in diabetes control within the various age groups would help in developing strategies that can be implemented in order to provide effective diabetes care to patients as they age. Objectives: This study aimed to determine an association between age and diabetes control in an HIV endemic area. Methods: Data from standardised clinic sheets were used from the DM clinic at Edendale Hospital, Pietermaritzburg, South Africa, from January 1, 2019 to December 31, 2019. Statistical analysis was done. Results: This study had 957 PLWD with 146 PLWD who were HIV-infected (PLWDH). Older age was associated with improved mean glycated haemoglobin (HbA1c) levels after adjusting for glomerular filtration rate (GFR) (r = −0.141, p < 0.001; before adjustment: r = −0.108; p = 0.001). HIV-infected patients had lower mean HbA1c levels than their HIV-uninfected counterparts while age was positively associated with patients’ BMI (r = 0.246, p < 0.001). PLWDH with a mean HbA1c > 7% were significantly younger than those with HbA1c ≤ 7% (47.38 years vs. 52.77 years, p = 0.013). GFR declined with age: PLWD with GFR < 60 ml/minute were significantly older than those with GFR ≥ 60 ml/minute (62.72 years vs. 48.30 years, p < 0.001), this remaining significant after factoring in for HIV infection and hypertension. Conclusion: Younger PLWD have poorer glycaemic control and are likely to develop diabetes-related complications later in life. Notably, younger PLWDH also had poorer glycaemic control, which places them at increased cardio-metabolic risk from sequelae of both the HIV infection and DM. This study highlights that more emphasis needs to be placed on diabetes education and management in the younger age categories of both PLWD and PLWDH.
{"title":"Age and diabetes control in an HIV-endemic country: is there an association?","authors":"R. Chetty, S. Pillay","doi":"10.1080/16089677.2021.2002586","DOIUrl":"https://doi.org/10.1080/16089677.2021.2002586","url":null,"abstract":"Background: The prevalence of diabetes mellitus (DM) in South Africa (SA) is 12.80% and is rising, while that of HIV infection remains the highest globally (13%). Literature varies on the associations between glycaemic control and age in patients living with DM (PLWD). Through effective anti-retroviral treatment (ART), HIV-infected patients can now live longer and develop co-morbidities as experienced by HIV-uninfected patients. Identification of challenges faced in diabetes control within the various age groups would help in developing strategies that can be implemented in order to provide effective diabetes care to patients as they age. Objectives: This study aimed to determine an association between age and diabetes control in an HIV endemic area. Methods: Data from standardised clinic sheets were used from the DM clinic at Edendale Hospital, Pietermaritzburg, South Africa, from January 1, 2019 to December 31, 2019. Statistical analysis was done. Results: This study had 957 PLWD with 146 PLWD who were HIV-infected (PLWDH). Older age was associated with improved mean glycated haemoglobin (HbA1c) levels after adjusting for glomerular filtration rate (GFR) (r = −0.141, p < 0.001; before adjustment: r = −0.108; p = 0.001). HIV-infected patients had lower mean HbA1c levels than their HIV-uninfected counterparts while age was positively associated with patients’ BMI (r = 0.246, p < 0.001). PLWDH with a mean HbA1c > 7% were significantly younger than those with HbA1c ≤ 7% (47.38 years vs. 52.77 years, p = 0.013). GFR declined with age: PLWD with GFR < 60 ml/minute were significantly older than those with GFR ≥ 60 ml/minute (62.72 years vs. 48.30 years, p < 0.001), this remaining significant after factoring in for HIV infection and hypertension. Conclusion: Younger PLWD have poorer glycaemic control and are likely to develop diabetes-related complications later in life. Notably, younger PLWDH also had poorer glycaemic control, which places them at increased cardio-metabolic risk from sequelae of both the HIV infection and DM. This study highlights that more emphasis needs to be placed on diabetes education and management in the younger age categories of both PLWD and PLWDH.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"9 1","pages":"49 - 56"},"PeriodicalIF":0.5,"publicationDate":"2021-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82591218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-21DOI: 10.1080/16089677.2021.1997415
B. Phiri-Ramongane, A. Khine
Transgender individuals experience discordance between their gender identity and sex assigned at birth. To relieve the disconnection between their identity and their biological state, some may take hormonal therapy, which leads to notable changes in several laboratory results. As reference intervals in the clinical laboratory reports are mainly gender specific for biological male and female, the transgender population on hormonal therapy may end up with misinterpretation of their test results, which could lead to misdiagnosis or inappropriate medical decisions. The aim of this review is to highlight the challenges experienced by clinicians in this regard and some strategies used to interpret these results. Establishing reference intervals for transgender individuals will assist in correct interpretation of patients’ results and their management. This will also maximise their overall health, psychological well-being and self-actualisation.
{"title":"Role of clinical laboratories in reporting results of transgender individuals on hormonal therapy","authors":"B. Phiri-Ramongane, A. Khine","doi":"10.1080/16089677.2021.1997415","DOIUrl":"https://doi.org/10.1080/16089677.2021.1997415","url":null,"abstract":"Transgender individuals experience discordance between their gender identity and sex assigned at birth. To relieve the disconnection between their identity and their biological state, some may take hormonal therapy, which leads to notable changes in several laboratory results. As reference intervals in the clinical laboratory reports are mainly gender specific for biological male and female, the transgender population on hormonal therapy may end up with misinterpretation of their test results, which could lead to misdiagnosis or inappropriate medical decisions. The aim of this review is to highlight the challenges experienced by clinicians in this regard and some strategies used to interpret these results. Establishing reference intervals for transgender individuals will assist in correct interpretation of patients’ results and their management. This will also maximise their overall health, psychological well-being and self-actualisation.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"75 1","pages":"8 - 13"},"PeriodicalIF":0.5,"publicationDate":"2021-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78207154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-19DOI: 10.1080/16089677.2021.1997427
A. Ikram, S. Pillay
Background: Despite a substantial diabetes mellitus (DM) burden, there are few data regarding the relationship between DM and hyperglycaemia on COVID-19 severity and outcome in African populations. This study aimed to describe this relationship in the local context, and to determine whether our data correlated with observations made globally. Methods: Retrospective analysis of patients admitted to King Edward VIII Hospital with COVID-19 during June–September 2020 was undertaken. The sample was subdivided into three cohorts: DM; hyperglycaemia only (HO); and neither DM nor hyperglycaemia (NDNH). Patients living with DM (PLWD) were further subdivided into those with hyperglycaemia (PLWDH) versus normoglycaemia (PLWDN). Comparisons were made across groups. Results: The 236 participants enrolled comprised 79 with DM, 22 with HO, and 135 with NDNH. Half of patients with HO, 26.6% of PLWD and 15.6% of NDNH died. A log-rank test revealed significantly lower survival rates for those with HO compared with PLWDN (p = 0.001) and NDNH (p = 0.002). PLWDH also had significantly lower survival rates when compared with these two groups (p = 0.018 and p = 0.039 respectively). PLWD were significantly more likely to receive steroids (odds ratio [OR] 2.03) and oxygen therapy (OR 2.93). Patients with HO were significantly more likely to receive mechanical ventilation (MV) (OR 7.7) and die (OR 5.43). Compared with PLWDN, PLWDH were significantly more likely to receive MV (OR 10.83) and die (OR 4.24). When compared with PLWDN, patients with HO were significantly more likely to receive oxygen (100% vs. 70.4%), MV (63.6% vs. 3.7%) or die (50% vs. 11.1%). Conclusion: This study concurred with global findings, highlighting the importance of glycaemia as a prognostic marker in patients hospitalised with COVID-19. We recommend that all patients admitted with COVID-19 have a random glucose on admission and strict glycaemic control in those with hyperglycaemia to improve outcomes.
{"title":"Hyperglycaemia, diabetes mellitus and COVID-19 in a tertiary hospital in KwaZulu-Natal","authors":"A. Ikram, S. Pillay","doi":"10.1080/16089677.2021.1997427","DOIUrl":"https://doi.org/10.1080/16089677.2021.1997427","url":null,"abstract":"Background: Despite a substantial diabetes mellitus (DM) burden, there are few data regarding the relationship between DM and hyperglycaemia on COVID-19 severity and outcome in African populations. This study aimed to describe this relationship in the local context, and to determine whether our data correlated with observations made globally. Methods: Retrospective analysis of patients admitted to King Edward VIII Hospital with COVID-19 during June–September 2020 was undertaken. The sample was subdivided into three cohorts: DM; hyperglycaemia only (HO); and neither DM nor hyperglycaemia (NDNH). Patients living with DM (PLWD) were further subdivided into those with hyperglycaemia (PLWDH) versus normoglycaemia (PLWDN). Comparisons were made across groups. Results: The 236 participants enrolled comprised 79 with DM, 22 with HO, and 135 with NDNH. Half of patients with HO, 26.6% of PLWD and 15.6% of NDNH died. A log-rank test revealed significantly lower survival rates for those with HO compared with PLWDN (p = 0.001) and NDNH (p = 0.002). PLWDH also had significantly lower survival rates when compared with these two groups (p = 0.018 and p = 0.039 respectively). PLWD were significantly more likely to receive steroids (odds ratio [OR] 2.03) and oxygen therapy (OR 2.93). Patients with HO were significantly more likely to receive mechanical ventilation (MV) (OR 7.7) and die (OR 5.43). Compared with PLWDN, PLWDH were significantly more likely to receive MV (OR 10.83) and die (OR 4.24). When compared with PLWDN, patients with HO were significantly more likely to receive oxygen (100% vs. 70.4%), MV (63.6% vs. 3.7%) or die (50% vs. 11.1%). Conclusion: This study concurred with global findings, highlighting the importance of glycaemia as a prognostic marker in patients hospitalised with COVID-19. We recommend that all patients admitted with COVID-19 have a random glucose on admission and strict glycaemic control in those with hyperglycaemia to improve outcomes.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"11 1","pages":"32 - 41"},"PeriodicalIF":0.5,"publicationDate":"2021-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73939090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-11DOI: 10.1080/16089677.2021.1980972
P. Manickum, T. Madiba, S. Ramklass
Background and aims: Improving foot-care knowledge and practice is the foundation of curbing diabetic foot disease and subsequent amputation. This study aimed to determine the effectiveness of a foot-care education module on change in knowledge and behaviour among patients living with diabetes mellitus (DM). Methods: A total of 120 participants with Type 2 diabetes mellitus (T2DM were recruited) from Addington Hospital Medical Outpatient Department and randomised them into three groups. A pre- and post-test questionnaire was administered to participants on recruitment and six weeks later. All groups received baseline treatment and Group 1 did not receive any further treatment. Participants in Group 2 received a foot-care handout with instructions. Group 3 received a teaching session, foot-care handout with instructions and pictures on practices as well as five lower-limb exercises. Group 2 and 3 participants were requested to follow the instructions on the handouts. Results: Transfer of knowledge of foot care was successful and practice of foot care improved among all groups following the intervention. Groups 2 and 3 showed significant improvement in behaviour and this was highest in Group 3. Knowledge transfer of exercises was successful in Group 3. Conclusion: A face-to-face education module improves foot-care knowledge and practice among patients with DM.
{"title":"The effectiveness of diabetic foot-care education in a South African regional hospital: a randomised controlled trial","authors":"P. Manickum, T. Madiba, S. Ramklass","doi":"10.1080/16089677.2021.1980972","DOIUrl":"https://doi.org/10.1080/16089677.2021.1980972","url":null,"abstract":"Background and aims: Improving foot-care knowledge and practice is the foundation of curbing diabetic foot disease and subsequent amputation. This study aimed to determine the effectiveness of a foot-care education module on change in knowledge and behaviour among patients living with diabetes mellitus (DM). Methods: A total of 120 participants with Type 2 diabetes mellitus (T2DM were recruited) from Addington Hospital Medical Outpatient Department and randomised them into three groups. A pre- and post-test questionnaire was administered to participants on recruitment and six weeks later. All groups received baseline treatment and Group 1 did not receive any further treatment. Participants in Group 2 received a foot-care handout with instructions. Group 3 received a teaching session, foot-care handout with instructions and pictures on practices as well as five lower-limb exercises. Group 2 and 3 participants were requested to follow the instructions on the handouts. Results: Transfer of knowledge of foot care was successful and practice of foot care improved among all groups following the intervention. Groups 2 and 3 showed significant improvement in behaviour and this was highest in Group 3. Knowledge transfer of exercises was successful in Group 3. Conclusion: A face-to-face education module improves foot-care knowledge and practice among patients with DM.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"195 1","pages":"20 - 31"},"PeriodicalIF":0.5,"publicationDate":"2021-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75887280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-22DOI: 10.1080/16089677.2021.1969156
N. Sahadew, S. Pillay, V. Singaram
Background: The need for greater information on the burden of diabetes has never been more significant than at present, especially when considering the association between diabetes and the severity of COVID-19. Statistics South Africa has identified diabetes mellitus (DM) as the leading cause of death in the Western Cape (WC) province, South Africa. Aims: This study aimed to analyse diabetes-related data collected on patient visits, screening frequency, age proportion and distribution of new patients at primary health levels in the WC public healthcare sector. Methods: An eight-year (2012–2019) audit was conducted of all diabetes-related public health data routinely collected using the WC District Health Information System (DHIS). The data were analysed using Excel® 2016. Time-series and cross-sectional analyses were made possible using pivot tables to gain insight into data trends and incidence rates. Results: This study found that the eight-year crude incidence rate for diabetes increased by 2% between 2012 and 2019. In addition, the incidence rate of diabetes increased by an average of 21% when private institutions were excluded. The recorded number of patients diagnosed with type 1 DM (T1DM) decreased annually between 2013 and 2017 (796 vs. 217, respectively). This decreasing trend could be due to the late onset of T1DM in patients from the African continent or possible data misinterpretation and inadequate training at a primary collection level. The cumulative number of patients screened for diabetes within the WC public health sector (2016–2019) depicts a compound annual growth rate of 16%. A strong positive correlation (p = 0.98) was found between patients screened and the frequency of patients newly diagnosed with DM. The majority (64%) of clinical visits by patients registered with a confirmed diagnosis of diabetes were seen in the metropolitan municipality of ‘The City of Cape Town’. Conclusions: The incidence of DM in the WC province, as in South Africa and globally, is increasing. Intensified screening translates into improved ‘pick-up’ rates and decreases the overall prevalence of undiagnosed DM with its complications. The findings of this study have implications for the development of public healthcare policies and guidelines. Personnel training and resources are suggested to improve the quality of the clinical data and strengthen the DHIS.
{"title":"Diabetes in the Western Cape: an eight-year profile","authors":"N. Sahadew, S. Pillay, V. Singaram","doi":"10.1080/16089677.2021.1969156","DOIUrl":"https://doi.org/10.1080/16089677.2021.1969156","url":null,"abstract":"Background: The need for greater information on the burden of diabetes has never been more significant than at present, especially when considering the association between diabetes and the severity of COVID-19. Statistics South Africa has identified diabetes mellitus (DM) as the leading cause of death in the Western Cape (WC) province, South Africa. Aims: This study aimed to analyse diabetes-related data collected on patient visits, screening frequency, age proportion and distribution of new patients at primary health levels in the WC public healthcare sector. Methods: An eight-year (2012–2019) audit was conducted of all diabetes-related public health data routinely collected using the WC District Health Information System (DHIS). The data were analysed using Excel® 2016. Time-series and cross-sectional analyses were made possible using pivot tables to gain insight into data trends and incidence rates. Results: This study found that the eight-year crude incidence rate for diabetes increased by 2% between 2012 and 2019. In addition, the incidence rate of diabetes increased by an average of 21% when private institutions were excluded. The recorded number of patients diagnosed with type 1 DM (T1DM) decreased annually between 2013 and 2017 (796 vs. 217, respectively). This decreasing trend could be due to the late onset of T1DM in patients from the African continent or possible data misinterpretation and inadequate training at a primary collection level. The cumulative number of patients screened for diabetes within the WC public health sector (2016–2019) depicts a compound annual growth rate of 16%. A strong positive correlation (p = 0.98) was found between patients screened and the frequency of patients newly diagnosed with DM. The majority (64%) of clinical visits by patients registered with a confirmed diagnosis of diabetes were seen in the metropolitan municipality of ‘The City of Cape Town’. Conclusions: The incidence of DM in the WC province, as in South Africa and globally, is increasing. Intensified screening translates into improved ‘pick-up’ rates and decreases the overall prevalence of undiagnosed DM with its complications. The findings of this study have implications for the development of public healthcare policies and guidelines. Personnel training and resources are suggested to improve the quality of the clinical data and strengthen the DHIS.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"14 1","pages":"14 - 19"},"PeriodicalIF":0.5,"publicationDate":"2021-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90349431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-02DOI: 10.1080/16089677.2021.1928982
N. McGrath, S. Pillay
Background: The majority of patients living with diabetes mellitus (PLWD) are diagnosed and managed at primary care level. Much research has focused on diabetes mellitus, its complications and the need for earlier referral from primary to higher levels of health care. Little research, however, has focused on down-referrals of PLWD. Methods: This study assessed whether down-referral letters of PLWD to primary healthcare clinics (PHCs) and community healthcare centres (CHCs) in the uMgungundlovu district of KwaZulu-Natal contained adequate information, were legible, had a follow-up plan and whether national guidelines were adhered to. Questionnaires were distributed to nurses and doctors working in PHCs and CHCs to assess their opinions of appropriateness of down-referrals of PLWD during November and December 2019. Results: A total of 127 referral letters and 55 questionnaires were assessed. Referral letter assessment revealed that 81.1% of PLWD had no glucose control and 85% had no renal function documented. Diabetic complications were recorded infrequently (3.94%). One-third (33.6%) of the PLWD over the age of 40 years were not down-referred on a statin while 6.3% were on a medication combination that was not in accordance with the South African Essential Medicines List. A significant number of referral letters had no clear management plan other than medications listed (96.1%), with no follow-up appointments documented (95.3%). Less than two-thirds (60%) of letters were easily legible. The most common down-referrals were from district hospitals (98.43%). Questionnaire respondents agreed that referral letters generally contained information on the patient’s medication and comorbidities but rarely contained information regarding glucose control or complications of diabetes, among which foot and eye complications were significantly omitted. Conclusion: Analysis of down-referral letters identified many omissions, in both clinical and biochemical data, that are needed by clinicians working at both CHCs and PHCs to optimally manage PLWD. It is imperative that findings of studies like this be used in developing intervention strategies targeting this level of diabetes care.
{"title":"Appropriateness of diabetic down-referral letters to primary healthcare clinics in the uMgungundlovu district municipality of KwaZulu-Natal","authors":"N. McGrath, S. Pillay","doi":"10.1080/16089677.2021.1928982","DOIUrl":"https://doi.org/10.1080/16089677.2021.1928982","url":null,"abstract":"Background: The majority of patients living with diabetes mellitus (PLWD) are diagnosed and managed at primary care level. Much research has focused on diabetes mellitus, its complications and the need for earlier referral from primary to higher levels of health care. Little research, however, has focused on down-referrals of PLWD. Methods: This study assessed whether down-referral letters of PLWD to primary healthcare clinics (PHCs) and community healthcare centres (CHCs) in the uMgungundlovu district of KwaZulu-Natal contained adequate information, were legible, had a follow-up plan and whether national guidelines were adhered to. Questionnaires were distributed to nurses and doctors working in PHCs and CHCs to assess their opinions of appropriateness of down-referrals of PLWD during November and December 2019. Results: A total of 127 referral letters and 55 questionnaires were assessed. Referral letter assessment revealed that 81.1% of PLWD had no glucose control and 85% had no renal function documented. Diabetic complications were recorded infrequently (3.94%). One-third (33.6%) of the PLWD over the age of 40 years were not down-referred on a statin while 6.3% were on a medication combination that was not in accordance with the South African Essential Medicines List. A significant number of referral letters had no clear management plan other than medications listed (96.1%), with no follow-up appointments documented (95.3%). Less than two-thirds (60%) of letters were easily legible. The most common down-referrals were from district hospitals (98.43%). Questionnaire respondents agreed that referral letters generally contained information on the patient’s medication and comorbidities but rarely contained information regarding glucose control or complications of diabetes, among which foot and eye complications were significantly omitted. Conclusion: Analysis of down-referral letters identified many omissions, in both clinical and biochemical data, that are needed by clinicians working at both CHCs and PHCs to optimally manage PLWD. It is imperative that findings of studies like this be used in developing intervention strategies targeting this level of diabetes care.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"63 1","pages":"106 - 115"},"PeriodicalIF":0.5,"publicationDate":"2021-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89218178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-21DOI: 10.1080/16089677.2021.1945767
R. Chetty, S. Pillay
Background: Patients living in low- and middle-income countries (LMIC) comprise approximately 79% of the global number of adult patients living with diabetes (PLWD). In addition, South Africa (SA), a LMIC, has the highest prevalence of HIV infection globally (13%). The literature suggests that poor glycaemic control is found in the younger PLWD while older PLWD have a poorer quality of life with greater disability. With the effective roll-out of anti-retroviral treatment (ART), patients are living longer and can develop diabetes mellitus as a result of longevity, ART and the HIV infection itself. Assessing the relationship between age in PLWD and HIV would help in developing effective strategies that can be implemented to optimise healthcare for this cohort of patients. Objectives: A study was undertaken to summarise publications on age and glycaemic control in PLWD within the context of an HIV infection. Methods: A scoping review was performed using online medical journal search engines with specific search terms according to the PRISMA guidelines. The Abstracts of articles were read and articles that matched the search criteria were downloaded and read in full. If they matched the chosen topic, they were summarised for analysis. Results: There were 260 results found across 3 medical search engines (55 from Cochrane; 59 from PubMed; 101 from Scopus). A Google search was conducted for completeness (45 results). Seventeen journal articles were identified for the scoping review with 45 095 patients included in these studies from 7 countries. Associations between age and glycaemia differed greatly, being dispersed among the ‘older age has worse glycaemia category’, ‘non-significant category’ and ‘older age has improved glycaemia category’. Conclusion: Varying data exist on the associations between glycaemic control and age in PLWD in the context of HIV infection. Further studies are recommended to determine associations in this regard, especially in LMIC where HIV and DM have a higher prevalence.
{"title":"The relationship between age and glycaemic control in patients living with diabetes mellitus in the context of HIV infection: a scoping review","authors":"R. Chetty, S. Pillay","doi":"10.1080/16089677.2021.1945767","DOIUrl":"https://doi.org/10.1080/16089677.2021.1945767","url":null,"abstract":"Background: Patients living in low- and middle-income countries (LMIC) comprise approximately 79% of the global number of adult patients living with diabetes (PLWD). In addition, South Africa (SA), a LMIC, has the highest prevalence of HIV infection globally (13%). The literature suggests that poor glycaemic control is found in the younger PLWD while older PLWD have a poorer quality of life with greater disability. With the effective roll-out of anti-retroviral treatment (ART), patients are living longer and can develop diabetes mellitus as a result of longevity, ART and the HIV infection itself. Assessing the relationship between age in PLWD and HIV would help in developing effective strategies that can be implemented to optimise healthcare for this cohort of patients. Objectives: A study was undertaken to summarise publications on age and glycaemic control in PLWD within the context of an HIV infection. Methods: A scoping review was performed using online medical journal search engines with specific search terms according to the PRISMA guidelines. The Abstracts of articles were read and articles that matched the search criteria were downloaded and read in full. If they matched the chosen topic, they were summarised for analysis. Results: There were 260 results found across 3 medical search engines (55 from Cochrane; 59 from PubMed; 101 from Scopus). A Google search was conducted for completeness (45 results). Seventeen journal articles were identified for the scoping review with 45 095 patients included in these studies from 7 countries. Associations between age and glycaemia differed greatly, being dispersed among the ‘older age has worse glycaemia category’, ‘non-significant category’ and ‘older age has improved glycaemia category’. Conclusion: Varying data exist on the associations between glycaemic control and age in PLWD in the context of HIV infection. Further studies are recommended to determine associations in this regard, especially in LMIC where HIV and DM have a higher prevalence.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"38 1","pages":"1 - 7"},"PeriodicalIF":0.5,"publicationDate":"2021-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87313872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.1080/16089677.2021.1939934
R. Bhikoo, M. Conradie-Smit, G. van Wyk, S. Lahri, E. D. Du Plessis, J. Cilliers, S. Hugo, A. Coetzee
Background: Pre-existing diabetes mellitus (DM), hyperglycaemia and obesity emerged as prognostic factors in severe Coronavirus disease 2019 (COVID-19). To date, no published South African studies report on the incidence, presentation and outcomes of DM and diabetic ketoacidosis (DKA) during the COVID-19 pandemic. Objective: To reflect on the diagnosis, management, obstacles to care and outcome of four patients who were admitted to Tygerberg Hospital, Cape Town, South Africa. The outcome of these cases that presented consecutively with DKA and COVID-19 between May and July 2020 are discussed, the presentation, management and long-term considerations with specific reference to DKA and COVID-19 are reviewed. Results: Three of the four patients had newly diagnosed DM. These patients presented with non-specific symptoms and signs leading to a diagnosis of both DKA and COVID-19. The single surviving patient in this series was known to have pre-existing DM but discontinued his insulin upon becoming unwell. One patient required insulin therapy at the time of initial presentation a week or two prior to the current admission but received metformin instead. She was diagnosed with COVID-19 after having poor glycaemic control for over one week, after which insulin was initiated. Ultimately she died as a result of severe hypokalaemia. One patient primarily had respiratory complaints, severe COVID-19 pneumonia and received concomitant dexamethasone. Glycaemic control in this patient was complicated by both hypo- and hyperglycaemia. Conclusion: These cases highlight the management challenges faced by many developing countries, and identify the missed opportunities in persons presenting with COVID-19 and hyperglycaemic emergencies.
{"title":"COVID-19 and hyperglycaemic emergencies: perspectives from a developing country","authors":"R. Bhikoo, M. Conradie-Smit, G. van Wyk, S. Lahri, E. D. Du Plessis, J. Cilliers, S. Hugo, A. Coetzee","doi":"10.1080/16089677.2021.1939934","DOIUrl":"https://doi.org/10.1080/16089677.2021.1939934","url":null,"abstract":"Background: Pre-existing diabetes mellitus (DM), hyperglycaemia and obesity emerged as prognostic factors in severe Coronavirus disease 2019 (COVID-19). To date, no published South African studies report on the incidence, presentation and outcomes of DM and diabetic ketoacidosis (DKA) during the COVID-19 pandemic. Objective: To reflect on the diagnosis, management, obstacles to care and outcome of four patients who were admitted to Tygerberg Hospital, Cape Town, South Africa. The outcome of these cases that presented consecutively with DKA and COVID-19 between May and July 2020 are discussed, the presentation, management and long-term considerations with specific reference to DKA and COVID-19 are reviewed. Results: Three of the four patients had newly diagnosed DM. These patients presented with non-specific symptoms and signs leading to a diagnosis of both DKA and COVID-19. The single surviving patient in this series was known to have pre-existing DM but discontinued his insulin upon becoming unwell. One patient required insulin therapy at the time of initial presentation a week or two prior to the current admission but received metformin instead. She was diagnosed with COVID-19 after having poor glycaemic control for over one week, after which insulin was initiated. Ultimately she died as a result of severe hypokalaemia. One patient primarily had respiratory complaints, severe COVID-19 pneumonia and received concomitant dexamethasone. Glycaemic control in this patient was complicated by both hypo- and hyperglycaemia. Conclusion: These cases highlight the management challenges faced by many developing countries, and identify the missed opportunities in persons presenting with COVID-19 and hyperglycaemic emergencies.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"11 1","pages":"42 - 48"},"PeriodicalIF":0.5,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84150659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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