Pub Date : 2020-01-02DOI: 10.1080/16089677.2019.1686869
S. Naidoo, F. Raal
Introduction: Atherosclerotic cardiovascular disease is a major contributor to morbidity and mortality in diabetic patients. Strict goal-directed lipid control in patients with diabetes is associated with better cardiovascular outcomes. Aim: The main aim of this study is to describe the lipid profiles of a cohort of patients with type 2 diabetes mellitus in order to highlight the quality of lipid control by correlating the type and dose of lipid-modifying therapy used with lipid levels. Method: A retrospective analysis was performed on 200 type 2 diabetic patients who attended the Charlotte Maxeke Johannesburg Academic Hospital diabetic clinic. Their lipid profiles and the type and dose of lipid-modifying therapy prescribed was assessed. Results: Although the majority of participants (146 [73%]) were at the ideal level for total cholesterol, fewer (133 [66.5%]) were at the ideal level for triglycerides and 112 (56%) participants were at the ideal level for HDL cholesterol, only 53 (26.5%) participants were at target for LDL cholesterol, and very few, only 25 (12.5%), participants were at target for all four lipid parameters. Conclusion: Higher doses of statins or the use of more potent statins with or without the addition of other lipid modifying drugs is recommended in order to achieve LDL cholesterol target in the majority of patients with type 2 diabetes.
{"title":"Pattern of dyslipidaemia in relation to statin use in patients with type 2 diabetes mellitus attending a tertiary care hospital","authors":"S. Naidoo, F. Raal","doi":"10.1080/16089677.2019.1686869","DOIUrl":"https://doi.org/10.1080/16089677.2019.1686869","url":null,"abstract":"Introduction: Atherosclerotic cardiovascular disease is a major contributor to morbidity and mortality in diabetic patients. Strict goal-directed lipid control in patients with diabetes is associated with better cardiovascular outcomes. Aim: The main aim of this study is to describe the lipid profiles of a cohort of patients with type 2 diabetes mellitus in order to highlight the quality of lipid control by correlating the type and dose of lipid-modifying therapy used with lipid levels. Method: A retrospective analysis was performed on 200 type 2 diabetic patients who attended the Charlotte Maxeke Johannesburg Academic Hospital diabetic clinic. Their lipid profiles and the type and dose of lipid-modifying therapy prescribed was assessed. Results: Although the majority of participants (146 [73%]) were at the ideal level for total cholesterol, fewer (133 [66.5%]) were at the ideal level for triglycerides and 112 (56%) participants were at the ideal level for HDL cholesterol, only 53 (26.5%) participants were at target for LDL cholesterol, and very few, only 25 (12.5%), participants were at target for all four lipid parameters. Conclusion: Higher doses of statins or the use of more potent statins with or without the addition of other lipid modifying drugs is recommended in order to achieve LDL cholesterol target in the majority of patients with type 2 diabetes.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"11 1","pages":"11 - 6"},"PeriodicalIF":0.5,"publicationDate":"2020-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80677928","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 : 2020-01-02DOI: 10.1080/16089677.2019.1692471
S. Bulbulia, F. Variava, Z. Bayat
Background: The risk of complications from type 2 diabetes mellitus (T2DM) is high. Achieving targets reduces the morbidity and mortality. This study aims to assess whether patients at the Helen Joseph Hospital's Diabetic Clinic are meeting the 2012 SEMDSA targets for diabetes. Methods: A retrospective clinical audit was carried out. The files of 321 patients with T2DM were reviewed. Glycated haemoglobin (HbA1c), blood pressure, abdominal circumference and lipograms were assessed. Results: The study population comprised majority black (n = 143; 44.6%) and coloured (n = 109; 34%) patients and was predominantly female (n = 200; 62.3%). The mean age was 59.4 years (SD 9.9 years). In total, 89.1% (n = 286) had hypertension, and 82.2% (n = 264) dyslipidaemia. The metabolic syndrome criteria were fulfilled by 266 (91.2%) patients. The majority did not exercise (n = 174; 56.3%). A small number smoked (n = 39; 12.5%) and used alcohol (n = 33; 10.6%). Mean HbA1c was 9.5% (SD 2.4; range 3.9–16.9%). Only 49 (15.3%) achieved the target HbA1c. Target blood pressure was achieved by 72 patients (25%). LDL target was achieved by 71 (22.6%) and abdominal circumference by 32 (11%) patients. Conclusions: Despite adequate protocols and access to tertiary medical care, a very small percentage of patients are achieving proposed targets. The reasons for this are likely multi-fold and further analysis is required to assess these.
{"title":"Are type 2 diabetic patients meeting targets? A Helen Joseph Hospital Diabetic Clinic Audit","authors":"S. Bulbulia, F. Variava, Z. Bayat","doi":"10.1080/16089677.2019.1692471","DOIUrl":"https://doi.org/10.1080/16089677.2019.1692471","url":null,"abstract":"Background: The risk of complications from type 2 diabetes mellitus (T2DM) is high. Achieving targets reduces the morbidity and mortality. This study aims to assess whether patients at the Helen Joseph Hospital's Diabetic Clinic are meeting the 2012 SEMDSA targets for diabetes. Methods: A retrospective clinical audit was carried out. The files of 321 patients with T2DM were reviewed. Glycated haemoglobin (HbA1c), blood pressure, abdominal circumference and lipograms were assessed. Results: The study population comprised majority black (n = 143; 44.6%) and coloured (n = 109; 34%) patients and was predominantly female (n = 200; 62.3%). The mean age was 59.4 years (SD 9.9 years). In total, 89.1% (n = 286) had hypertension, and 82.2% (n = 264) dyslipidaemia. The metabolic syndrome criteria were fulfilled by 266 (91.2%) patients. The majority did not exercise (n = 174; 56.3%). A small number smoked (n = 39; 12.5%) and used alcohol (n = 33; 10.6%). Mean HbA1c was 9.5% (SD 2.4; range 3.9–16.9%). Only 49 (15.3%) achieved the target HbA1c. Target blood pressure was achieved by 72 patients (25%). LDL target was achieved by 71 (22.6%) and abdominal circumference by 32 (11%) patients. Conclusions: Despite adequate protocols and access to tertiary medical care, a very small percentage of patients are achieving proposed targets. The reasons for this are likely multi-fold and further analysis is required to assess these.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"2 1","pages":"12 - 17"},"PeriodicalIF":0.5,"publicationDate":"2020-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80425930","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 : 2019-08-30DOI: 10.1080/16089677.2019.1649341
L. van den Berg, Mohlakotsana Mokhehle, J. Raubenheimer
Objectives: To evaluate the nutritional status, glycaemic control and barriers to treatment compliance of outpatients with type 2 diabetes mellitus (T2DM) attending two public primary health clinics in Maseru, Lesotho. Design: Cross-sectional analytical study. Setting: Lesotho Defence Force Clinic and Domiciliary Clinic. Subjects: 124 participants with T2DM, 30–69 years. Outcome measures: Sociodemography, medical history, diet, lifestyle, metabolic risk-related anthropometry, glycaemic and metabolic control, and barriers that may impact on treatment compliance. Results: Participants (53.9; SD 9.4 years; 79.5% females; 53.3% diagnosed for > 5 years) were knowledgeable about basic lifestyle recommendations for diabetes, and reported being active (98.3%). However, 88.5% were overweight or obese; 93.4%, 78.1%; 66.1% did not meet the recommended intakes of dairy, vegetables and fruit; 10.7% used tobacco; and 52% of men drank excessively. None performed blood glucose self-monitoring, and 90.2% were ignorant of normal blood glucose ranges, while 94.3% had uncontrolled hypertension despite being on anti-hypertensive medication. Participants were rarely screened for long-term glycaemic control or comorbidities, or referred to dietitians, but 98.4% were satisfied with the services. Conclusions: In this setting, patients were not meeting treatment goals for T2DM, and were not being screened or referred, rendering clinic visits a revolving door that poses the risk of costly complications.
{"title":"Nutritional status, glycaemic control and barriers to treatment compliance among patients with type 2 diabetes attending public primary health clinics in Maseru, Lesotho","authors":"L. van den Berg, Mohlakotsana Mokhehle, J. Raubenheimer","doi":"10.1080/16089677.2019.1649341","DOIUrl":"https://doi.org/10.1080/16089677.2019.1649341","url":null,"abstract":"Objectives: To evaluate the nutritional status, glycaemic control and barriers to treatment compliance of outpatients with type 2 diabetes mellitus (T2DM) attending two public primary health clinics in Maseru, Lesotho. Design: Cross-sectional analytical study. Setting: Lesotho Defence Force Clinic and Domiciliary Clinic. Subjects: 124 participants with T2DM, 30–69 years. Outcome measures: Sociodemography, medical history, diet, lifestyle, metabolic risk-related anthropometry, glycaemic and metabolic control, and barriers that may impact on treatment compliance. Results: Participants (53.9; SD 9.4 years; 79.5% females; 53.3% diagnosed for > 5 years) were knowledgeable about basic lifestyle recommendations for diabetes, and reported being active (98.3%). However, 88.5% were overweight or obese; 93.4%, 78.1%; 66.1% did not meet the recommended intakes of dairy, vegetables and fruit; 10.7% used tobacco; and 52% of men drank excessively. None performed blood glucose self-monitoring, and 90.2% were ignorant of normal blood glucose ranges, while 94.3% had uncontrolled hypertension despite being on anti-hypertensive medication. Participants were rarely screened for long-term glycaemic control or comorbidities, or referred to dietitians, but 98.4% were satisfied with the services. Conclusions: In this setting, patients were not meeting treatment goals for T2DM, and were not being screened or referred, rendering clinic visits a revolving door that poses the risk of costly complications.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"11 11","pages":"110 - 98"},"PeriodicalIF":0.5,"publicationDate":"2019-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72620740","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 : 2019-08-29DOI: 10.1080/16089677.2019.1629080
N. Sahadew, V. Singaram
Aims: This study analysed diabetes-related information routinely collected by the KwaZulu-Natal (KZN) Department of Health (DOH). Methods: Primary data were obtained for all public health facilities through the District Health Information System (DHIS) for the period 2006–2016 inclusive (11 years). Additional open source data on population estimates were obtained from Statistics South Africa. Quantitative analysis of DHIS data was performed using Microsoft Excel before graphical representations were generated using the ThinkCell software. Results: The number of clinical visits by diabetic patients in KZN increased by 305% in the 10 years between 2006 and 2015. According to the data collected by the Department of Health, a large majority of patients diagnosed with diabetes are seeking medical care in the more populated district of eThekwini. The number of patients not returning for scheduled treatment (defaulters) has reduced since recording began in 2012. According to the data, the incidence of diabetes in KZN is oscillating; however, a strong correlation is found between incidence and patient screening. Conclusion: The largest number of diabetic patients were seen in the highly urbanised district of eThekwini. The screening of high-risk patients has increased in frequency and exhibits strong correlations with incidence, further supporting the effectiveness of screening and its inclusion in a new primary healthcare protocol. There was a sharp reduction in number of defaulting patients in 2016, probably indicating improved compliance. The inconsistency of data input is a limitation of the study. However, this study within these constraints highlights the importance of ‘big data’ for healthcare policy and more effective health care in KZN.
{"title":"Progress in diabetes care in the KwaZulu-Natal public health sector: a decade of analysis","authors":"N. Sahadew, V. Singaram","doi":"10.1080/16089677.2019.1629080","DOIUrl":"https://doi.org/10.1080/16089677.2019.1629080","url":null,"abstract":"Aims: This study analysed diabetes-related information routinely collected by the KwaZulu-Natal (KZN) Department of Health (DOH). Methods: Primary data were obtained for all public health facilities through the District Health Information System (DHIS) for the period 2006–2016 inclusive (11 years). Additional open source data on population estimates were obtained from Statistics South Africa. Quantitative analysis of DHIS data was performed using Microsoft Excel before graphical representations were generated using the ThinkCell software. Results: The number of clinical visits by diabetic patients in KZN increased by 305% in the 10 years between 2006 and 2015. According to the data collected by the Department of Health, a large majority of patients diagnosed with diabetes are seeking medical care in the more populated district of eThekwini. The number of patients not returning for scheduled treatment (defaulters) has reduced since recording began in 2012. According to the data, the incidence of diabetes in KZN is oscillating; however, a strong correlation is found between incidence and patient screening. Conclusion: The largest number of diabetic patients were seen in the highly urbanised district of eThekwini. The screening of high-risk patients has increased in frequency and exhibits strong correlations with incidence, further supporting the effectiveness of screening and its inclusion in a new primary healthcare protocol. There was a sharp reduction in number of defaulting patients in 2016, probably indicating improved compliance. The inconsistency of data input is a limitation of the study. However, this study within these constraints highlights the importance of ‘big data’ for healthcare policy and more effective health care in KZN.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"39 1","pages":"83 - 91"},"PeriodicalIF":0.5,"publicationDate":"2019-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81655742","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 : 2019-07-23DOI: 10.1080/16089677.2019.1640490
O. Ojo, R. Ikem, B. Kolawole, O. Ojo, M. Ajala
Background: Thyroid autoimmunity was thought to be rare in Africans but there is evidence that its prevalence is increasing. Since undetected autoimmune thyroid disease carries considerable morbidity, this study set out to determine the proportion of patients with goitre who have thyroid autoantibodies and the relationship, if any, between the presence of thyroid autoantibodies, thyroid function and thyroid size. Methods: The study was cross-sectional and conducted over a 12-month period. It involved 100 subjects with goitre and 50 apparently healthy controls without goitre, matched for age and sex. Thyroid dysfunction was assessed by history, clinical examination and biochemical tests, thyroid peroxidase and thyroglobulin antibodies. The size of the thyroid gland was assessed by ultrasound. Results: Fifty-seven percent (57%) of study subjects were euthyroid, 38% were hyperthyroid, while 2% were hypothyroid. The overall prevalence of elevated thyroid peroxidase antibody (TPOAb) in the subjects with goitre was 35% and 8% in the controls (p < 0.001). Elevated thyroglobulin antibody (TgAb) was found in 24% of subjects with goitre and 12% of controls (p = 0.083). Elevated TPOAb was found in 76.3% of subjects who were hyperthyroid, 7% of subjects who were euthyroid and 100% of subjects who were hypothyroid (p < 0.001). Elevated TgAb level was present in 36.8%, 15.8% and 50% of subjects with hyperthyroid, euthyroid and hypothyroid goitre respectively (p = 0.068). A positive correlation was observed between TPOAb and erythrocyte sedimentation rate (r = 0.582, p < 0.001) and TgAb and erythrocyte sedimentation rate (r = 0.176, p = 0.08). The correlation between TPOAb and thyroid volume (r = –0.139, p = 0.167) and that of TgAb and thyroid volume (r = –0.119, p = 0.238) was not significant. Conclusion: The prevalence of thyroid autoantibodies in patients with goitre is high in Nigeria. Thyroid peroxidase antibody is more prevalent than thyroglobulin antibody in thyroid disorders and appears to be a better marker than thyroglobulin antibody in detecting autoimmune thyroid dysfunction.
背景:甲状腺自身免疫在非洲被认为是罕见的，但有证据表明其患病率正在增加。由于未被发现的自身免疫性甲状腺疾病具有相当高的发病率，本研究旨在确定甲状腺肿患者中存在甲状腺自身抗体的比例，以及甲状腺自身抗体的存在、甲状腺功能和甲状腺大小之间的关系(如果有的话)。方法:本研究为横断面研究，为期12个月。该研究涉及100名有甲状腺肿的受试者和50名没有甲状腺肿的健康对照组，年龄和性别相匹配。通过病史、临床检查、生化检查、甲状腺过氧化物酶和甲状腺球蛋白抗体评估甲状腺功能障碍。超声检查甲状腺大小。结果:57%的研究对象为甲状腺功能正常，38%为甲状腺功能亢进，2%为甲状腺功能减退。甲状腺肿患者甲状腺过氧化物酶抗体(TPOAb)升高的总体患病率为35%，对照组为8% (p < 0.001)。甲状腺肿患者中甲状腺球蛋白抗体(TgAb)升高的比例为24%，对照组为12% (p = 0.083)。TPOAb在甲状腺机能亢进、甲状腺功能正常和甲状腺功能减退患者中分别为76.3%、7%和100% (p < 0.001)。甲状腺功能亢进、甲状腺功能正常和甲状腺功能减退患者中TgAb水平升高的比例分别为36.8%、15.8%和50% (p = 0.068)。TPOAb与血沉(r = 0.582, p < 0.001)、TgAb与血沉(r = 0.176, p = 0.08)呈正相关。TPOAb与甲状腺体积(r = -0.139, p = 0.167)、TgAb与甲状腺体积(r = -0.119, p = 0.238)的相关性无统计学意义。结论:尼日利亚甲状腺肿患者甲状腺自身抗体的患病率较高。甲状腺过氧化物酶抗体在甲状腺疾病中比甲状腺球蛋白抗体更普遍，在检测自身免疫性甲状腺功能障碍方面似乎比甲状腺球蛋白抗体更好。
{"title":"Prevalence and clinical relevance of thyroid autoantibodies in patients with goitre in Nigeria","authors":"O. Ojo, R. Ikem, B. Kolawole, O. Ojo, M. Ajala","doi":"10.1080/16089677.2019.1640490","DOIUrl":"https://doi.org/10.1080/16089677.2019.1640490","url":null,"abstract":"Background: Thyroid autoimmunity was thought to be rare in Africans but there is evidence that its prevalence is increasing. Since undetected autoimmune thyroid disease carries considerable morbidity, this study set out to determine the proportion of patients with goitre who have thyroid autoantibodies and the relationship, if any, between the presence of thyroid autoantibodies, thyroid function and thyroid size. Methods: The study was cross-sectional and conducted over a 12-month period. It involved 100 subjects with goitre and 50 apparently healthy controls without goitre, matched for age and sex. Thyroid dysfunction was assessed by history, clinical examination and biochemical tests, thyroid peroxidase and thyroglobulin antibodies. The size of the thyroid gland was assessed by ultrasound. Results: Fifty-seven percent (57%) of study subjects were euthyroid, 38% were hyperthyroid, while 2% were hypothyroid. The overall prevalence of elevated thyroid peroxidase antibody (TPOAb) in the subjects with goitre was 35% and 8% in the controls (p < 0.001). Elevated thyroglobulin antibody (TgAb) was found in 24% of subjects with goitre and 12% of controls (p = 0.083). Elevated TPOAb was found in 76.3% of subjects who were hyperthyroid, 7% of subjects who were euthyroid and 100% of subjects who were hypothyroid (p < 0.001). Elevated TgAb level was present in 36.8%, 15.8% and 50% of subjects with hyperthyroid, euthyroid and hypothyroid goitre respectively (p = 0.068). A positive correlation was observed between TPOAb and erythrocyte sedimentation rate (r = 0.582, p < 0.001) and TgAb and erythrocyte sedimentation rate (r = 0.176, p = 0.08). The correlation between TPOAb and thyroid volume (r = –0.139, p = 0.167) and that of TgAb and thyroid volume (r = –0.119, p = 0.238) was not significant. Conclusion: The prevalence of thyroid autoantibodies in patients with goitre is high in Nigeria. Thyroid peroxidase antibody is more prevalent than thyroglobulin antibody in thyroid disorders and appears to be a better marker than thyroglobulin antibody in detecting autoimmune thyroid dysfunction.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"22 1","pages":"92 - 97"},"PeriodicalIF":0.5,"publicationDate":"2019-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88507464","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 : 2019-06-06DOI: 10.1080/16089677.2019.1613042
L. Naidoo, N. Butkow, P. Barnard-Ashton, E. Libhaber
Background: The relationship between Type 2 diabetes mellitus (T2DM) and associated co-morbidities, particularly major depressive disorder (MDD), is poorly acknowledged in chronic disease management practices in South Africa. Managed healthcare costs and hospitalisation rates may be influenced by the discrete management of co-morbid conditions. Therefore, the relationship between T2DM and MDD in terms of co-morbidity incidence and hospitalisation resource utilisation was investigated. Method: This retrospective descriptive study analysed the data of 902 adult patients with T2DM from the health system database of a private managed healthcare organisation for 2014. Results: The mean age was 57 ± 15 years and 85% of the identified T2DM patients had at least one recorded co-morbidity. Among this population 17% presented with MDD. A higher percentage of T2DM patients with MDD were admitted to hospital (42%, p = 0.004) compared with those without MDD (30%). The number of overnight admissions was higher among the T2DM with MDD (76%, p = 0.016) compared with T2DM without MDD (66%). The T2DM with MDD group (85%, p = 0.018) had greater non-diabetes related hospital events compared with the T2DM without MDD group (73%). The T2DM patients without MDD were more likely to be hospitalised for diabetes-related events (27%, p = 0.018) at significantly higher admission cost (p = 0.001). Conclusion: Patients with T2DM and MDD present with more co-morbid conditions and had a higher number of hospitalisations than their non-MDD counterparts. However, the hospitalisation costs were significantly higher for diabetes-related admissions in the non-MDD group due to a higher number of macrovascular events. Healthcare organisations need to focus on an integrated approach in the management of chronic conditions with emphasis on active surveillance of T2DM patients, where MDD is identified and treated to lessen the risk of macrovascular complications.
{"title":"Hospitalisation of Type 2 diabetes mellitus patients with and without major depressive disorder in a private managed healthcare organisation","authors":"L. Naidoo, N. Butkow, P. Barnard-Ashton, E. Libhaber","doi":"10.1080/16089677.2019.1613042","DOIUrl":"https://doi.org/10.1080/16089677.2019.1613042","url":null,"abstract":"Background: The relationship between Type 2 diabetes mellitus (T2DM) and associated co-morbidities, particularly major depressive disorder (MDD), is poorly acknowledged in chronic disease management practices in South Africa. Managed healthcare costs and hospitalisation rates may be influenced by the discrete management of co-morbid conditions. Therefore, the relationship between T2DM and MDD in terms of co-morbidity incidence and hospitalisation resource utilisation was investigated. Method: This retrospective descriptive study analysed the data of 902 adult patients with T2DM from the health system database of a private managed healthcare organisation for 2014. Results: The mean age was 57 ± 15 years and 85% of the identified T2DM patients had at least one recorded co-morbidity. Among this population 17% presented with MDD. A higher percentage of T2DM patients with MDD were admitted to hospital (42%, p = 0.004) compared with those without MDD (30%). The number of overnight admissions was higher among the T2DM with MDD (76%, p = 0.016) compared with T2DM without MDD (66%). The T2DM with MDD group (85%, p = 0.018) had greater non-diabetes related hospital events compared with the T2DM without MDD group (73%). The T2DM patients without MDD were more likely to be hospitalised for diabetes-related events (27%, p = 0.018) at significantly higher admission cost (p = 0.001). Conclusion: Patients with T2DM and MDD present with more co-morbid conditions and had a higher number of hospitalisations than their non-MDD counterparts. However, the hospitalisation costs were significantly higher for diabetes-related admissions in the non-MDD group due to a higher number of macrovascular events. Healthcare organisations need to focus on an integrated approach in the management of chronic conditions with emphasis on active surveillance of T2DM patients, where MDD is identified and treated to lessen the risk of macrovascular complications.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"28 1","pages":"70 - 76"},"PeriodicalIF":0.5,"publicationDate":"2019-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74015106","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 : 2019-06-05DOI: 10.1080/16089677.2019.1620009
A. Coetzee, A. Beukes, R. Dreyer, S. Solomon, L. van Wyk, Roshni Mistry, M. Conradie, M. van de Vyver
Objectives: To assess the contribution of traditional and modifiable risk factors to the overall risk and prevalence of type 2 diabetes mellitus (T2DM) amongst health workers (HWs) in the public sector. Design: A retrospective analysis was performed on data obtained from 260 participants. Setting and subjects: HWs at Tygerberg Hospital, Western Cape attending the World Diabetes Day (WDD) metabolic screening and educational event. Outcome measures: The 10-year risk stratification for T2DM was calculated in all HWs attending the WDD event. This was based on the Finnish ‘Test2prevent’ diabetes risk calculator endorsed by the International Diabetes Federation assessing a set of well-established metabolic risk factors. Self-reported consumption of sugar-sweetened beverages (SSBs) was added to the questionnaire but did not add to the risk calculation. Results: The prevalence of known hyperglycaemia in this cohort is concerning (11%, n = 62). An additional 29 health workers were identified as at high risk to develop T2DM within 10 years. Consumption of SSBs and minimal physical activity were identified as modifiable targets for intervention. Conclusions: Education and lifestyle interventions are of paramount importance to ensure the metabolic health of HWs and their communities. Policies and guidelines focused on limiting unhealthy/obesogenic work environments are urgently needed.
{"title":"The prevalence and risk factors for diabetes mellitus in healthcare workers at Tygerberg hospital, Cape Town, South Africa: a retrospective study","authors":"A. Coetzee, A. Beukes, R. Dreyer, S. Solomon, L. van Wyk, Roshni Mistry, M. Conradie, M. van de Vyver","doi":"10.1080/16089677.2019.1620009","DOIUrl":"https://doi.org/10.1080/16089677.2019.1620009","url":null,"abstract":"Objectives: To assess the contribution of traditional and modifiable risk factors to the overall risk and prevalence of type 2 diabetes mellitus (T2DM) amongst health workers (HWs) in the public sector. Design: A retrospective analysis was performed on data obtained from 260 participants. Setting and subjects: HWs at Tygerberg Hospital, Western Cape attending the World Diabetes Day (WDD) metabolic screening and educational event. Outcome measures: The 10-year risk stratification for T2DM was calculated in all HWs attending the WDD event. This was based on the Finnish ‘Test2prevent’ diabetes risk calculator endorsed by the International Diabetes Federation assessing a set of well-established metabolic risk factors. Self-reported consumption of sugar-sweetened beverages (SSBs) was added to the questionnaire but did not add to the risk calculation. Results: The prevalence of known hyperglycaemia in this cohort is concerning (11%, n = 62). An additional 29 health workers were identified as at high risk to develop T2DM within 10 years. Consumption of SSBs and minimal physical activity were identified as modifiable targets for intervention. Conclusions: Education and lifestyle interventions are of paramount importance to ensure the metabolic health of HWs and their communities. Policies and guidelines focused on limiting unhealthy/obesogenic work environments are urgently needed.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"29 Pt 6 1","pages":"77 - 82"},"PeriodicalIF":0.5,"publicationDate":"2019-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80372593","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 : 2019-05-04DOI: 10.1080/16089677.2019.1585069
J. M. Jansen van Vuuren, S. Pillay, C. Jansen van Vuuren
Introduction: Non-communicable diseases, especially cardiovascular diseases (CVD), have become more prevalent across the world, more so in developing countries. Novel methods in the management of CVD risks in patients with diabetes mellitus, type 2 (DM2) requires constant attention and an ever-evolving approach. The role of magnesium supplementation in the management of CVD has been described, but the relationship between serum magnesium (Mg) and the lipid subsets have had conflicting results in different population groups. Methods: A cross-sectional study was performed by collecting data on patients with DM2 from a specialised diabetes clinic at Edendale Hospital, Pietermaritzburg, KwaZulu-Natal, South Africa, between July 1, 2015 and June 30, 2016. Lipid subsets (total cholesterol [TC], high-density lipoprotein cholesterol [HDL], low-density lipoprotein cholesterol [LDL] and triglycerides [TG]), age, sex and Mg were recorded for analysis. Results: A total of 495 clinical data sheets were analysed. The majority of participants were female (73.45%) with a mean age of 56.97 years. A statistically significant, positive, linear relationship was found between Mg and TC (R = 0.11; p = 0.01) as well as Mg and LDL R = 0.14; p = 0.001), but not between Mg and HDL (R = 0.02; p = 0.66) and Mg and TG (R = 0.01; p = 0.82). Discussion: The results of this study are similar to findings by a group of researchers in China and differ when compared with studies observing Caucasian patients. It is plausible that intrinsic ethnic differences in lipid metabolism and the various ways in which magnesium requiring enzymatic processes are utilised may be responsible for the results found in the present study population versus those found in Caucasian study participants in other countries. More research is required to determine the effect of magnesium supplementation and CVD outcomes in the present study population.
{"title":"Relationship between magnesium and lipids in patients with diabetes mellitus","authors":"J. M. Jansen van Vuuren, S. Pillay, C. Jansen van Vuuren","doi":"10.1080/16089677.2019.1585069","DOIUrl":"https://doi.org/10.1080/16089677.2019.1585069","url":null,"abstract":"Introduction: Non-communicable diseases, especially cardiovascular diseases (CVD), have become more prevalent across the world, more so in developing countries. Novel methods in the management of CVD risks in patients with diabetes mellitus, type 2 (DM2) requires constant attention and an ever-evolving approach. The role of magnesium supplementation in the management of CVD has been described, but the relationship between serum magnesium (Mg) and the lipid subsets have had conflicting results in different population groups. Methods: A cross-sectional study was performed by collecting data on patients with DM2 from a specialised diabetes clinic at Edendale Hospital, Pietermaritzburg, KwaZulu-Natal, South Africa, between July 1, 2015 and June 30, 2016. Lipid subsets (total cholesterol [TC], high-density lipoprotein cholesterol [HDL], low-density lipoprotein cholesterol [LDL] and triglycerides [TG]), age, sex and Mg were recorded for analysis. Results: A total of 495 clinical data sheets were analysed. The majority of participants were female (73.45%) with a mean age of 56.97 years. A statistically significant, positive, linear relationship was found between Mg and TC (R = 0.11; p = 0.01) as well as Mg and LDL R = 0.14; p = 0.001), but not between Mg and HDL (R = 0.02; p = 0.66) and Mg and TG (R = 0.01; p = 0.82). Discussion: The results of this study are similar to findings by a group of researchers in China and differ when compared with studies observing Caucasian patients. It is plausible that intrinsic ethnic differences in lipid metabolism and the various ways in which magnesium requiring enzymatic processes are utilised may be responsible for the results found in the present study population versus those found in Caucasian study participants in other countries. More research is required to determine the effect of magnesium supplementation and CVD outcomes in the present study population.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"12 1","pages":"46 - 49"},"PeriodicalIF":0.5,"publicationDate":"2019-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81339031","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 : 2019-05-04DOI: 10.1080/16089677.2019.1589047
C. Ellis, H. Kruger, P. Ukegbu, IM Kruger, M. Viljoen, M. Kruger
Objectives: To investigate the differences between bone mineral density (BMD), lean and fat mass of human immunodeficiency virus (HIV-) positive and HIV-negative black women and to investigate factors associated with low BMD. Methods: Case-control study of black women (n = 565) aged 29–65 years from Potchefstroom, North West province, South Africa, based on secondary analysis of data. Total BMD, left femur neck of the hip (LFN BMD), spine BMD, total fat, fat-free tissue mass and percentage body fat (%BF) were measured by dual-energy X-ray absorptiometry. Results: HIV-negative women had significantly higher median BMD, %BF, appendicular skeletal mass (ASM), ASM index, body mass index (BMI) and waist circumference than HIV-positive women. When the groups were matched for age and BMI, only spine BMD was marginally lower in HIV-positive women. In the total group, age, smoking and HIV status were associated with lower BMD, while calcium intake was positively associated with BMD. Similar variables were associated with BMD in HIV-negative women, while age and educational status were associated with BMD in HIV-positive women. Conclusion: Low BMD was more common among HIV-positive than HIV-negative women. Older HIV-positive women with low educational status are particularly at risk.
{"title":"Differences between bone mineral density, lean and fat mass of HIV-positive and HIV-negative black women","authors":"C. Ellis, H. Kruger, P. Ukegbu, IM Kruger, M. Viljoen, M. Kruger","doi":"10.1080/16089677.2019.1589047","DOIUrl":"https://doi.org/10.1080/16089677.2019.1589047","url":null,"abstract":"Objectives: To investigate the differences between bone mineral density (BMD), lean and fat mass of human immunodeficiency virus (HIV-) positive and HIV-negative black women and to investigate factors associated with low BMD. Methods: Case-control study of black women (n = 565) aged 29–65 years from Potchefstroom, North West province, South Africa, based on secondary analysis of data. Total BMD, left femur neck of the hip (LFN BMD), spine BMD, total fat, fat-free tissue mass and percentage body fat (%BF) were measured by dual-energy X-ray absorptiometry. Results: HIV-negative women had significantly higher median BMD, %BF, appendicular skeletal mass (ASM), ASM index, body mass index (BMI) and waist circumference than HIV-positive women. When the groups were matched for age and BMI, only spine BMD was marginally lower in HIV-positive women. In the total group, age, smoking and HIV status were associated with lower BMD, while calcium intake was positively associated with BMD. Similar variables were associated with BMD in HIV-negative women, while age and educational status were associated with BMD in HIV-positive women. Conclusion: Low BMD was more common among HIV-positive than HIV-negative women. Older HIV-positive women with low educational status are particularly at risk.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"14 1","pages":"50 - 57"},"PeriodicalIF":0.5,"publicationDate":"2019-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73455790","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 : 2019-05-04DOI: 10.1080/16089677.2018.1553344
J. D. Du Plessis, H. L. Bester, M. Julyan, M. Cockeran
Background: According to the literature, parenteral testosterone replacement therapy (TRT)-induced polycythaemia is associated with cardiovascular events. No or minimal data exist for the prevalence of TRT-induced polycythaemia in late-onset hypogonadism (LOH) patients from South Africa. Polycythaemia is the side effect most frequently associated with parental TRT formulations. Design: This was a quantitative, observational, descriptive, retrospective study. Setting: The study setting was a private practice male clinic in Emalahleni. Subject: An all-inclusive sampling method was used. Outcome measures: The main outcome measure for polycythaemia was haematocrit (Hct). An Hct percentage of > 50% at month 3 (post-treatment initiation) constituted a positive diagnosis for polycythaemia. For the rise in total testosterone (TT) and Hct, the variance was used as documented between pre- and post-treatment initiation. Results: The prevalence of polycythaemia was 34%. A statistically significant increase in both TT and Hct was observed. The Cohen's d effect size was 0.68 and 0.73, respectively, for TT and Hct. Conclusion: Depot-testosterone undecanoate parenteral formulation induces polycythaemia in LOH patients, where the rise in TT demonstrates the effectiveness of therapy.
{"title":"Acute changes in haematocrit leading to polycythaemia in late-onset hypogonadism patients that receive testosterone replacement therapy: a South African study","authors":"J. D. Du Plessis, H. L. Bester, M. Julyan, M. Cockeran","doi":"10.1080/16089677.2018.1553344","DOIUrl":"https://doi.org/10.1080/16089677.2018.1553344","url":null,"abstract":"Background: According to the literature, parenteral testosterone replacement therapy (TRT)-induced polycythaemia is associated with cardiovascular events. No or minimal data exist for the prevalence of TRT-induced polycythaemia in late-onset hypogonadism (LOH) patients from South Africa. Polycythaemia is the side effect most frequently associated with parental TRT formulations. Design: This was a quantitative, observational, descriptive, retrospective study. Setting: The study setting was a private practice male clinic in Emalahleni. Subject: An all-inclusive sampling method was used. Outcome measures: The main outcome measure for polycythaemia was haematocrit (Hct). An Hct percentage of > 50% at month 3 (post-treatment initiation) constituted a positive diagnosis for polycythaemia. For the rise in total testosterone (TT) and Hct, the variance was used as documented between pre- and post-treatment initiation. Results: The prevalence of polycythaemia was 34%. A statistically significant increase in both TT and Hct was observed. The Cohen's d effect size was 0.68 and 0.73, respectively, for TT and Hct. Conclusion: Depot-testosterone undecanoate parenteral formulation induces polycythaemia in LOH patients, where the rise in TT demonstrates the effectiveness of therapy.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"4 1","pages":"37 - 40"},"PeriodicalIF":0.5,"publicationDate":"2019-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87981489","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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