Pub Date : 2019-05-04DOI: 10.1080/16089677.2019.1608053
Hilton Kaplan, A. Amod, F. Van Zyl, Jeevren Reddy, A. van Tonder, E. Tsymbal, A. McMaster
Objectives: Management of diabetes is a balancing act of preventing a state of hyperglycaemia while avoiding episodes of hypoglycaemia. Limited information is currently available on the incidence of hypoglycaemia in South African people diagnosed with diabetes. Data regarding the management of diabetes and incidence of hypoglycaemia in the South African population was collected as part of Wave 7 of the International Diabetes Management Practices Study (IDMPS). Design and methods: During this observational study the first 10 adult individuals with type 2 diabetes and the first five adult individuals with type 1 diabetes presenting to a study site during the two-week study period were enrolled. Setting: Patients were enrolled from the private healthcare sector in South Africa only. Subjects: A total of 445 individuals (49 diagnosed with T1D, 396 diagnosed with T2D) were included. Outcome measures: Glycated haemoglobin and hypoglycaemia data were recorded for each patient. Results: Of the patients who reported experiencing hypoglycaemia, 48.6% (17/35) among T1D individuals and 67.8% (40/71) among T2D individuals experienced hypoglycaemia over a four-week period. Furthermore, in patients who discontinued insulin treatment (n = 11), fear of hypoglycaemia was reported to influence adherence to insulin treatment by 27.3% in T1D and T2D individuals. Of the 148 patients not achieving their HbA1c target, 23.0% reported fear of hypoglycaemia as a reason. Conclusions: This report demonstrates the need to address hypoglycaemia and fear of hypoglycaemia in the South African diabetes population.
{"title":"Incidence of hypoglycaemia in the South African population with diabetes: results from the IDMPS Wave 7 study","authors":"Hilton Kaplan, A. Amod, F. Van Zyl, Jeevren Reddy, A. van Tonder, E. Tsymbal, A. McMaster","doi":"10.1080/16089677.2019.1608053","DOIUrl":"https://doi.org/10.1080/16089677.2019.1608053","url":null,"abstract":"Objectives: Management of diabetes is a balancing act of preventing a state of hyperglycaemia while avoiding episodes of hypoglycaemia. Limited information is currently available on the incidence of hypoglycaemia in South African people diagnosed with diabetes. Data regarding the management of diabetes and incidence of hypoglycaemia in the South African population was collected as part of Wave 7 of the International Diabetes Management Practices Study (IDMPS). Design and methods: During this observational study the first 10 adult individuals with type 2 diabetes and the first five adult individuals with type 1 diabetes presenting to a study site during the two-week study period were enrolled. Setting: Patients were enrolled from the private healthcare sector in South Africa only. Subjects: A total of 445 individuals (49 diagnosed with T1D, 396 diagnosed with T2D) were included. Outcome measures: Glycated haemoglobin and hypoglycaemia data were recorded for each patient. Results: Of the patients who reported experiencing hypoglycaemia, 48.6% (17/35) among T1D individuals and 67.8% (40/71) among T2D individuals experienced hypoglycaemia over a four-week period. Furthermore, in patients who discontinued insulin treatment (n = 11), fear of hypoglycaemia was reported to influence adherence to insulin treatment by 27.3% in T1D and T2D individuals. Of the 148 patients not achieving their HbA1c target, 23.0% reported fear of hypoglycaemia as a reason. Conclusions: This report demonstrates the need to address hypoglycaemia and fear of hypoglycaemia in the South African diabetes population.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"59 1","pages":"58 - 64"},"PeriodicalIF":0.5,"publicationDate":"2019-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74347929","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: 10.1080/16089677.2019.1608054
Tshidi Thaane, A. Motala, A. Mckune
Physical inactivity is a major contributor to overweight/obesity and associated disorders including cardiovascular diseases (CVDs), diabetes, and insulin resistance (IR). Intensive lifestyle modification (ILM) is recommended as first-line treatment for obese individuals at risk for IR. Exercise is considered to be a critical component of ILM. This narrative review discusses the role of exercise in the management of IR in overweight/obesity. PubMed and Google Scholar were searched for articles published between January 1990 and January 2019 that examined mechanisms behind the effects of exercise on IR states associated with overweight/obesity. Studies examining and/comparing effects of exercise mode, volume and/intensity on IR were also retrieved. Medical Subject Headings (MeSH) used were ‘metabolic diseases’ OR ‘chronic diseases’ AND ‘exercise’ and their related terms. Text words used in conjunction with the MeSH terms were ‘aerobic training/exercise’ OR ‘resistance training/exercise’ OR ‘high intensity interval training/exercise’, OR ‘low volume training/exercise’. Reference lists of retrieved articles were also searched for appropriate studies. Aerobic exercise training (AET) and resistance exercise training (RET) appear to produce comparable effects on obesity-induced IR states. RET, however, appears to be associated with greater improvements in glucose disposal in skeletal muscle, which is usually the primary site for IR. This is partly attributed to greater increases in key proteins involved in the insulin signalling pathway including protein content of glucose transporter 4 (GLUT-4) following RET. A study on individuals with impaired glucose tolerance (IGT) showed that RET improved glucose disposal by 23%, primarily due to a 27% increase in non-oxidative glucose metabolism, suggesting that RET may delay the manifestation of diabetes in patients with IGT. Furthermore, studies reviewed here show that components of exercise including the mode, volume and intensity of exercise training are an integral element in exercise prescription and must be recommended in accordance with the desired outcome.
{"title":"Lifestyle modification in the management of insulin resistance states in overweight/obesity: the role of exercise training","authors":"Tshidi Thaane, A. Motala, A. Mckune","doi":"10.1080/16089677.2019.1608054","DOIUrl":"https://doi.org/10.1080/16089677.2019.1608054","url":null,"abstract":"Physical inactivity is a major contributor to overweight/obesity and associated disorders including cardiovascular diseases (CVDs), diabetes, and insulin resistance (IR). Intensive lifestyle modification (ILM) is recommended as first-line treatment for obese individuals at risk for IR. Exercise is considered to be a critical component of ILM. This narrative review discusses the role of exercise in the management of IR in overweight/obesity. PubMed and Google Scholar were searched for articles published between January 1990 and January 2019 that examined mechanisms behind the effects of exercise on IR states associated with overweight/obesity. Studies examining and/comparing effects of exercise mode, volume and/intensity on IR were also retrieved. Medical Subject Headings (MeSH) used were ‘metabolic diseases’ OR ‘chronic diseases’ AND ‘exercise’ and their related terms. Text words used in conjunction with the MeSH terms were ‘aerobic training/exercise’ OR ‘resistance training/exercise’ OR ‘high intensity interval training/exercise’, OR ‘low volume training/exercise’. Reference lists of retrieved articles were also searched for appropriate studies. Aerobic exercise training (AET) and resistance exercise training (RET) appear to produce comparable effects on obesity-induced IR states. RET, however, appears to be associated with greater improvements in glucose disposal in skeletal muscle, which is usually the primary site for IR. This is partly attributed to greater increases in key proteins involved in the insulin signalling pathway including protein content of glucose transporter 4 (GLUT-4) following RET. A study on individuals with impaired glucose tolerance (IGT) showed that RET improved glucose disposal by 23%, primarily due to a 27% increase in non-oxidative glucose metabolism, suggesting that RET may delay the manifestation of diabetes in patients with IGT. Furthermore, studies reviewed here show that components of exercise including the mode, volume and intensity of exercise training are an integral element in exercise prescription and must be recommended in accordance with the desired outcome.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"22 1","pages":"65 - 69"},"PeriodicalIF":0.5,"publicationDate":"2019-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84143779","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 : 2019-01-02DOI: 10.1080/16089677.2018.1553378
P. Manickum, S. Ramklass, T. Madiba
Introduction: Lower limb amputation (LLA) due to diabetes mellitus (DM) is a growing epidemic worldwide. Objectives: To determine the prevalence of LLAs at Addington Hospital from 2010 to 2014 and to explore the rehabilitation outcomes of amputees. Design and setting: A retrospective chart review of LLAs below the knee was undertaken at Addington Hospital. Subjects: Patients who underwent LLAs were filtered from theatre registers. Methodology: A data collection sheet included demographic profile, diabetic status, level of amputation, limb orientation and rehabilitation outcomes. Outcome measures: Study endpoints were prevalence, compliance and rehabilitation outcomes. Results: From 2010 to 2014, 767 LLAs in 667 patients were identified. Mean age was 59 (13.2) years. M:F ratio was 1:1. Of these, 354 patients (53.1%) had DM. Level of amputation was below-knee 57%, trans-metatarsal 12.4% and toectomy 30.6%. Only 116 patients (17.4%) were referred for physiotherapy, of whom 95 (81.9%) attended. Median frequency of physiotherapy visits was five and four for diabetic and non-diabetic amputees respectively. Mobility after rehabilitation was with a walking frame (49%), crutches (32%), prosthesis and crutches (8%), wheelchair-bound (9%) and independent gait (1%). Conclusion: Over half of amputations were associated with DM. The gender incidence was similar. Referral to physiotherapy and adherence thereto was poor.
{"title":"A five-year audit of lower limb amputations below the knee and rehabilitation outcomes: the Durban experience","authors":"P. Manickum, S. Ramklass, T. Madiba","doi":"10.1080/16089677.2018.1553378","DOIUrl":"https://doi.org/10.1080/16089677.2018.1553378","url":null,"abstract":"Introduction: Lower limb amputation (LLA) due to diabetes mellitus (DM) is a growing epidemic worldwide. Objectives: To determine the prevalence of LLAs at Addington Hospital from 2010 to 2014 and to explore the rehabilitation outcomes of amputees. Design and setting: A retrospective chart review of LLAs below the knee was undertaken at Addington Hospital. Subjects: Patients who underwent LLAs were filtered from theatre registers. Methodology: A data collection sheet included demographic profile, diabetic status, level of amputation, limb orientation and rehabilitation outcomes. Outcome measures: Study endpoints were prevalence, compliance and rehabilitation outcomes. Results: From 2010 to 2014, 767 LLAs in 667 patients were identified. Mean age was 59 (13.2) years. M:F ratio was 1:1. Of these, 354 patients (53.1%) had DM. Level of amputation was below-knee 57%, trans-metatarsal 12.4% and toectomy 30.6%. Only 116 patients (17.4%) were referred for physiotherapy, of whom 95 (81.9%) attended. Median frequency of physiotherapy visits was five and four for diabetic and non-diabetic amputees respectively. Mobility after rehabilitation was with a walking frame (49%), crutches (32%), prosthesis and crutches (8%), wheelchair-bound (9%) and independent gait (1%). Conclusion: Over half of amputations were associated with DM. The gender incidence was similar. Referral to physiotherapy and adherence thereto was poor.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"37 1","pages":"41 - 45"},"PeriodicalIF":0.5,"publicationDate":"2019-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81394850","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 : 2019-01-02DOI: 10.1080/16089677.2018.1550956
P. Somasundram, Pillay Davashni, S. Deepak, Pillay Romashan
Background: Diabetes-related complications in the form of lower limb amputations (LLA) remain a major concern globally in the form of both human suffering and increased fiscal burden. Studies conducted in developed countries have demonstrated that the burden of diabetes-related amputations is on the decrease. These decreasing trends in developed countries provide an insight (a surrogate marker) into overall diabetes control achieved in these countries. Similar data from studies conducted in South Africa and Africa itself are scarce. Methods: The data collected by Department of Health Information Systems (DHIS) for all patients with diabetes seen at public healthcare facilities within KwaZulu-Natal from 2013 to 2017 inclusive were assessed. The DHIS data element used for this study was ‘diabetes-related amputations’. The location of the hospital was used to classify them as urban or rural. Data relating to type of housing, access to piped water, electricity and sanitation were obtained from the South African mid-year population estimates from 2016. Results: This study demonstrated that a strong positive correlation existed between amputation rate and the increasing years of the study (r = 0.70). The trend in diabetes-related LLA in 5 of the 11 districts (45.45%) had an upward slope. The incidence of LLA was on an upward trend in urban compared with rural areas (slope 71.90 ± 26.75 vs 5.20 ± 10.04, respectively). Positive slopes for LLA were noted in both regional and tertiary KwaZulu-Natal hospitals (48.00 ± 44.67 and 19.80 ± 36.38 respectively). The prevalence of diabetes-related LLA was associated with poor accessibility to adequate housing, piped water, electricity and sanitation. Each of these four variables independently had a significant effect on the prevalence of LLA within all districts in KwaZulu-Natal. Conclusion: Diabetes-related LLA serves as a surrogate marker for overall diabetes control within a country. This study has shown that there was a strong positive correlation between amputation rates and time within KwaZulu-Natal. This finding serves as an indicator that only sub-optimal diabetes control is still being achieved.
{"title":"Diabetes-related amputations in the public healthcare sector in KwaZulu-Natal: a five-year perspective. Are we winning?","authors":"P. Somasundram, Pillay Davashni, S. Deepak, Pillay Romashan","doi":"10.1080/16089677.2018.1550956","DOIUrl":"https://doi.org/10.1080/16089677.2018.1550956","url":null,"abstract":"Background: Diabetes-related complications in the form of lower limb amputations (LLA) remain a major concern globally in the form of both human suffering and increased fiscal burden. Studies conducted in developed countries have demonstrated that the burden of diabetes-related amputations is on the decrease. These decreasing trends in developed countries provide an insight (a surrogate marker) into overall diabetes control achieved in these countries. Similar data from studies conducted in South Africa and Africa itself are scarce. Methods: The data collected by Department of Health Information Systems (DHIS) for all patients with diabetes seen at public healthcare facilities within KwaZulu-Natal from 2013 to 2017 inclusive were assessed. The DHIS data element used for this study was ‘diabetes-related amputations’. The location of the hospital was used to classify them as urban or rural. Data relating to type of housing, access to piped water, electricity and sanitation were obtained from the South African mid-year population estimates from 2016. Results: This study demonstrated that a strong positive correlation existed between amputation rate and the increasing years of the study (r = 0.70). The trend in diabetes-related LLA in 5 of the 11 districts (45.45%) had an upward slope. The incidence of LLA was on an upward trend in urban compared with rural areas (slope 71.90 ± 26.75 vs 5.20 ± 10.04, respectively). Positive slopes for LLA were noted in both regional and tertiary KwaZulu-Natal hospitals (48.00 ± 44.67 and 19.80 ± 36.38 respectively). The prevalence of diabetes-related LLA was associated with poor accessibility to adequate housing, piped water, electricity and sanitation. Each of these four variables independently had a significant effect on the prevalence of LLA within all districts in KwaZulu-Natal. Conclusion: Diabetes-related LLA serves as a surrogate marker for overall diabetes control within a country. This study has shown that there was a strong positive correlation between amputation rates and time within KwaZulu-Natal. This finding serves as an indicator that only sub-optimal diabetes control is still being achieved.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"84 1","pages":"32 - 36"},"PeriodicalIF":0.5,"publicationDate":"2019-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79347217","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 : 2018-12-11DOI: 10.1080/16089677.2018.1546365
I. Paruk, F. Pirie, A. Motala
The presentation of primary hyperparathyroidism (PHPT) in most Western countries has evolved from the classic description of ‘stones, bones, and groans’ to becoming increasingly asymptomatic as a result of more frequent serum calcium screening. However, many developing countries are still reporting predominantly symptomatic PHPT with the classic complications of skeletal disease and nephrolithiasis still being quite common. Furthermore, the exact prevalence of PHPT in children is not known but it is thought to be uncommon and the clinical presentation and outcomes in this subgroup of patients are not well described in the literature. Two cases of PHPT occurring in adolescent boys are reported. Both cases initially presented with chronic bone pain involving the lower limbs and had a long delay before the diagnosis of PHPT was confirmed. They developed progressive deformities of the lower limbs, which resembled rickets clinically. Radiological features were also suggestive of rickets. However, biochemistry confirmed parathyroid hormone mediated hypercalcaemia in both cases and after parathyroid surgery a parathyroid adenoma was confirmed histologically as the aetiology of hypercalcaemia. Therefore, PHPT occurring in adolescence may have a clinical presentation almost identical to that of rickets. All patients presenting with skeletal deformities including a rickets phenotype must have serum calcium and phosphate levels measured as part of the diagnostic workup.
{"title":"Rickets mimicker: a report of two cases of primary hyperparathyroidism in adolescence","authors":"I. Paruk, F. Pirie, A. Motala","doi":"10.1080/16089677.2018.1546365","DOIUrl":"https://doi.org/10.1080/16089677.2018.1546365","url":null,"abstract":"The presentation of primary hyperparathyroidism (PHPT) in most Western countries has evolved from the classic description of ‘stones, bones, and groans’ to becoming increasingly asymptomatic as a result of more frequent serum calcium screening. However, many developing countries are still reporting predominantly symptomatic PHPT with the classic complications of skeletal disease and nephrolithiasis still being quite common. Furthermore, the exact prevalence of PHPT in children is not known but it is thought to be uncommon and the clinical presentation and outcomes in this subgroup of patients are not well described in the literature. Two cases of PHPT occurring in adolescent boys are reported. Both cases initially presented with chronic bone pain involving the lower limbs and had a long delay before the diagnosis of PHPT was confirmed. They developed progressive deformities of the lower limbs, which resembled rickets clinically. Radiological features were also suggestive of rickets. However, biochemistry confirmed parathyroid hormone mediated hypercalcaemia in both cases and after parathyroid surgery a parathyroid adenoma was confirmed histologically as the aetiology of hypercalcaemia. Therefore, PHPT occurring in adolescence may have a clinical presentation almost identical to that of rickets. All patients presenting with skeletal deformities including a rickets phenotype must have serum calcium and phosphate levels measured as part of the diagnostic workup.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"116 1","pages":"23 - 27"},"PeriodicalIF":0.5,"publicationDate":"2018-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74793147","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 : 2018-11-26DOI: 10.1080/16089677.2018.1541669
A. Ale, OO Odusan, TO Afe, OL Adeyemo, A. Ogbera
Background: Hyperthyroidism is a common endocrine disorder with multi-systemic effects, the least reported of which is bone loss and fractures. Objective: The aim was to evaluate the risk factors, pattern and frequency of bone fractures among Nigerians with hyperthyroidism. Methodology: An analytical study was undertaken of 40 patients with hyperthyroidism aged between 21 and 50 years. They were seen at the outpatient Endocrine, Diabetic and Metabolism (EDM) clinic of Lagos State University Teaching Hospital (LASUTH). Using an interviewer-administered questionnaire, information on sociodemographics, medical history, clinical and biochemical parameters and dual-energy X-ray absorptiometry (DXA) scan was obtained. Risk of fracture was assessed using WHO and ISCD risk calculators. During statistical analysis, quantitative and qualitative data were expressed as mean (SD) and percentages. Results: In all, 40 patients with hyperthyroidism were studied with a mean age of 36.16 (8.43) years. There were 32 females (80%, female:male ratio 4:1) and mean body mass index was 24.14 (4.3) kg/m. Hyperthyroidism was defined by Waynes’ scoring index greater than 19 and confirmed by elevated thyroid hormones (FT4 39.44 (24.11) (pmol/l), FT3 12.13 (7.83) (pmol/l)) and suppressed TSH 0.26 (0.03) (u/U/ml). Increased bone turnover was documented by elevated bone formation markers (osteocalcin 45.7 (19.9) ng/ml and alkaline phosphatase 221.1 (143.46 IU/l)), bone resorption markers (24-hour calcium excretion 590.95 (506.1) mg/day). The mean BMD T- and Z-scores were reduced –2.0 (1.2). Bone loss was observed in 31 (72.5%) hyperthyroid subjects, but only three (7.5%) had fractures due to minor trauma. Conclusion: Bone fractures may not be uncommon in hyperthyroidism. Early screening for bone diseases should be encouraged to improve treatment outcome.
{"title":"Bone fractures among adult Nigerians with hyperthyroidism: risk factors, pattern and frequency","authors":"A. Ale, OO Odusan, TO Afe, OL Adeyemo, A. Ogbera","doi":"10.1080/16089677.2018.1541669","DOIUrl":"https://doi.org/10.1080/16089677.2018.1541669","url":null,"abstract":"Background: Hyperthyroidism is a common endocrine disorder with multi-systemic effects, the least reported of which is bone loss and fractures. Objective: The aim was to evaluate the risk factors, pattern and frequency of bone fractures among Nigerians with hyperthyroidism. Methodology: An analytical study was undertaken of 40 patients with hyperthyroidism aged between 21 and 50 years. They were seen at the outpatient Endocrine, Diabetic and Metabolism (EDM) clinic of Lagos State University Teaching Hospital (LASUTH). Using an interviewer-administered questionnaire, information on sociodemographics, medical history, clinical and biochemical parameters and dual-energy X-ray absorptiometry (DXA) scan was obtained. Risk of fracture was assessed using WHO and ISCD risk calculators. During statistical analysis, quantitative and qualitative data were expressed as mean (SD) and percentages. Results: In all, 40 patients with hyperthyroidism were studied with a mean age of 36.16 (8.43) years. There were 32 females (80%, female:male ratio 4:1) and mean body mass index was 24.14 (4.3) kg/m. Hyperthyroidism was defined by Waynes’ scoring index greater than 19 and confirmed by elevated thyroid hormones (FT4 39.44 (24.11) (pmol/l), FT3 12.13 (7.83) (pmol/l)) and suppressed TSH 0.26 (0.03) (u/U/ml). Increased bone turnover was documented by elevated bone formation markers (osteocalcin 45.7 (19.9) ng/ml and alkaline phosphatase 221.1 (143.46 IU/l)), bone resorption markers (24-hour calcium excretion 590.95 (506.1) mg/day). The mean BMD T- and Z-scores were reduced –2.0 (1.2). Bone loss was observed in 31 (72.5%) hyperthyroid subjects, but only three (7.5%) had fractures due to minor trauma. Conclusion: Bone fractures may not be uncommon in hyperthyroidism. Early screening for bone diseases should be encouraged to improve treatment outcome.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"9 1","pages":"28 - 31"},"PeriodicalIF":0.5,"publicationDate":"2018-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74859379","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 : 2018-11-25DOI: 10.1080/16089677.2018.1541668
S. Teka, S. Kinde, Gobena Dedefo, K. Mudi, Getahun Tarekegn
Background: A high prevalence of hypogonadism among men with type 2 diabetes mellitus (T2DM) has been reported worldwide. This in turn creates a substantial public health burden in terms of inadequate sexual function and potential infertility. However, the status of this health problem is not well established in Ethiopia. Therefore, this study was aimed to assess hypogonadism and its associated risk factors among men with T2DM. Methods: This cross-sectional study was conducted at Tikur Anbesa Specialized Teaching Hospital in Addis Ababa, Ethiopia from February to May 2017 on 115 male patients with T2DM aged 40–80 years. Symptoms of hypogonadism were assessed using the Androgen Deficiency in Aging Men (ADAM) questionnaire. Total testosterone (TT), luteinising hormone (LH) and follicle stimulating hormone (FSH), fasting blood glucose (FBG) and lipid profiles were measured at the clinical chemistry laboratory of Ethiopian Public Health Institute. Hypogonadism was defined as the presence of clinical symptoms and low TT [TT < 12.1 nmol/l] according to International Society for the Study of the Aging Male. Results: Of the total 115 study subjects, hypogonadism was seen in 23.5%, of whom 74.1% and 25.9% had secondary and primary hypogonadism, respectively. TT showed a significant negative correlation with waist circumference (WC) (r = −0.465, p < 0.001), BMI (r = −0.363; p < 0.001), FBG (rho = −0.328, p < 0.001) and TG (rho = −0.357, p < 0.001) respectively but a significant positive correlation with HDL-C (r = 0.339, p < 0.001)]. WC and FBG were independently associated with hypogonadism. Conclusion: According to our study, visceral obesity and hyperglycaemia were found to be independent risk factors associated with hypogonadism.
背景:据报道，在全球范围内，男性2型糖尿病(T2DM)患者性腺功能减退的患病率很高。这反过来又在性功能不足和潜在不孕症方面造成了巨大的公共卫生负担。然而，这一健康问题在埃塞俄比亚的地位尚未得到很好的确定。因此，本研究旨在评估男性2型糖尿病患者的性腺功能减退及其相关危险因素。方法:本横断面研究于2017年2月至5月在埃塞俄比亚亚的斯亚贝巴的Tikur Anbesa专科教学医院对115例40-80岁男性2型糖尿病患者进行了研究。使用老年男性雄激素缺乏(ADAM)问卷评估性腺功能减退的症状。总睾酮(TT)、促黄体生成素(LH)和促卵泡激素(FSH)、空腹血糖(FBG)和脂质谱在埃塞俄比亚公共卫生研究所临床化学实验室测量。国际老年男性研究学会将性腺功能减退定义为有临床症状且TT < 12.1 nmol/l。结果:115例研究对象中性腺功能减退者占23.5%，其中继发性性腺功能减退者占74.1%，原发性性腺功能减退者占25.9%。TT与腰围(WC) (r = - 0.465, p < 0.001)、BMI (r = - 0.363;p < 0.001)、FBG (rho = - 0.328, p < 0.001)、TG (rho = - 0.357, p < 0.001)与HDL-C呈显著正相关(r = 0.339, p < 0.001)。WC和FBG与性腺功能减退独立相关。结论:根据我们的研究，发现内脏型肥胖和高血糖是性腺功能减退的独立危险因素。
{"title":"Hypogonadism and associated risk factors in male patients with type 2 diabetes mellitus attending the diabetic clinic of Tikur Anbessa Specialized Teaching Hospital, Addis Ababa, Ethiopia","authors":"S. Teka, S. Kinde, Gobena Dedefo, K. Mudi, Getahun Tarekegn","doi":"10.1080/16089677.2018.1541668","DOIUrl":"https://doi.org/10.1080/16089677.2018.1541668","url":null,"abstract":"Background: A high prevalence of hypogonadism among men with type 2 diabetes mellitus (T2DM) has been reported worldwide. This in turn creates a substantial public health burden in terms of inadequate sexual function and potential infertility. However, the status of this health problem is not well established in Ethiopia. Therefore, this study was aimed to assess hypogonadism and its associated risk factors among men with T2DM. Methods: This cross-sectional study was conducted at Tikur Anbesa Specialized Teaching Hospital in Addis Ababa, Ethiopia from February to May 2017 on 115 male patients with T2DM aged 40–80 years. Symptoms of hypogonadism were assessed using the Androgen Deficiency in Aging Men (ADAM) questionnaire. Total testosterone (TT), luteinising hormone (LH) and follicle stimulating hormone (FSH), fasting blood glucose (FBG) and lipid profiles were measured at the clinical chemistry laboratory of Ethiopian Public Health Institute. Hypogonadism was defined as the presence of clinical symptoms and low TT [TT < 12.1 nmol/l] according to International Society for the Study of the Aging Male. Results: Of the total 115 study subjects, hypogonadism was seen in 23.5%, of whom 74.1% and 25.9% had secondary and primary hypogonadism, respectively. TT showed a significant negative correlation with waist circumference (WC) (r = −0.465, p < 0.001), BMI (r = −0.363; p < 0.001), FBG (rho = −0.328, p < 0.001) and TG (rho = −0.357, p < 0.001) respectively but a significant positive correlation with HDL-C (r = 0.339, p < 0.001)]. WC and FBG were independently associated with hypogonadism. Conclusion: According to our study, visceral obesity and hyperglycaemia were found to be independent risk factors associated with hypogonadism.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"17 1","pages":"16 - 22"},"PeriodicalIF":0.5,"publicationDate":"2018-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78250311","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 : 2018-11-22DOI: 10.1080/16089677.2018.1541211
Jane W. Muchiri, G. Gericke, P. Rheeder
Objective: To inform the adaptation of an intervention from a primary healthcare setting to a tertiary setting, the dietary and related self-management challenges and education programme preferences of adults with type 2 diabetes (T2DM) were explored. Setting: A study was undertaken in a tertiary teaching hospital in Gauteng Province, South Africa. Methods: A qualitative approach was employed. Data were collected via focus-group discussions and open-ended self-administered questionnaires from a convenient purposive sample of T2DM patients (n = 28; 40–70 years) and health professionals (n = 10) respectively. Data were analysed using a thematic framework method. Results: Participants revealed diabetes-related knowledge deficits and struggle with adhering to diet, exercise, medication and appointment keeping as problems affecting patients. They also perceived multiple barriers to effective self-management (financial constraints, unsupportive social and physical environments and personal factors). Patients perceived the challenges to greatly impact on their quality of life and consequently the motivation to self-care appropriately. Participants desired an education programme in the form of monthly group meetings with approaches to enhance learning (e.g. use of examples from peers and the provision of education materials). Strategies for motivating and sustaining programme participation (e.g. testimonials from successful participants) were perceived as necessary. Involving family was seen as a key support for positive behaviour change. Conclusion: In adapting the intervention, the participants’ preferences for education need to be considered and the unique challenges addressed. In particular, strategies for enhancing the patients’ motivation and the self-efficacy to effectively self-manage are essential.
{"title":"Stakeholders’ perceptions of dietary and related self-management challenges and education programme preferences for type 2 diabetes adults","authors":"Jane W. Muchiri, G. Gericke, P. Rheeder","doi":"10.1080/16089677.2018.1541211","DOIUrl":"https://doi.org/10.1080/16089677.2018.1541211","url":null,"abstract":"Objective: To inform the adaptation of an intervention from a primary healthcare setting to a tertiary setting, the dietary and related self-management challenges and education programme preferences of adults with type 2 diabetes (T2DM) were explored. Setting: A study was undertaken in a tertiary teaching hospital in Gauteng Province, South Africa. Methods: A qualitative approach was employed. Data were collected via focus-group discussions and open-ended self-administered questionnaires from a convenient purposive sample of T2DM patients (n = 28; 40–70 years) and health professionals (n = 10) respectively. Data were analysed using a thematic framework method. Results: Participants revealed diabetes-related knowledge deficits and struggle with adhering to diet, exercise, medication and appointment keeping as problems affecting patients. They also perceived multiple barriers to effective self-management (financial constraints, unsupportive social and physical environments and personal factors). Patients perceived the challenges to greatly impact on their quality of life and consequently the motivation to self-care appropriately. Participants desired an education programme in the form of monthly group meetings with approaches to enhance learning (e.g. use of examples from peers and the provision of education materials). Strategies for motivating and sustaining programme participation (e.g. testimonials from successful participants) were perceived as necessary. Involving family was seen as a key support for positive behaviour change. Conclusion: In adapting the intervention, the participants’ preferences for education need to be considered and the unique challenges addressed. In particular, strategies for enhancing the patients’ motivation and the self-efficacy to effectively self-manage are essential.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"65 1","pages":"1 - 9"},"PeriodicalIF":0.5,"publicationDate":"2018-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75912918","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 : 2018-11-13DOI: 10.1080/16089677.2018.1534360
P. Chutterpaul, F. Paruk, B. Cassim
Background: Vitamin D plays an important role in many physiological and pathological processes, including bone metabolism. Vitamin D deficiency is common worldwide, but there are few data in older South Africans. Objectives: This study aimed to determine vitamin D status in older adults with and without hip fractures and the effect of demography, body mass index (BMI) and functional status on vitamin D levels. Methodology: In a secondary analysis, the association between 25(OH) vitamin D levels, obtained from 327 subjects (151 with fractures and 176 controls), and age, gender, ethnicity, BMI and functional status, was explored using Student’s t-test, a chi-square test, regression analysis and ANOVA. Results: In the total cohort, vitamin D deficiency and insufficiency was present in 27% and 38%, respectively. While vitamin D levels decreased with age, this was not significant (p = 0.082). There was a significant association between vitamin D and BMI (p = 0.023), the physical maintenance scale (p = 0.002) and independent activities of daily living (p = 0.001). Mean vitamin D levels in fracture subjects was significantly lower than controls (39.4 ± 23.1 nmol/l vs. 50.1 ± 23.3 nmol/l, p = 0.00) and vitamin D deficiency and/or insufficiency was significantly more common in the fracture group compared with controls (75.5% vs. 56.8%, p = 0.00). There was no association with gender or ethnicity. Conclusions: Vitamin D deficiency is common in this population, especially in those with hip fractures. Contrary to other studies, increasing BMI was associated with higher vitamin D levels. This suggests that poor health status as indicated by a low BMI and poorer functional status is associated with lower vitamin D levels. The high prevalence of vitamin D deficiency and/or insufficiency in the cohort strongly argues for universal vitamin D supplementation in older adults, especially those at risk for osteoporotic fractures.
背景:维生素D在包括骨代谢在内的许多生理和病理过程中起重要作用。维生素D缺乏症在世界范围内都很常见，但在南非老年人中很少有相关数据。目的:本研究旨在确定有和没有髋部骨折的老年人的维生素D水平，以及人口统计学、体重指数(BMI)和功能状态对维生素D水平的影响。方法:在二次分析中，采用学生t检验、卡方检验、回归分析和方差分析，探讨了327名受试者(151名骨折患者和176名对照组)25(OH)维生素D水平与年龄、性别、种族、BMI和功能状态之间的关系。结果:在整个队列中，分别有27%和38%的人存在维生素D缺乏和不足。虽然维生素D水平随着年龄的增长而下降，但这并不显著(p = 0.082)。维生素D与BMI (p = 0.023)、体力维持量表(p = 0.002)和独立日常生活活动(p = 0.001)存在显著相关性。骨折组的平均维生素D水平明显低于对照组(39.4±23.1 nmol/l vs. 50.1±23.3 nmol/l, p = 0.00)，骨折组维生素D缺乏和/或不足的发生率明显高于对照组(75.5% vs. 56.8%， p = 0.00)。这与性别或种族无关。结论:维生素D缺乏在这一人群中很常见，尤其是髋部骨折患者。与其他研究相反，体重指数的增加与维生素D水平的升高有关。这表明较低的身体质量指数和较差的身体机能与较低的维生素D水平有关。该队列中维生素D缺乏和/或不足的高发率有力地证明了老年人普遍补充维生素D的必要性，特别是那些有骨质疏松性骨折风险的老年人。
{"title":"Prevalence of vitamin D deficiency in older South Africans with and without hip fractures and the effects of age, body weight, ethnicity and functional status","authors":"P. Chutterpaul, F. Paruk, B. Cassim","doi":"10.1080/16089677.2018.1534360","DOIUrl":"https://doi.org/10.1080/16089677.2018.1534360","url":null,"abstract":"Background: Vitamin D plays an important role in many physiological and pathological processes, including bone metabolism. Vitamin D deficiency is common worldwide, but there are few data in older South Africans. Objectives: This study aimed to determine vitamin D status in older adults with and without hip fractures and the effect of demography, body mass index (BMI) and functional status on vitamin D levels. Methodology: In a secondary analysis, the association between 25(OH) vitamin D levels, obtained from 327 subjects (151 with fractures and 176 controls), and age, gender, ethnicity, BMI and functional status, was explored using Student’s t-test, a chi-square test, regression analysis and ANOVA. Results: In the total cohort, vitamin D deficiency and insufficiency was present in 27% and 38%, respectively. While vitamin D levels decreased with age, this was not significant (p = 0.082). There was a significant association between vitamin D and BMI (p = 0.023), the physical maintenance scale (p = 0.002) and independent activities of daily living (p = 0.001). Mean vitamin D levels in fracture subjects was significantly lower than controls (39.4 ± 23.1 nmol/l vs. 50.1 ± 23.3 nmol/l, p = 0.00) and vitamin D deficiency and/or insufficiency was significantly more common in the fracture group compared with controls (75.5% vs. 56.8%, p = 0.00). There was no association with gender or ethnicity. Conclusions: Vitamin D deficiency is common in this population, especially in those with hip fractures. Contrary to other studies, increasing BMI was associated with higher vitamin D levels. This suggests that poor health status as indicated by a low BMI and poorer functional status is associated with lower vitamin D levels. The high prevalence of vitamin D deficiency and/or insufficiency in the cohort strongly argues for universal vitamin D supplementation in older adults, especially those at risk for osteoporotic fractures.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"174 1","pages":"10 - 15"},"PeriodicalIF":0.5,"publicationDate":"2018-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76920842","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 : 2018-09-02DOI: 10.1080/16089677.2018.1515164
L. Distiller
Continuous glucose monitoring (CGM) is being used increasingly both in patients on insulin pumps (CSII) and more recently in those on multiple injection regimens (MIR). This review lists the CGM devices available in South Africa and explores the literature supporting the use of CGM as a primary modality for monitoring blood glucose in those with diabetes on MIR. In particular, the role of CGM as a modality for improving glycaemic control and reducing hypoglycaemia is explored. The identification of appropriate patients, the possible barriers to the institution of CGM and the role of CGM in the future of diabetes care is discussed.
{"title":"Should all patients on insulin be using continuous glucose monitoring?","authors":"L. Distiller","doi":"10.1080/16089677.2018.1515164","DOIUrl":"https://doi.org/10.1080/16089677.2018.1515164","url":null,"abstract":"Continuous glucose monitoring (CGM) is being used increasingly both in patients on insulin pumps (CSII) and more recently in those on multiple injection regimens (MIR). This review lists the CGM devices available in South Africa and explores the literature supporting the use of CGM as a primary modality for monitoring blood glucose in those with diabetes on MIR. In particular, the role of CGM as a modality for improving glycaemic control and reducing hypoglycaemia is explored. The identification of appropriate patients, the possible barriers to the institution of CGM and the role of CGM in the future of diabetes care is discussed.","PeriodicalId":43919,"journal":{"name":"Journal of Endocrinology Metabolism and Diabetes of South Africa","volume":"11 1","pages":"59 - 63"},"PeriodicalIF":0.5,"publicationDate":"2018-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82189936","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：