Introduction

Beyond HbA1c cardiovascular protection in type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is a progressive metabolic disorder characterised by a decreased sensitivity to insulin in adipose tissue, skeletal muscle and the liver. It typically presents with inappropriate hyperglycaemia. T2DM is a significant public health problem that poses a considerable socioeconomic burden on the individual, society and the healthcare system. Adults with T2DM have higher rates of atherosclerotic cardiovascular disease (ASCVD) when compared with those without diabetes. Diabetes mellitus increases the propensity for cardiovascular disease (CVD) by two- to threefold in men and three- to fourfold in women. This elevated CVD risk is proportional to the high plasma glucose levels and independent of the other CVD risk factors, which are also common in T2DM patients. T2DM is the third leading cause of disability-adjusted life years (DALYs) loss and the eighth leading cause of mortality globally. This review will discuss the burden of cardiovascular complications in T2DM. Particular focus will be given to the relatively new antidiabetic medications, the glucagon-like receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) with proven cardiovascular and renal end-organ protection.

Association between anthropometry and cardiovascular risk in patients attending a diabetic clinic

Diabetes mellitus (DM), a chronic metabolic disorder, has been recognised as a major global public health burden. By 2030, the number of adults with type 2 diabetes (T2DM) is expected to increase faster in low- to middle-income countries (LMICs) than in high-income countries (20%). Cardiovascular disease (CVD) is the leading cause of death worldwide. T2DM is associated with increased cardiovascular morbidity and mortality. Patients with T2DM have a two- to fourfold increase in risk of incident coronary heart disease ischaemic stroke and mortality. Hypertension (HPT), DM, dyslipidaemia and obesity are all well-documented modifiable risk factors for CVD. Importantly, obesity is an independent risk factor for CVD, most notably HPT. Patients with T2DM are generally more obese and have a greater number of cardiovascular risk factors when compared with patients without T2DM. Weight loss is considered a key measure to the management of T2DM. Increasing evidence suggests that visceral adiposity is a greater risk for CVD than body mass index. Current evidence on anthropometric indices as a predictor for HPT remain unclear in PLWD. Most studies have described these indices in non-diabetic patients, which is not amenable to the PLWD profile.

Relationship between hypothyroidism and gestational diabetes mellitus: a retrospective cohort study

Gestational diabetes mellitus is defined as a form of glucose intolerance, first detected during pregnancy. It has been the most common complaint during pregnancy, with a prevalence of 9.4–10.6%, and is associated with many foetal and maternal adverse outcomes. The short-term complications include macrosomia foetuses, gestational hypertension and preeclampsia, and the long-term complications include postpartum diabetes mellitus, cardiovascular disease, renal disease, and disorders of glucose metabolism in the newborn. Thyroid function can be reversibly affected following various hormonal and metabolic changes during pregnancy. Up to 3% of pregnant women experience subclinical hypothyroidism (SCH) due to the elevation of the thyroid stimulating hormone (TSH).

Clinical characteristics of people with diabetic ketoacidosis at a clinic in The Gambia: a retrospective study

As the prevalence of diabetes mellitus (DM) increases in low and middle-income countries, understanding the manifestations and complications become increasingly important. The prevalence of DM is expected to rise to in sub-Saharan countries. DM is responsible for about 10% of hospitalisations due to non-communicable diseases in The Gambia and it is estimated that 3.6% of the annual national health budget is spent on its management. Although there are several classes of DM, the commonest types of DM are type 1 and type 2 DM. Type 1 DM is associated with lean body habitus and usually presents in children and young adults. It results from a deficiency of insulin arising from the destruction of pancreatic beta islet cells responsible for insulin synthesis and secretion. In contrast, type 2 DM typically occurs in older adults who are overweight and is as a result of relative insulin deficiency caused by insulin resistance and increased demand for insulin from extra adipose tissue.

Primary health care–family partnership for better diabetes outcomes of patients: a systematic review

Diabetes mellitus is a lifelong disease requiring daily self-care activities for better outcomes. Although most of these self-care activities for outpatients are taught in primary health care, their actual practice occurs at home where patients stay. Family dynamics or established cultures impact the management of the disease, hence a need for primary health care–family partnership to empower both families and patients with ways to manage the disease. This systematic review aims to describe the primary health care–family partnership.

Unexpected finding of thyroid hemiagenesis in a patient presenting with a right thyroid nodule and a history of Poland syndrome 

Poland syndrome is defined primarily by congenital absence of the pectoralis major. Thyroid hemiagenesis is the congenital absence of a single thyroid lobe. The combination of both pathologies has not been previously descried. 

Accreditation

Health Professions Council of South Africa

MDB015/064/01/2023

3 Clinical

Certification

Attempts allowed: 2

70% pass rate





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Journal of Endocrinology, Metabolism and Diabetes of South Africa - April 2023 Vol 28 No 1