Management of type 2 diabetes mellitus for general practitioners

A 55-year-old Asian man presents with a history of intense thirst, polyuria, blurring of vision and weight loss over a period of several weeks. He is obese with a waist circumference of 110 cm and a body mass index (BMI) of 32 kg/m2. His blood pressure is 170/110 mmHg. Laboratory investigations indicate the following: random blood glucose 13.6 mmol/l, haemoglobin A1c (HbA1c) 9.5%, total serum cholesterol 6.8 mmol/l, low-density lipoprotein (LDL) cholesterol 3.5 mmol/l, high-density lipoprotein (HDL) cholesterol 0.7 mmol/l, triglycerides 3.2 mmol/l, and serum creatinine normal. His urine shows glycosuria and microalbuminuria. What would be your approach to this patient’s management?Keywords: type 2 diabetes mellitus, management, general practitioners, lifestyle intervention

Sub-Optimal Management of Type 2 Diabetes Mellitus – A Local Audit

Background: Despite increased awareness of risk factors for coronary artery disease and randomized trial data supporting comprehensive diabetic care, these risk factors continue to be largely ignored in patients with type 2 diabetes mellitus. Objective: Cross-sectional study to determine the level of control in patients with type 2 diabetes in tertiary diabetes clinics. Methods: Patient demographic, diabetes and cardiovascular disease related (CVD) data was collected from 150 (F:M; 98:52) randomly selected patients with type 2 diabetes mellitus attending the diabetes clinics at the three academic teaching hospitals served by the University of the Witwatersrand. Blood pressure, height, weight, body mass index and waist circumference were measured. Glycated haemoglobin and fasting serum lipid levels were obtained from patient records. Black patients contributed 68%, White 12, 7%, Indian 10, 7% and Coloured 8, 7%. Results: Mean HbA1c for the whole cohort was 8, 7%. Obesity was present in 37, 3%, hypercholesterolaemia in 29, 3% and hypertriglyceridaemia in 45, 3%. Waist circumference was ≥ 80 cm in 98% of the females and ≥ 94 cm in 69% of the males. 127 patients out of 150 (85%) were hypertensive and 74% of these had a systolic blood pressure ≥ 130 mmHg and 84% a diastolic blood pressure ≥ 80 mmHg. 43% of the patients did minimal exercise, 6% smoked and only 51% were on aspirin. Conclusion: Comprehensive diabetic care is still largely lacking despite clinical trial data documenting improved outcomes associated not only with glycaemic control but also with use of antihypertensive, lipid lowering and anti-platelet therapy

Euthyroid hyperthyroxinaemia due to assay interference

Background: The authors report a case of euthyroid hyperthyroxinaemia and the systematic approach that led to the diagnosis. The related literature is also reviewed in an attempt to increase awareness of this condition. Case report: A 47-year-old female patient was referred for further investigation and management of “hyperthyroidism.” The patient was clinically euthyroid and had previously been treated with carbimazole, but self-discontinued therapy as she felt unwell on treatment. A careful review of this patient’s blood results revealed elevated free thyroxine and unsuppressed thyroid-stimulating hormone (TSH). This is atypical of primary hyperthyroidism, in which case suppressed TSH would have been expected. In view of the clinical euthyroidism, euthyroid hyperthyroxinaemia was considered the most likely diagnosis and an appropriate work-up was initiated. Following on the consultation with the Chemical Pathology Unit, assay interference was established as the likely cause and the patient was reassured. She remains well, with no treatment. Conclusion: Thyroid function tests should not be interpreted in isolation and, if the clinical picture and biochemistry are discordant, it is imperative to consider assay interference. It is also important to apply basic physiological principles in interpreting endocrine blood results. In this patient, both the clinical euthyroidism and the unsuppressed TSH, which are atypical of primary hyperthyroidism, prompted further work-up.Keywords: euthyroid hyperthyroxinaemia, factitious, assay interferenc

Comprehensive management of type Diabetes mellitus patients study 2006

ABSTRACT The Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) estimates the prevalence of Type 2 Diabetes Mellitus in South Africa to be approximately 13% in the Indian, 3% in the European and 4.8-8% in the African population group. Morbidity from diabetes is a consequence of both macrovascular and microvascular disease. Over the last decade, a fundamental transformation of the principles of management of type 2 diabetes has occurred. This was driven by a large number of multicentre randomized clinical trials documenting improved outcomes associated not only with glycaemic control, but also with use of antihypertensive, lipid lowering and anti-platelet therapy. The objective of this research report was to ‘revisit’ our diabetes clinics to ascertain how many diabetic patients are reaching the lipid, blood pressure, body mass index, waist circumference and glucose targets as recommended by the SEMDSA guidelines and to ascertain if there has been any improvement since a previous study conducted a decade ago. Study design included a sample of 150 patients. Body mass indices (BMI), fasting lipograms, glycated haemoglobin (HbA1c), waist measurements and blood pressure were determined in patients with type 2 diabetes mellitus who were on oral agents or insulin (Protaphane), or a combination thereof, and who were age 35 years or older. Results showed that, out of the 150 patients, 98 were females and 52 were males. Black patients constituted 68%, White 12,7%, Indian 10,7% and Coloured 8,7%. The mean age was 59 years. The mean HbA1c was 8,7% with HbA1c being more than 8% in 83 patients (55%). Obesity was present in 37,3% of the patients; it was class I (BMI 30-34,9 kg/m2) in 22%, class II (BMI 35-39,9) in 10% and class III (BMI >40) in 5,3%. Hypercholesterolaemia (total cholesterol > 5,0 mmol/l) was present in 29,3%, hypertriglyceridaemia (total triglycerides > 1,5 mmol/l) in 45,3% of the patients. Waist circumference was greater or equal than 80cm in 98% of the females and greater or equal than 94cm in 69% of males. In the whole cohort of 150 patients, 127 were hypertensive (84,67%). 78,74% of patients with hypertension had systolic blood pressure above or equal to 130 mmHg and 59,84% had diastolic blood pressure above or equal to 80 mmHg. Out of the 150 patients, 43% did not engage in regular exercise, 6% smoked cigarettes and 51% were on aspirin. In conclusion these findings are similar to those from a previous study conducted in 1996 and show little improvement in the holistic care of patients with type 2 diabetes

A impotância da atividade motora adaptada no desenvolvimento do portador de Síndrome de Down

Orientadora: Elizabeth Maria de Almeida TezzaMonografia (licenciatura) - Universidade Federal do Paraná. Setor de Ciências Biológicas. Curso de Educação Físic

Next-generation sequencing for diagnosis of thoracic aortic aneurysms and dissections: diagnostic yield, novel mutations and genotype phenotype correlations

Additional file 1. Complementary data on primer sequences, SKI amplification and survival analyses