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World Diabetes Day - 14 November 2017

Dear SEMDSA Member

This year the theme of World Diabetes Day 2017 is Women and diabetes - our right to a healthy future.

The accelerating prevalence of Diabetes Mellitus (DM), has taken pandemic proportions. Most indicators suggest that current prevalence rates in South Africa (SA) are underestimating the burden of disease. A major limitation is that South Africa does not have a national diabetes registry. Despite the paucity of epidemiological data, the prevalence of DM is reported to be higher in the reproductive age group in SA than that of Africa and of the world. With the projected increase in DM, no economy in the world will be able to afford to treat all people with DM in the near future. The mortality rate from diabetes now exceeds that from HIV/AIDS, tuberculosis and malaria combined. In SA the highest prevalence of DM is reported in the Asian and mixed race populations.

Globally, it is estimated that 16% of live births are affected by hyperglycemia in pregnancy. This includes women with gestational diabetes mellitus (GDM) and women with overt DM in pregnancy. It is important to distinguish between hyperglycemia first occurring in pregnancy (GDM) vs diabetes first recognized in pregnancy as the risk profiles differ markedly. It is a sad reality that women are often first exposed to healthcare only when they are pregnant, and as a result they may be erroneously classified as GDM when in fact they have unrecognized DM first noted in pregnancy. GDM is a milder degree of hyperglycemia and occurs towards the latter end of pregnancy. In contrast to overt DM it usually resolves soon after delivery. The current gold standard for diagnosis of GDM is the IADPSG criteria. If WHO criteria for DM during pregnancy is met, it should be classified as overt DM and not GDM. Despite its milder degree, GDM carries an almost eight-fold risk for future diabetes in the mother. The offspring of women with GDM also have a significant increased risk for childhood obesity and diabetes. The fact that two out of every five women with DM are of reproductive age, may perpetuate the vicious cycle of the transgenerational metabolic disadvantage that ultimately leads to DM. GDM accounts for 85% of diabetes in pregnancy and one in seven births is affected globally.

Under the current economic circumstances, across all medical specialities, every cent spent in healthcare must work more effectively and efficiently. GDM provides an opportunity to impact positively on the mother and the unborn fetus, by preventing disease without added cost. It also provides the prospect to build capacity amongst women and girls, as they are key agents in the adoption of healthy lifestyles to improve the health and wellbeing of future generations.

Society at large (both men and women) need to work to curb this epidemic. Ubuntu - the African philosophy of ‘I am because you are’ underpins an approach of taking care of ourselves so we can take care of others.

With the focus on Women’s health and emerging evidence it is clear that a more aggressive approach to prevention and treatment must be adopted. When considering resource allocation, we need to shift our focus from clinical and preclinical disease to disease-free states or health. We need to focus on primordial prevention- only then will the vicious cycle of metabolic imprinting that casts a shadow over the lives of so many people be broken.

SEMDSA proposes a multi-sectorial approach towards creating environments conducive to health in order to curb the epidemic of diabetes in our country. We propose that it is the duty of the custodians of this rainbow nation to address the current economic and political elements that impacts directly on food security, healthy safe recreation options like outdoor exercise and health education in schools. Marketing and advertising of unhealthy food - like products must be curbed- health must not be traded for money. Early access to health facilities, early diagnosis and screening are essential components of the pro-active care model SEMDSA envisions.

With the above in mind SEMDSA invites its members to become active and instill a long term consciousness of the issues around diabetes not just on WDD 2017, but beyond.

The IDF website (www.idf.org/our-activities/world-diabetes-day/resources.html) contains useful resources to assist you in this regards.

SEMDSA will post updates on its website (http://www.semdsa.org.za/) and twitter (@SEMDSAorg) account on local activities being carried out on 14th November.

MEDIA STATEMENT ISSUED BY SEMDSA (THE SOCIETY FOR ENDOCRINOLOGY,
METABOLISM AND DIABETES OF SOUTH AFRICA)
FOR IMMEDIATE RELEASE: THURSDAY, 20 OCTOBER 2016


Love your bones – protect your future

World Osteoporosis Day is marked on 20 October 2016

It is estimated that, worldwide, an osteoporotic fracture occurs every three seconds. Osteoporosis (OP) is a preventable disease and earlier detection and successful intervention may prevent the heavy toll the disease can take on a person’s future.

What is osteoporosis?
“Osteo” literally means bone and “porosis” means porous. The term osteoporosis describes the appearance of bone were they to be broken in half and visually examined. Normal bone would have small holes but a bone with osteoporosis would have much more and larger pores or holes in them. This decrease in bone quantity is an important risk factor for fractures as it contributes to a decrease in the strength of the bone.

The prevalence of OP is much more common than is generally thought. Over 200 million people worldwide are affected. In South Africa one in three women and one in five men will develop the disease within their lifetime.

Broken bones due to OP are a serious concern mainly due to the impact it has on the quality of life and longevity of the person affected. It is estimated that 20 to 24 percent of patients do not survive for another year after sustaining a hip fracture.

The common perception that OP is a disease of the white female is incorrect. Research done at the University of Stellenbosch demonstrated similar vertebral fracture prevalence in black and white women, highlighting that the disease need to be suspected in patients of all ethnic groups.

To make matters worse, some fractures, mostly lumbar, often go undiagnosed and even if a fracture is diagnosed OP are too infrequently considered as the underlying cause.

Prevention is always better than cure and the importance of lifestyle strategies cannot be overemphasised. But unfortunately for some, lifestyle measures alone will not be enough. It is therefore essential that people talk to their doctors to seek early diagnosis and appropriate treatment if indicated. Anyone at high risk must take advantage of all available measures to reduce the likelihood of future debilitating fractures.

The good news is that OP can be prevented to a great extent. Frequently the factors that lead to OP are those that accelerate bone loss. Some of these accelerating factors can be out of a patient’s control (such as family history).

Yet there are steps everyone can take to prevent bone loss. Good nutrition and regular weight-bearing exercise are very important ways to protect bone. It is recommended that a person exercises 30 to 40 minutes per day three to four times per week. Ensure an adequate intake of protein, calcium and vitamin D, limit alcohol intake and refrain from smoking.

A frequently overseen aspect that deserves mentioning is to prevent falls at all cost, especially in the elderly.

Bone mineral density (BMD) is generally assessed by means of a Dexa scan. Because ageing itself is one of the biggest risk factors for OP it is advised that all women aged 65 or older and all men aged 70 years or older should be screened for low BMD even in the absence of additional risk factors.

In younger patients the presence of other clinical risk factors for example early menopause, the use of glucocorticoids and concomitant conditions such as rheumatoid arthritis warrants screening.

It is however important to take note that even though BMD is used to screen for OP it has numerous limitations and the assessment of fracture risk should be an integrated approach and should not rely on BMD alone.

Fractures, of particularly (but not restricted to) the hip and spine, often lead to a vicious cycle of more fractures. Furthermore it leads to chronic pain, immobility, and disability in most instances. As a result patients every so often face loss of physical independence. Of patients with hip fracture 40 percent are unable to walk independently and 33 percent are totally dependent on family or care in a nursing home in the year following the fracture.

The International Osteoporosis Foundation’s theme of this year’s awareness campaign, “Love your bones – protect your future” calls on the general public to take early action to protect their bone and muscle health, in order to enjoy a good quality of life and independence in the

Dr. Ankia Coetzee
Endocrinologist
University of Stellenbosch