Journal of Endocrinology, Metabolism and Diabetes of South Africa

Feasibility study on the use of the modified Finnish Diabetes Risk Score in South African context: a case of home-based carers

T.M. Mothiba — 2025-03-28

Background: The Finnish Diabetes Risk Score (FINDRISC) tool is used to identify undetected cases of diabetes and risk scores. The FINDRISC tool outlines questions to ask, including anthropometric parameters to measure, during screening and detection of diabetes cases. This study assessed the feasibility for the introduction of FINDRISC tool for use in South Africa. The aim is to determine the overall competence of home-based carers (HBCs) in utilising this tool.

Method: A quantitative approach and cross-sectional feasibility study was conducted involving 52 HBCs who were sampled using homogeneous purposive sampling. The study was conducted in clinics of Ga- Dikgale Village in Polokwane. A FINDRISC questionnaire was used to assess competence of HBCs. Data were analysed using SPSS, with both descriptive and inferential statistical analysis.

Results: None (0%) of the participants were fully competent, 6% were incompetent and 94% were moderately competent on use of the FINDRISC tool.

Conclusion: Most HBCs were moderately competent in the use of this tool, while none were competent. It is feasible that the FINDRISC tool can be adapted and utilised by HBCs in South Africa. However, a proper training should be offered to HBCs on the use of the FINDRISC tool. It is also recommended to assess components of requiring professionals considering the scope of work and qualification.

A case of hyponatraemia secondary to vitamin D deficiency

L.S. Greenstein — 2025-03-28

Hyponatraemia and Vitamin D deficiency are common conditions in older adults. Both conditions cause bone fragility and gait abnormalities, which are risk factors for falls and poor health outcomes in older adults. Vitamin D deficiency is a risk factor for osteoporosis and increases the risk for fragility fractures. Hyponatraemia, the commonest electrolyte abnormality, causes bone resorption and contributes to falls by impairing cognition and by causing gait abnormalities. Sodium homeostasis is complex and the syndrome of inappropriate antidiuretic hormone secretion (SIADH), a diagnosis of exclusion, is one of the most common causes of hyponatraemia. Instability is a feared geriatric syndrome, as falls can have devastating consequences for the older adult, leading to significant morbidity and mortality. Previous studies have shown that patients with hyponatraemia had a higher rate of vitamin D deficiency and, conversely, those with vitamin D deficiency had a higher rate of hyponatraemia. The exact pathophysiological mechanism behind this correlation is unclear but may involve bone derived hormone fibroblast growth factor 23 and the renin–angiotensin– aldosterone system. A case of an 83-year-old Asian female, who presented with an osteoporotic intertrochanteric femoral fracture following a fall, is presented. She was found to have chronic hyponatraemia and was subsequently diagnosed with SIADH due to vitamin D deficiency.

Features of Turner syndrome in patients managed at the adult endocrinology clinic, Steve Biko Academic Hospital

M. Noeth — 2025-03-28

Background: Turner syndrome is a multisystem disease with varied clinical features influenced by genetic composition and possibly ethnicity.

Objective: To review local data and identify the clinical features more common in our population.

Methods: A retrospective review of the clinical, biochemical features and karyotype of all patients with a confirmed diagnosis of Turner syndrome receiving treatment at the adult endocrinology clinic, Steve Biko Academic Hospital, was performed. Seventeen patients with complete data sets were identified.

Conclusion: Our population group had a higher percentage of mosaic Turner syndrome than that described in the literature. The clinical features also differed significantly from the classic features described, with the exception of the universal presence of short stature and hypogonadism. This may explain the delayed age of diagnosis. Screening programmes are necessary, and the consistent finding of short stature can be used as a screening tool in early childhood to identify more patients who will benefit from referral.

Initiating or switching to IDegAsp in a real-world South African population with type 2 diabetes – a cohort analysis from the ARISE study

Adri Kok — 2025-03-28

Background: The ARISE study was a 26-week, multicentre, prospective, open-label, non-interventional observational study to investigate clinical outcomes in people with T2D treated with IDegAsp in everyday clinical practice.

Objectives: To report results from the South African cohort of the ARISE study and compare them with those from the overall population.

Design: Non-interventional observational study.

Setting: General and specialist private practices.

Subjects: Adults ≥ 18 years of age with a diagnosis of T2D could be included in the study if they had been switched to, or had initiated, IDegAsp at the discretion of the treating physician. The primary endpoint was change in HbA1c from baseline to end of study.

Outcome measures: The primary endpoint was change in HbA1c from baseline to end of study.

Results: Data were available from 179 patients. Prior to starting IDegAsp, the majority of the patients (76%) were already being treated with insulin therapy and the mean duration of follow-up was 210 days. The most commonly reported reasons for switching to IDegAsp were to improve glycaemic control (88.8%) and reduce the risk of hypoglycaemia (39.1%). In comparison with baseline values, mean HbA1c and fasting plasma glucose were significantly lower at end of study (8.4% vs. 9.6%; estimated mean difference −1.3% [95% confidence interval −1.6 to −1.1, p < 0.0001]; and 7.3 vs. 10.9 mmol/L; −3.5 mmol/L [−4.5 to −2.5, p < 0.0001], respectively). Improvement in glycaemic control after the switch to IDegAsp was achieved with lower daily insulin doses and less hypoglycaemia when compared with the time period prior to switch. Two patients discontinued IDegAsp due to adverse events.

Conclusion: In this South African cohort, initiating or switching to IDegAsp was associated with improved glycaemic control, lower insulin dose requirements among patients already on insulin therapy, and significantly lower rates of non-severe (overall and nocturnal) and severe hypoglycaemia in comparison with previous therapy.

Relevance and therapeutic implication of macroprolactinemia detection using PEG 6000 in women of childbearing age with hyperprolactinemia: experience at a tertiary hospital

Anne Ongmeb Boli — 2025-03-28

Introduction: Macroprolactin may interfere with hormonal assay and falsely increase serum prolactin levels. Therefore, failure to identify macroprolactinemia can lead to inappropriate investigations and treatment in women already susceptible to anxiety and stress. The aim of this study was to identify macroprolactinemia among women of childbearing age with hyperprolactinemia.

Materials and methods: A cross-sectional study was conducted in a tertiary care setting at the endocrine unit. Study participants were recruited from both endocrine and gynaecological outpatient consultation services. They were women of childbearing age (18 to 49 years) consulting for signs and symptoms of gonadal dysfunction or hyperprolactinemia (PRL > 25 ng/ml). Total prolactin was measured using a Human direct ELISA method. Polyethylene glycol 6000 (PEG 6000) precipitation was used to detect macroprolactin.

Results: A total of 33 women with a mean age of 31 ± 7 years (range 21–48) were enrolled. Twenty-seven (81.8%) participants were symptomatic, the majority (23/27) (69.7%) reported having galactorrhoea, and 21 (63.4%) women reported having an irregular menstrual cycle. The median pre-precipitation prolactinemia reduced significantly after PEG precipitation from 61.2 (IQR 33.2–115.9) ng/ml to 33.8 (IQR 17.9– 70.5) ng/ml, p < 0.001. After PEG precipitation, five participants had a serum prolactin recovery rate below 60% and, therefore, a prevalence of macroprolactinemia at 15.2%. Four out of five (80%) women with macroprolactinemia presented with the symptoms amenorrhea, oligomenorrhea, and galactorrhoea.

Conclusion: PEG 6000 permitted the detection of macroprolactinemia in women of childbearing age with hyperprolactinemia who otherwise would have been subjected to unnecessary medical investigations and treatment.

Effect of an educational intervention based on the Theory of Planned Behaviour in type 2 diabetic patients at a foot and eye care practice

B. Pezeshki — 2025-03-28

Background: Eye and foot problems are two of the most common consequences of diabetes. The goal of this study was to investigate the impact of an educational programme based on the Theory of Planned Behaviour (TPB) on foot and eye care among patients with type 2 diabetes mellitus in Fasa City, Fars Province, Iran.
Methods: A total of 100 individuals with non-insulin-dependent diabetes mellitus (Type II) who met the study’s inclusion criteria were included. The participants were randomly assigned to one of two groups (intervention = 50, control = 50). The questionnaires were completed by all groups and included demographic information, TPB constructs, foot and eye care, and patients’ HbA1c levels. Questionnaires were completed prior to, immediately following, and three months after the intervention by members of the experimental and control groups. During the intervention period, the experimental group attended 10 instructive sessions. SPSS 22 software was used to analyse the data. Paired t-tests, independent t-tests, chisquare, and RMA (Repeated Measurement ANOVA) were all used (p < 0.05).
Results: Knowledge and all TPB components were significantly increased in the experimental group compared with the control group after intervention. In addition, foot and eye care practice and HbA1c level improved significantly among the experimental group compared with the control group (p < 0.001).
Conclusion: Applying the TPB is quite helpful in designing an educational programme for diabetic people to control their blood sugar and improve behavioural foot and eye care. Aside from such programmes, follow-up education on regulating and monitoring is strongly advised.

Editorial

Jeff Wing — 2025-03-28

No Abstract