Journal of Endocrinology, Metabolism and Diabetes of South Africa

Clinical, biochemical, and densitometric profiles and FRAX risk calculations of South African patients with fragility fractures of the hip: observations from a tertiary care centre

Fri, 28 Mar 2025 00:00:00 +0000

Purpose: Although fragility hip fractures (HF) in the South African (SA) population are among the lowest worldwide, the incidence of HF is expected to more than double over the next few decades. Little is known about the contributors to increased hip fracture risk, including low bone mineral density (BMD), in our unique population. In addition, the ability of the recently calibrated SA Fracture Risk Assessment Tool (FRAX) to identify high fracture risk in the SA population accurately has not been validated.

Methods: A retrospective, descriptive, cohort study of SA postmenopausal women and men ≥ 50 years who presented with fragility HFs was conducted. The ability of clinical risk factors (CRFs) and BMD measured by dual-energy X-ray absorptiometry (DXA), as well as calculated FRAX probability scores, to identify the known high fracture risk in SA patients were evaluated. The SA FRAX tool was used, and a high fracture risk defined if the United States (US) fixed thresholds for major osteoporotic (MOF) and/or HF risk were exceeded (≥ 20% and ≥ 3% over 10 years respectively).

Results: A total of 163 patients were included. The most useful predictive CRFs were age and gender, recreational toxins in men, and a history of falls. Most were females (71%), who were older than males. DXA-BMD and FRAX-HF calculations best identified the known high fracture risk in the study cohort. FRAX-MOF calculations performed poorly.

Conclusion: Fracture risk assessment tools did not identify the known high fracture risk in all of the elderly study cohort with HF. Clinicians must continue to appreciate the important role of a good clinical assessment to ensure optimal fracture risk prediction.

Clinical characteristics of endocrine disturbances in post-COVID-19 condition, case report with review of literature

Fri, 28 Mar 2025 00:00:00 +0000

Post-COVID-19 condition (PCC) is frequently associated with multiple endocrine hormone disturbances, primarily involving the hypothalamic–pituitary–adrenal axis. However, the exact cause remains unclear, particularly concerning whether these symptoms result from hypothalamus damage. This study reports on the clinical characteristics and examination methods of five patients exhibiting multiple endocrine disorders during PCC following SARS-CoV-2 infections, as well as the corresponding treatment strategies. Insulin tolerance test (ITT), arginine stimulation test, rapid adrenocorticotropic hormone (ACTH) stimulation test, and supine–standing test were used to evaluate endocrine hormone disturbances. Magnetic resonance imaging of the pituitary and computed tomography of the adrenal gland on one patient were performed to reveal the pathology. All five patients had hypothalamic syndrome with secondary adrenal insufficiency, growth hormone (GH) deficiency, and secondary hyperaldosteronism. Treatment included ACTH injection, recombinant human GH injection, and/or oral administration of synthetic glucocorticoids (prednisone acetate or methylprednisolone) and mineralocorticoid receptor antagonist finerenone. Remarkable improvement was observed within one week for all patients. To assess disorders in the hypothalamic–pituitary–§adrenal axis, dynamic endocrine testing is recommended. Upon confirmation of a diagnosis, timely supplementation of ACTH, glucocorticoids, GH, and aldosterone antagonists can yield remarkable therapeutic outcomes.

Clinical insights from continuous glucose monitor use in patients living with type 1 diabetes in rural Malawi

Fri, 28 Mar 2025 00:00:00 +0000

Background: People living with type 1 diabetes (PLWT1D) in low-resource settings face numerous barriers to achieving glycaemic targets. Use of continuous glucose monitoring (CGM) is increasing but uptake remains low in sub-Saharan Africa. In 2022, a randomised controlled trial (RCT) evaluating feasibility of CGM was conducted in Neno, Malawi. This is a retrospective sub-study examining three- month blood glucose trends from participants randomised to the CGM arm.

Methods: This is a sub-study of a 2:1 parallel arm open randomised controlled trial to assess the feasibility and impact of CGM. Ambulatory glucose profiles (AGP) from 29 participants in the CGM arm were reviewed by clinicians. Two patient reports with AGP patterns exemplifying observed trends were identified and described in detail, and interventions were highlighted.

Results: Time below optimal blood glucose range was highest from 12 am to 6 am: 7.0%, 6.9%, and 5.1% for months one, two, and three respectively. From baseline to endline, the average absolute value (increase or decrease) of the percentage change in total daily dose (TDD) of insulin was 11.2%. Case studies of two patients who demonstrated a positive impact of CGM are reported.

Conclusions: CGM provided compelling insights into blood glucose trends with significant clinical implications, specifically high prevalence of overnight hypoglycaemia. The ability to monitor blood glucose levels is critical because high variability and severe hypoglycaemia increase the risk of morbidity and mortality. CGM is a tool that can enhance patient education and the ability to guide treatment decisions for patients and clinicians in low-resource settings.

Prevalence and treatment-related outcome of hospitalised type 2 diabetes mellitus patients with comorbidities at an academic hospital in Johannesburg

T. Makhabane, G. Gabriels, S. Chetty — Fri, 28 Mar 2025 00:00:00 +0000

Background: Diabetic patients with comorbidities face increased risks of morbidity, mortality, and hospitalisation, leading to higher healthcare costs. Despite compliance with treatment, many do not achieve desired glycaemic control (HbA1c < 7%). Identifying comorbidities in T2DM patients can enable more comprehensive care. This study aimed to investigate T2DM control in hospitalised T2DM patients with and without comorbidities.

Method: A retrospective chart review of 246 T2DM patients aged ≥ 18 admitted in 2019 to Helen Joseph Academic Hospital was conducted. Files were randomly selected and data summarised using descriptive statistics.

Results: The mean age was 52 ± 13.4 years. Comorbidities were present in 73% (179) of patients, with a majority being female (51%, 126). Among those with comorbidities, 30% (74) had complications. Hypertension was the most common concordant disease, and HIV the most common discordant disease. Diabetes-related conditions led to hospitalisation in 63% (155) of T2DM patients.

Conclusion: A high prevalence of comorbidities was observed in hospitalised T2DM patients. Although there was no significant association with some cardiac risk factors (blood glucose, cholesterol, HbA1c), blood pressure was higher in T2DM patients with comorbidities compared with those without.

Knowledge, attitude, and practices related to diabetes among patients with type 2 diabetes mellitus at Tshepong Hospital

Fri, 28 Mar 2025 00:00:00 +0000

Background: Despite advancements in pharmacological treatments for diabetes mellitus (DM), the significance of adequate knowledge, a positive attitude, and proper self-care practices among individuals with DM cannot be overstated.

Aim: This study assessed the knowledge, attitude, and practices (KAP) related to diabetes among patients with type 2 diabetes mellitus (T2DM).

Materials and methods: This cross-sectional study surveyed 161 patients with T2DM at Tshepong Hospital over five months. An interviewer- administered questionnaire was used to evaluate their KAP. Glycaemic control was assessed using the most recent glycated haemoglobin (HbA1c). Data were analysed descriptively using means (standard deviation), frequencies, and correlation statistics.

Results: The mean age of the participants was 55.94 ± 14 years, with females comprising 59% of the sample. Scores for knowledge, attitude, and practice were 57 ± 17%, 94 ± 9%, and 40 ± 10%, respectively. No correlation was found between KAP and sociodemographic or clinical characteristics. A significant but weak positive correlation was identified between knowledge and practice (r = 0.19391, p-value 0.013). There was no association between composite KAP scores and glycaemic control. Poor glycaemic control (HbA1c ≥ 7%) was observed in 86.34% of participants.

Conclusion: The study indicates that a positive attitude alone is insufficient for effective self-care practices, due to poor knowledge. The absence of a significant relationship between KAP and participants’ characteristics suggests the presence of other unexplored confounding factors. Further research is needed to identify these determinants of KAP.

Editorial

Joel Dave — Fri, 28 Mar 2025 00:00:00 +0000

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