Perspectives on gestational diabetes mellitus in South Africa.

The field of gestational diabetes mellitus has attracted increasing attention and research in South Africa (SA) over the past decade, creating a better understanding of the disease burden, risk factors, availability of specialised healthcare services, and importantly the far-reaching maternal and childhood consequences beyond the pregnancy. This article brings together all the local published literature in the field and outlines the implications of this condition, together with recommendations regarding particular areas that require attention in order to prevent and alleviate the disease burden in SA.

Cardiometabolic outcomes of women exposed to hyperglycaemia first detected in pregnancy at 3-6 years post-partum in an urban South African setting.

Background: Hyperglycaemia first detected during pregnancy(HFDP) has far-reaching maternal consequences beyond the pregnancy. Our study evaluated the cardiometabolic outcomes in women with prior HFDP versus women without HFDP 3-6 years post-partum in urban South Africa.

Design And Methods: A prospective cohort study was performed of 103 black African women with prior HFDP and 101 without HFDP, 3-6 years post-partum at Chris Hani Baragwanath Academic Hospital, Soweto.

Consensus study on the health system and patient-related barriers for lung cancer management in South Africa.

Background: Lung cancer is the highest incident cancer globally and is associated with significant morbidity and mortality particularly if identified at a late stage. Poor patient outcomes in low- and middle-income countries (LMIC's) might reflect contextual patient and health system constraints at multiple levels, that act as barriers to prevention, disease recognition, diagnosis, and treatment. Lung cancer screening, even for high-risk patients, is not available in the public health sector in South Africa (SA), where the current HIV and tuberculosis (TB) epidemics often take precedence.

Maternal and neonatal outcomes following the introduction of oral hypoglycaemic agents for gestational diabetes mellitus were comparable to insulin monotherapy in two historical cohorts.

Background: Gestational diabetes mellitus (GDM), a disorder of glucose intolerance first encountered during pregnancy, has far-reaching implications for both mother and child. Insulin therapy remains the 'gold standard' of care, with oral hypoglycaemic agents (OHAs) increasingly being viewed as potential alternatives.

Objectives: To compare maternal and neonatal outcomes in two cohorts of women with GDM exposed to either insulin monotherapy or OHAs.

Maternal and neonatal outcomes following a diabetic pregnancy within the context of HIV.

Objective: To characterize the demographics, comorbidities, management, and outcomes of pregnant women with pre-gestational and gestational diabetes (GDM), including overt and true GDM, taking into account HIV infection and the influence of exposure to oral hypoglycemic agents (OHAs).

Methods: A review of medical records of 1071 diabetic pregnancies (between 2012 and 2018) at a tertiary hospital in South Africa.

Results: Of the women, 43% had GDM, 19% had type 1 diabetes (T1DM), and 38% had type 2 diabetes (T2DM).

Phaeochromocytoma in black South Africans - a 30-year audit.

Objective: Phaeochromocytomas are catecholamine-secreting tumours, the majority of which arise from the adrenal medulla. Untreated, they are potentially lethal; early diagnosis and treatment offer a good chance of cure. They are rarely reported in blacks.

Long-term (20 years) outcome and mortality of Type 1 diabetic patients in Soweto, South Africa.

Aims: To assess the long-term (20 years) mortality, with causes of death, in a cohort of Type 1 diabetic patients resident in Soweto, South Africa.

Methods: A cohort of Type 1 diabetic patients attending the Diabetic Clinic of Baragwanath Hospital, Soweto were studied in 1982. They were followed over the subsequent 20 years, the final investigation being in 2002.

Audit of the outcome of pregnancy in diabetic women in Soweto, South Africa, 1992 - 2002.

Objective: To audit the outcome of pregnancy among diabetic black women in Soweto following the introduction of a specialised service.

Design And Methods: An analysis of patients' records was conducted for the period 1992 - 2002. Maternal characteristics, aspects of treatment and its complications, mode of delivery and perinatal outcome are reported.

Phaeochromocytoma by way of case reports.

Endocrine causes of hypertension are relatively rare, but their detection offers a real chance for cure. This is particularly true of phaeochromocytoma, a catecholamine-producing tumour derived from chromaffin tissue, which, if left undetected, is invariably fatal. The lethal nature of this tumour is dependent on two major characteristics: firstly, its ability to secrete catecholamines in excess, resulting in potentially catastrophic consequences; and, secondly, its malignant potential.

Phaeochromocytoma in pregnancy.

The diagnosis of phaeochromocytoma during pregnancy requires a high index of suspicion and is essential for the favourable outcome of mother and offspring. Delayed diagnosis is associated with considerable morbidity and mortality. The cases of 4 patients presenting with phaeochromocytoma during pregnancy over an 11-year period are presented.

Multiple endocrine neoplasia type 2A in a black South African family.

The genetic abnormality of multiple endocrine neoplasia type 2A (MEN 2A) has recently been elucidated. Over 95% of families with MEN 2A have an identifiable mutation of the RET proto-oncogene on chromosome 10. This report describes a black South African woman with MEN 2A in whom a mutation of the RET proto-oncogene was identified.

Smoking habits of black South African patients with diabetes mellitus.

Cigarette smoking is a major arteriosclerotic risk factor, and this is enhanced by the presence of diabetes mellitus. Although smoking rates are increasing in many African countries, they have been little studied. We have critically assessed smoking among black diabetic and general medical patients at Baragwanath Hospital in Soweto, South Africa.

Pheochromocytoma associated with clinical and echocardiographic features simulating hypertrophic obstructive cardiomyopathy.

Left ventricular hypertrophy simulating hypertrophic obstructive cardiomyopathy is a rare complication of pheochromocytoma. In this report, two cases of pheochromocytoma with this complication are described. Successful tumor removal in both cases led to relief of symptoms, normalization of BP, regression of abnormal clinical features, normalization of the ECGs, but only partial regression of the echocardiographic features despite prolonged follow-up of 24 and 32 months, respectively.

Mortality and outcome of insulin-dependent diabetes in Soweto, South Africa.

Sixty-four insulin-dependent (Type 1) diabetic patients (IDDM) in Soweto, South Africa were followed over a 10-year period. Patients were assessed in 1982 and again in 1992. There were 10 deaths (16%), half of which were due to renal failure.

Hyperosmolar non-ketotic diabetic coma as a cause of emergency hyperglycaemic admission to Baragwanath Hospital.

There were 136 emergency hyperglycaemic admissions to Baragwanath Hospital over a 6-month period during 1992-1993, representing 1.2% of the total number of medical admissions; 24 (18%) patients died. Diabetic keto-acidosis (DKA) accounted for 88 (65%) admissions (mortality rate 9%) while 16 admissions (12%) were as a result of hyperosmolar non-ketotic coma (HNKC), defined as hyperglycaemia, dehydration and an altered level of consciousness with a plasma osmolality > or = 330 and an arterial pH > or = 7.

Autonomic neuropathy in African diabetic patients.

To determine the prevalence and extent of autonomic neuropathy amongst Africans with insulin-dependent diabetes mellitus (IDDM), we investigated 50 such patients at our clinic. Mean age (+/- 1 s.d.

The age of onset and sex distribution of insulin-dependent diabetes mellitus in Africans in South Africa.

Type I (insulin-dependent) diabetes mellitus (IDDM) appears to be rare in indigenous African populations, but little detailed information has been published. We have therefore analysed the age of onset of diabetes in 176 African patients with IDDM (age of onset < 35 years), and in 149 consecutive white patients of European extraction for comparison. In the Africans the peak age of onset occurred at 22-23 years (median 22 years) with an earlier peak from 14 to 17 years.

Outcome of pregnancy in diabetic women in Soweto, South Africa 1983-1992.

A specialized service for pregnant diabetic women of African ethnic origin from Soweto was introduced in May 1983 at Baragwanath Hospital. Modern methods of management were used, including home blood glucose monitoring. A total of 354 pregnancies (147 gestational, 207 pregestational) were managed over an 8 1/2 year period.

Hypoglycaemic admissions among diabetic patients in Soweto, South Africa.

An audit of hypoglycaemic admissions among diabetic patients to Baragwanath Hospital, Soweto, South Africa was carried out prospectively during a recent 5-month period. A total of 51 episodes of biochemically confirmed hypoglycaemia (blood glucose < 2.2 mmol l-1 with coma or pre-coma, and requiring intravenous glucose) were observed in 43 patients.

Patterns of insulin dependence in an African diabetic clinic.

Analysis of the age of onset of diabetes amongst insulin-treated patients in a large African diabetic clinic revealed a bimodal type of distribution, 23 per cent having an age of onset before 30 years and 77 per cent with onset at greater than or equal to 30 years of age. All 66 of the young insulin-treated group (21.7 +/- 4.