Page 80 - University of Pretoria RESEARCH REVIEW 2018
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Diabetes –
addressing the growing burden of non-communicable diseases
Paul Rheeder, Department of Internal Medicine, and Steve Biko Academic Hospital
Diabetes is a growing epidemic and the second biggest killer in South Africa, second only to TB. In Africa, diabetes is responsible for more deaths than malaria, HIV/AIDS and TB together.
these studies have been published in the South African Medical Journal, the Journal of Diabetes Research, and in the International Journal of Molecular Sciences in 2018.
Adam and Rheeder also tested the performance of the Roche Accuchek Active glucometer in diagnosing gestational diabetes mellitus, com- paring their results with those of the gold-standard laboratory test. From the same sample of women, the standard laboratory test identified twice as many women with gestational diabetes compared to the glucometer, suggesting that the glucometer is not an accurate measure of gestational diabetes. These important findings were published in Biomarkers.
The team has also demonstrated that women with gestational diabetes have lower circulating levels of microRNAs (very short sequences of RNA which are involved in the regulation of gene expression), suggesting that there may be value in adding these biomarkers to a screening toolkit for gestational diabetes. Published in Molecular Diagnosis and Therapy, the findings point to insulin-sensitivity markers
as good predictors of gestational diabetes.
One of South Africa’s greatest challenges in controlling this epidemic at primary healthcare level is in the initial provision of insulin and then its up-titration; i.e., increasing the concentration of the drug to have the optimum effect. Legally, only a doctor can prescribe insulin, yet many clinics are primarily managed by nurses. So, for many South Africans with diabetes, accessing quality care close to home is almost impossible. Professor Paul Rheeder leads the Tshwane Insulin Project (TIP), a five- year collaborative project between
a number of departments, including Internal Medicine, Family Medicine, Human Nutrition and the School of
Health Systems and Public Health. The project focusses on investigating the use of remote prescription to help primary care physicians and nurses better serve the needs of people living with diabetes in underserved areas.
Professor Sumaiya Adam in the Department of Obstetrics and Gynaecology has been working with Rheeder and colleagues to identify potential biomarkers for gestational diabetes. Gestational diabetes develops during pregnancy, and
is characterised by relative insulin resistance and high blood sugar. This type of diabetes is associated with the baby growing too large for natural birth, with premature birth, or with too much amniotic fluid which may complicate the birth.
Although high-risk groups have been identified for gestational diabetes, there is a need for routine screening of all pregnant women. In this context and at the primary healthcare level, biomarkers are a promising screening tool. The research findings from
  Sumaiya Adam and Paul Rheeder
The Tshwane Insulin Project is in collaboration with and funded by the Lilly Global Health Partnership, a global pharmaceutical research company that introduced human insulin to the market in the 1980s.
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