Danie G Van Zyl

• MBChB, MMed(int), FCP(SA), MSc(Clin epi), PhD
• Lecturer at University of Pretoria

Over time diabetes affects the amount of insulin a person's body makes. This happens even when people take tablets properly and have excellent control of blood sugars. This is why almost all people who have diabetes have to start taking insulin injections. This guide is a collaborative output of experts to support the initiation of insulin therapy...

Background: Self-monitoring of blood glucose (SMBG) can inform on the timing of hyperglycaemia, but there is currently no standardised approach to utilising these data to improve glycaemic control in patients with type 2 diabetes. Objectives: To assess the improvement in glycaemic control when an insulin titration algorithm was used in combinati...

Background. To maintain fasting blood glucose levels within near to the normal range in type 1 diabetes mellitus (DM), frequent insulin dose adjustments may be required with short-, intermediate- and long-acting insulin formulations. Patients on human insulin generally experience weight gain over time, regardless of the level of glycaemic control a...

Aim: Therapy with low-dose amitriptyline is commonly used to treat painful diabetic peripheral neuropathy. There is a knowledge gap, however, regarding the role of variable CYP2D6-mediated drug metabolism and side effects (SEs). We aimed to generate pilot data to demonstrate that SEs are more frequent in patients with variant CYP2D6 alleles. Meth...

Background: Obstructive sleep apnoea (OSA) in pregnancy is associated with an increased morbidity and mortality to both mother and foetus. In the South African setting the proportion of pregnant females suffering from OSA has not been well studied; nor has the association with pre-eclampsia. This study aimed to determine the prevalence of OSA in fe...

Objective: The aim of this study was to determine the prevalence of micro- or macroalbuminuria in type 1 and type 2 diabetic patients, and to examine the relationship with the diabetes control parameters such as haemoglobin (Hb)A1c, blood pressure (BP) and lipids. Design: This was an analytical cross-sectional study. Setting and subjects: The study...

Background. Diabetes in pregnancy is associated with both accelerated fetal growth and intrauterine growth restriction.Objective. To compare the difference in occurrence of large-for-gestational-age (LGA) and small-for-gestational-age (SGA) fetuses in a pregnant diabetic population using population-based growth charts and customised growth charts.M...

Type 2 diabetes contributes to significant risk of cardiovascular and micro-vascular complications. The family practitioner plays a significant role in the management of glycaemic control and thereby reducing the related morbidity and mortality. Monitoring of blood glucose control has become an integral part of disease management that can empower p...

Background: Diabetes has become a major health problem worldwide, as well as in South Africa. This, coupled with the chronicity of the disease, relate to an increasing burden on health care facilities and an increasing number of hospital admissions of patients suffering from diabetes. Admissions are mostly related to diabetes itself, but the freque...

Type 2 diabetes mellitus (DM) is a disorder that is placing an increasing burden on health service delivery worldwide. Consequently, it has become increasingly important that physicians who treat such patients have a good knowledge of antidiabetic drugs that are currently available or will come onto the market. This article presents an overview of...

Objectives: Carotid intima-media thickness (CIMT) is a surrogate marker of subclinical atherosclerosis and a predictor of cardiovascular events. Few studies in Africa have evaluated CIMT and its associations in people with type 2 diabetes mellitus. This study measured CIMT in a sample of mainly black South African patients with type 2 diabetes mell...

Background. The objective of this study was to investigate levels of foot care knowledge among patients attending the diabetes clinic at Pretoria Academic Hospital by comparing the knowledge of patients with ‘at risk’ feet (ARF) to those with ‘normal/not at risk’ feet (NARF) and so assess whether the education effort by the clinic is effective.Meth...

Objective: To determine the factors influencing non-attendance with clinic appointments in diabetic patients at a Gauteng Hospital in 2007/2008.Setting: Two diabetes clinics situated at a secondary-level hospital, that offer more specialised outpatient care to adult patients with type 1 and 2 diabetes.Design: Between 21 November 2007 and 12 March 2...

Objective. The objective of this study was to evaluate perceptions regarding current practices in the care of diabetic inpatients as well as the knowledge and attitudes of nursing and medical caregivers at a large secondary hospital.Design and methods. Doctors and nurses taking care of diabetic inpatients were surveyed to assess their knowledge of...

Objective: The purpose of this study was to determine the prevalence of subclinical hypothyroidism among patients with diabetes mellitus at the Kalafong Diabetes Clinic in Pretoria.Design: Cross-sectional study.Setting and subjects: Five hundred and sixty-five patients with diabetes mellitus (type 1, type 2 or unknown), who were following-up at the...

Aims: To describe the diabetic population receiving primary care from the Tshwane district public health services and to assess the quality of care of members of this population, their level of disease control and the extent of their complications. Methods: A cluster-randomised trial was conducted in 12 primary care clinics in Tshwane district....

ARTICLE The Editor, This study originated due to a disagreement between physicians and intensivists regarding which resuscitation fluid was best to use in the initial management of diabetic ketoacidosis (DKA). The claim was that acidosis is maintained and prolonged if 0.9% sodium chloride solution was used (using pH as criterium). The study was p...

The prevalence of type 2 diabetes is not the same in the different population groups of South Africa. It also seems that the risk for the development of diabetic complications is not equal for the different population groups. This section will highlight differences in prevalence of type 2 diabetes and the risk for complications between different et...

To determine if Ringer's lactate is superior to 0.9% sodium chloride solution for resolution of acidosis in the management of diabetic ketoacidosis (DKA). Parallel double blind randomized controlled trial. Patients presenting with DKA at Kalafong and Steve Biko Academic hospitals were recruited for inclusion in this study if they were >18 years of...

To evaluate the VersaTREK (TREK Diagnostic Systems, Cleveland, Ohio) blood culture system against the Bactec9240 (BD Microbiology, Cockeysville, MD), for the recovery of bloodstream pathogens. Venous blood from patients with suspected bacterial sepsis was evenly distributed into bottles of each system. Positive signals were recorded and bottles pro...

Diabetic subjects have been shown to have altered fibrin network structures. One proposed mechanism for this is non-enzymatic glycation of fibrinogen due to high blood glucose. We investigated whether glycaemic control would result in altered fibrin network structures due to decreased fibrinogen glycation. Twenty uncontrolled type 2 diabetic subjec...

Diabetic ketoacidosis (DKA) is the most frequent hyperglycaemic acute diabetic complication. Furthermore it carries a significant risk of death, which can be prevented by early and effective management. All physicians, irrespective of the discipline they are working in and whether in primary, secondary or tertiary care institutions, should be able...

Evidence exists for a relationship between glycaemic control and macrovascular disease. Non-enzymatic glycation of proteins may explain this relationship in part. We investigated the effect of blood glucose control, under out-patient conditions, on fibrinogen glycation as well as the relationship between glycated fibrinogen and glycaemic control us...

Diabetic subjects have been shown to have altered fibrin network structures. One possible cause may be fibrinogen glycation resulting in altered structure/function properties. We investigated the effect of glucose control on fibrinogen glycation and fibrin network structure in type 2 diabetes. Blood samples were taken from twenty uncontrolled diabe...

To determine the underlying dimensions of a social support measure and investigate the effects of social support on health, well-being and management of diabetes mellitus (metabolic control and blood pressure (BP) control). A cross-sectional, analytical design was used with a structured questionnaire, comprising demographic characteristics, the MOS...

Diabetes mellitus is a common chronic disease needing long-term glycaemic control to prevent complications. Guidelines are available for achievement of optimal glycaemic control, but these are seldom properly instituted. To determine if a physician education programme and a structured consultation schedule would improve the quality of diabetes pati...

Based on Donabedian's structure, process, and outcome model, this study was conducted to identify the underlying dimensions of patient satisfaction for diabetic patients and determine the effects of demographic characteristics and health status on these dimensions. A cross-sectional analytical research design was used with a questionnaire, comprisi...

Although there is general agreement that patient satisfaction is an integral component of service quality, there is a paucity of South African research on reliable and valid satisfaction measures and the effects of health status on satisfaction. A 25-item patient satisfaction scale was developed and tested for evaluating the quality of health care...