Electronic Theses and Dissertations (Masters)

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Subject: search.filters.subject.Diabetes mellitus

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    HbA1c Control in Type 2 Diabetic Patients with Coronary Artery Disease
    (University of the Witwatersrand, Johannesburg, 2023-10) Mhlaba, Lona; Tsabedze, Nqoba; Mpanya, Dineo
    Background: Type 2 diabetes mellitus (T2DM) patients with coronary artery disease (CAD) have an increased risk of recurrent cardiovascular events. These patients require optimal glucose control to prevent the progression of atherosclerotic cardiovascular disease (ASCVD). Current guideline recommendations target an HbA1c ≤7% to mitigate this risk. This study evaluated the level of HbA1c control in T2DM patients with CAD. Methods: This retrospective study assessed consecutive patients who presented with CAD to the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) between April 2017 and December 2019. The study included T2DM patients on anti-diabetic medication with angiographically confirmed CAD. HbA1c control was assessed using the HbA1c level measured at the index presentation and during the most recent follow-up visit. Results: The study population comprised 262 T2DM patients with a mean age was 61.3 ±10.4 years. Among the T2DM patients, 188 (71.8%) were males. At index presentation, 110 (42.1%) T2DM patients presented with ST-segment elevation myocardial infarction, 69 (26.4%) had non-ST-segment elevation myocardial infarction, 43 (16.5%) had unstable angina, and 39 (14.9%) had stable angina. The baseline median systolic blood pressure was higher in patients with an HbA1c ≤7% [136 mmHg (Interquartile range (IQR): 117-151) vs 124 mmHg (IQR: 112-142), p= 0.0121], compared to those with an HbA1c level above 7%. Furthermore, T2DM with an HbA1c ≤7% also had a higher median diastolic blood pressure [85 mmHg (IQR: 75.5-97) vs 78 mmHg (IQR: 71-88), p=0.0205]. After a median follow-up of 16.5 months (IQR: 7-29), 28.7% of the study participants had an HbA1c ≤7%. On multivariable regression analysis, patients with ST-segment depression on the resting electrocardiogram and index presentation had optimal glycaemic control (Odds ratio: 0.27, CI: 0.12-0.59, p= 0.001). Conclusion: After a median follow-up duration of 16.5 months, only 28.7% of T2DM patients with CAD had optimal glycaemic control. This finding underscores the substantial unmet need for optimal diabetes control in this very high-risk group.
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    Clinical Characteristics and Outcomes of Patients with COVID Admitted to a Tertiary Care Centre: A Retrospective Study at Tshepong Hospital
    (University of the Witwatersrand, Johannesburg, 2023-11) Dullabh, Dixit Anil; Zachariah, Don
    Introduction: In December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified in China. It has since then rapidly spread across the globe causing millions to die. In March 2020, the WHO declared coronavirus disease 2019 (COVID-19) a pandemic. It’s clinical presentation and outcomes have been variable across the world. Thus, an analysis of the clinical characteristic and outcomes of patients with COVID-19 at a local setting, namely Tshepong Hospital. Objective: To determine the clinical presentation and outcomes, and correlate clinical and biochemical parameters to outcomes of patients admitted with COVID-19 at Tshepong Hospital. Method: This is a single centre retrospective review of all patients with COVID-19 admitted at Tshepong Hospital during the period 1 June – 31 July 2020. The study contains both inferential and descriptive elements. Results: A total of 200 patients were admitted with COVID-19 during this study period, of which 135 were female and 65 males. The mean age was 53 years with no significant gender differences. 63% of patients had hypertension as a coexisting condition while 35% had diabetes mellitus. Presence of co-morbid conditions were associated with severe disease. Dyspnoea (73%) and cough (94%) were the predominant symptoms. Laboratory parameters including elevated white cell count, C-reactive protein, urea, and creatinine were associated with severe disease. Of the 200 patients, 36 were deemed as severe. 34 of these patients required ICU admissions. 17 demised showing a case fatality rate of 8%. Treatment options given were in keeping with guidelines. Conclusion: COVID-19 has proven to be a clinical and therapeutic challenge. Its main factors being its novelty and variable presentation across the globe. This study has shown that a local setting, not all data is congruent with national or global trends. This speaks to the need of more centres and countries looking at their own variation of COVID-19 presentations, thus challenging the clinical and therapeutic decisions around the disease.