The prevalence of microalbuminuria and associated factors among patients with type 2 diabetes mellitus in Botswana.

BACKGROUND: Microalbuminuria (MA) has been established as an early marker of both diabetic nephropathy and vascular disease in patients with diabetes mellitus (DM). AIMS: This study was conducted to determine the prevalence of MA and associated factors among patients with type 2 DM in Botswana. SETTINGS AND DESIGN: Outpatient tertiary clinic. MATERIALS AND METHODS: A cross-sectional descriptive study involving 289 patients with type 2DM was conducted from January 2013 to June 2013 in Block 6 Reference Clinic, a tertiary clinic in Gaborone, Botswana. A random spot urine sample was collected from each patient with MA defined as urine albumin-to-creatinine ratio (ACR) between 3.0 and 30.0 mg/mmol. STATISTICAL ANALYSIS USED: Data analysis was done using STATA version 12 (College Station, TX, USA). Unpaired Student's t-test was used for compairing means and Chi-squared test was used for comparison of proportions between groups. A P value of <0.05 was considered statistically significant. RESULTS: The majority of recruited patients (191, 66.1%) were females, and the median age (interquartile range) of the patients was 52 (42-53) years. The mean glycosylated hemoglobin (HbA1c) for the study population was 8.43% with 70.6% of the population having HbA1c over 7%. MA was found in 129 (44.6%) of study participants. The duration of diabetes of 6-10 years, estimated glomerular filtration rate, HbA1c, and higher serum trigerycides levels were significantly associated with presence of MA. CONCLUSION: High prevalence of MA raises an urgent need for changes in the management of patients with type 2 DM in Botswana, with emphasis on prevention and reduction of MA to avoid development of overt diabetic nephropathy and ensuing cardiovascular morbidity and mortality.

Tele-cardiology.

After defining tele-medicine, we describe its situation in the public health service of South Africa and its application to cardiology. Methods of communication relevant to tele-cardiology are outlined, together with their bearing on primary healthcare. The range of tele-cardiological applications to electrocardiology, echocardiology, auscultation, imaging and pathology are indicated. Tele-cardiology's contributions to a range of cardiological problems and types of management are described briefly. Finally, a mention is made of the relevance of tele-medicine to education and the costs related to cardiology, with an indication of some future needs for tele-cardiology.