First trimester sex hormone-binding globulin predicts gestational diabetes mellitus in a population of Nigerian women.

There has been a steady rise in the disease burden of Gestational Diabetes Mellitus (GDM) in the sub-Saharan African region over time. Diagnostic testing for GDM is currently recommended at 24 - 28 weeks of gestation, leaving a narrow window for intervention before delivery. Hence the need for early prediction and preventive intervention. The performance of first trimester serum sex hormone-binding globulin (SHBG) assay as a predictor of GDM was determined by binary logistic regression. Women with GDM (n = 49) had a significantly lower mean first trimester SHBG level (104.7 ± 61.6 nmol/L) than did those without GDM (n = 180; 265.2 ± 141.5 nmol/L; p < .001). First trimester SHBG was significantly negatively correlated (rpb = -0.460, p value = <.001) with subsequent development of GDM and an area under receiver operator characteristics (ROC) curve of 0.874 (p < .001). A cut-off value of 158.0 nmol/L predictive of GDM had a diagnostic sensitivity of 81.5%, a specificity of 80.1%, and an overall diagnostic efficiency of 80.3%.IMPACT STATEMENTWhat is already known on this subject? GDM is associated with high risk of various complications and is commonly diagnosed at 24-28 weeks of gestation, leaving a narrow window for intervention. The performance of current maternal clinical and demographic risk factor-based prediction approaches is unreliable. Thus, more favourable prediction approaches need to be developed. Previous studies have suggested that SHBG, a readily assessable marker, has potential to predict GDM; however, these studies have mostly involved Caucasian and other non-African populations.What the results of this study add? SHBG may serve as a reliable first trimester screening tool for GDM development in Nigerian women with singleton pregnancies. This study demonstrates that first trimester SHBG can predict GDM development in sub-Saharan African women despite racial, ethnic and geographical differences.What are the implications of these findings for clinical practice and/or further research? Effective first trimester prediction of GDM using SHBG may enable preventive interventions, thereby mitigating the high burden of the disease in the sub-Saharan African region. It may also provide relevant information that may guide adaptation of current management guidelines to ensure effective management of GDM in the region.

Diabetes/Dementia in Sub-Saharian Africa and Nigerian Women in the Eye of Storm.

In the next few years, the prevalence of diabetes mellitus (DM) is projected to dramatically increase globally, but most of the cases will occur in low-to-middle-income countries. Some of the major risk factors for diabetes accelerate the development of dementia in African-Americans, thus leading to a higher prevalence of dementia than Caucasians. Sub-Saharian Africa women have a disproportionately two-to-eight fold increased prevalence of dementia. In the eye of this storm, Nigeria holds the highest number of diabetics on the African continent, and its prevalence is rising in parallel to obesity, hypertension, and the population's aging. The socio-economic impact of the rising prevalence of DM and dementia will be huge and unsustainable for the healthcare system in Nigeria, as has been recognized in developed economies. Here, we analyze the current situation of women's health in Nigeria and explore future perspectives and directions. The complex interplay of factors involved in diabetes and dementia in Nigerian women include key biological agents (metabolic syndrome, vascular damage, inflammation, oxidative stress, insulin resistance), nutritional habits, lifestyle, and anemia, that worsen with comorbidities. In addition, restricted resources, lack of visibility, and poor management result in a painful chain that increases the risk and burden of disease in Nigerian women from youth to old ages. Heath policies to increase the ratio of mental health professionals per number of patients, mostly in rural areas, foment of proactive primary care centers, and interventions targeting adolescents and adult women and other specific mothers-children pairs are strongly required for a sustainable development goal.

Commentary: improving persistently elevated HbA1c in diabetes mellitus patients in Nigeria.

Glycated hemoglobin (HbA1c) level in patients with diabetes reflects quality of disease control and propensity to develop hyperglycemic complications. During more than 12 years of using HbA1c for monitoring of glycemic control among patients at Nigerian hospitals, the mean glycated hemoglobin ranged from 7.9% ± 2.4 to 8.3% ± 2.2. Most of these patients (63% to 68%) had poor glycemic controls with mean HbA1c greater than 7%. Factors that are implicated in this scenario are: 1) high cost of HbA1c testing, 2) ineffective management of risk factors, 3) poor patient compliance, 4) improperly managed diabetes education program, and 5) health care system defect. Central to improving diabetes glycemia is education of doctors, other health workers and patients, within the confines of an overhauled national health system. Physicians need to increase adherence to diabetes mellitus management guidelines and patients must be enrolled into a well-structured education program at health centers. Doctors, as leader of the health team, should drive such education schemes, which must be based on standard training curriculum, sufficient number of trained diabetes educators, and effective monitoring of patients. The most appropriate diabetes education model features small-to-moderate sized participant groups and makes use of motivational interviewing rather than a traditional advice-giving format. Improved health care funding is mandatory given the issue of cost and this can be helped by increased participation of patients in Nigeria's National Health Insurance Scheme. Failure to address the persistently elevated HbA1c will affect long-term quality of life, longevity and health care services in Nigeria.