Sonographic Evaluation of the Heel Pad Thickness in Diabetics in Nigeria.

Background: Diabetes mellitus is a chronic disease process affecting millions of people worldwide. Its prevalence is forecasted to reach a value of 7.7% by 2030. It carries severe morbidities and even mortality. Hyperglycemia and increased formation of advanced glycosylation end products causes the majority of soft tissue changes seen among diabetics. The effects are observed particularly in the heel pad and plantar fascia where thinning or thickening, fibre disorganization, calcification and hypoechoic foci are among the changes seen. Methods: This cross-sectional descriptive study was carried out at the Department of Radiology, OAUTHC, Ile Ife, Osun state, Southwest Nigeria. 40 years old and above subjects with Type 2 diabetes mellitus were recruited from the diabetic clinic of the institution and Ultrasound evaluation of the heel fat pad and plantar fascia were subsequently performed for those who met the criteria using ultrasound machine equipped with a 7.5- 12.0 MHz high frequency linear array transducer. Results: The mean heel pad thickness on the right feet was greater than that of the left in the study subjects. There was statistical significant difference in the heel fat pad thickness of diabetic subjects and the control group, in both feet. (P=0.000). The heel pad thickness is higher in diabetic subject than in non-diabetic control subjects. However, there was no statistical significant difference in the right and left heel fat pad thickness of the participants of this study (P value 0.6062). Only HPT was a statistically significant predictor of foot ulcers among other variables after binary regression was computed. Using Spearman's rank correlation to test the relationship between the BMI of diabetic subjects and mean heel pad thickness, it revealed a moderate positive correlation, with good statistically significance (Spearman's rho = 0.4397, P=0.0000). The relationship between the BMI of diabetic subjects and mean plantar fascia thickness showed a weak positive correlation, with good statistical significance (Spearman's rho = 0.2635, P=0.0008). Conclusion: The duration of diabetes mellitus did not determine the heel pad thickness and plantar fascia thickness. The findings in the study suggested that history of foot ulcer in the diabetic predispose them to have reduce HPT and further foot ulcers. Sonographic measurement of heel pad thickness can therefore be an additional imaging modality to evaluate and be used in the management of the diabetic patients' feet.

Salivary inflammatory biomarkers and glycated haemoglobin among patients with type 2 diabetic mellitus.

BACKGROUND: Type 2 diabetes mellitus has reached epidemic proportions worldwide and improved detection techniques and biomarkers are urgently needed across the spectrum of diabetes initiation and progression. Inflammatory biomarkers play a role in the development of the condition and blood is the gold standard body fluid for the diagnosis of diabetes mellitus. Serum glycated haemoglobin is a widely used marker of chronic hyperglycemia, and it is currently used to diagnose type 2 diabetes mellitus and it is the standard biomarker for the adequacy of management. However, saliva offers an alternative to serum as a biological fluid for diagnostic purposes. Non-invasive measures of inflammatory biomarkers (such as saliva diagnostics) are increasingly being investigated due to significant similarities between salivary and serum proteome. The role of saliva diagnostics in diabetes mellitus has not been explored in our study population. OBJECTIVES: This study investigated the association of selected salivary inflammatory biomarkers (Interleukin 6 [IL-6], C-reactive protein [CRP], and Tumour necrosis factor α [TNF-α]) to glycated haemoglobin (HbA1C) in type 2 diabetics. MATERIALS AND METHODS: Seventy-five participants, 39 type 2 diabetics (52%) and 36 (48%) healthy controls were recruited. Saliva and blood samples were collected for each participant. The levels of selected salivary inflammatory biomarkers (IL-6, CRP and TNF-α) were estimated by Enzyme Linked Immunosorbent Assay (ELISA) method and glycated haemogloin (HbA1C) was estimated using the liquid chromatography method. Periodontal status of the participants were determined using the Basic Periodontal Examination (BPE). RESULTS: The mean salivary levels of CRP was significantly higher in diabetics, 0.05 ± 0.04 µg/ml than in controls, 0.02 ± 0.02 µg/ml (p < 0.001). Mean TNF-α was also significantly higher in diabetics, 5.39 ± 12.10 pg/ml than in controls, 1.51 ± 3.66 pg/ml (p = 0.036). Mean salivary IL-6 was also higher in diabetics compared with controls (47.20 ± 18.49 versus 41.94 ± 16.88 pg/ml), but the difference was not statistically significant, p = 0.204. In the multivariate analysis adjusting for age and periodontal status, only the mean salivary CRP was significantly higher in diabetics, 0.034 higher than controls (95% CI 0.009, 0.059 and p = 0.01). There was a positive correlation between salivary CRP and HbA1C levels, which was moderate with r-value 0.4929 and p-value < 0.0001. CONCLUSIONS: Salivary inflammatory biomarkers especially CRP are higher in diabetics compared with controls and CRP is positively correlated with serum HbA1C levels. The biomarkers show potentials as non-invasive alternative method to evaluate glycaemic control in diabetes.

Correlation of Doppler ultrasound resistive index in the prostatic gland with severity of male lower urinary tract symptoms, prostate volume, and concomitant diabetes mellitus.

Introduction: Benign prostatic enlargement (BPE) and type 2 diabetes mellitus (T2DM) are common in elderly men. This study aimed to correlate the Doppler resistive indices of prostatic arteries with the severity of lower urinary tract symptoms (LUTS) and prostate volume in men with concomitant BPE and T2DM. Material and methods: Fifty men with T2DM and BPE (BPE-DM) as cases and 50 age-matched men with BPE but no T2DM (BPE-ND) as controls were enrolled. B-mode and power Doppler ultrasonography of the prostate gland were done for both groups. Results: The mean total prostatic volume of the BPE-DM was 79.18 ±8.9 ml, while that of BPE-ND was 60.73 ±10.6 ml (p <0.0001). The mean prostatic resistive index (PRI) was significantly higher among BPE-DM than BPE-ND (0.74 ±0.02 vs 0.68 ±0.09 for right capsular artery; 0.77 ±0.04 vs 0.71 ±0.02 for left capsular artery; and 0.76 ±0.04 vs 0.70 ±0.02 for the urethral artery). BPE-DM with higher glycated haemoglobin, fasting plasma glucose, and longer duration of T2DM experienced more severe lower urinary tract symptoms and had higher PRI. Conclusions: In conclusion, the BPE-DM group presented larger prostate glands and more bothersome LUTS, which correlated with higher PRI. Strict glycaemic control is necessary in men with co-existing BPE and T2DM.

The burden of diabetic complications in subjects with type 2 diabetes attending the diabetes clinic of the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria - a cross-sectional study.

Introduction: the increasing prevalence of diabetes (DM) worldwide has resulted in an increase in the morbidity and mortality of DM. This burden is as a result of the development of the chronic complications associated with it. This study determined the burden of occurrence of microvascular and macrovascular complications of subjects with type 2 diabetes attending the out -patient clinic of a tertiary hospital in south west Nigeria. Methods: this cross-sectional study involved 400 consecutive subjects with type 2 diabetes. A study proforma was used to document the socio demographic data. While clinical assessment for anthropometric measurement, blood pressure was done. Laboratory measurement of blood glucose control and lipids were done. Assessment of the occurrence of microvascular and macrovascular complications were performed and documented. Results: four hundred type 2 DM participants made up of 190 males and 210 females with a mean age of 60.35±9.53 years, with a mean age of 60.35(SD 9.53) years for males and 60.81(SD10.29) years for females. Median duration of DM for all subjects was 6.00(IQR 3.00 - 11.00) years. Majority (45%) of the participants were overweight. The prevalence of hypertension was 78% and poor glycaemia using HBA1C was 75.5% and 59.8% had dyslipidaemia. The occurrence of microvascular complications (diabetic neuropathy - 82%, diabetic retinopathy - 46% and diabetic nephropathy - 44%) 69.3% while macrovascular complications (peripheral arterial disease - 42.5%, stroke - 4%, electrocardiographic changes if ischaemic heart disease -9.3% and left ventricular hypertrophy - 22%) in 49%. Regression analyses showed advancing age aOR (1.18 [95%CI 1.01 - 1.38]) and waist circumference (aOR 1.17 [95% CI 1.00 - 1.36]), as significant contributors to the presence of diabetes complications. Conclusion: the risk factors of both microvascular and macrovascular complications remain high in our clinic and this is linked to the high burden of diabetes mellitus and its long duration.

Prevalence of cardiovascular risk factors and their association with renal impairment in elderly patients with type 2 diabetes mellitus in a Nigerian tertiary hospital: a cross-sectional study.

Introduction: the population of elderly with Type 2 Diabetes Mellitus (T2DM) has been on the increase. The burden of cardiovascular disease and renal impairment may also increase due to the relationship between cardiovascular risk factors and ageing in those with T2DM. The prevalence of cardiovascular risk factors and their association with renal impairment in elderly with T2DM were determined. Methods: this is a cross-sectional study that involved 96 elderly patients with T2DM and 96 elderly individuals without DM as control. The prevalence of cardiovascular risk factors was determined among the study participants. Binary logistic regression was used to determine the significant cardiovascular factors associated with renal impairment among the elderly with T2DM. P-value <0.05 was taken as significant. Results: the mean age of the elderly with T2DM and control group were 66.73±5.18 years and 66.78±5.25years, respectively. The male: female ratio was 1: 1 for both groups. The prevalence of the cardiovascular risk factors in the elderly with T2DM and control were; hypertension (72.9%vs39.6%; p ≤0.001), high glycated haemoglobin (77.1% vs 0%; p ≤0.001), generalized obesity (34.4%vs1.0%; p ≤0.001), central obesity (50.0%vs11.5%; p ≤0.001), dyslipidemia (97.9%vs89.6%; p=0.016), albuminuria (69.8% vs 11.2%; p ≤0.001), anaemia (53.1%vs18.8%; p ≤0.001). Renal impairment was present in 44.8% of the elderly T2DM. On multivariate analysis, the cardiovascular risk factors significantly associated with renal impairment in elderly with T2DM were high glycated haemoglobin (aOR: 6.21, 95% CI: 1.61-24.04; p=0.008), albuminuria (aOR: 4.77, 95% CI: 1.59-14.31; p=0.005) and obesity (aOR: 2.78, 95%CI 1.04-7.45; p=0.042). Conclusion: cardiovascular risks factors were highly prevalent and closely associated with renal impairment in elderly with T2DM. Early cardiovascular risk factor modification may reduce both renal and cardiovascular disease burden.

Diabetes and peripheral artery disease: A review.

Peripheral arterial disease (PAD) refers to partial or complete occlusion of the peripheral vessels of the upper and lower limbs. It usually occurs as part of systemic atherosclerosis in the coronary and cerebral arteries. The prevalence of PAD is expected to continue to increase in the foreseeable future owing to the rise in the occurrence of its major risk factors. Nonhealing ulcers, limb amputation and physical disability are some of its major complications. Diabetes mellitus (DM) remains a major risk for PAD, with DM patients having more than two-fold increased prevalence of PAD compared with the general population. The clinical presentation in people with DM also differs slightly from that in the general population. In addition, PAD in DM may lead to diabetic foot ulcers (DFUs), which precipitate hyperglycaemic emergencies and result in increased hospital admissions, reduced quality of life, and mortality. Despite the epidemiological and clinical importance of PAD, it remains largely under diagnosed and hence undertreated, possibly because it is largely asymptomatic. Emphasis has been placed on neuropathy as a cause of DFUs, however PAD is equally important. This review examines the epidemiology, pathophysiology and diagnosis of lower limb PAD in people with diabetes and relates these to the general population. It also highlights recent innovations in the management of PAD.

Management of adult patients with type 1 diabetes mellitus in Africa: A post-hoc cohort analysis of 12 African countries participating in the International Diabetes Management Practices Study (Wave 7).

There is a paucity of information on real world management of African adult patients with type 1 diabetes mellitus (T1DM). We aimed to describe a cohort of African adults with T1DM.The International Diabetes Management Practices Study is an observational survey conducted from 2005 to 2017. Data were collected in seven individual waves from countries in Asia, Africa, East Europe, and Latin America. Wave 7 was conducted from 2016 to 2017 and the African cohort included 12 countries. Questionnaires were administered to clinicians and patients. Analyses were mainly descriptive. Logistic regressions were performed to identify predictive factors for glycaemic control.A total of 788 patients were enrolled in the study. HbA1c values were available for 712 patients; only 16.6% had HbA1c values <7%. A total of 196 (24.9%) reported being hospitalized in the preceding year, with the most common reasons being diabetic ketoacidosis (58.1%, 93/160) and hypoglycaemia (31.1%; 52/167). Over half of the patients (55.4%) stated that the cost of test strips limited regular glycemic monitoring; a minority of patients (15%, 120/788) received structured diabetes education. Predictors of HbA1c <7% included patients receiving diabetes education (odds ratio [OR] [95% confidence interval, CI] = 2.707 [1.157-6.335] P = .022), following a healthy diet and exercise plan (OR [95% CI] = 2.253 [1.206-4.209], P < .001) and self-managing (monitoring glucose levels and adjusting insulin accordingly) (OR [95% CI] 2.508 [1.500-4.191] P < .001).African adults with T1DM have suboptimal glycemic control with almost one-quarter reporting hospitalization within the preceding year. Most patients felt comfortable with self-adjustment of insulin dose but said that the cost of test strips was the main factor that limited regular monitoring. Reducing direct costs of testing strips and insulin, and improving education will address major challenges within these settings.

Relationship between sonographically measured median nerve cross-sectional area and presence of peripheral neuropathy in diabetic subjects.

BACKGROUND: Neuropathy is a common complication of diabetes mellitus resulting from direct damage by hyperglycemia to the nerves and/or ischemia by microvascular injury to the endoneurial vessels which supply the nerves. Median nerve is one of the peripheral nerves commonly affected in diabetic neuropathy. The median nerve size has been studied in non-Nigerian diabetic populations. In attempt to contribute to existing literature, a study in a Nigerian population is needed. AIM: To evaluate the cross-sectional area (CSA) of the median nerve using B-mode ultrasonography (USS) and the presence of peripheral neuropathy (PN) in a cohort of adult diabetic Nigerians. METHODS: Demographic and anthropometric data of 85 adult diabetes mellitus (DM) and 85 age- and sex-matched apparently healthy control (HC) subjects were taken. A complete physical examination was performed on all study subjects to determine the presence of PN and modified Michigan Neuropathy Screening Instrument (MNSI) was used to grade its severity. Venous blood was taken from the study subjects for fasting lipid profile (FLP), fasting blood glucose (FBG) and glycated haemoglobin (HbA1c) while their MN CSA was evaluated at a point 5 cm proximal to (5cmCATL) and at the carpal tunnel (CATL) by high-resolution B-mode USS. Data was analysed using SPSS version 22. RESULTS: The mean MN CSA was significantly thicker in DM subjects compared to the HC at 5cmCATL (P < 0.01) and at the CATL (P < 0.01) on both sides. The presence of diabetic peripheral neuropathy (DPN) further increased the MN CSA at the CATL (P < 0.05) but not at 5cmCATL (P > 0.05). However, the severity of DPN had no additional effect on MN CSA 5 cm proximal to and at the CATL. There was no significant association between MN CSA and duration of DM and glycemic control. CONCLUSION: Thickening of the MN CSA at 5cmCATL and CATL is seen in DM. Presence of DPN is associated with worse thickening of the MN CSA at the CATL but not at 5cmCATL. Severity of DPN, duration of DM, and glycemic control had no additional effect on the MN CSA.

Determinants of previous dilated eye examination among type II diabetics in Southwestern Nigeria.

PURPOSE: To assess the prevalence and factors influencing previous dilated eye examination in screening for retinopathy among type II diabetics. METHODOLOGY: Cross-sectional study of type II diabetic patients receiving treatment at a tertiary hospital in southwestern Nigeria was conducted with information on gender, age, duration of diabetes, current medication and previous dilated eye examination recorded. Eye examination included visual acuity, pen torch examination, applanation tonometry and direct ophthalmoscopy of the dilated eye in a dark room. Visual acuity was presented as classified by WHO while data was analyzed using SPSS version 11 and statistical significance inferred at P<0.05. RESULTS: Eighty three type II diabetics with mean age 57.5+/-10.8 years and mean duration of diabetes of 6.6 years were studied. Visual impairment (<6/18 in the better eye) and blindness (<3/60 in the better eye) were recorded in 3.6% and 12% of the patients respectively while diabetic retinopathy was present in 21.6%. Only 24 [28.9%] diabetics had previous dilated eye examination; absence of eye symptoms [50.8%] and lack of referral [45.8%] were the main barriers to having previous dilated eye examination. Previous dilated eye examination was significantly influenced by the presence of visual impairment/blindness [P=0.002], longer duration diabetes mellitus [P=0.006], current insulin treatment [P=0.040] and presence of non-diabetic vision threatening eye diseases [P=0.016]. CONCLUSION: Dilated eye examination rate is low; inadequate knowledge about diabetic retinopathy as well as low referral rates is contributory. Massive health education on diabetic retinopathy as well as development of sustainable retinopathy screening protocol would be helpful.