Community based diabetes risk assessment in Ogun state, Nigeria (World Diabetes Foundation project 08-321).

OBJECTIVE: The study assessed the risk of developing type 2 diabetes Mellitus in Ogun State, Nigeria. MATERIALS AND METHODS: Finnish Medical Association diabetes risk score was administered across 25 communities facilitated by non-communicable disease clinics established under a World Diabetes Foundation project. Subjects in the high risk group had blood glucose estimated. RESULTS: 58,567 respondents included 34,990 (59.6%) females and 23,667 (40.3%) males. Majority (61.2%) were between 25 years and 54 years. Considering waist circumference, 34,990 (38.1%) females and 23,667 (5.3%) males had values above 88 cm and 102 cm respectively. Overall, 11,266 (19.2%) were obese and 28.9% overweight using body mass index (BMI). More females had elevated BMI than males. Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) of all subjects were 129.54 mm Hg ± 23.5 mm Hg and 76.21 mm Hg ± 15.5 mm Hg respectively. Prevalence of hypertension (Joint National Committee VII classification) was 27.7%. More subjects had normal DBP than SBP (68.2% vs. 42.5% P < 0.05). Mean fasting blood glucose (FBG) of all subjects was 5.5 mmol/L ± 0.67 mmol/L. Using a casual blood glucose >11.1 mmol/L and/or FBG >7 mmol/L, the total yield of subjects adjudged as having diabetes was 2,956 (5.05%). Mean total risk score was 5.60 ± 3.90; this was significantly higher in females (6.34 ± 4.16 vs. 4.24 ± 3.71, P < 0.05). A total of 2,956 (5.05%) had high risk of developing DM within 10 years. CONCLUSION: The risk of developing DM is high in the community studied with females having a higher risk score. There is urgent need to implement diabetes prevention strategies.

Quality of sleep among hypertensive patients in a semi-urban Nigerian community: a prospective study.

BACKGROUND: Sleep complaints are common in patients with chronic medical disorders; however, the prevalence of "poor sleep" in patients with chronic hypertension is not yet known in Nigeria. In the general population, insomnia negatively impacts quality of life. OBJECTIVE: The objective of this study was to examine the quality of sleep among Nigerian hypertensive patients. The study aimed to measure the prevalence of "poor sleep" in hypertensive patients and to examine the association between quality of sleep and the severity of hypertension in this population. METHODS: Quality of sleep was measured using the Pittsburgh Sleep Quality Index (PSQI) in chronic hypertensive patients attending a tertiary hospital in Nigeria. This was compared with normal control subjects. RESULTS: The mean age of the hypertensive patients was 58.15 +/- 9.65 years (range, 19 - 76 years). This did not differ from the controls at 58.7 +/- 10.8 years. A total of 80 (60.6%) respondents were females with a mean age of 58.3 +/- 12.2 years while 52 (39.4%) were males with a mean age of 58.8 +/- 11.7 years. The mean body mass index (BMI) was 26.42 +/- 4.13 kg/m2 (range, 18.9 - 36.4 kg/m2), with 63.1% of the respondents being either overweight or obese. The mean systolic blood pressure was 167.4 +/- 21.8 mm Hg (range, 100 - 210 mm Hg) while the mean diastolic blood pressure was 96.7 +/- 14.9 mm Hg (range, 60 - 130 mm Hg). Fifty-six (42.4%) hypertensive subjects were "poor sleepers" (global PSQI > 5), with a global mean PSQI of 5.03 +/- 3.28. This was significantly more than 17.3% of control subjects, with a mean global PSQI of 3.10 +/- 0.83. Among the hypertensives, there was no statistically significant relationship between the global PSQI and the age (P = 0.653), sex (P = 0.710), BMI (P = 0.253), systolic (P = 0.145), and diastolic blood pressure (P = 0.827). CONCLUSIONS: Poor sleep is common in hypertensive patients and may be associated with lower health-related quality of life. Large-scale, prospective, longitudinal studies on quality of sleep in hypertensive patients are needed to confirm the high prevalence of impaired quality of sleep in this population and to examine the association between severity of hypertension and quality of sleep while controlling for potential confounding variables. We hypothesize that severity of hypertension directly influences quality of sleep, and poor quality of sleep may worsen hypertensive conditions.

Natural history and epidemiology of post transplantation diabetes mellitus.

OBJECTIVE: High patient mortality continues to be the major threat to the success of solid organ transplantation despite improvements in the control of immunologic phenomena post-transplantation with improvements in grafts survival. Post-transplantation diabetes mellitus (PTD) occurring commonly in patients receiving immunosuppressives has been identified as a major culprit. AIM: This paper reviews the current concepts of PTD. METHODS: A Medline literature search limited to research /review articles in English language, spanning 1984 January - 2004 June on post transplantation diabetes mellitus or hyperglycemia was done. RESULTS: Post-transplantation diabetes mellitus is a heterogeneous condition of abnormal glucose tolerance with a variable onset, duration and severity. It is defined as a fasting plasma glucose = 7.0 mmol / L (126 mg / dL) and / or a 2 hour plasma glucose during an OGTT = 11.1 mmol / L (200 mg / dL), or a casual plasma glucose = 11.1 mmol / L (200 mg / dL), on 3 or more occasions over a period of at least 3 months. The risk factors predisposing to PTD are age, recipient's ethnicity, immunosuppressive regimen and family history of diabetes. The condition not only increases the risk of graft-related complications such as graft rejection, graft loss and infection, but also is a major determinant of the increased cardiovascular morbidity and mortality. CONCLUSION: The most important risk factor predisposing to the development of PTD is the immunosuppressive drugs. The selection of immunosuppressive regimen should take into account individuals diabetes risk profile and the relative diabetogenicity and risk for diabetes of each immunosuppressant, balancing minimal risk of diabetes with effective immunosuppression.