The Baseline Self-Efficacy Scores to Manage Chronic Diseases Amongst Nigerian Patients with Non-Communicable Diseases are Sub-Optimal.

Nigeria is one of the developing countries with a major burden of non-communicable diseases (NCDs) without a disease self-management program in its healthcare system. Thus, this study was aimed to assess the baseline self-efficacy levels of Nigerian patients with chronic NCDs at tertiary level hospitals. This is a cross sectional study of 286 NCD patients attending tertiary level clinics from 26 July to 27 October 2023. Patients were interviewed on a 10 Self-Efficacy to Manage Chronic Disease (SEMCD) item scales that were considered suitable for the Nigerian population. The 10 SEMCD questions covered: (i) Exercise regularly scale, (ii) Help from community, family and friends scale, (iii) Communication with Physician scale, (iv) Manage disease scale and (v) Manage symptom self-efficacy domains. Data were analyzed both descriptively and statistically using Student's t-tests and Chi-square tests as appropriate. The results showed that more female (59.4%) than males (40.6%) attended clinics during the study, and the mean age of the patients did not differ between gender (P > .05). About 40% of all the patients manage their NCDs with medications alone, a trend that is similar in male and female patients (P > .05). While all the patients had a relatively lower self-efficacy scores under regular exercise scale (52%-55%) and manage disease symptoms scale (53%-55%), they tended toward higher self-efficacy scores under getting assistance from community, family, and friends (79%-80%) and communication with attending physicians (81%-85%). It is concluded that Nigeria literate NCD patients registered at tertiary level institution routine clinics are less than optimal in disease self-management care. We recommend that this study population will benefit from introduction and implementation of disease self-management program in the healthcare system.

Measurement of neutrophil gelatinase-associated lipocalin (NGAL) in patients with non-communicable diseases: any additional benefit?

AIM: Chronic kidney disease (CKD) is one of the major complication from non-communicable diseases (NCD), such as diabetes or hypertension. We aimed to determine if routine measurement of neutrophil gelatinase-associated lipocalin (NGAL) in NCD patients could provide additional benefit for diagnosing kidney disease. METHODS: Fasting serum NGAL, urea, creatinine, uric acid and albumin were measured in 298 NCD patients. Estimated glomerular filtration rate (e-GFR) was calculated using the CKD-EPI equation. Multiple linear regression modeling was used for analysis. RESULTS: CKD patients have the highest levels of NGAL than the other NCD patients (p < 0.001). Although NGAL was significantly related to e-GFR, creatinine, urea and albumin in CKD-patients (p < 0.001) and not in the other NCD patients (p > 0.05), only serum creatinine predicted NGAL levels in CKD-patients (p < 0.001). CONCLUSION: NGAL level is best associated with serum creatinine only in patients with CKD and NGAL measurement may not be cost effective as a routine kidney function test in NCD patients in under-resourced economies.

Implementing diabetes self-management education (DSME) in a Nigerian population: perceptions of practice nurses and dieticians.

Hyperglycaemic complication is the most common cause of hospitalization amongst diabetes patients in Nigeria. Research showed that diabetes self-management education (DSME) assists in controlling hyperglycaemia in diabetes patients. We assessed the opinions of practice nurses and dieticians on implementing DSME in a Nigerian population. 517 nurses and dieticians completed a self-administered questionnaire tool. Results showed that the majority of the participants agreed that DSME in a Nigerian population will assist patients (88.3%) and assist to reduce diabetes complications (91.4%). While only 34% of all participants believed that their establishments were prepared to implement DSME, a large proportion of the participants agreed that their work places do not have enough qualified health personnel (62.4%), educational facilities (65.8%) and economic resources (65.6%) to embark on DSME. These constitute significant barriers for effective DSME and demand that strategic investment in human and material resources for DSME is needed in this population of a developing country.

Effects of a 6-month nurse-led self-management program on comprehensive pulmonary rehabilitation for patients with COPD receiving home oxygen therapy.

PURPOSE: This study was to examine the effectiveness of a nurse-led 6-month comprehensive pulmonary rehabilitation program for stage IV chronic obstructive pulmonary disease patients receiving home oxygen therapy. DESIGN: A controlled clinical study was performed. METHODS: Face-to-face and telephone interviews were conducted with the intervention group, whereas conventional education was given to the control group. FINDINGS: Fifteen participants were analyzed in each group. There were no improvements in physiological outcomes; however, the severity of dyspnea, social activity, and walking distance significantly improved in the intervention group, and consequently quality of life was improved. Three patients in the intervention group received treatment for cold-like-symptoms but did not require hospitalization. However, five patients in the control group received treatment for cold-like-symptoms and two required hospitalization. CONCLUSIONS: The findings demonstrate that our program contributes to patients' learning of self-management skills and significantly improves dyspnea, social activity level, walking distance, and overall quality of life.

High prevalence of abdominal obesity increases the risk of the metabolic syndrome in Nigerian type 2 diabetes patients: using the International Diabetes Federation worldwide definition.

BACKGROUND: Some Nigerian studies have reported cases of the metabolic syndrome in the population. This study aims to assess the prevalence of the components of the metabolic syndrome in type 2 diabetes mellitus (T2DM) patients using the International Diabetes Federation (IDF) worldwide definition. METHODS: Eighty-nine T2DM patients were studied after an overnight fast. The patients' blood pressure, anthropometric indices, and biochemical parameters were measured. The components of the metabolic syndrome-raised blood pressure, waist circumference, triglycerides (TGs), and reduced high-density lipoprotein cholesterol (HDL-C)-were calculated using the IDF definition for the European ethnic group. RESULTS: About 25% of the patients had raised blood pressure (>130/85 mmHg), with the male patients having higher prevalence of raised systolic blood pressure (SBP>130 mmHg) than the female patients (73.3 vs. 52.3%, P<0.05). Although the prevalence of raised TGs did not differ in gender, more females than males had reduced HDL-C (77.3 vs. 46.7%, P<0.001). Although generalized obesity is similar in both gender (17.8% vs. 31.8%, P>0.05), abdominal obesity predominates significantly in female patients (97.7 vs. 68.9%, P<0.001). Overall, total obesity (P<0.05), raised blood pressure (P<0.05), raised TGs, and reduced HDL-C are significantly clustered in abdominally obese patients. CONCLUSION: It is concluded that the abdominally obese T2DM patients had a higher cluster of the components of the metabolic syndrome and are consequently at greater risk of cardiovascular disease (CVD). We recommend that diabetes education emphasizing the risk of CVD in patients with increased abdominal fat should be intensified in the developing countries.

Anaemia and kidney dysfunction in Caribbean type 2 diabetic patients.

BACKGROUND: Anaemia has been shown in previous studies to be a risk factor for cardiovascular disease in diabetic patients with chronic kidney disorder. This study was aimed to assess the prevalence of anaemia and kidney dysfunction in Caribbean type 2 diabetic patients that have been previously shown to have a high prevalence of the metabolic syndrome. METHODS: 155 type 2 diabetic patients and 51 non-diabetic subjects of African origin were studied. Anthropometric parameters were measured and fasting blood samples were collected for glucose, creatinine, glycated hemoglobin and complete blood count. Anaemia was defined as haemoglobin < 12 g/dl (F) or < 13 g/dl (M). Kidney function was assessed using glomerular filtration rate (GFR) as estimated by the four-variable Modification of Diet in Renal Disease (MDRD) study equation. Subjects were considered to have chronic kidney disease when the estimated GFR was < 60 ml/min per 1.73 m2. Comparisons for within- and between-gender, between diabetic and non-diabetic subjects were performed using Student's t-test while chi-square test was employed for categorical variables. RESULTS: The diabetic patients were older than the non-diabetic subjects. While male non-diabetic subjects had significantly higher red blood cell count (RBC), haemoglobin and hematocrit concentrations than non-diabetic female subjects (p < 0.001), the RBC and hematocrit concentrations were similar in male and female diabetic patients. Furthermore, irrespective of gender, diabetic patients had significantly higher prevalence rate of anemia than non-diabetic subjects (p < 0.05). Anaemic diabetes patients had significantly lower GFR (67.1 +/- 3.0 vs. 87.9 +/- 5.4 ml/min per 1.73 m2, p < 0.001) than non-anaemic patients. CONCLUSION: A high prevalence of anaemia was identified in this group of type 2 diabetic patients previously shown to have a high prevalence of the metabolic syndrome. It is therefore recommended that diagnostic laboratories in developing countries and elsewhere should include complete blood count in routine laboratory investigations in the management of diabetic patients.

Carbohydrate-induced hypertriglyceridaemia among West Indian diabetic and non-diabetic subjects after ingestion of three local carbohydrate foods.

BACKGROUND AND OBJECTIVE: Studies suggest that the link between postprandial hyperglycaemia and cardiovascular risk in type 2 diabetes mellitus might be related to postprandial hypertriglyceridaemia and the increased levels of the highly atherogenic small and dense low density lipoprotein (LDL) particles. In this study we therefore aimed to determine which of the three popular carbohydrate foods has the highest potential of increasing postprandial triglyceride levels in type 2 diabetic patients and in healthy non diabetic individuals. METHODS: All subjects were studied on three different occasions seven days apart after an overnight fast. On each day of study, anthropometric indices were measured and after collecting fasting blood sample, subjects consumed bread, roti or rice within 10 min and water taken as wished. Subsequently, 7 ml of venous blood samples were collected at 60, 90, 120 and 150 min for insulin, glucose and lipids determinations. RESULTS: The diabetic and non diabetic healthy subjects had similar baseline body mass index, insulin, triglyceride, total and LDL-cholesterol. The mean percentage triglyceride increase after ingestion of the test foods was highest with bread and lowest with rice irrespective of diabetic status or ethnicity, and despite similar baseline triglyceride, insulin and body mass index levels, the diabetic patients of East Indian origin had comparatively higher incremental triglyceride levels for the three test foods than those of African origin. INTERPRETATION AND CONCLUSION: Contrary to anecdotal perception, the commercially prepared whole wheat bread has the highest propensity to induce hypertriglyceridaemia especially among diabetic patients of East Indian origin.

Determination of the differences in 2-h plasma glucose values after ingestion of carbohydrate foods and oral glucose in Caribbean non-diabetic subjects.

It has been reported that mixed meals are used in clinics in developing and developed countries in screening and diagnosis of diabetes. Thus, we aimed to determine the differences in 2-h plasma glucose values after non-diabetic subjects ingested 75 g pure glucose and its equivalent content in frequently consumed carbohydrate foods in Caribbean subjects. Twenty-seven apparently healthy non-diabetic subjects (nine males, 18 females) consumed 75 g pure glucose and its carbohydrate equivalent in three ethnic test foods (bread, rice and roti) at 7 days apart. Plasma glucose and insulin levels were determined in blood samples collected before and after 60, 90, 120 and 150 min of ingestion of these foods. In comparison with each of the test foods, the postprandial 1-h and 2-h plasma glucose values and the 60, 90, 120 and 150 min incremental glucose concentrations after oral glucose load were significantly higher than the corresponding values for each of the test foods (all P<0.01). In spite of these higher postprandial glucose concentrations, the postprandial insulin responses following the oral glucose load and the test foods did not significantly differ at any time point (all P>0.05). However, the test food, roti, tended to stimulate higher absolute and incremental insulin secretions than pure glucose or any other test food (all P>0.05). Generally, the correlation between 2-h plasma glucose value after the ingestion of the pure glucose and each of the test foods was significant (all correlation coefficients were greater than 0.70, P<0.01). In conclusion, different ethnic mixed meals could serve as an alternative to glucose in routine screening and diagnosis of diabetes if its available carbohydrate content is known and quantified.

Glycaemic responses after ingestion of 3 local carbohydrate-based foods in West Indian patients with type-2 diabetes mellitus.

BACKGROUND & AIM: Previous studies suggest that inadequate glycaemic control in diabetic patients might be related to the type of carbohydrates the patients consume regularly. Thus, we aimed to assess glucose and insulin responses after diabetic and non-diabetic subjects ingested 3 commonly consumed carbohydrate-based foods. METHODS: Thirty-eight type-2 diabetic and 27 non-diabetic subjects were studied in 3 different occasions of 7 days apart. On each day of the study, anthropometric indices were measured and after collecting fasting blood samples, subjects randomly consumed bread, roti or rice within 10 min. Subsequently 7 ml of venous blood samples were collected at 60, 90, 120 and 150 min for determination of glucose and insulin responses. RESULTS: Although the diabetic patients were older than the healthy subjects (P < 0.05), both subjects had similar weight, body mass index and waist and hip circumferences (P > 0.05). The mean fasting and post meal plasma glucose concentrations for the 3 test foods were higher in diabetic patients than the corresponding values for the healthy subjects (all; P < 0.001). Generally, roti elicited the highest total incremental glucose responses in the diabetic patients irrespective of ethnic group (P < 0.05). CONCLUSION: There were variations in glucose and insulin responses to the 3 test foods. However, roti elicited the highest postprandial hyperglycaemia and should therefore be discouraged in regular dietary plan of diabetic patients.

Indices of obesity, dyslipidemia, and insulin resistance in apparently healthy Caribbean subjects.

Reports from developing countries indicate that a rise in the socioeconomic level is a risk factor for metabolic disorders. We aimed to assess the indices of obesity, dyslipidemia, and insulin resistance among fairly literate healthy adults in a multidisciplinary institution in Trinidad. The study included 156 volunteers (46 males and 110 females, 17-40 years old). The subjects provided information on age, ethnicity, educational attainment, and occupation in self-administered, closed-ended questionnaires. Waist and hip circumferences (cm), weight (kg), and height (m) were measured. Fasting blood samples were taken for glucose, insulin, and lipid determinations in 78 subjects who volunteered for laboratory measurements. Insulin resistance was determined with homeostasis model assessment (HOMA). Of the 156 subjects studied, 83% had received tertiary education, and had no previous record of body mass index (BMI); 8% were obese, 17% were overweight, and 27% were underweight. Laboratory measurements in 78 subjects revealed 28% hypercholesterolemia and 20% hyperinsulinemia. There were no significant gender-related differences in these prevalence rates (P>0.05). The identification of obesity, underweight, hyperinsulinemia, and hypercholesterolemia in this healthy population suggests that screening for the indices of metabolic disorders in a healthy population would be potentially useful for the early identification and treatment of metabolic-related disorders.