Cardiovascular Risk Indices and Their Impact on Outcome in Patients with Hyperglycaemic Emergencies in a Nigerian Hospital.

BACKGROUND: High sensitivity C-reactive protein (hsCRP) and Plasminogen Activator Inhibitor-1 (PAI-1) are recognised independent novel risk factors for cardiovascular disease. Few studies have assessed cardiovascular risk factors in patients with hyperglycaemic emergencies (HE), despite it being a major cause of death in diabetics. OBJECTIVE: The objective of this study was to determine cardiovascular risk indices in patients with hyperglycaemic emergencies and related these with outcome. METHODS: This cross sectional study involved 45 patients that presented with HE and 45 age and sex matched diabetics without HE who served as controls. Historical features, physical findings and laboratory parameters including hsCRP and PAI-1 were compared between subjects and controls. RESULTS: The mean values of serum hsCRP and PAI-1 were significantly higher in patients with HE compared to diabetic control. (49.52 ± 13.6 vs. 2.4 ± 1.35, 51.2 ± 28.7 vs. 33.2 ± 10.7 respectively). Traditional cardiovascular risk factors such as HbA1c, Atherogenic Index and microalbuminuria were also significantly higher in them. Mortality was associated with increasing age, higher values of waist circumference, pulse rate, respiratory rate, hsCRP, Atherogenic index and lower blood pressure and HDL values. CONCLUSION: Cardiovascular risk indices are higher in patients with HE.

Influence of gender on the distribution of type 2 diabetic complications at the obafemi awolowo teaching hospital, Ile-Ife, Nigeria.

BACKGROUND: Sex specific differences appear particularly relevant in the management of type 2 DM. OBJECTIVE: We determined gender specific differences in cardio-metabolic risk, microvascular and macrovascular complications in patients with type 2 diabetes. METHODS: Four hundred type 2 diabetes patients, males and females, matched for age and disease duration were recruited from the diabetes clinic. Relevant clinical and laboratory information were obtained or performed. RESULTS: 190(47.5%) were male and 210 (52.5%) were female respectively. The mean age of the study population was 60.6 + 9.93 years. Women had higher prevalence of hypertension (and obesity. Mean total cholesterol was significantly higher in women but men were more likely to achieve LDL treatment goals than women (69.5% vs 59.0%, p<0.05). More women (47.1% & 31.4%) reached glycaemic goals of <10mmol/l for 2HPP and HBA1c of <7.0%.There were no gender differences in the distribution of microvascular and macrovascular complications (p>0.05) but women were more likely to develop moderate and severe diabetic retinopathy (p= 0.027). CONCLUSION: Women with T2DM had worse cardiometabolic risk profile with regards to hypertension, obesity and lipid goals. Men achieved therapeutic goals less frequently than did women in terms of glycaemia. Microvascular and macrovascular complications occurred commonly in both sexes.

Sonographic Evaluation of the Achilles Tendon and Plantar Fascia of Type 2 Diabetics in Nigeria.

BACKGROUND: The aim of this study is to compare the Achilles tendon (AT) thickness (ATT) and plantar fascia (PF) thickness (PFT) of diabetics with and without peripheral neuropathy (PN) to that of a control population. MATERIALS AND METHODS: B-mode sonography of the AT and PF was done. Correlation analysis was used to determine the relationship between ATT and PFT with demographic data such as body mass index, duration of diabetes, and presence of PN. A multivariate regression was used to construct models for determining the thicknesses. RESULTS: Eighty type 2 diabetics were recruited and categorized into groups based on the presence or absence of PN (Groups A and B, respectively). Group A constituted 57 participants while there were 23 in Group B. Eighty controls constituted Group C. Mean values of 6.08 ± 0.65, 5.08 ± 0.48, and 4.57 ± 0.57 mm (P < 0.001) of the right ATT were obtained in Groups A to C while values of 1.95 ± 0.35, 1.88 ± 0.39, and 1.44 ± 0.20 mm (P < 0.001) were obtained for the right PFT. CONCLUSION: The presence of PN and factors such as diabetes duration can affect the thickness of AT and PF.

Insulin resistance and plasma glucose tolerance abnormalities in Nigerians with chronic liver disease.

AIMS: Glucose tolerance abnormalities are frequently observed in patients with chronic liver disease (CLD). Insulin resistance (IR) has been suggested to be a major factor responsible for these abnormalities in CLD. However studies relating IR with severity of CLD are scarce in Nigeria. This study assessed insulin resistance and glucose tolerance abnormalities in CLD and their relationship with the severity of CLD in a tertiary hospital in South-West, Nigeria. METHODS: This cross sectional study involved 100 subjects with CLD. Ethical clearance was obtained and informed consent was granted by participants. Participants were interviewed using a structured proforma; physical examination and relevant investigations were performed. Insulin resistance was measured using the homeostasis model assessment (HOMA-IR) Data was analysed using Statistical Package for Social Sciences version 20.0 and p value of <0.05 was considered significant. RESULTS: Mean age of the study participants was 51.9 ±â€¯11.9 years, and mean duration of CLD was 15.9 ±â€¯5.8 months. Glucose tolerance abnormalities were present in 66 subjects (66%) and increased from 16.1% in Child Pugh's class A to 90.0% in class C. HOMA-IR positively correlated with age, body mass index, serum blood glucose, duration and severity of CLD. Increasing age, presence of hepatocellular carcinoma, Child Pugh's class B and class C were associated with glucose tolerance abnormalities. CONCLUSION: Glucose tolerance abnormalities and insulin resistance were highly prevalent among chronic liver disease subjects studied and seemed to parallel the severity of CLD, determined by the Child Pugh's score.

Association between insulin resistance and total plasma homocysteine levels in type 2 diabetes mellitus patients in south west Nigeria.

AIM: To determine the levels of serum homocysteine and its association with insulin resistance among T2DM patients at Obafemi Awolowo University Teaching Hospital, Ile Ife Nigeria. METHODS: It was a cross sectional study. It involved consecutive recruitment of 100 T2DM subjects with 100 age and sex matched controls. The fasting plasma glucose, serum creatinine, fasting lipid profile, glycosylated haemoglobin levels, fasting serum insulin and plasma homocysteine concentration were done. Insulin resistance was also determined. SPSS version 17.0 was used for data analysis. RESULTS: The mean age of subjects was not significantly different from controls. (58.9±8.3 vs. 59.0±8.3years, p=0.926 respectively). Mean Homocysteine level (tHcy) was significantly higher among T2DM subjects compared to controls (27.4±12.1 and 8.3±3.2µmol/L respectively, p=0.0001). Hyperhomocystinaemia was commoner among diabetic subjects compared with controls (81% vs. 5%, p<0.0001). T2DM with hyperhomocystinaemia were more likely to have poorer glucose control profile using glycated haemoglobin (7.4±1.9 vs 6.4±1.4%, p=0.04) and fasting blood glucose 8.6±2.2 vs 7.5±2.4mmol/L p=0.047 and insulin resistance (4.4±4.3 vs. 2.0±0.6, p=0.02) compared with T2DM with normohomocystenaemia. There were significant associations between hyperhomocystinaemic T2DM patients and IR, HbA1c, TC, TG and LDL cholesterol. CONCLUSION: The study showed higher homocysteine levels in T2DM than controls. Homocysteine level is worsened by increasing insulin resistance, dyslipidaemia and poor glucose control. Homocysteine level is a potential cardiovascular risk marker in type 2 diabetic mellitus subjects.

Clinicopathologic assessment of hypogonadism in men with type 2 diabetes mellitus.

OBJECTIVE: To determine the prevalence of hypogonadism in men with type 2 diabetes mellitus and evaluate its clinical and pathologic correlates. SUBJECTS AND METHODS: In a cross-sectional survey of 200 type 2 diabetic males aged 32-69 years, total testosterone (TT), follicle stimulating hormone, luteinizing hormone, waist circumference (WC), glycated hemoglobin, and lipids were measured. Clinical assessment of androgen deficiency was done using the androgen deficiency in aging male (ADAM) questionnaire. Overt hypogonadism was defined as a combination of positive ADAM score and TT < 8 nmol/L while possible hypogonadism was defined as positive ADAM score with TT 8-12 nmol/L. RESULTS: Overt and possible hypogonadism occurred in 29.5% and 23% of the participants, respectively. Majority (76.3%) of the subjects who had overt hypogonadism had the hypogonadotrophic pattern. Hypogonadal subjects were significantly older (P = 0.014) and had higher mean WC (P = 0.009) than eugonadal ones. Erectile dysfunction was the most common symptom, occurring in 79.7% of overtly hypogonadal subjects. There was a significant negative correlation between WC and serum TT (r = -0.41, P = 0.001). CONCLUSION: There is a high frequency of symptomatic hypogonadism in men with type 2 diabetes and the frequency increases with advancing age and visceral adiposity.

Relationships among exercise capacity, dynamic balance and gait characteristics of Nigerian patients with type-2 diabetes: an indication for fall prevention.

This study investigated the relationships among exercise capacity (EC), dynamic balance (DB), and gait characteristics (GCs) of patients with type-2 diabetes (T2D) and healthy controls (HCs). This observational controlled study involved 125 patients with T2D receiving treatment at a Nigerian university teaching hospital and 125 apparently healthy patients' relatives and hospital staff recruited as controls. EC maximum oxygen consumption (VO2max) was estimated following a 6-min walk test. DB and GC were assessed using the Time Up to Go Test and an accelerometer (BTS G-Walk) assessing gait speed, step length, stride length, and cadence respectively during a self-selected walk. Data were analyzed using descriptive and inferential statistics. Alpha level was set at P<0.05. The mean ages of patients with T2D and HCs were 57.6±6.6 and 60.0±7.0 years, respectively. All physical characteristics were comparable (P>0.05). There were significant differences in the VO2max and DB between patients with T2D and HCs; 7.6±0.6 mL/kg/min vs. 9.6±0.6 mL/kg/min (t=-16.6, P=0.001) and 14.2±2.1 sec vs. 10.4±1.5 sec (t=-6.37, P=0.001), respectively. Furthermore, significant differences were found in GC between patients with T2D and HCs; gait speed: 0.7±0.1 m/sec vs. 1.2±0.1 m/sec (t=-16.60, P=0.001), step length: 0.6±0.2 m vs. 0.9±0.3 m (t=-7.56, P=0.001) and stride length: 0.9±0.1 m vs. 1.1±0.5 m (t=-6.09, P=0.001). There were significant correlations between EC and gait speed in both groups (T2D: r=-0.26, P=0.032 and HCs: r=0.51, P=0.003). In conclusion, patients with T2D demonstrated lower EC, unstable DB, and altered GCs compared with HCs. Exercise interventions to improve EC and gait balance are recommended.

Prevalence and predictors of obstructive sleep apnea syndrome in a sample of patients with type 2 Diabetes Mellitus in Nigeria.

INTRODUCTION: Obstructive sleep apnea (OSA) and Diabetes Mellitus (DM) are growing health challenges worldwide. However, the relation of OSA with type 2 diabetes is not well understood in developing countries. This study described the prevalence and predictors of OSA in type 2 DM patients using a screening questionnaire. MATERIALS AND METHODS: Patients aged 40years and above with type 2 diabetes mellitus were recruited into the study consecutively from the outpatient clinics of a university hospital. They were all administered the Berlin questionnaire and the Epworth sleepiness scale (ESS) to assess the risk of OSA and the tendency to doze off, respectively. Anthropometric details like height, weight and body mass index (BMI) were measured and short-term glycaemic control was determined using fasting blood glucose. RESULTS: A total of 117 patients with type 2 diabetes mellitus were recruited into the study. The mean (SD) age, height and BMI was 63 years (11), 160 cm (9) and 27.5 kg/ m(2) (5.7), respectively. Twenty-seven percent of the respondents had a high risk for OSA and 22% had excessive daytime sleepiness denoted by ESS score above 10. In addition, the regression model showed that for every 1 cm increase in neck circumference, there is a 56% independent increase in the likelihood of high risk of OSA after adjusting for age, sex, BMI, waist, hip circumferences and blood glucose. CONCLUSION: Our study shows a substantial proportion of patients with type 2 diabetes may have OSA, the key predictor being neck circumference after controlling for obesity.

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.