Treatment outcome and prognostic indices in patients with hyperglycemic emergencies.

OBJECTIVE: The objective of this study is to assess the treatment outcomes in patients with hyperglycemic emergencies and to ascertain the factors associated with outcome, with emphasis on the determinants of outcome. METHOD: A total of 105 patients admitted to the Accident and Emergency unit, who fulfilled the criteria for hyperglycemic emergencies, were selected. The information extracted included sociodemographic, clinical, and laboratory data, as well as hospitalization outcome. RESULTS: Of the 105 subjects that participated in the study, hyperosmolar hyperglycemic nonketotic state (HHNK) was seen in 50% (53) of the subjects, while diabetic ketoacidosis (DKA) was seen in 31% (29), normo-osmolar nonketotic hyperglycemic state (NNHS) in 12% (13), and mixed hyperglycemic emergency in 7% (10) of the subjects. The overall mortality rate in this study was 4.8%. Three deaths were recorded in patients with HHNK, while DKA and NNHS each had one death. Three of the deaths occurred within the first 24 hours of admission while the other two were more than 24 hours after admission. The mean (standard deviation) total duration of hospital stay was 24.2 days (SD), and the range of stay was 0.5-88 days. CONCLUSION: The most common type of hyperglycemic emergency seen in this study was HHNK. Also, the presence of infection, and sex of the study subject, were significant determinants of outcome in this study.

Prevalence of hypertension amongst persons with diabetes mellitus in Benin City, Nigeria.

OBJECTIVE: To determine the prevalence of hypertension amongst persons with diabetes mellitus (DM) in Benin city. MATERIALS AND METHODS: Four hundred and fifty diabetic subjects were evaluated for hypertension by measuring their blood pressure using a sphygmomanometer at the diabetes clinics of the University of Benin Teaching Hospital and Central Hospital, both in Benin City, Nigeria. Other data obtained included age, sex, type of DM, weight, height, body mass index and waist hip ratio. RESULTS: Two hundred and forty-four out of 450 subjects had hypertension, thus giving a prevalence rate of 54.2%. 124 males (50.8%) were hypertensive compared with 120 (49.2%) females, but this difference was not significant (χ2 = 0.1, df = 1, P > 0.05). Thirteen (22.4%) of the 58 Type 1 subjects had hypertension, while 231 (58.9%) of the Type 2 subjects had hypertension, and this difference was statistically significant (χ2 = 27, df = 1, P < 0.05). CONCLUSIONS: Hypertension is prevalent in persons with DM. Studies have shown that adequate control of the blood pressure reduces the microvascular and macrovascular complications of DM. DM care providers must prescribe appropriate antihypertensive therapy to control hypertension in persons with DM.

Glycaemic response to some commonly eaten fruits in type 2 diabetes mellitus.

BACKGROUND: It is not known which of the commonly consumed fruits in Nigeria are suitable for persons with diabetes mellitus especially with regards to the attendant plasma glucose response (PGR) to consumption of such fruits. OBJECTIVES: To determine and compare the PGR to commonly eaten fruits in patients with diabetes mellitus. METHODS: Ten persons with type 2 diabetes mellitus were studied. Fifty-gram portions of five fruits containing 50 g carbohydrate [ banana, Musa paradisiaca; orange, Citrus sinensis; pineapple, Ananus comosus; mango, Magnifera indica; pawpaw, Carica papaya], and glucose were randomly fed to the study subjects at one-week intervals. Blood samples were collected in the fasting state and half-hourly over a 2- hour period post-ingestion of the fruits or glucose for plasma glucose determination. Plasma glucose responses were assessed by the peak plasma glucose concentration (PPPG), maximum increase in postprandial plasma glucose (MIPG), two-hour postprandial plasma glucose level (2hPG) and incremental area under the glucose curve (IAUGC). RESULTS: The mean ± SEM PPPG in mmol/L were: banana, 9.0± 1.6; orange, 8.1± 0.8; pineapple, 9.2±1.1; mango, 8.0 ± 1.1; and pawpaw, 7.8±0.9. The mean ±SEM IAUGC in mmol.min/L were: banana, 131.7±53.4; orange, 108.7±29.8; pineapple, 115.3±33.2; mango, 101.6 ± 28.7; and pawpaw, 124.1± 46.1. However, mango showed the least MIPG (1.8 ± 0.5 mmol/l) followed by orange and pawpaw. The IAUGC also followed this pattern. There were no significant differences among the glycaemic indices of the fruits. Glucose load produced a significantly higher IAUGC than the fruits (orange, pineapple, mango, pawpaw, p<0.005; banana, p<0.025). CONCLUSION: The plasma glucose response to consumption of Nigeria fruits are similar. The PGR indices to all fruits were less than the PGR after an equivalent carbohydrate load of glucose. It appears safe to recommend these Nigerian fruits to persons with diabetes within the prescribed daily total calorie intake.

Postprandial glucose response to selected tropical fruits in normal glucose-tolerant Nigerians.

BACKGROUND AND OBJECTIVES: The glycemic response to commonly eaten fruits in Nigeria has not been reported. Therefore, this study assessed the plasma glucose response to selected fruits in Nigeria. PATIENTS AND METHODS: Ten normal glucose-tolerant subjects randomly consumed 50 g carbohydrate portions of three fruits: banana (Musa paradisiaca), pineapple (Ananus comosus), and pawpaw (Carica papaya), and a 50-g glucose load at 1-week intervals. Blood samples were collected in the fasting state and half-hourly over a 2-h period post-ingestion of the fruits or glucose. The samples were analyzed for plasma glucose concentrations. Plasma glucose responses were assessed by the peak plasma glucose concentration, maximum increase in plasma glucose, 2-h postprandial plasma glucose level, and incremental area under the glucose curve and glycemic index (GI). RESULTS: The results showed that the blood glucose response to these three fruits was similar in terms of their incremental areas under the glucose curve, maximum increase in plasma glucose, and glycemic indices (GIs). The 2-h postprandial plasma glucose level of banana was significantly higher than that of pineapple, P < 0.025. The mean ± SEM GI values were as follows: pawpaw; 86 ± 26.8%; banana, 75.1 ± 21.8%; pineapple, 64.5 ± 11.3%. The GI of glucose is taken as 100. The GI of pineapple was significantly lower than that of glucose (P < 0.05). CONCLUSION: Banana, pawpaw, and pineapple produced a similar postprandial glucose response. Measured portions of these fruits may be used as fruit exchanges with pineapple having the most favorable glycemic response.

Factors associated with self-monitoring of glycaemic control among persons with diabetes in Benin City, Nigeria

Persons with diabetes in our hospital are taught various methods of self-monitoring. However, the factors associated with this practice are poorly documented. We therefore investigated 100 consecutive patients from our clinic. Seventy-two (72%) subjects practised self-monitoring, 63 by testing urine, 8 by testing blood glucose, and 1 person by tasting his urine. Most tested once a week, and the frequency of testing differed on the basis of the method employed and also the level of education. We therefore recommend the inclusion of routine teaching of self-monitoring to diabetic persons in health educational talks

Pregnancy associated with recurrent acromegaly: a case report.

BACKGROUND: Acromegaly is an uncommon endocrine disorder. Pregnancy is an unusual event in acromegalic females because fertility is often reduced. With the advent of advanced surgical and medical management, more acromegalic women will achieve pregnancy. Reports of pregnancy in acromegaly and recurrent acromegaly postpartum are rare. OBJECTIVE: To present a rare occurrence of pregnancy in acromegaly after macroadenectomy and recurrent acromegaly postpartum. METHODS: Clinical and biochemical evaluation of a 39-year-old female Nigerian with features of acromegaly before and after macroadenectomy and postpartum was done. Investigations carried out included oral glucose tolerance test with serial growth hormone assays and insulin-like growth factor 1 as well as computed tomography scan and magnetic resonance imaging of the pituitary. RESULTS: There was a history of menorrhagia, swelling of the feet and increasing coarsening of the facial appearance. She had biochemical evidence of acromegaly and subsequently had a transsphenoidal macroadenectomy. There was postoperative clinical and biochemical remission. Magnetic resonance imaging done six months postsurgery showed no evidence of tumour regrowth. Clinical and biochemical evidence of acromegaly recurred after pregnancy. Magnetic resonance imaging confirmed tumour regrowth. CONCLUSION: Pregnancy in treated acromegaly, though a rare occurrence, is achievable but is capable of provoking recurrence of acromegaly.

Trace mineral status and glycaemic control in Nigerians with type 2 diabetes

Diabetes has been shown to be associated with abnormalities in the metabolism of micronutrients, especially chromium, zinc, copper, magnesium, and manganese. People with type 2 diabetes attending the Diabetes Clinic of the University of Benin Teaching Hospital, were recruited to examine the relationship between trace mineral status and glycaemic control. A total of 120 persons were studied, mean (±SD) age was 54±7 years and mean duration of diabetes 4±4 years. Serum chromium level correlated inversely with fasting blood glucose (FBG) and HbA1c, unlike the serum concentration of zinc which had no significant correlation with either FBG or HbA1c. People with diabetes should be encouraged to eat local specific foods rich in chromium

Hypoclycaemia unawareness and falls in older adults with type 2 diabete

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The role of radioactive iodine usage in the management of thyroid disorders with emphasis on sub-Saharan Africa.

BACKGROUND: Radioactive iodine (RAI) usage is increasingly becoming a standard therapeutic and diagnostic measure in the management of thyroid disorders. Despite these advances, there are varying opinions on the appropriate usage of this treatment option of thyroid disorders. In sub-saharan Africa, reports on RAI in the management of thyroid disorders are scanty and RAI usage is shrouded in mystery. OBJECTIVES: This review article sought to evaluate the role of RAI in the diagnosis and treatment of thyroid disorders with emphasis on its usage in Africa. It also addresses specific areas of concern amongst others such as RAI use in children, in large compressive goiters, reproductive function and the issue of associated iatrogenic hypothyroidism. METHODS: A systematic review of literature--local and otherwise--on radioactive iodine usage from indexed and online journals using Pubmed, Google and Google Scholar in the period between 1942 till 2007. RESULTS: The most common complication of RAI therapy is hypothyroidism which appears to be almost inevitable. There is controversy as to whether RAI therapy is a risk factor for thyroid cancer or cancer of other iodine-concentrating organs. Equally controversial is whether RAI leads to infertility or genetic disorders of children whose parents were treated with RAI. The use of RAI in the diagnosis and treatment of thyroid disorders appears unduly limited. CONCLUSION: Radioactive iodine--a major tool in the diagnosis and management of benign and malignant thyroid disorders--is underutilized in the African. There is a need for heightened awareness amongst endocrinologists from the African continent on the usage of this all-important treatment modality of thyroid disorders.

Bacteriology of Diabetic Foot Ulcers in Bacteriology; in Benin City; Nigeria

This study aimed to determine the bacteriological pattern and antimicrobial susceptibility of diabetic foot ulcer (DFU) infections seen in our practice; with a view to suggesting optimal therapy for these patients. Forty-seven persons with DFU were seen. The mean age was 56 years. Of these; 30 (64) had wound swabs sent for bacteriological assessment and antibiotic sensitivity patterns. There were 20 non-gangrenous ulcers and 10 gangrenous ulcers. Proteus spp and coliform organisms were the most predominantly isolated organisms in gangrenous ulcers; while Staphylococcus aureus; coliforms; and Pseudomonas aeruginosa were commonly isolated in non-gangrenous ulcers. Grampositive organisms were sensitive to ciprofloxacin (100); gentamicin (100); and perfloxacin (88). Gram-negative organisms were sensitive to ciprofloxacin (74); gentamicin (43); and perfloxacin (39). We conclude that ciprofloxacin and gentamicin are the most effective antibiotics against gram-positive and gram-negative organisms; and thus recommend the combination of ciprofloxacin and/or gentamicin and metronidazole as initial therapy for patients with infected DFU while awaiting culture results

Assessment for markers of nephropathy in newly diagnosed type 2 diabetics.

BACKGROUND: Type 2 diabetics account for a large proportion of patients presenting in end-stage kidney disease (ESKD). Although diabetic renal disease can be predicted, a lot of diabetics present to Nephrologists in ESKD. OBJECTIVE: To assess for markers of nephropathy in newly diagnosed type 2 diabetics, using blood pressure levels, endogenous creatinine clearance and urinary protein excretion as markers of renal disease. STUDY DESIGN: Ninety newly diagnosed type 2 diabetics were studied within 6 weeks of diagnosis. They were in good glycaemic control during the period of study. Seventy-two age and sex-matched and apparently healthy non-diabetics served as controls. Blood pressure was recorded in all subjects. 24 hours urine sample was collected for estimation of urinary protein excretion and endogenous creatinine clearance. RESULTS: Systolic and diastolic blood pressures were consistently higher in diabetics than in controls (p=0.001 and p=0.001 respectively). High-normal and midly elevated blood pressure were more prevalent in diabetics (p=0.001). Mean creatinine clearance in diabetics was significantly lower than in non-diabetics (p=0.037). 7 % of diabetics had supra-normal creatinine clearance of >125mls/minute. The prevalence of microproteinuria was 40% in diabetics and 33% in non-diabetics, while macroproteinuria was present in 44% of diabetics but absent in non-diabetics (p=0.000). CONCLUSION: High-normal, mildly elevated blood pressure and microproteinuria were commonly encountered in newly diagnosed diabetics studied. The phenomenon of hyperfiltration was present in type 2 diabetics. These tools should be assessed at diagnosis of diabetes as this will help in identifying those who are at an increased risk for developing diabetic nephropathy.