Burden of Thyroid Dysfunction Among Type 2 Diabetes Mellitus Patients in South East Nigeria with Emphasis on its Prevalence and Pattern of Presentation: A Case-Controlled Study.

BACKGROUND: Studies from different parts of the world on thyroid dysfunction have shown it to be widespread in patients with type 2 diabetes mellitus (T2DM); however, there is insufficient local data to support this observation. AIM: To determine the burden of thyroid dysfunction among patients with T2DM at a Tertiary Hospital in Southeast Nigeria with emphasis on its prevalence and pattern of presentation. METHODS: Four hundred and seventy-two subjects were recruited for the study. All the subjects (100%) were of African descent. Three hundred and fifty-four (354) of them were patients with T2DM, while 118 subjects who did not have T2DM served as the controls. This study is a descriptive cross-sectional study involving patients with type 2 diabetes mellitus attending the Diabetes Clinic or receiving treatment in the Medical Wards. Subjects were recruited using systematic sampling. The first patient was selected by simple random sampling, and subsequently, every consecutive subject was selected. Blood samples were tested for HbA1c, fT3, fT4, thyrotropin, and thyroid stimulating hormone. Socio-demographic information was retrieved from patient medical records. We used the Student's t-test for statistical comparison of quantitative variables such as weight, height, blood pressure, serum TSH, and serum T3; while for comparison of proportions, we used a Chi-squared test. We set a p-value of less than 0.05 to be statistically significant. RESULTS: Females formed the majority of the study population accounting for 56.5% of the type 2 DM patients and 62.7% of the controls. We observed that the mean age of the type 2 DM patients was 57.5 (±9.3) years, which was similar to the mean age of controls: 57.7±8.9 (p=0.17). We also observed that the mean age at diagnosis of DM was 54±7.6 years, while the mean duration of DM for all the type 2 DM patients was 6.5±2.8 years. We observed that in patients with T2DM, the prevalence of thyroid dysfunction was 12.4% and among the controls, a prevalence of 1.7% was observed (P <0.05). Females formed the majority (75%) of T2DM patients with thyroid dysfunction and hypothyroidism was the most common type of thyroid dysfunction (93.2%) observed in this study. CONCLUSION: The prevalence of thyroid dysfunction in T2DM patients in this study was 12.4% which was high compared to 1.7% observed in the controls (P = 0.001). The majority of those who had thyroid dysfunction were females. About 9 in 10 of all subjects with thyroid dysfunction had hypothyroidism.

CONTEXTE: Des études menées dans différentes régions du monde sur la dysfonction thyroïdienne ont montré qu'elle est répandue chez les patients atteints de diabète sucré de type 2 (T2DM) ; cependant, il existe des données locales insuffisantes pour étayer cette observation. OBJECTIF: Déterminer la charge de la dysfonction thyroïdienne chez les patients atteints de T2DM dans un hôpital tertiaire du sud-est du Nigeria, en mettant l'accent sur sa prévalence et son modèle de présentation. MÉTHODES: Quatre cent soixante-douze sujets ont été recrutés pour l'étude. Tous les sujets (100 %) étaient d'origine africaine. Trois cent cinquante-quatre (354) d'entre eux étaient des patients atteints de T2DM, tandis que 118 sujets ne présentaient pas de T2DM et servaient de témoins. Cette étude est une étude transversale descriptive impliquant des patients atteints de diabète sucré de type 2 fréquentant la clinique du diabète ou recevant un traitement dans les services de médecine. Les sujets ont été recrutés par échantillonnage systématique. Le premier patient a été sélectionné par échantillonnage aléatoire simple, et par la suite, chaque sujet consécutif a été sélectionné. Des échantillons de sang ont été testés pour l'HbA1c, le fT3, le fT4 et la thyrotropine, hormone stimulant la thyroïde. Les informations sociodémographiques ont été récupérées à partir des dossiers médicaux des patients. Nous avons utilisé le test t de Student pour la comparaison statistique des variables quantitatives telles que le poids, la taille, la pression artérielle, la TSH sérique et la T3 sérique ; tandis que pour la comparaison des proportions, nous avons utilisé un test du Chi-carré. Nous avons fixé une valeur de p inférieure à 0,05 pour être statistiquement significative. RÉSULTATS: Les femmes formaient la majorité de la population étudiée, représentant 56,5 % des patients atteints de DM de type 2 et 62,7 % des témoins. Nous avons observé que l'âge moyen des patients atteints de DM de type 2 était de 57,5 (±9,3) ans, ce qui était similaire à l'âge moyen des témoins: 57,7±8,9 (p=0,17). Nous avons également observé que l'âge moyen au diagnostic du DM était de 54±7,6 ans, tandis que la durée moyenne du DM pour l'ensemble des patients atteints de DM de type 2 était de 6,5±2,8 ans. Nous avons observé que chez les patients atteints de T2DM, la prévalence de la dysfonction thyroïdienne était de 12,4 % et parmi les témoins, une prévalence de 1,7 % a été observée (P <0,05). Les femmes formaient la majorité (75 %) des patients atteints de T2DM avec une dysfonction thyroïdienne et l'hypothyroïdie était le type le plus courant de dysfonction thyroïdienne (93,2 %) observé dans cette étude. CONCLUSION: La prévalence de la dysfonction thyroïdienne chez les patients atteints de T2DM dans cette étude était de 12,4 %, ce qui était élevé par rapport à 1,7 % observé chez les témoins (P = 0,001). La majorité de ceux qui avaient une dysfonction thyroïdienne étaient des femmes. Environ 9 sujets sur 10 présentant une dysfonction thyroïdienne avaient une hypothyroïdie. MOTS-CLÉS: Dysfonction thyroïdienne; Diabète sucré de type 2; Hypothyroïdie; Sud-est du Nigeria; Prévalence.

Determinants of wound healing in patients hospitalized for diabetic foot ulcer: results from the MEDFUN study.

OBJECTIVE: The high amputation rates from diabetic foot ulcer (DFU) in Nigeria and prolonged hospitalization due to poor wound healing is a source of concern. Furthermore, factors that affect wound healing of DFUs have not yet been well studied in Nigeria, whereas knowing these factors could improve DFU outcomes. Therefore, the objective of this study was to determine the factors that are associated with the wound healing in patients hospitalized for DFU. METHODS: The Multi-Center Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN) was an observational study involving 336 diabetic patients hospitalized for DFU and managed by a multi-disciplinary team until discharge or death. Demographic, clinical, and biochemical characteristics were documented. Test statistics used were chi square, t-test, univariate, and multivariate logistic regression. The study endpoints were ulcer healing, LEA, duration of hospitalization, and mortality. Here we present data on wound healing. RESULTS: The mean ± SD age was 55.9±12.5 years. Univariate predictors of wound healing were ulcer duration more than 1 month prior to hospitalization (p<0.001), peripheral arterial disease (PAD) (p<0.001), foot gangrene (p<0.001), Ulcer grade ≥3 (p=0.002), proteinuria (p=0.005), anemia (p=0.009), renal impairment (p=0.021), glycated hemoglobin ≥7% (0.012), and osteomyelitis (p<0.001). On multivariate regression, osteomyelitis was the strongest independent predictor of wound healing after adjusting for all other variables (OR 0.035; 95% CI 0.004-0.332). This was followed by PAD (OR 0.093; 95% CI 0.028-0.311), ulcer duration >1 month (OR 0.109; 95% CI 0.030-0.395), anemia (OR 0.179; 95% CI 0.056-0.571). CONCLUSION: Presence of osteomyelitis, duration of ulcer greater than 1 month, PAD, Wagner grade 3 or higher, proteinuria, presence of gangrene, anemia, renal impairment, and HbA1c ≥7% were the significant predictors of wound healing in patients hospitalized for DFU. Early identification and prompt attention to these factors in a diabetic foot wound might significantly improve healing and reduce adverse outcomes such as amputation and death.

Prevalence and Risk Factors for Diabetes Mellitus in A State in South East Nigeria: Results of a Population Based House to House Survey.

BACKGROUND: Population based studies on diabetes mellitus (DM) are scarce in Nigeria. INTRODUCTION: This was a population-based house to house survey aimed at determining the prevalence of DM and assessing the risk factors associated with DM in a state in Southeast Nigeria. METHODS: This was a cross-sectional observational study in which 1680 adults were recruited using a multistage sampling method to randomly select not more than two suitable participants of both sex in each household from four enumeration areas (EAs) in each local government area (LGA) and the three senatorial zones in the state. A modified World Health Organization (WHO) Stepwise Approach to Surveillance questionnaire was used for data collection and random blood glucose (RBG) was measured after anthropometric assessment. Test statistics used were chi-square, t-test, and logistic regression. RESULTS: The overall prevalence of DM in this study was 3.3%. A positive family history of DM was significantly higher in patients with diabetes: 18.2% vs. 9.6% (p=0.036). The mean (SD) of weight, body mass index (BMI), hip circumference (HC) and waist circumference (WC) were significantly higher in patients with DM(p=0.001,<0.001,<0.001,<0.001, respectively).The odd ratio (95% CI) of a person>35years developing DM was 3.89(1.11-13.60). The OR (95% CI) for waist-hip ratio (WHR) was 3.04 (1.02-9.03) and family history of DM had an OR of 2.62(0.88-6.50). The odd of developing DM is positively associated with age>35years, increased WHR, WC, family history of DM, BMI>25Kg/m2, and HC. The odd of developing DM was negatively associated with smoking. CONCLUSION: The prevalence of DM in this study was 3.3%. A BMI>25 kg/m2, WHR >0.85, family history of DM, HC, and older age were associated with significantly higher prevalence.

Risk Factors of Thyroid Dysfunction in Patients With Type 2 Diabetes Mellitus.

Background: Thyroid dysfunction has been widely reported among persons with diabetes (DM) in other parts of the World. In Nigeria, few studies have been reported. This study focused on risk factors for thyroid dysfunction in type 2 diabetes mellitus (T2DM) patients and will therefore add to the Nigerian literature, more so, as it is the first in South-East Nigeria. Objective: To determine the risk factors of thyroid dysfunction in patients with Type 2 DM. Methodology: Three hundred and fifty-four T2DM patients and 118 non-diabetic persons (controls) were recruited for the study. A pretested questionnaire was filled for each subject after due explanations. The subjects were subsequently examined and the findings, including anthropometric values and clinical parameters were documented. Their blood samples were tested for HbA1c, fT3, fT4, and TSH. Information retrieved from patients medical records included: age at diagnosis of DM, duration of DM, complications of DM. The Student's t-test, chi square test and regression analysis were used in the analysis of the data obtained. P < 0.05 was taken to be statistically significant. Results: About 56.5% of the T2DM patients who participated in this study were females and 62.7% of the controls were females. The T2DM patients had significantly higher BMI than controls (27.6 ± 5.0 kg/m2 vs. 26.2 ± 3.8 kg/m2, p = 0.002). Mean HbA1c was significantly higher in T2DM patients than in the controls (7.8 ± 2.0% vs. 5.8 ± 1.2%, p = 0.001). Female gender (OR = 3.8, p = 0.002), central obesity (OR = 2.5, 95%CI = 1.5-5.2, p = 0.001), DM nephropathy (OR = 4.8, p = 0.001), HbA1c ≥7% (OR = 4.3, p = 0.025) and duration of DM >5years (OR = 3.3, p = 0.012) were significantly associated with thyroid dysfunction in T2DM patients in this study. Conclusion: Female gender, central obesity, DM nephropathy, above normal HbA1c, and duration of DM were risk factors of thyroid dysfunction in type 2 DM patients in this study.

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.

Validation of Siriraj Stroke Score in southeast Nigeria.

The aim of the study is to validate the use of Siriraj Stroke Score (SSS) in the diagnosis of acute hemorrhagic and acute ischemic stroke in southeast Nigeria. This was a prospective study on validity of SSS in the diagnosis of stroke types in southeast Nigeria. Subjects diagnosed with stroke for whom brain computerized tomography (CT) scan was performed on admission were recruited during the study period. SSS was calculated for each subject, and the SSS diagnosis was compared with brain CT scan-based diagnosis. A total of 2,307 patients were admitted in the hospital medical wards during the study period, of whom 360 (15.6%) were stroke patients and of these, 113 (31.4%) adult subjects met the inclusion criteria. The mean age of the subjects was 66.5±2.6 years. The mean interval between ictus and presentation was 2.5±0.4 days. Ischemic stroke was confirmed by CT in 74 subjects; however, SSS predicted 60 (81.1%) of these subjects correctly (P<0.05). Hemorrhagic stroke was confirmed by CT in 39 subjects, and SSS predicted 36 (92.3%) of them correctly (P<0.05). In acute ischemic stroke, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SSS were 92%, 94%, 97%, 86%, and 93%, respectively, while in patients with hemorrhagic stroke, the corresponding percentages were 94%, 92%, 86%, 97%, and 93%, respectively. SSS is not reliable enough to clinically differentiate stroke types in southeast Nigeria to warrant interventions like thrombolysis in acute ischemic stroke.

Evaluating the impact of type 2 diabetes mellitus on cardiovascular risk in persons with metabolic syndrome using the UKPDS risk engine.

BACKGROUND: The aim of this study is to evaluate the impact of coexistence of metabolic syndrome (MS) and type 2 diabetes mellitus (T2DM) on the estimated cardiovascular risk as calculated using the United Kingdom Prospective Diabetic Study risk engine (UKPDS-RE) and also to determine the impact of the coexistence of MS and T2DM on the 10-year risk of developing coronary heart disease and stroke. METHODOLOGY: This is a cross-sectional study in which convenience sampling technique was used to recruit 124 consecutive persons with T2DM and 96 controls using a questionnaire administered technique. The World Health Organization (WHO) criterion was used to define MS and the UKPDS-RE was used to identify persons with increased risk for stroke and those with increased risk for coronary heart disease. The data obtained were analyzed using SPSS version 16. Statistical comparisons were made with chi-square for comparison of proportions. A P-value of less than 0.05 was taken as statistically significant. RESULTS: Fifteen subjects were identified as having an increased 10-year risk for stroke and ten as having an increased risk for a coronary event. The odds of a T2DM subject with MS having an increased risk for stroke compared with a T2DM subject without MS was 0.9579≈1 while the odds of a T2DM subject with MS developing an increased risk for a coronary event compared with a T2DM subject without MS was =3.451≈3. CONCLUSION: MS was more common in subjects with T2DM compared with controls (irrespective of the diagnostic criteria used) and MS appears to increase the risk of a coronary event in subjects with T2DM by threefold. Also from this study, MS did not appear to cause an additional increase in the risk of stroke in subjects with T2DM.

Profile of metabolic abnormalities seen in patients with type 2 diabetes mellitus and their first degree relatives with metabolic syndrome seen in Benin City, Edo state Nigeria.

BACKGROUND: To determine the profile of metabolic abnormalities in T2DM persons with metabolic syndrome and their non-diabetic first-degree relatives who also had metabolic syndrome in Benin City. METHODOLOGY: This was a cross sectional case controlled study in which convenience sampling technique was used to recruit 106 persons with T2DM, 96 people who are first degree relatives of type 2 diabetic persons and 96 controls using a interviewer administered questionnaire technique. The following were assessed: anthropometric indices, blood pressure, serum lipid profile, fasting blood sugar, proteinuria, and microalbuminuria. The data obtained were analyzed using the statistical software-Statistical package for social sciences [SPSS] version 16. A p-value of less than 0.05 was taken as statistically significant. RESULTS: THE MEAN AGE (SD) OF THE STUDY GROUPS WERE: persons living with T2DM: 58.6 ± 11.2 years, control: 57.69 ± 60.8 years and FDR: 57.4 ± 10.6 years. No significant age and sex differences were observed in these groups. There were more females (59.7%) than males (40.3%) with T2DM. The prevalence of MS was 13.5%, 16.7%, and 87.1% in the control, FDR and T2DM patients respectively. For the T2DM group of subjects, impaired fasting glycaemia was the commonest metabolic abnormality followed by microalbuminuria, low HDL cholesterol, high LDL cholesterol, hypercholesterolaemia and hypertriglyceridaemia in decreasing frequency. For the FDR group, low HDL cholesterol was the commonest metabolic abnormality followed by hypertriglyceridaemia, impaired fasting glucose, high LDL cholesterol, hypertriglyceridaemia and microalbuminuria in decreasing frequency. Hypercholesterolemia and low HDL cholesterol were the commonest metabolic abnormalities in the control group. CONCLUSION: The prevalence of the MS in persons with T2DM in Nigeria appears to be high. Secondly, there is a high prevalence of lipid abnormalities in all the study groups.

Risk factors, ulcer grade and management outcome of diabetic foot ulcers in a Tropical Tertiary Care Hospital.

BACKGROUND: The objective was to determine the risk factors, ulcer grade, and management outcome of patients with diabetic foot ulcers (DFU) managed in a tropical tertiary hospital. MATERIALS AND METHODS: This is a prospective observational study of all consecutive diabetes mellitus (DM) patients with DFU admitted in the University of Benin Teaching Hospital, Benin City, Nigeria over a 26-month period. Data documented included age, gender, type of DM, duration of DM, risk factors of DFU, duration of DFU, Wagner's ulcer grade, and the blood glucose at presentation and management outcome. RESULTS: Thirty-four (55.7%) of the 61 study subjects were females. Their mean age was 56.29±12.71 years. 85.2% had type 2 DM. 13.1% of the patients were newly diagnosed diabetic at presentation. The mean duration of DM was 7.8±6.98 years. The mean duration of DFU was 46.09±47.82 days and the casual blood glucose level at presentation was 18.41±9.31mmol/l. Risk factors of DFU included spontaneous blisters (52.46%), peripheral vascular disease (44.3%), peripheral neuropathy (42.6%), and visual impairment (21.3%). The common ulcer grades were IV (44.3%) and III (36.1%).The amputation rate was 52.2% while the mortality rate was 14.3%.The baseline ulcer grade was significantly associated with the risk of lower extremity amputation, and the odds ratio was 2.36 (95% 1.06-5.21). CONCLUSIONS: Spontaneous blisters, peripheral vascular disease, peripheral neuropathy,and visual impairment are common risk factors of DFUs. Many of our patients with DFUs presented with grade IV and V ulcers with the resultant high rate of lower extremity amputations (LEAs). Early presentation and treatment of DFUs will reduce LEAs.