Assessing the Burden of Kidney Disease among Type 2 Diabetic Subjects Attending a Semi-Urban Tertiary Health Facility in South-West Nigeria.

BACKGROUND AND OBJECTIVES: Diabetes Mellitus (DM) remains an important public health issue and its complications are important causes of morbidity and mortality. Diabetic nephropathy (DN) is one of these complications and could be prevented/delayed by early detection. This study determined the burden of DN among patients with type 2 diabetes (T2DM). METHODS: This cross-sectional, hospital-based study was conducted among 100 T2DM patients attending the medical outpatient clinics of a tertiary hospital in Nigeria and 100 age- and sex-matched healthy controls. The procedure included collection of sociodemographic parameters, urine for microalbuminuria and blood samples for estimation of fasting plasma glucose, glycated haemoglobin (HbA1c), and creatinine. Estimated creatinine clearance (eGFR) was derived from two formulae - Cockroft Gault formula, and Modification of Diet in Renal Disease study (MDRD) for staging chronic kidney disease. Data were analysed using the IBM SPSS version 23 software. RESULTS: Participants' ages ranged from 28 years to 73 years [mean 53.0 (±10.7) years] with males accounting for 56% of the population and females 44%. Mean HbA1c was 7.6 (±1.8) % among the subjects; 59% had poor glycaemic control with HbA1c >7% (p-value <0.001). Overt proteinuria was present in 13% of T2DM participants while 48% had microalbuminuria compared to the non-diabetic group where 2% had overt proteinuria and 17% had microalbuminuria. Using the eGFR, chronic kidney disease was present in 14% of T2DM group and in 6% of the non-diabetic population. Increased age [OR= 1.09; 95%CI (1.03-1.14)], male sex [OR = 3.50; 95%CI (1.13 10.88)], and duration of diabetes [OR =1.01; 95%CI (1.00-1.01)] were associated with DN. CONCLUSION: The burden of diabetic nephropathy is high in the T2DM patients attending our clinic and this is linked with advancing age.

CONTEXTE ET OBJECTIFS: Le diabète sucré (DM) reste un problème de santé publique important, et ses complications sont des causes importantes de morbidité et de mortalité. La néphropathie diabétique (DN) est l'une de ces complications et pourrait être évitée/ retardée par une détection précoce. Cette étude a déterminé le poids de la néphropathie diabétique chez les patients atteints de diabète detype 2 (DT2). MÉTHODES: Cette étude transversale en milieu hospitalier a été menée auprès de 100 patients atteints de diabète de type 2 fréquentant les consultations médicales externes d'un hôpital tertiaire au Nigeria, et de 100 témoins sains appariés selon l'âge et le sexe. La procédure comprend la collecte de paramètres sociodémographiques, d'urine pour la microalbuminurie et d'échantillons de sang pour l'estimation de la glycémie à jeun, de l'hémoglobine glyquée (HbA1c) et de la créatinine. La clairance estimée de la créatinine (eGFR) a été calculée à partir de deux formules : i) la formule de Cockroft Gault ii) l'étude de Modification de diète en maladie rénale (MDRD) pour la stadification de l'insuffisance rénale chronique. Les données ont été analysées à l'aide du logiciel IBM SPSS version 23. RÉSULTATS: Les participants étaient âgés de 28 à 73 ans [moyenne 53,0 (±10,7) ans], les hommes représentant 56 % de la population et les femmes 44 %. L'HbA1c moyenne était de 7,6 (±1,8) % chez les sujets ; 59 % avaient un mauvais contrôle glycémique avec une HbA1c >7 % (valeur p <0,001). Une protéinurie manifeste était présente chez 13 % des participants atteints de DT2, tandis que 48 % présentaient une microalbuminurie, par rapport au groupe non diabétique, où 2 % présentaient une protéinurie manifeste et 17 % une microalbuminurie. En utilisant le DFGe, la maladie rénale chronique était présente chez 14 % du groupe DT2 et chez 6 % de la population non diabétique. L'âge élevé [OR= 1,09 ; 95%CI (1,03 - 1,14)], le sexe masculin [OR = 3,50 ; 95%CI (1,13 - 10,88)] et la durée du diabète [OR =1,01 ; 95%CI (1,00 - 1,01)] étaient associés à la DN. CONCLUSION: Le fardeau de la néphropathie diabétique est élevé chez les patients atteints de DT2 qui fréquentent notre clinique et ceci est lié à l'âge avancé. Mots-clés: Maladie rénale diabétique, Complications du diabète, Diabète de type 2, Durée du diabète, Âge, Hypertension.

Hyperglycaemic Emergencies are Associated with Increased Pro-inflammatory Cytokine (Interleukin-6) and Cortisol.

BACKGROUND: Cortisol, a counter-regulatory hormone, has been implicated in the pathogenesis of metabolic disturbance in patients with diabetes, and high levels of cortisol have been reported in relation to blood glucose. Elevated blood glucose has been shown to stimulate production of pro-inflammatory cytokines such as interleukin-6 (IL-6). AIM: We set out to investigate pro-inflammatory cytokine (Interleukin-6 [IL-6]) and counter-regulatory hormone (cortisol) and their relationship with outcome in patients with HE in a Nigerian hospital. METHODS: This descriptive, cross-sectional study involved 67 patients with HE and 67 age-, sex-, and body mass index (BMI)-matched diabetic patients without HE who served as controls. Clinical findings and laboratory parameters including IL-6 and cortisol were compared between subjects and controls. RESULTS: Mean serum cortisol and interleukin-6 were significantly higher in HE subjects compared with diabetic non-HE controls (26.9 ±13.1 vs 9.4 ± 1.8µg/dl, 24.0 ± 8.5 vs 8.1 ± 4.1pg/ml, respectively). There was a significant drop in the values of cortisol and IL-6 at resolution of HE. Mean cortisol and IL-6 were significantly higher in HE patients with a fatal outcome compared with HE survivors (46.9±5.6 vs 25.3±12.1 µg/dl, 45.2±2.2 vs 22.3±6.2 pg/ml, respectively). Serum Cortisol correlated positively with total insulin dose required to resolve HE. CONCLUSION: Hyperglycaemia in Nigerians with HE is associated with more profound inflammatory response characterized by higher interleukin-6 and cortisol and a worse outcome compared with levels at resolution of HE and in non-HE diabetic controls. Perhaps, treatment targeting this heightened response may be beneficial to the management of HE.

CONTEXTE: Le cortisol, une hormone de contre-régulation, a été impliqué dans la pathogenèse des troubles métaboliques chez les patients diabétiques, et des taux élevés de cortisol ont été signalés en relation avec la glycémie. Il a été démontré que l'élévation de la glycémie stimule la production de cytokines pro-inflammatoires telles que l'interleukine-6 (IL-6). OBJECTIF: Nous avons entrepris d'étudier la cytokine proinflammatoire (Interleukine-6 [IL-6]) et l'hormone de contrerégulation (cortisol) et leur relation avec le résultat chez les patients atteints d'HE dans un hôpital nigérian. Méthodes: Cette étude descriptive et transversale a porté sur 67 patients atteints d'HE et 67 patients diabétiques sans HE, appariés selon l'âge, le sexe et l'indice de masse corporelle (IMC), qui ont servi de témoins. Les résultats cliniques et les paramètres de laboratoire, notamment l'IL-6 et le cortisol, ont été comparés entre les sujets et les témoins. RÉSULTATS: Le cortisol et l'interleukine-6 sériques moyens étaient significativement plus élevés chez les sujets atteints d'HE que chez les témoins diabétiques sans HE (26,9 ± 13,1 contre 9,4 ± 1,8µg/dl, 24,0 ± 8,5 contre 8,1 ± 4,1pg/ml, respectivement). Il y avait une baisse significative des valeurs de cortisol et d'IL-6 à la résolution de l'HE. Les valeurs moyennes du cortisol et de l'IL-6 étaient significativement plus élevées chez les patients atteints d'HE dont l'issue était fatale par rapport aux survivants de l'HE (46,9±5,6 vs 25,3±12,1 µg/dl, 45,2±2,2 vs 22,3±6,2 pg/ml, respectivement). Le cortisol sérique était corrélé positivement avec la dose totale d'insuline nécessaire pour résoudre l'HE. CONCLUSION: L'hyperglycémie chez les Nigérians atteints d'HE est associée à une réponse inflammatoire plus profonde caractérisée par une interleukine-6 et un cortisol plus élevés et à un résultat plus mauvais par rapport aux niveaux de résolution de l'HE et aux contrôles diabétiques sans HE. Peut-être qu'un traitement ciblant cette réponse accrue pourrait être bénéfique pour la gestion de l'HE. MOTS CLÉS: Urgences hyperglycémiques, Cytokines, Hormones de contre-régulation, Interleukine-6, Cortisol.

Screening for Diabetes Mellitus and Hypertension in Ile-Ife - A World Diabetes Day Experience.

BACKGROUND AND OBJECTIVES: Non-communicable diseases have emerged as major public health concerns in developing nations, where communicable diseases used to be the major contributor to the public health burden. Diabetes and hypertension contribute significantly to this menace, and they are largely undiagnosed in the affected population. We determined the prevalence of previously diagnosed and undiagnosed hypertension and diabetes mellitus in adult Nigerians. METHODS: Participants who presented in response to advertisement for the study and gave informed consent were recruited using convenience sampling. Data was collected using a proforma to obtain salient medical and social history. Anthropometric and blood pressure measurements were done. Capillary blood was taken for initial glucose measurements. Oral glucose tolerance test (OGTT) was subsequently done in non-diabetics with elevated blood glucose to confirm the diagnosis of diabetes. RESULTS: One hundred and thirty-six participants with age range 24 - 90 years were recruited for the study. Participants were mainly females (61.8%). Prevalence of diabetes among study participants was 19.9% (previously diagnosed -16.9% vs undiagnosed - 3.0%) with higher occurrence among males. Hypertension was found in 50.7% of participants; 28.7% were on treatment for hypertension, while 22.0% were newly diagnosed. Diabetes was associated with older age and elevated systolic blood pressure while hypertension was associated with older age, obesity and elevated blood glucose. CONCLUSION: This study showed a high occurrence of diabetes and hypertension among adult Nigerians; hence efforts to address these should be intensified. Targeted screening of people at risk for non-communicable diseases is an added benefit.

CONTEXTE ET OBJECTIFS: Les maladies non transmissibles sont devenues des problèmes de santé publique majeurs dans les pays en développement, où les maladies transmissibles étaient autrefois le principal contributeur au fardeau de la santé publique. Le diabète et l'hypertension contribuent de manière significative à cette menace, et ils ne sont en grande partie pas diagnostiqués dans la population touchée. Nous avons déterminé la prévalence de l'hypertension et du diabète sucré précédemment diagnostiqués et non diagnostiqués chez les Nigérians adultes. MÉTHODES: Les participants qui se sont présentés en réponse à l'annonce de l'étude et ont donné leur consentement éclairé ont été recrutés à l'aide d'un échantillonnage de convenance. Les données ont été recueillies à l'aide d'un formulaire pour obtenir les antécédents médicaux et sociaux saillants. Des mesures anthropométriques et de pression artérielle ont été effectuées. Du sang capillaire a été prélevé pour les mesures initiales de glucose. Un test de tolérance au glucose par voie orale (OGTT) a ensuite été effectué chez des non-diabétiques présentant une glycémie élevée pour confirmer le diagnostic de diabète. RÉSULTATS: Cent trente-six participants âgés de 24 à 90 ans ont été recrutés pour l'étude. Les participants étaient principalement des femmes (61,8%). La prévalence du diabète chez les participants à l'étude était de 19,9% (diagnostiqué précédemment ­16,9% vs non diagnostiqué - 3,0%) avec une fréquence plus élevée chez les hommes. L'hypertension a été trouvée chez 50,7% des participants; 28,7% étaient sous traitement contre l'hypertension, tandis que 22,0% étaient nouvellement diagnostiqués. Le diabète était associé à un âge plus avancé et à une pression artérielle systolique élevée, tandis que l'hypertension était associée à un âge plus avancé, à l'obésité et à une glycémie élevée. CONCLUSION: Cette étude a montré une fréquence élevée de diabète et d'hypertension chez les Nigérians adultes; par conséquent, les efforts pour y remédier devraient être intensifiés. Un dépistage ciblé des personnes à risque de maladies non transmissibles est un avantage supplémentaire.

Relationship between Renal Doppler Indices and Biochemical indices of Renal Function in Type 2 Diabetes Mellitus.

OBJECTIVES: Diabetic nephropathy is a common complication of diabetes mellitus due to microangiopathy leading to end stage renal disease. This study determined the relationship between renal resistivity index and pulsatility index with biochemical indices of renal function in patients with type 2 diabetes mellitus methods: This study involved 80 adults with type 2 diabetes mellitus. Urinary albumin excretion rate (UAER) and serum creatinine levels were measured, and the estimated glomerular filtration rate (eGFR) was calculated. Right renal resistivity index (RI) and pulsatility index (PI) values were determined. RESULTS: Mean renal resistivity index was 0.72±0.06 while the pulsatility index was 1.36 ± 0.24. Resistivity index was positively correlated with albuminuria (r = 0.426; p <0.001) and serum creatinine (r = 0.458; p <0.001), but negatively correlated with eGFR (r = -0.399; p <0.001). There was positive correlation between pulsatility index and albuminuria (r = 0.341; p = 0.002), and serum creatinine (r = 0.478; p = <0.001); and negative correlation between PI and eGFR (r = - 0.359; p = 0.001). CONCLUSIONS: Renal resistivity index and pulsatility index may provide valuable non-invasive estimate of predicting the presence and severity of renal dysfunction in patients with type 2 diabetes.

Prevalence and Correlates of Peripheral Arterial Disease in Nigerians with Type 2 Diabetes.

Background. Peripheral arterial disease (PAD) is a major risk factor for nonhealing foot ulcers in people with diabetes. A number of traditional risk factors have been reported to be associated with PAD; however, there may be a need to consider nontraditional risk factors especially in some vulnerable populations. This study determined the prevalence and risk factors associated with PAD in diabetics. Methods. One hundred and fifty type 2 diabetics and an equal number of age- and sex-matched apparently healthy controls were studied. Assessment of PAD was made using history, palpation of lower limb vessels, and measurement of ankle-brachial index (ABI). Statistically significant differences between categorical and continuous variables were determined using Chi square (χ2) and Student t-tests, respectively. Regression analysis was done to determine the associated risk factors for PAD. Results. Prevalence of PAD using ABI was 22.0% and 8.0% among diabetic and nondiabetic populations, respectively. Peripheral arterial disease was associated with age, male gender, waist circumference, and high-sensitivity C-reactive protein. Conclusion. This study highlights the high prevalence of PAD in people with type 2 diabetes mellitus and in apparently healthy controls; age, male gender, abdominal obesity, and high hs-CRP values were the associated risk factors.

Gall bladder volume and contractility in type 2 diabetes mellitus

The aim of this study was to sonographically evaluate gall bladder changes in type 2 diabetes. One hundred type 2 diabetic subjects (50 with neuropathy and 50 without neuropathy) and 50 healthy controls un-derwent sonographic evaluation of the gall bladder. Fasting and postprandial gall bladder volumes (FGBV and PPGBV) were measured; and the gall bladder contractility index (GBCI) calculated. The presence of gallstones was also noted. It was found that patients with diabetic neuropathy had a significantly higher FGBV and PPGBV; and lower GBCI; compared with diabetic patients without neuropathy; PPGBV and GBCI also differed significantly from non-diabetic controls. Gallstones were present in 22% of diabetic patients with neuropathy; in 10% of those without neuropathy; and in 8% of controls. We conclude that diabetic patients with neuropathy have significant abnormalities of gall bladder function; presumably due to autonomic nerve dysfunction. These patients also have a higher prevalence of gallstones; suggesting that ultrasound screening may be worthwhile

C-reactive protein in healthy adult Nigerians.

BACKGROUND: C-reactive protein (CRP) is an acute phase reactant produced in the liver in response to tissue injury or systemic inflammation, its release is stimulated by cytokines (interleukin-6 and tumour necrosis factor-alpha). Elevated CRP levels have been linked to an increased risk of later development of diabetes mellitus and systemic hypertension. Baseline level of C-reactive protein in apparently healthy men and women predict long-term risk of a first myocardial infarction. METHOD: The study design was cross-sectional conducted among apparently healthy adult relative of patients and hospital staff of the Obafemi Awolowo University Teaching Hospitals complex (OAUTHC) Ile Ife, Osun State south western Nigeria. Serum lipids and fasting blood glucose were measured, while C-reactive protein measurement was based on the principle of solid phase enzyme-linked immunosorbent assay (ELISA). RESULTS: Atotal of 50 apparently healthy consecutive adult subjects were recruited into the study comprising 19 male and 31 female. There was no significant difference in mean Fasting blood glucose and serum lipids between the male and female study subjects. However, C-reactive protein was found to be higher in female compared to male, but the difference was not statistically significant. CONCLUSION: This study showed that apparently healthy adult female Nigerians have higher level of C-reactive protein compared to male, but with no significant difference.

Assessment of Lung Function Parameters in Nigerian Males with Diabetes

Despite scarce information on the implications of diabetes for pulmonary function; existing evidence suggests that the respiratory system might also be affected by diabetes. We therefore conducted a crosssectional study of pulmonary function in male Nigerian diabetes patients using spirometric indices. Seventy-six male diabetes patients aged 27-80 years were studied at the Endocrinology and Diabetes Clinic at the Obafemi Awolowo University Teaching Hospital; Ile-Ife; Nigeria. Overall; all lung function parameters/volumes studied were significantly lower in the diabetes patients compared with predicted values p=0.000. Patients' ages correlated negatively with all spirometric indices but there was no significant relationship between lung function and fasting blood sugar; body mass index; or diabetic microvascular complications. The implications of abnormal lung function parameters for respiratory disease in diabetes are unclear. Routine tests of pulmonary function are not presently indicated in Nigerian diabetes patients

Comparison of lispro insulin and regular insulin in the management of hyperglycaemic emergencies.

This study compared the efficacy and safety of Lispro insulin and regular insulin in the management of hyperglycemic emergencies (HE). Fifty patients who presented in HE to the Emergency unit of Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife participated in the study. Hyperglycaemic emergency was diagnosed when plasma glucose level was >17 mmol/L (300 mg/dl) in the presence of polyuria and polydipsia that warrants emergency hospital admission. Subjects in the Lispro insulin group had a statum dose of 0.3 IU/kg, while those in the regular insulin group had a statum dose of 20 IU equally split between the intravenous and intramuscular routes. Further insulin therapy was by the intramuscular route. Data was analysed using the Statistical package for social sciences (SPSS) version 11. Hyperglycaemia resolved within the first 8 hours in 60 and 40% percent of subjects in the lispro and regular insulin treated groups respectively. The time taken for resolution of hyperglycaemia was similar in both treatment groups, 6.6 +/- 0.8 hours for the lispro insulin group and 7.4 +/- 0.8 hours for the regular insulin group p = 0.51. The number of episodes of hypoglycaemia and hypokalemia in the two treatment groups did not differ statistically (p = 1.0 and 0.38 respectively). Eight (16%) subjects died. Lispro insulin is a safe and efficacious alternative to regular insulin in the treatment of HE.

Serum C-reactive protein in Nigerians with type II diabetes mellitus.

BACKGROUND: C-reactive protein is an acute-phase proteins, produce in the liver, its release is stimulated by cytokines (interleukin 6 and tumour necrosis factor alpha). Elevated level of it is a risk factor for coronary heart disease. Baseline levels of C-reactive protein in apparently healthy men and women predict long-term risk of a first myocardial infarction. Diabetics are at increased risk for coronary heart disease, data from the Framingham Study showed a two-to three-fold elevation in the risk of clinically evident atherosclerotic disease in patients with type II diabetes compared to those without diabetes. However, but data regarding CRP in Nigerian diabetic is lacking. OBJECTIVES: The study was to determine serum C-reactive protein in Nigerian with Type II diabetes mellitus. METHODS: The study design was cross-sectional conducted among patients attending out patient clinic of the Obafemi Awolowo University Teaching Hospitals complex (OAUTHC) Ile Ife, Osun State south western Nigeria. Measurement of C-reactive protein was based on the principle of solid phase enzyme-linked immunosorbent assay (ELISA). RESULTS: A total of 125 consecutive subjects were recruited comprising 75 patients with type II diabetes mellitus with or without hypertension and 50 apparently healthy age-and-sex comparable controls. There was a significant difference between the mean systolic and diastolic blood pressures of the patients and controls. The fasting blood glucose and C-reactive protein were significantly higher in diabetics compared to controls. There was a positive and significant correlation between FBG and CRP in both patients and controls. CONCLUSION: This study showed that diabetics have significantly higher serum C-reactive protein compared to the apparently controls. Also there was a positive and significant correlation between C-reactive protein and fasting blood glucose among both patients and controls.

Blood pressure response to an exercise treadmill test, and echocardiographic left ventricular geometry in Nigerian normotensive diabetics.

OBJECTIVES: This study evaluated normotensive diabetic patients' blood pressure response to graded exercise and their echocardiographic pattern of left ventricular geometry. METHODS: A descriptive, cross-sectional, hospital-based study was carried out on 30 normotensive type 2 diabetic patients and 34 controls, aged 30 to 60 years. The outcome measures were to determine the exercise-related variable, blood pressure response, and left ventricular geometry by means of echocardiography. RESULTS: Nineteen (29.7%) and 11 (17.2%) normotensive diabetic subjects had normal left ventricular geometry and concentric left ventricular remodelling, respectively. None of the subjects had concentric or eccentric left ventricular hypertrophy. On this basis, the normotensive diabetic subjects were divided to two groups: G1 (normal) and G2 (concentric left ventricular remodelling). The groups had comparable mean age, body mass index (BMI), fasting blood glucose (FBG) and two-hour post-prandial blood glucose values, and heart rate, systolic (SBP) and diastolic blood pressure (DBP) at rest. G2 patients had higher mean duration of diabetes than G1 subjects (69.0 +/- 9.48 vs 18.7 +/- 8.7 months; p = 0.007). Peak systolic blood pressure was significantly higher in G2 than G1 subjects (213.6 +/- 20.1 vs 200.0 +/- 15.3 mmHg; p = 0.04). Although there was no statistically significant difference in the left ventricular (LV) mass index between the groups, G2 patients had significantly higher relative wall thicknesses than G1 patients (0.53 +/- 0.03 vs 0.41 +/- 0.04; p < 0.001). CONCLUSION: Normotensive diabetic subjects with concentric left ventricular remodelling have increased blood pressure reactivity to exercise. It is probable, as suggested in earlier studies, that increased blood pressure reactivity to exercise is an indicator of target-organ damage, particularly in normotensive diabetics.

Comparison of lispro insulin and regular insulin in the management of hyperglycaemic emergencies

This study compared the efficacy and safety of Lispro insulin and regular insulin in the management of hyperglycemic emergencies (HE). Fifty patients who presented in HE to the Emergency unit of Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife participated in the study. Hyperglycaemic emergency was diagnosed when plasma glucose level was >17 mmol/L (300 mg/dl) in the presence of polyuria and polydipsia that warrants emergency hospital admission. Subjects in the Lispro insulin group had a statum dose of 0.3 IU/kg, while those in the regular insulin group had a statum dose of 20 IU equally split between the intravenous and intramuscular routes. Further insulin therapy was by the intramuscular route. Data was analysed using the Statistical package for social sciences (SPSS) version 11. Hyperglycaemia resolved within the first 8 hours in 60 and 40% percent of subjects in the lispro and regular insulin treated groups respectively. The time taken for resolution of hyperglycaemia was similar in both treatment groups, 6.6 +/- 0.8 hours for the lispro insulin group and 7.4 +/- 0.8 hours for the regular insulin group p = 0.51. The number of episodes of hypoglycaemia and hypokalemia in the two treatment groups did not differ statistically (p = 1.0 and 0.38 respectively). Eight (16%) subjects died. Lispro insulin is a safe and efficacious alternative to regular insulin in the treatment of HE

Assessment of limited joint mobility of the hand in Black Africans with diabetes mellitus and in non-diabetics.

OBJECTIVE: This study is designed to further characterize Limited Joint Mobility (LJM) of the hand using quantitative goniometric measurements among Black Africans with Type 2 diabetes mellitus and non-diabetes. METHODS: Seventy-six patients with Type 2 diabetes and 63 normal controls matched for age and gender were purposively selected. Visual clinical examination and quantitative goniometric assessment of patients with DM and non-DM controls were done. The LJM was graded using the criteria of Silverstein et al. Glycaemic control and proteinuria were also assessed. RESULTS: Prevalence of LJM among Type 2 DM patients was 26.3% compared with 4.8% in normal controls. Subjects with LJM within the control group were significantly older than those with LJM within the DM group (p < 0.05). Prayer sign was 11.8% in DM patients compared with 4.8% of control. The flattening sign demonstrated by the inability to flatten their hands on a flat surface was more in patients with DM (10.5%) compared with 4.8% in the control group. Stage II LJM with 18.4% prevalence was the commonest followed by Stage III (7.9%) among patients with DM. Poor glycaemic control was found in 85%, using fasting plasma glucose and 70%, using 2-hour postprandial blood glucose (2 hpp). CONCLUSION: We conclude that Black Africans with Type 2 DM only have moderately severe cases of LJM.

A comparison of two measures of quality of life of Nigerian clinic patients with type 2 diabetes mellitus.

BACKGROUND: We present data comparing the quality of life effects of type 2 diabetes determined by the Bradley well-being questionnaire and the WHOQOL-BREF, a generic instrument. We also present data on the reliability and validity of these instruments. METHOD: The Well-being and the WHO-bref were administered on fifty-three consecutive type 2 diabetics. The internal consistency of the quality of life scales was assessed using Cronbach's alpha. Convergent, discriminant, and known groups validity were determined and compared. RESULTS: Our patients had a mean age of 55.8+/-13 years. 31(58.5%) were males and all patients had been diabetic for 7.9+/-7.1 years. 13(24.5%) were being treated with oral agents, 14(26.4%) were on insulin and 26(49.1%) were on combined therapy. The Cronbach alpha coefficients ranged from 0.31 to 0.72 on the Well-being subscales and from 0.47 to 0.78 on the WHOQOL-BREF subscales. Both scales were modestly related to one another. In general the quality of life measures were not influenced by characteristics such as age, gender, marital or educational status. Both scales were not influenced significantly by treatment type or the severity or number of complications. CONCLUSION: Our study has shown how two different measures of quality of life perform in patients with type 2 diabetes. Even though the subscales of the Well-being and WHOQOL-BREF were not very sensitive to external criteria of disease impact (complications) casting a doubt on their utility as psychological outcome measures, they demonstrated fairly reasonable internal consistency in our patients with type 2 diabetes. Further larger studies are thus required to clarify this given our present limitations.

Screening and identifying diabetic patients at risk of foot ulceration: use of the Semes­Weinstein monofilament

The diabetic foot can present with many different problems and the most important clinically are ulceration, amputation, and Charcot neuropathy. The majority of lower limb amputations in patients with diabetes are preceded by foot ulceration. Neuropathy results in loss of protective sensation and the use of 5.07/10 g Semmes­Weinstein monofilament is a simple device that detects patients with insensate feet. Clinical and demographic parameters of all consenting consecutive type 2 diabetes patients were documented. A history of the presence of peripheral neuropathy and sensory modalities of light touch, vibration sense, and joint position were assessed and the 5.07/10 g Semmes-Weinstein monofilament was used to detect patients with insensate feet. A total of 117 patients were examined (mean age 58 years, diabetes duration 6 years: there were 51% males and 49% females, and mean fasting plasma glucose was 8.1±2.9 mmol/L. Ninety-three (79%) presented with a history of peripheral neuropathy and 96% had one or more impaired sensory modality. The use of the monofilament showed impairment in 49%. Twenty-seven (23%) of these had severe peripheral neuropathy. The most frequent site of loss of sensation was the heel (31%). We concluded that the prevalence of peripheral neuropathy in our patients is high. Most patients walked sometimes barefoot, which may account for a high occurrence of foot ulceration. The Semmes-Weinstein monofilament should be routinely used in diabetes clinics

Asymptomatic bacteriuria in patients with diabetes mellitus in Ile-Ife, South-West, Nigeria.

OBJECTIVES: To investigate the prevalence and associates of asymptomatic bacteriuria (ASB) in a sample of Nigerian diabetic patients. DESIGN: Cross-sectional descriptive and analytic study. SETTING: The Wesley Guild Hospital and Ife State Hospital, both units of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. SUBJECTS: One hundred and thirty five diabetic patients and 57 non-diabetic patients as controls. MAIN OUTCOME MEASURES: Demographic parameters of participants were recorded. Significant bacteriuria was determined for each of the mid-stream urine specimen obtained from all the subjects. Organisms isolated were identified and evaluated for antibiotic susceptibility patterns. RESULTS: There was a significant difference in the prevalence of ASB in the two groups. Prevalence of ASB was 16% and 3.5% in the diabetic patients and control respectively (p=0.03). Demographic parameters except age were not related to the presence of ASB. ASB was found in 54.4% of diabetic patients with poor glycaemia control compared with 2.9% in diabetics with good glycaemia control (p = 0.006). Organisms associated with ASB were Staphylococcus aureus, Klebsiella sp, Escherichia coli and Enterococcus faecalis, however the most predominant was Staphylococcus aureus. These organisms were largely resistant to the common antibiotics tested such as cotrimoxazole and gentamicin but susceptible to nitrofurantoin. CONCLUSIONS: The prevalence of ASB is high in diabetic patients and poor glucose control can be considered a predisposing factor.

Seroprevalence of hepatitis C virus infection in Nigerians with type 2 diabetes mellitus.

BACKGROUND: Several studies have suggested a strong epidemiologic association between Diabetes Mellitus (DM) and Hepatitis C Virus (HCV) infection in some populations. However, the reasons why chronic HCV infection is prevalent in DM remain unknown. Our aims were to determine the prevalence of HCV infection in a population of Nigerian diabetics compared with the general population as well as assess the influence of sex and age on HCV infection in the same diabetic population. DESIGN AND METHODS: A total of 115 diabetic patients were compared with 2,301 blood donors matched by recognized risk factors to acquire HCV infection. Serologic testing for anti HCV was done using a commercial enzyme-linked immunosorbent assay (ELISA) kits. RESULTS: Sixty (60) type 2 diabetic patients were males while fifty-five (55) were females. Their mean age was 55.4 +/- 9 years and mean blood glucose level was 8.5mmol/l. One subject tested positive for HCV infection. The control group consisted of 2,031 adults recruited from the blood donor's clinic. Forty five of them (2.2%) tested positive for HCV. CONCLUSION: Our preliminary results suggest a low sero-prevalence of HCV infection among our patients with type 2 diabetes. Presently, routine screening for HCV infection in persons with diabetes may not be necessary.

A test of the reliability and validity of a diabetes specific quality of life scale in a Nigerian hospital.

The purpose of this study was to test the reliability of the Well-being and Diabetes Treatment Satisfaction Questionnaires among clinic patients with type 2 diabetes as well as determine the clinical correlates of these measures. A cross-sectional survey was conducted using the Well-being Questionnaire and the Diabetes Treatment Satisfaction Questionnaire. Other demographic and clinical indices of age, sex, body mass index, disease duration and blood glucose levels were also recorded. 83 responses were analysed. Subjects were aged between 25 and 75 years, mean 55.5+/-11.1 years. 50.6% were males while 49.4% were females. Mean diabetes duration was 4.9+/-6.5 years. 67 (80.7%) were receiving oral agents and dietary modification while 16 (19.3%) were on insulin therapy. The internal consistency for responses to the well-being subscales and treatment satisfaction scale produced satisfactory alpha coefficients ranging from 0.73 to 0.88 and 0.74 respectively. Inter-item correlations were ranged between 0.19 and 0.45 for depression subscale; 0.22-0.78 for anxiety subscale; 0.33-0.58 for energy subscale; 0.33-0.79 for positive well-being subscale; and -0.22 to 0.79 for the treatment satisfaction scale. Item-total correlations ranged between 0.39 and 0.87 across the two scales: well-being (0.59-0.87) and treatment satisfaction (0.39-0.78). Mean scale scores were similar in both insulin and oral hypoglycaemic drug treated patients. Positive well-being was higher in males 13.4+/-4.1 vs. 11.5+/-4.3 in females p = 0.04. None of the well-being subscale scores, or treatment satisfaction correlated with age, disease duration, body mass index or glycaemic control. The well-being and treatment satisfaction scales are reliable instruments for the measurement of diabetes specific quality of life and treatment satisfaction in Nigerians although they were originally designed and developed among a UK population. It is hoped that our data would provide the basis for future comparisons and improving diabetes care.

Fibrinolytic activity in Nigerian diabetics.

Fibrinolytic activity, using euglobulin lysis time (ELT), was assessed in 46 Nigerians with type 2 diabetes mellitus to study the effect of the disease on fibrinolytic component of haemostasis. There were 20 females and 26 males. Fifty age matched non-diabetics and apparently healthy Nigerians were similarly studied as controls; there were 24 females and 26 males. In the patients, the mean (SD) age of the females was 56.7 (12.0) years and mean (SD) ELT was 276.4 (62.2) min; the mean age of the males was 55.7 (8.5) years and mean ELT was 303.5 (51.5) min. The mean age for female controls was 54.3 (12.6) years and their mean ELT was 198.3 (37.5) min; the mean age of the male controls was 53.4 (11.0) years and mean ELT was 181.6 (39.4) min. There was reduced fibrinolytic activity in diabetic Nigerians as revealed by significantly prolonged ELT in diabetic patients compared with healthy controls. There was good correlation between the blood glucose level and ELT. The observed changes in fibrinolytic activity in this study were not affected by duration of illness. The prolonged ELT in the diabetic population is an additional risk factor for thromboembolic disorders. Fibrinolytic agents may therefore be useful in the management of diabetes mellitus.

A study of psychiatric symptoms in thyrotoxic Nigerians.

Psychiatric symptoms suggesting panic, affective, and even schizophrenic disorders have been described in thyrotoxic patients. However, this has not been previously described among Nigerians. We have therefore conducted a cross-sectional study of psychiatric symptoms among thyrotoxic Nigerians. The self-rated General Health Questionnaire (GHQ-30) and the Hospital Anxiety and Depression Scale (HADS) were administered on 8 previously untreated newly diagnosed thyrotoxics. Eight age and sex-matched diabetics and 8 apparently healthy controls were also recruited as controls. 1 subject was a male while 7 were females. Their ages ranged from 29 to 60 years, mean 44.5 +/- 11.4 years. Graves' disease was the cause of thyrotoxicosis in 7 subjects while the other had toxic multinodular goiter. Symptoms of thyroid disease had been present in them for a mean of 9.1 +/- 6.8 months. Based on GHQ-30 scores, 4 thyrotoxics, 4 diabetics and 2 healthy controls had significant psychiatric symptoms. The HADS identified symptoms of anxiety in 3 thyrotoxics, no diabetic and 2 healthy controls. Symptoms of depression was however present in 2 thyrotoxics, 1 diabetic and no healthy control. The mean GHQ-30, Anxiety and Depression scores were comparable across all subject groups: P = 0.489, 0.277, and 0.125 (ANOVA), respectively. None of the psychiatric symptom ratings significantly correlated with serum T3 levels. Our result does not show prominence of psychiatric symptoms in our thyrotoxic patients. Further, larger studies are required to validate this finding.