Evaluating Vitamin D Status in Pre- and Postmenopausal Type 2 Diabetics and Its Association with Glucose Homeostasis.

BACKGROUND: Type 2 Diabetes Mellitus (T2DM) and menopause are associated with vitamin D status. Oestrogen decline during menopausal stages promotes hypovitaminosis D. However, the interplay between vitamin D, menopause, lifestyle, and T2DM cannot be overlooked. This study assessed vitamin D status among pre- and postmenopausal T2DM women and determined its association with glycemic control and influence of lifestyle habits on hypovitaminosis D. METHODS: This cross-sectional study was conducted at the Komfo Anokye Teaching Hospital, Kumasi, Ghana. Structured questionnaires were administered to 192 T2DM women; blood samples were collected for estimation of 25(OH) D and insulin using ELISA. Fasting blood glucose (FBG), lipid profile, glycated haemoglobin (HbA1c), and calcium were measured. Statistical analyses were performed using Graphpad Prism 6. RESULTS: The prevalence of vitamin D inadequacy was 92.2%. Hypovitaminosis D was more prevalent among the postmenopausal T2DM women (63.8% versus 58.2%). Hypovitaminosis D significantly associated with insulin [R2 = 0.01760, p = 0.0008], HbA1c [R2 = 0.3709, p = <0.0001], and FBG [R2 = 0.3465, p = 0.0001] in only the postmenopausal women. CONCLUSION: Vitamin D deficiency is prevalent in pre- and postmenopausal T2DM but higher among postmenopausal women. Adequate vitamin D levels in both groups were associated with improved glucose control while hypovitaminosis D in the postmenopausal women was related to poorer glucose control. Vitamin D screening should be incorporated into management plan for T2DM to serve as an early tool for prevention of vitamin D deficiency.

The potential of N-glycosylation profiles as biomarkers for monitoring the progression of Type II diabetes mellitus towards diabetic kidney disease.

BACKGROUND: On a global scale, type II diabetes mellitus (T2DM) remain a major health problem and it is the driver for chronic kidney disease (CKD). Despite this association, we still do not have sufficient biomarkers to anticipate better outcomes. N-glycosylation profiles are robust biomarkers and can be used for early monitoring of the progression of T2DM towards CKD. METHODS: In this cross-sectional study, we recruited 241 T2DM patients from January to May 2016. Demographic and anthropometric data were collected, following which fasting blood samples were collected for clinical analyses. Renal function decline was determined by estimation of glomerular filtration rate (eGFR) and N-glycosylation profiles were analysed by Ultra-performance liquid chromatography (UPLC). RESULTS: The prevalence of undiagnosed CKD was 31.53%. Compared to men, women had a statistically significantly higher HbA1c (p = 0.031), TG (p = 0.015), HDL-c (p < 0.0001), creatinine (<0.0001), urea (p < 0.028) and uric acid (p < 0.0001). T2DM patients with undiagnosed CKD had higher serum creatinine (145.75 ± 50.83 vs 88.59 ± 19.46, p < 0.0001), higher uric acid (361.10 ± 115.37 vs 294.54 ± 97.75; p < 0.0001) and higher urea (5.17 ± 2.35 vs 3.58 ± 1.19; p < 0.0001). After performing logistic regression and adjusting for age, sex and BMI, three N-glycan peaks [OR (95%CI): (GP12 (0.05(0.01-0.54), p = 0.013)); GP16 (0.61(0.43-0.87), p = 0.006)); GP22 (0.60(0.39-0.92), p = 0.018)) were associated with renal function. CONCLUSION: There was an increased prevalence of undiagnosed CKD among T2DM patients. This prevalence is the consequence of uncontrolled modifiable risk factors, which collectively may lead to end stage renal disease (ESRD). Although, the identified N-glycans could not adequately predict incident CKD, our investigation indicates the potential role of N-glycosylation in renal function and that their inclusion may improve risk stratification for CKD.

Long-Term Outcomes of Stroke in a Ghanaian Outpatient Clinic.

BACKGROUND: Compared with high-income countries, sub-Saharan African (SSA) countries experience a comparatively higher early mortality from stroke. However, data on long-term mortality from stroke in SSA are lacking. OBJECTIVE: Our aim is to assess long-term outcomes of stroke in an SSA setting. METHODS: We conducted a retrospective analysis of longitudinal data involving 607 consecutive stroke survivor encountered at an outpatient clinic in Kumasi, Ghana, between January 2012 and June 2014. Data were closed for analysis in June 2016. Data on demography, presence of vascular risk factors, stroke type, and functional status were evaluated. We followed up subjects who were no longer attending clinic by phone to assess their vital status. Primary outcome was death after initiation of clinic care, and its predictors were determined using a Cox proportional hazards regression model. RESULTS: Mean ± standard deviation (SD) age of cohort was 59.9 ± 13.9 years and 50.3% were female. Of the 607 stroke survivors, 377 (62.1%) were still alive, 59 (9.7%) were confirmed to have died, whereas 171 (28.2%) were lost to follow-up at the clinic. Mean ± SD observation time for the cohort was 32 ± 30 months. Upon adjustment for confounders, the independent predictors of mortality were age (adjusted hazard ratio [aHR] of 1.41 [95% confidence interval 1.15-1.73] for a 10-year increase in age) and diabetes mellitus (aHR of 2.24 [1.32-3.80]). CONCLUSIONS: Diabetes mellitus, a modifiable risk factor for stroke, is associated with an increased risk of mortality among West African stroke survivors over the long term.

Type 2 diabetes in a rapidly urbanizing region of Ghana, West Africa: a qualitative study of dietary preferences, knowledge and practices.

BACKGROUND: Urban centers in Sub-Saharan Africa, such as Kumasi, Ghana, are especially impacted by the dual burden of infectious and non-communicable disease (NCD), including a rise in type 2 diabetes mellitus (T2DM) prevalence. To develop effective intervention programs, the World Health Organization recommends more research to better understand the relationship between food consumption and the escalation of non-communicable disease such as T2DM. This study provides qualitative information about current food knowledge, attitudes and practices among T2DM patients and their caregivers in the region of Kumasi, Ghana. METHODS: In this qualitative study, three focus groups discussions of 30 persons total and 10 individual interviews were used to assess food preferences, knowledge, attitudes and practices of patients with T2DM as well as caregivers responsible for food preparation. Participants included both urban and rural dwellers. Hospital-based health talks were observed, a dietician was interviewed, and educational documents were collected. Themes were identified and coded using Nvivo10 software. RESULTS: Findings suggest that messages regarding sweetened foods, fats, use of seasonings and meal timing are followed. However, confusion exists regarding the impact of fruits, food portioning, plantains and processed foods on health outcomes for diabetic patients. Results also revealed a problem-solving approach to increasing vegetable consumption, and a concern about unhealthy food preferences among younger generations. CONCLUSIONS: Education about the impact of commonly available carbohydrates on blood sugar should be emphasized; messaging on portion sizes and certain foods should be more consistent; the economic benefits of local vegetable consumption should be promoted; and a research-informed, T2DM prevention campaign should be developed specifically for younger generations.