Health Resource Utilization among Patients with Type 2 Diabetes Mellitus In Nigeria: An Analysis from the International Diabetes Management Practice Study (IDMPS).

PURPOSE: To assess the data on health resource utilization collected from patients with T2DM in Nigeria, within the seventh wave (2016) of the International Diabetes Management Practices Study (IDMPS). METHODS: In this cross-sectional study, adults (≥25 years) with T2DM, who had requisite diabetes treatment data and were attended by participating physicians during the two-week recruitment period, were included. Results: Thirty-one participating physicians enrolled 304 eligible patients (mostly 40-60 years of age) with the duration of T2DM ranging from 1 to 31 years (median: 7). Only 34.2% (102/298) patients possessed health insurance and 46.8% (138/295) co-paid for medications outside the insurance. About 70.1% of patients had T2DM-related complications; 19.7% of patients were hospitalized in the past 12 months due to these complications. Altogether, 275 patients with T2DM received oral glucose-lowering drugs, with (88/275) or without (187/275) insulin. The cost of medications/strips was the reason reported for not achieving glycemic targets in ~60.0% (50/84) insulin users and 54.3% (114/210) patients self-monitoring blood glucose, respectively. Specialists in diabetes care attended to a lower number of patients/day than non-specialists (31.61±30.74 vs. 49.25±49.64). Most of the specialists (14/22; 63.6%) reported insulin use in 20%-40% patients; while non-specialists (6/9; 66.6%) reported insulin use in <20% patients. Conclusion: In Nigeria, low insurance coverage and high out-of pocket payments for healthcare limit access to healthcare. Physicians are overburdened and medical resources trained in diabetes care seem insufficient. These findings highlight the need to formulate effective healthcare strategies for patients with T2DM.

Objectif: Évaluer les données sur l'utilisation des ressources de santé collectées auprès des patients atteints de DT2 au Nigéria dans le cadre de la septième vague (2016) de l'Étude Internationale sur les Pratiques de Gestion du Diabète (IDMPS). Méthodes: Dans cette étude transversale, les adultes (≥25 ans) atteints de DT2, qui disposaient de données de traitement du diabète nécessaires et qui ont été pris en charge par des médecins participants au cours de la période de recrutement de deux semaines, ont été inclus. Résultats: Trente et un médecins participants ont inscrit 304 patients éligibles (principalement âgés de 40 à 60 ans) avec une durée du DT2 variant de 1 à 31 ans (médiane : 7). Seuls 34,2% (102/298) des patients étaient assurés santé, et 46,8% (138/295) payaient eux-mêmes pour les médicaments en dehors de l'assurance. Environ 70,1% des patients présentaient des complications liées au DT2 ; 19,7% des patients avaient été hospitalisés au cours des 12 derniers mois en raison de ces complications. Au total, 275 patients atteints de DT2 ont reçu des antidiabétiques oraux, avec (88/275) ou sans (187/275) insuline. Le coût des médicaments/ bandelettes était la raison invoquée pour ne pas atteindre les objectifs glycémiques chez ~60,0% (50/84) des utilisateurs d'insuline et 54,3% (114/210) des patients effectuant l'autosurveillance de la glycémie, respectivement. Les spécialistes en diabétologie prenaient en charge un nombre inférieur de patients par jour que les non-spécialistes (31,61±30,74 contre 49,25±49,64). La plupart des spécialistes (14/22 ; 63,6%) ont signalé l'utilisation de l'insuline chez 20 à 40% des patients ; tandis que les non-spécialistes (6/9 ; 66,6%) ont signalé l'utilisation de l'insuline chez moins de 20% des patients. Conclusion: Au Nigéria , une faible couverture d'assurance et des paiements élevés directement par les patients limitent l'accès aux soins de santé. Les médecins sont surchargés et les ressources médicales formées dans la prise en charge du diabète semblent insuffisantes. Ces résultats soulignent la nécessité de formuler des stratégies de santé efficaces pour les patients atteints de Dt2. Mots-clés: Nigeria, diabète, utilisation des ressources, hospitalisation.

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.

Health Information Technology Acceptance Framework for diabetes management.

This study examined the level of acceptance of Health Information Technology (HIT) as tools for diabetes care and management, in six selected tertiary hospitals in southwestern zone of Nigeria. Using both quantitative and qualitative methods, this study was conducted amongst selected healthcare stakeholders namely Nurses, Doctors, Laboratory Scientists, Pharmacists, ICT unit Professionals, Medical Record Officers, and Type-2 diabetes out-patients available in the designated hospitals. Adapting Technology Acceptance and Chronic Care Models, the level of HIT acceptance by the respondents in the study area was measured in terms of Perceived Ease-of-Use, Perceived Usefulness, and the Perceived Unintended Consequences relating to HIT, while also considering the roles of the government, community and healthcare organizations. One hundred and fifty (150) respondents were examined, each for both Staff and Patients, and the factor variables studied on a 5-point Likert rating scale of measurement from 1 (Strongly Disagree) to 5 (Strongly Agree). The results revealed strong perception of Staff and Patients about HIT implementation and acceptance and showed that in some cases, the perception of Staff and patients about HIT acceptance are the same, while different in some. The study concluded that for acceptability of HIT, hospitals have to embark on 'continuous' training for the HIT users, so that users would familiarize themselves with the system, and it will be fully incorporated into their workflow. Based on the findings, a conceptual Health Information Technology Acceptance Framework for Chronic diseases' management, especially for diabetes mellitus was developed.

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.

Visual impairment and blindness in type 2 diabetics: Ife-Ijesa diabetic retinopathy study.

Diabetes and blindness are important health issues globally; we determined the prevalence of blindness, diabetic retinopathy, and other eye diseases in Nigerian-type 2 diabetics. A prospective, cross-sectional study was conducted on consenting type 2 diabetic patients who had scheduled comprehensive eye examination including dilated funduscopy with +78DS. Visual status was graded using the WHO criteria. Approval from Institutional Ethics Committee was obtained. Primary outcome measures were the prevalence and causes of blindness as well as prevalence of diabetic retinopathy. Secondary outcome measures were the presence of other eye diseases. Data were analyzed using SPSS version 13. Two hundred and sixty-six eyes of 133 type 2 diabetic patients aged 22-89 years were studied; 69 (51.9 %) were males while 64 (48.1 %) were females. Five (3.8 %) patients were blind while 27 (20.3 %) were visually impaired. Cataract was the leading cause of blindness (60 %) and visual impairment was found in 59.3 %. Diabetic retinopathy was present in 37 (27.8 %) diabetic patients of which 5 (3.8 %) were proliferative. Diabetic macular edema was present in 31 (23.3 %) patients. Severe visual impairment and blindness were commoner in those with diabetic retinopathy. Refractive error 67 (25.2 %), cataract 63 (23.7 %), and chronic glaucoma 44 (16.5 %) were the most prevalent non-diabetic retinopathy eye diseases. High prevalence of blindness, diabetic retinopathy, and other diseases are seen in type 2 diabetics. Health education, early diagnosis as well as treatment of diabetic retinopathy and other diseases will largely alleviate these ocular morbidities.

Compliance with diabetic retinopathy screening in a Nigerian tertiary hospital

There is little information on default rates and reasons for retinal screening in diabetes. We prospectively studied 179 type 2 diabetic patients referred for screening at a tertiary Nigerian medical centre. Defaulting occurred in 100 patients, i.e. over half (56%). Defaulting was associated with not having had a previous eye examination (p=0.027) and either a short (<1 year) or medium (6­10 year) duration of diabetes (p=0.001). Location of residence, level of education, diabetes treatment, age and gender did not correlate with screening compliance. We recommend that screening be carried out as soon as possible after diagnosis, which may improve future compliance

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.

Serum C-reactive protein in Nigerians with type 2 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. METHOD: A cross-sectional study 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.

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

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.

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.

Effectiveness of a structured diabetes education program on some non-glycemic endpoints in Nigerians with type 2 diabetes mellitus.

This study evaluated the effectiveness of a structured group education program on non-glycemic endpoints of diabetes knowledge, compliance with treatment and medical advice, use of monitoring devices, and treatment satisfaction. A cross-sectional comparative design was employed. Study participants were members of the local Diabetes Association (DAN) who had participated in a structured group education program and comparison subjects were outpatients with type 2 diabetes mellitus who had not registered as members of DAN and do not attend DAN activities. Self- and interviewer-administered structured questionnaires were used to determine study endpoints. The responses of study participants were analyzed and then compared. Seventy-five patients were studied in each group comprising 78 males and 72 females. DAN members had good knowledge of their disease, complied satisfactorily with their medications and physician's advice, knew and used at least one monitoring device and had better knowledge of hypoglycemia than control subjects. Treatment Satisfaction scores were also higher among DAN members. Diabetes associations and clubs provide a practical and acceptable means of disseminating diabetes related information and should be strengthened.

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.

Diabetes mellitus related treatment goals: awareness and attainment in the Ife-Ijesa zone of south-western Nigeria.

Evidence emanating from research data have demonstrated that improved metabolic and blood pressure outcomes reduce the morbidity and mortality associated with diabetes. Primary goals of therapy have also been recommended to realise this objective. This study determined the prevalence of attainment of recommended goals for glycaemic and blood pressure control in type 2 diabetics attending the diabetes clinic of the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. We also assessed the knowledge and use of International guidelines for the clinical management of diabetes mellitus by health care providers in the Ife-Ijesa health zone of Osun State, South Western Nigeria. The charts and case records of One hundred and five (105) type 2 diabetics seen over a five-week period were reviewed to assess the prevalence of attainment of blood pressure and glycaemic control goals. The mean BP and fasting blood glucose of all patients at each clinic visit was determined and were compared statistically. Knowledge and practice of diabetes related treatment goals were assessed by means of a questionnaire administered on 133 diabetes health care providers. Forty-six (43.8%) patients attained the target fasting blood glucose level of = 6.7mmol/l while 52 (49.5%) had blood sugar levels = 7.8mmol/l after three clinic visits. Comparable results were obtained for the target 2 hour post prandial blood glucose targets. 15 (20%) subjects attained the target SBP of = 120/80 mmHg and 25 (25%) if the target was = 130/85 mmHg. All patients demonstrated significant mean BP lowering by the third clinic visit P = 0.000 (ANOVA) in all cases. There was also a significant lowering of mean FBS and 2hrPP blood glucose in all patients after 3 clinic visits P < 0.01. 16 (12%) health care providers had a good knowledge of current treatment recommendations. Of these, 13 (81.3%) were Doctors, 2 (12.5%) were nurses, and 1 (6.3%) other allied health worker. When analysed according to occupational groups, 17.3% doctors, 4.1% nurses and 11.1% amongst the group of allied health providers possessed good knowledge and practice of current treatment guidelines and treatment goals. While our current strategies achieved significant BP and blood glucose lowering, very few patients attained recommended targets. There is still a need for intensification of current strategies and periodic evaluation of its effectiveness in achieving optimal targets.

Endogenous opioids, mu-opiate receptors and chloroquine-induced pruritus: a double-blind comparison of naltrexone and promethazine in patients with malaria fever who have an established history of generalized chloroquine-induced itching.

AIMS: Chloroquine induces a severe generalized pruritus, in predisposed Black African patients, during treatment of malaria fever, and also in some Caucasian patients treated for rheumatological diseases. We have previously shown that chloroquine may release endogenous opioids and/or interact with micro-opiate receptors in rats, and that both histamine and malaria parasite blood density, contribute to the itching severity in malaria fever in humans. The aim of our present study was to assess and compare the antipruritic efficacy of the micro-opiate receptor antagonist, naltrexone, and the antihistamine, promethazine, in chloroquine treated patients with malaria fever. METHODS: A double-blind, randomized, parallel group comparison of the chloroquine-induced pruritus intensity and time profile in patients with parasitologically proven malaria fever, who were pretreated with a single dose of either naltrexone 50 mg or promethazine 25 mg orally (six patients each). All patients had an established history of severe pruritus following chloroquine treatment of malaria fever. A self-assessed itching severity score was undertaken at 0, 6, 12, 24, 48 and 72 h after initial chloroquine dosing, and the areas under the pruritus-intensity time curve AUCP0-72 h was determined in each patient and correlated to the malaria parasite density in blood. RESULTS: Both naltrexone and promethazine subjectively reduced itching severity compared with prior historical experience. One patient on naltrexone and two on promethazine never experienced any itching. There was no statistically significant treatment effect, but a significant time effect (P = 0.001, F = 4.77 d.f. 5) by two-way repeated measures ANOVA. The AUCP for naltrexone was 82 +/- 25 units/h, and 57 +/- 34 units/h for promethazine [95% confidence interval for the difference being -73 to 123]. However, the malaria parasite density in the naltrexone group (740 +/- 178 microl(-1)) tended to be higher than in the promethazine group 314 +/- 69 microl(-1) (P = 0.056, 95% confidence interval for the difference being -15 to 866 microl(-1)). Correction of the AUCP for malaria parasite density (parasite pruritogenic index, AUCP. units/h/parasites/microl blood) tended to be lower with naltrexone 9.1 +/- 2.6 than with promethazine 12.2 +/- 7.0 There was a highly significant and positive correlation between the malaria parasite density and the AUCP0-72 h, on naltrexone (r2 = 0.78, P = 0.040) and promethazine (r2 = 0.93, P = 0.008). However, comparison of regressions revealed that the slope of the regression was significantly steeper with promethazine 0.48 than naltrexone 0.12 (P = 0.006, t = 4.2), with the intercepts showing a trend to a difference (P = 0.086). CONCLUSION: Naltrexone exerted an antipruritic action, at least to a similar extent to promethazine in patients with chloroquine-induced itching in malaria fever. However, the relationship between parasite density and resultant pruritus was significantly different between naltrexone and promethazine. Thus, micro-opiate receptors/and or endogenous opioids may contribute to chloroquine itching in malaria fever, in humans, in accord with animal experimental findings. Malaria parasite density in blood is a strong determinant of itching severity in patients predisposed to chloroquine-induced pruritus.