Diabetes-related-distress and its relationship with glycaemic control among type 2 diabetes mellitus patients attending a specialty clinic in Lagos, Nigeria

Diabetes Mellitus (DM) is a chronic metabolic disease with various complications throughout its course. The presence of emotional burden in diabetes disease, which is referred to as diabetes-related distress (DRD) is common among such patients and may affect their response to treatment. Objectives: To assess the relationship of diabetes-related distress and glycaemic control among patients with Type 2 Diabetes mellitus. Methods: This hospital-based cross-sectional study was conducted at the Family Medicine Department of LASUTH, Ikeja, Lagos. A total of 317 patients with Type 2 Diabetes mellitus were systematically recruited. The data were collected over a four-month period. Important clinical information including clinical characteristics and diabetes-related distress using the diabetes distress scale (DDS-17) was collected. Glycosylated haemoglobin (HbA1c) was also assessed. Results: The degrees of DRD were as follows: 54.9% (None/little), 40.1% (moderate) and 5.0% (severe). The mean HbA1c estimate for all participants was 7.83±1.8%. Among the 317 study participants, 67.2% had poor glycaemic control while 32.8% had good glycaemic control. There was a statistically significant association between DRD and glycaemic control (p< 0.001). Likewise, the various domains of DRD had statistically significant associations with glycaemic control with the exception of physician-related domain. Participants with better glycaemic control reported lower levels of DRD than participants with poorer glycaemic control. Conclusion: There is a high level of diabetes-related distress patients with diabetes mellitus. Good glycaemic control is important in improving or preventing DRD. Therefore, T2DM patients should be screened for DRD during their treatment.

Sex-related differential prevalence of central obesity in diabetes mellitus: a multi-centred survey in North-Central Nigeria

Contrary to the old dictum that central obesity is more common among men than women, recent reports have shown a gradual reversal of this trend, as suggested by some studies. Objective: To compare the prevalence of central obesity among men and women with Diabetes mellitus in NorthCentral Nigeria. Methods: This multi-centred, cross-sectional study was conducted across 20 hospitals in Abuja, Nasarawa State, and Niger State, involving 1040 participants. Some obesity indices (body mass index, waist circumference and waist-toheight ratio) were measured. Results: The prevalence of central obesity (waist circumference criterion) was significantly higher in the females compared to male participants (89.6% vs 51.6%, χ2 = 1231.37, p<0.001), similar to the prevalence determined by waistheight ratio criterion (female vs male, 88.8% vs 71.5%, χ2 = 58.83, p<0.001). Following correction for age, duration of diabetes mellitus, blood pressure, blood glucose, and glycated haemoglobin using logistic regression, female gender remained a significant determinant of central obesity (OR = 2.76, 95% CI 1.81-3.83, p = 0.004). Conclusion: The prevalence of central obesity was higher among women than men in a cross-section of patients with diabetes mellitus in North-Central Nigeria

Correlates of hypertension among persons living with HIV at Livingstone Central Hospital: A cross sectional study

Background: Persons living with HIV (PLWH) are more likely to develop hypertension and cardiovascular disease than the HIV-negative population. The new hypertension guidelines by the American Heart Association (AHA) and the American College of Cardiology (ACC) lowered the definition of hypertension from systolic and diastolic blood pressure (BP) of ≥ 140/90mmHg to ≥ 130/80, respectively. This study was aimed at determining the prevalence and factors associated with hypertension in PLWH in Livingstone using the new hypertension diagnostic criteria. Methods: This was a cross-sectional study. We recruited 226 antiretroviral treated PLWH attending routine visits. Socio-demographic, health and clinical data including BP readings were collected. Interviewer-structured questionnaires adapted from the World Health Organization Stepwise approach to Surveillance ( WHO STEPs) and the international physical activity questionnaire (IPAQ) were used to collect data. Statistical evaluations were employed to elucidate relationships between hypertension and all response variables. Results: The prevalence of hypertension using the old and new guidelines was 16% and 42%, respectively. Factors significantly associated with increased and reduced odds of developing hypertension after adjustments in multivariate logistic regression were age, body mass index (BMI), employment status, fasting blood sugar (FBS) and table salt consumption, respectively (p<0.05 for all). Using the new AHA/ACC criteria for hypertension shifted the prevalence from 16% (old criteria) to 42%.Conclusion: The prevalence of hypertension in PLH in Livingstone was 42% and the major risk factors associated with hypertension in PLWH were increasing age, BMI and FBS. We recommend the inclusion of FBS in routine measurements in PLWH. The AHA/ ACC new guidelines should be reenforced in low-cost settings to increase the treatment of hypertension among PLWH.

Prospective cohort study of referred Malawian children and their survival by hypoxaemia and hypoglycaemia status

Objective To investigate survival in children referred from primary care in Malawi, with a focus on hypoglycaemia and hypoxaemia progression. Methods The study involved a prospective cohort of children aged 12 years or under referred from primary health-care facilities in Mchinji district, Malawi in 2019 and 2020. Peripheral blood oxygen saturation (SpO2) and blood glucose were measured at recruitment and on arrival at a subsequent health-care facility (i.e. four hospitals and 14 primary health-care facilities). Children were followed up 2 weeks after discharge or their last clinical visit. The primary study outcome was the case fatality ratio at 2 weeks. Associations between SpO2 and blood glucose levels and death were evaluated using Cox proportional hazards models and the treatment effect of hospitalization was assessed using propensity score matching. Findings Of 826 children recruited, 784 (94.9%) completed follow-up. At presentation, hypoxaemia was moderate (SpO2: 90­93%) in 13.1% (108/826) and severe (SpO2: < 90%) in 8.6% (71/826) and hypoglycaemia was moderate (blood glucose: 2.5­4.0 mmol/L) in 9.0% (74/826) and severe (blood glucose: < 2.5 mmol/L) in 2.3% (19/826). The case fatality ratio was 3.7% (29/784) overall but 26.3% (5/19) in severely hypoglycaemic children and 12.7% (9/71) in severely hypoxaemic children. Neither moderate hypoglycaemia nor moderate hypoxaemia was associated with mortality. Conclusion Presumptive pre-referral glucose treatment and better management of hypoglycaemia could reduce the high case fatality ratio observed in children with severe hypoglycaemia. The morbidity and mortality burden of severe hypoxaemia was high; ways of improving hypoxaemia identification and management are needed.

Correlation of some predisposing intrinsic conditions with the morphological integrity of the Achilles tendon

Background: Most studies have focused on ill-tendons with a little insight on how intrinsic factors correlate with the Achilles tendon (AT) morphology. Aim: This study aims at establishing how blood pressure (BP), blood glucose (BG), and body mass index (BMI) correlate with the morphology of the AT with emphasis on width changes. Materials and Methods: Participants were volunteers who were recruited during and after an organized health fair by the Medical Students' body of All Saints University, School of Medicine, Commonwealth of Dominica. A total of 336 people, consisting of 135 males and 201 females volunteered for the study. The most dominant age group was between 60 and 65 years. A self-administered questionnaire was used to acquire necessary information, and a preliminary clinical procedure was used to check for BP, BG, and BMI. Ultrasound examination was done in B-mode using a linear array high-frequency probe with a mediolateral approach at the AT. Results: Among the participants, 42.68%, 69.75%, and 30.38% had normal BP, BG, and BMI readings, respectively. BP, BG, and BMI statistically supported the hypothesis.Individuals with extreme BP, BG, and BMI had their AT width wider when compared with individuals with normal systemic readings. Sonographic examination revealed most participants with normal tendon morphology while some identifiable changes were observed among others. Conclusion: This study suggests that BP, BG, and BMI could affect the morphological integrity of the AT. It indicates that asymptomatic high blood sugar and BP could weaken the AT, leading to pain which may appear unrelated to the physician and patient

Vitamin D supplementation improves insulin resistance in type 2 diabetes subjects in Lagos, Nigeria

Type 2 diabetes is a disease caused by both insulin resistance and an insulin secretory defect. Reports suggest that vitamin D3 supplementation improves insulin resistance and pancreatic beta-cell function, but there is paucity of data on vitamin D and glycaemia in type 2 diabetes in Nigeria. We have therefore performed a single blind prospective randomised placebo-controlled trial, involving type 2 diabetes participants in Lagos, Nigeria. The participants consisted of 42 type 2 diabetes patients with vitamin D deficiency. These participants were randomised into two equal groups of treatment and a placebo arm. Vitamin D3(3000 IU daily) was given to the participants in the treatment arm. Insulin resistance (HOMA-IR) and pancreatic beta-cell (HOMA-B) function were determined at baseline and after 12 weeks of vitamin D3 supplementation, or placebo treatment. There was a reduction from baseline in the mean insulin resistance level in both the treatment and placebo groups. How-ever, this reduction was only statistically significant in the treatment group (p <0.01). The proportion of subjects with improvement in insulin resistance status (homeostatic model assessment insulin resistance score (HOMA-IR)<2.0) was significantly higher in the treatment arm (p<0.05). There was a reduction in the mean insulin secretory capacity in the treatment group while it increased in the placebo group, though this difference was not statistically significant. We conclude that vitamin D3 supplementation results in a reduction in insulin resistance, but has no effect on pancreatic beta-cell function in type 2 diabetes

Reduction of Cholesterol and Fasting Blood Sugar Levels by One Month Supplementation of Fresh Garlic in Diabetic Libyan Patients: A Double Blind, Baseline Controlled Study

Background: The therapeutic effects of fresh garlic remain controversial. The aim of this study is to investigate whether supplementation of fresh garlic could improve blood glucose and cholesterol profile in Libyan diabetic patients with moderate blood cholesterol.Methods:Forty-six diabetic patients were randomly assigned to either fresh garlic alone (≈2 grams/day), or fresh garlic in combination with glibenclamide taken on an empty stomach every morning for a month. Serum blood glucose, cholesterol and blood pressure were measured before starting treatment and after the end of the treatment period.Results: Fresh garlic alone was able to decrease the mean serum cholesterol levels by 26 mg/dl (84% of the original base values), while the combination of fresh garlic and glibenclamide produced a 28 mg/dl decrease in the mean serum cholesterol (85% of the original base values). Fresh garlic alone was able as well to decrease the mean blood glucose levels by 20 mg/dl (85% of the original base values), while the combination of fresh garlic and glibenclamide produced a 60 mg/dl decrease in the serum glucose levels (72% of the original base values). Neither treatment had a significant effect on the mean systolic or diastolic blood pressures after 30 days of treatment.Conclusion: Administration of fresh garlic every morning for a month significantly reduced the blood cholesterol and fasting blood glucose levels in diabetic patients. Thus administering dietary fresh garlic daily to diabetic patients might have cardio-protective effects on diabetic patients

Diabetes in older adults: experience from a rural community in south-east Nigeria

Diabetes is increasing globally with low- and middleincome countries bearing the greatest burden and the older population most affected. This study sought to highlight the problem of diabetes among older adults who participated in a health programme in a rural community. Fasting blood glucose levels and blood pressure of 147 people, aged between 40 years and above, in a rural community in south-east Nigeria were measured. The mean age of participants was 62±10y (1.SD) Thirty-seven (25.2%) were diabetic, 16 (43%) of which were undiagnosed. Most (67%) were aged 50 to 69 years. Twelve (8.2%) had impaired fasting glycaemia (IFG), of which 83% were aged 60 to 79 years. Male gender was moderately associated with the risk of diabetes, while family history was strongly associated. Twenty-five (67%) of the 37 diabetic patients were hypertensive, and only one (5%) of the 21 with known diabetes had a fasting glucose <7.0 mmol/L. This report showed a high prevalence of undiagnosed diabetes and impaired fasting glycaemia among these participants in a rural health programme. There is a strong implication for robust studies to validate these findings and an urgent need to improve access to healthcare for rural dwellers

Prevalence of Risk Factors for Non-Communicable Diseases for New Patients Reporting to Korle-Bu Teaching Hospital

Background: The risk factors of Noncommunicable diseases (NCDs) are not routinely monitored; especially among populace reporting to hospitals to detect and also advise on preventive measures; a key strategy to reducing the impact of NCDs on the Health Care System and population. Methods: A cross-sectional survey was carried out between the months of May and June; 2010 among a sample representative of the medical and surgical out-patients population to determine the prevalence of certain risk factors of non-communicable diseases (NCDs). Participants (n = 230) were selected by systematic random sampling. Standardized international protocols were used to measure the prevalence of smoking; alcohol consumption; physical inactivity; obesity; raised blood pressure; raised blood glucose and total cholesterol. Results: The obesity level of the study population was 40.4 with 54 being overweight. Tobacco use among the respondents was 4.8. Alcohol consumption was 64.8; with 54.3 of the study population being physically inactive. Almost 48 and 70.9 of the participants consumed fruits and vegetables respectively; at least three days in a week. The prevalence of hypertension was 33.6 for men and 35.2 for women. The prevalence of raised glucose and total blood cholesterol level among the study population was 6.5. Almost 62 of the participants had a combination of three or more risk factors. Conclusion: The prevalence of the significant risk factors in this study were physical inactivity (54.3); alcohol consumption (64.8); overweight (54); obesity (40.4) and raised blood pressure (34.3). Hospitals should therefore include NCD risk factor monitoring as part of routine services

Aerobic dance exercise improves blood glucose level in pregnant women with gestational diabetes mellitus

Exercise has been recommended by the World Health Organisation (WHO) as an adjunct treatment for Gestational Diabetes Mellitus (GDM); however; there is no planned exercise mode and type for this population. This study investigated the effect of structured aerobic dance exercise on the blood glucose level in pregnant women diagnosed with gestational diabetes attending clinic at Federal Medical Centre; Owerri; Nigeria. Thirty-four women diagnosed with gestational diabetes who met the inclusion criteria were recruited for the study. They were randomly assigned into exercise and control groups of 17 participants each. The Exercise group underwent 8 weeks aerobic dance exercise consisting of three exercise sessions per week; 40 minutes per session for the first 4 weeks and 60 minutes per session for the last 4 weeks. The Control group did not participate in any form of structured exercise programme throughout the period of the study but were encouraged to continue with their normal activities of daily living. The data for the study were collected at baseline; at 4 weeks and at 8 weeks of the exercise programme. Thirty (30) of the participants completed the study and so only their data were analysed using Repeated Measure ANOVA and Independent t-test. Results of the study showed significant improvement in the fasting blood sugar (p = .001) of the exercise group. It was suggested following the result of the study; that exercise be made part of treatment plan for women with GDM in our health institutions

Barriers to Self-Management of Diabetes : a Qualitative Study among Low-Income Minority Diabetics

Objectives : Diabetes self-management is a key element in the overall management of diabetes. Identifying barriers to disease self-management is a critical step in achieving optimal health outcomes. Our goal was to explore patients' perceptions about barriers to self-management of diabetes that could possibly help explain poor health outcomes among minority patients. Study design : Four focus groups were conducted among 31 predominately African-American patients with diabetes who were enrolled in the Baltimore Cardiovascular Partnership Study; a NIH-funded multi-year prospective partnership study. The topic guide consisted of a series of open-ended questions about knowledge of current health status; medication use; continuity of care; blood glucose level and nutrition. Results : The focus groups confirmed that previously reported barriers to self-management persisted; and identified new concerns that could be associated with poor health outcomes among minority patients with diabetes. Attitudes; perceptions and behaviours surrounding diabetes and self-management of the condition did vary across individuals; however; the variation appeared to reflect the individual's knowledge and opinions rather than patient's age; gender or culture. The primary barrier to diabetes self-management resulted from lack of knowledge of target blood glucose level and blood pressure. Several participants found some of the health information quite confusing. Conclusions : Diabetes is a major public health concern and the lack of awareness of target blood glucose level and blood pressure further complicates the problem. The limited health literacy seen in this study could help explain several of the barriers to self-management. The barriers to self-management identified in this qualitative study are amenable to intervention that could improve health outcomes

Blood glucose and serum lipid profiles during pregnancy

Pregnancy is associated with significant changes in the functions of the normal liver and understanding these changes is essential to a proper clinical evaluation of liver abnormalities during pregnancy. This study aimed at determining blood glucose level, triglyceride (TG), high-density lipoprotein (HDL), total cholesterol (TC), and low-density lipoprotein (LDL) in the three trimesters of pregnancy among women in Benin City, Nigeria. This was a prospective cohort study, in which 50 blood samples were collected at each mid trimester of pregnancy. Controls were age-matched, non-pregnant women. Data were analysed using ANOVA and p<0.05 was considered statistically significant. The results showed that glucose concentration was significantly higher in pregnant women than the control group, and it was highest in the third trimester of pregnancy. Lipid profile results showed that TG was significantly lower in the control group than in pregnant women. TG was highest in first trimester pregnancy and least in the control group. HDL was significantly lower in the first trimester than in the control group, second or third trimester. Delayed TG clearance is a function of increased blood TG levels and when this occurs with high blood pressure in pregnancy, it could lead to the development of pre-eclampsia. This association may be significant in understanding the process of pre-eclampsia and may help in developing strategies for prevention and early diagnosis of pre-eclampsia

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

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

Iron status and cardiovascular disease risk in black South African women: the PURE study

Objective: To examine the associations between measures of iron status and cardiovascular disease (CVD) risk factors in South African women.Method: In a cross-sectional study; demographic information and health history were obtained during individual interviews using validated questionnaires in the North West Province; South Africa. Anthropometric indices; iron indices; blood pressure; blood glucose and lipid profiles were measured using standard procedures in 1 262 apparently healthy black South African women aged 35 years or older. Iron status was assessed using serum concentrations of ferritin; transferrin receptor (TfR) and TfR:ferritin ratio.Results: Associations between iron status parameters and CVD risk factors were generally weak (r 0.3; p 0.01) and were not retained when adjustment was made for age; body mass index; smoking; alcohol consumption and C-reactive protein in the analysis. Waist circumference (WC) and waist:hip ratio (WHR) were higher in the fourth quartile of serum ferritin than in the third quartile; and also in the third quartile compared to the second quartile (P 0.05). Based on WC and WHR respectively; 31 and 52of the women had excess abdominal obesity. The mean (95 confidence interval) serum TfR concentration was high; at 9.09 ?g/ml (8.77; 9.44); indicating risk of iron deficiency. The mean (95 confidence interval) concentrations of lipids [total cholesterol 4.78 mmol/l (4.64; 4.93); high-density lipoprotein cholesterol 1.45 mmol/l (1.39; 1.52); low-density lipoprotein cholesterol 1.65 mmol/l (1.53; 1.78); triglyceride 1.12 mmol/l (1.07; 1.18)] were within reference ranges.Conclusion: No significant association was found between iron status parameters and established CVD risk factors. However; excessive abdominal adiposity indicated by high WC and WHR contributes significantly to increased serum ferritin concentration in this population

The Effect of Blood Glucose Concentration on the Error Monitoring and Processing System in Alcohol Users During Intensive Mental Activities

Background:The error monitoring and processing system (EMPS) located in the substantia nigra of the midbrain; basal ganglia and cortex of the forebrain; plays a leading role in error detection and correction. Although recent data show that alcohol disrupts the EMPS; the mechanism of alcohol's effect on this system remains unknown.Aims: To suggest a hypothesis that explains the processes and mechanism of alcohol-related disruption of EMPS. Methods:We critically examined our recent research data; as well as peer-reviewed literature on the effect of alcohol on blood glucose levels; and cognitive functions. The role of blood glucose concentration in the EMPS; including associated theories and hypothesis were also reviewed. Databases utilised were African Journals On Line; Elsevier; Science Direct; Medline from January 1940 to February 2010 . Results: Blood glucose concentration plays a vital role in the EMPS. The effect of blood glucose concentration on the EMPS is realised through the modulation of the activity of the dopaminergic system by proportional changes in the brain glucose level. Based on current literatures and the results of our recent study; here we suggest a hypothesis of alcohol-related glucose-dependent system of error monitoring and processing.The main postulate of this hypothesis holds that the disruption of EMPS by ethanol is related to disorders in glucose metabolism; which in turn may determine the dopamine level the major component of EMPS.Conclusion: Alcohol may disrupt the EMPS indirectly by affecting dopamine level through disorders in glucose homeostasis regulation